Le code d'éthique dans les organisations du réseau de la santé: outil de régulation des conduites?
Quebec’s Health and Social Services Law, ch. S-4.2, art. 233, requires that every health institution have a code of ethics that, in essence, sets out the rights of patients and the manner in which staff are expected to conduct themselves. The legislator had hoped that improvements in the conduct of personnel would begin to be seen at the start of the 1990s, and wanted to set up a watchdog body to ensure that progress was made. In the end, no such body was created, and 20 years later, even though they are still very much wished for, constraints and controls over staff conduct remain sorely lacking. In 2003 the Minister of Health and Social Services began a series of official visits to hospitals which to date have covered 150 institutions, and in each of these visits the minister’s teams have, with the backing of the hospitals’ administrators, made a point of looking at how each institution’s code of ethics is working. The general consensus of administrators, however, is that no health institution in Quebec has been able to use the ethics code as a basis for making clinical, organizational or managerial decisions. On the contrary, having a mandatory ethics code is seen by many as a hindrance, one among many that the institutions have to deal with. Every three years each institution goes through a process of re-accreditation to ensure it complies with government standards of quality, but its ethics code is not considered an important and dynamic element in this re-evaluation. One example of this blind spot: When a Quebec periodical specializing in health-care management published a special issue on “ethics and behaviour,” only two of its 15 articles specifically mentioned the notion of a code of ethics. This raises the question: Is “ethics” too general a term? Given that the legislator’s goal is to ensure proper behaviour on the part of staff and others who exercise their profession in the institutions – in other words, a preoccupation with professional ethics – would it not be more appropriate to instead refer to a “code of conduct”? This question is addressed in this thesis, through an examination of the concepts of ethics, professional ethics, codes and regulation of behaviour. As well, a detailed analyses of 35 ethics codes in diverse institutions throughout Quebec is presented. The vi academic literature provides ways of measuring the success of a code of ethics, and besides the importance given to institutional values, there is also the question of sanctions to impose when those values are not respected. Values must be clear to be properly applied. Finally, many organizations now refer to “codes of conduct” – a highly appropriate term, given that the legislator’s goal is to ensure that the conduct of employees and other personnel in health establishments is beyond reproach. This, in fact, is my conclusion, spelled out in the form of a recommendation.
code of ethics regulation code of conduct