Browsing by Author "Grobler, Gerhardus M."
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- ItemTo serve two masters? A moral analysis of an apparent conflict of interest in the profession of occupational physicians(Stellenbosch : Stellenbosch University, 2019-12) Grobler, Gerhardus M.; Van Niekerk, Anton A.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.ENGLISH ABSTRACT: Occupational medicine is the branch of the medical profession concerned with the health and safety of people at work. A nation’s labour force is a valuable asset and justifies legislation to preserve its productivity and well-being. Along with safety specialists, occupational hygienists, nursing professionals and human resources managers, physicians with specialised expertise in the field endeavour to keep workers safe and safeguard the public against accidents that might result from impaired workers performing safety-sensitive work. While these occupational physicians have a duty towards workers who become their de facto patients, the ultimate social good of occupational medicine and the discipline’s mission is occupational health and safety. An employer is legally responsible for the occupational safety and health of its workforce and has to carry all reasonable expenses. The occupational physician is thus employed by or contracted to the employer and remunerated to deliver an occupational medical service to the workforce. The question then arises whether the appointed physicians should primarily serve the interests of their patient, like doctors have been urged to do since time immemorial, or should serve the masters who pay their fee. Dual loyalty, or at least the suspicion that loyalty to either party would colour the occupational physician’s judgement, has vexed the discipline in recent times and creates ethical ambiguity. Consequently, codes of ethical conduct for occupational medicine have been developed. Occupational health and safety has many stakeholders and participants, rendering it an inclusive discipline. Allowing loyalty to influence decisions is incompatible with professionalism. Part of the answer lies in the unique context of the doctor–patient relationship in occupational medicine. When healthcare is practised in the labour milieu – with its hierarchical structures, employment contracts, disciplinary procedures and legislation – ethical controversy can be expected. This dissertation entails a description of the ethical field of occupational medicine in South Africa as experienced in a career of forty years and analyses various problematic aspects of the discipline. It is not possible to avoid all ethical qualms and suspicion in this discipline of medicine. However, there is some opportunity to raise the discipline’s ethical reputation with stakeholders. This includes acceptance that occupational medicine is not primarily patient centred, raising awareness of ethical codes, and exemplary professionalism of its practitioners. The prominent role of virtue ethics in the equation, emerges. Ethical practice in the field of occupational medicine calls for impartiality, veracity, tact when interacting with stakeholders and trustworthiness in clinical relationships.