However, many occupational studies are epidemiological, e. Yet, if the potential for effective interventions exists, the notification of workers at high risk of disease from past occupational exposures could be important for prevention. If no such potential exists, should workers still be notified of findings? Should they be notified if there are no known clinical implications? The necessity for and logistics of notification and follow-up remain important, unresolved questions in occupational health research Fayerweather, Higginson and Beauchamp Given the complexity of all of these ethical considerations, the role of the occupational health professional in workplace research assumes great importance.
The occupational physician enters the workplace with all of the obligations of any health care professional, as state by the International Commission on Occupational Health and reprinted in this chapter:.
Occupational health professionals must serve the health and social well-being of the workers, individually and collectively. The obligations of occupational health professionals include protecting the life and the health of workers, respecting human dignity and promoting the highest ethical principles in occupational health policies and programmes. In addition, the participation of the occupational physician in research has been viewed as a moral obligation. However, the occupational health professional must be particularly sensitive to these potential conflicts because, as discussed above, there is no formal independent review mechanism or IRB to protect the subjects of workplace exposures.
Thus, in large part it will fall to the occupational health professional to ensure that the ethical concerns of risk-benefit balancing and voluntary informed consent, among others, are given appropriate attention. Different tools result in different decisions.
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How do we decide to meet different and often conflicting needs found both in natural sets of humans such as individual, family, peer group, community and in synthetic sets of humans such as political party, union, corporation, nation which may include many diverse natural sets? How do we choose a level of risk in setting a permissible exposure limit? On this ladder, those most able to act are rationally obligated to rise to the highest rung of responsibility so that they may act first in pursuit of a moral objective.
They are obligated to act before others, because they are best or uniquely able to do so. This does not mean that only they should act. When those with special obligations fail to act, or need assistance, the obligation falls on the shoulders of those on the next rung. By rational we mean not only an action that logically follows another. We also mean actions taken to avoid pain, disability, death and loss of pleasure Gert The employer has duties based on a unique ability to ensure compliance with rules applicable to an entire workplace.
Government has a separate duty based on its unique abilities, for example, to mandate rules if persuasion fails. There are other assumptions in the framework common to any system of ethical values in any culture. We exist, ecologically, as a global community. In our niche, natural sets of humans such as families or peer groups are more meaningful than synthetic sets such as a corporation or politically defined entity.
In this community, we share necessary obligations to protect and to help everyone to act rationally in accordance with their rights, just as we should protect our own rights, regardless of differences in mores and cultural values.
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These obligations, when they result in actions that protect workers across an international border, are not the imposition of the synthetic values of one nation upon another synthetic set of people. They are acts of reverent recognition of natural, timeless, universal moral values. Basic human rights, the generic rights to freedom and life or well being derive from needs which, if met, enable us to be human Gewirth They are not given us by any government or enterprise.
We always have had them, logically and phylogenetically. Laws governing the work environment, and rules consistent with rights they implement, are not gifts of charity or benevolence. They are expressions of morality. Acting on the specifications of our rights may result in conflicts between those rights which protect the individual, such as protecting the privacy of personal medical records, and those concerned with the duties of the employer, such as deriving information from medical records to protect other lives through the avoidance of health hazards thus made known.
These conflicts may be resolved, not by depending upon the ability of a lone physician or even a professional society to withstand court or company challenges, but by choosing axioms of moral behaviour that are rational for everyone collectively in the workplace. A critical assumption at the very base of this framework of moral judgement is the belief that there is only one real world and that the generic rights apply to everyone in that world, not as ideals that need not be achieved, but as generic conditions of actual existence.
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What we should learn is how to use postulates or axioms not only in ethics, but to describe the world and to guide conduct in the absence of perfect knowledge. They are kept and used if fruitful in the application of basic ethical principles. When they are found to be no longer useful, they can be discarded and replaced with another set of conventions.
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An example is the common practice of developing professional codes of ethics for corporate physicians and other professionals. They are drafted to protect generic rights and their specifications by bridging gaps in knowledge, to organize experience and to permit us to act in advance of morally or scientifically certain knowledge. These sets of axioms, like all systems of axioms, are neither right nor wrong, true nor false. We act as if they are right or true in fact they may be and retain them only as long as they continue to be fruitful in permitting us to act rationally. The test of fruitfulness will yield different results in different cultures at different points in time because, unlike generic ethical principles, cultural norms reflect relative values.
In cultures of the East, powerful social and legal sanctions enforced professional behaviours consistent with the Buddhist belief in the eightfold path to righteous living, the fifth fold of which was righteous livelihood, or with Confucian traditions of professional responsibility. In such settings, professional codes of ethics can be powerful tools in the protection of the patient or research subject, as well as the physician or scientist. In cultures of the West, at least at this time despite the strong Hippocratic tradition in medicine, the codes are less effective, albeit retaining a limited value.
This is not only because the social and legal sanctions are less powerful, but also because of some assumptions that simply do not fit the realities of current western cultures. The consent is seldom really voluntary or informed. The information conveyed is seldom certain or complete even in the mind of the scientist or physician. Consent is usually obtained under socially or economically coercive conditions. The promises of the researcher to protect privacy and confidentiality cannot always be kept.
The professional may be socially and legally protected by codes that incorporate this doctrine, but the worker easily becomes the victim of a cruel hoax resulting in social stigma and economic duress due to job and insurance discrimination. The practice should be discarded and replaced with codes made effective by assumptions that fit the real world coupled with socially and legally enforceable protections.
It is irrational and therefore immoral to distribute or allocate the burden of risk by caste, that is, to assign different levels of risk for different sets of humans, as marked by genome, age, socioeconomic status, geographic location within the global community, ethnicity or occupation. Risk allocation by caste assumes that there are humans whose generic rights are different from others.
Basic human needs are the same.
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Therefore, basic human rights are the same. It depends upon the assignment of a risk differential based on calculating the risks of past work practice or prevalent exposure to a toxic substance or hazard in the workplace. Unnecessary risks are never morally acceptable. The generic rights to life and freedom necessitate empowering workers to rationally make and act upon choices made in pursuit of these rights. Empowerment occurs through access to information, educational opportunities to understand and not simply react to information , and unfettered or uncoerced ability to act on this understanding in avoiding or taking risks.
Education that yields understanding may not happen in a typical safety training session, since training is meant to induce a conditioned response to a set of foreseeable signals or events, and not to provide in-depth understanding. Yet not all the causal factors, including events under the control of workers or management, that result in so-called accidents can be foreseen. Thus they do not exist in nature. Every event has a cause Planck ; Einstein The concept of chance is an axiom fruitfully used when a cause is not known or understood.
It should not be confused with invariable reality.
Thus, even if time, financing and training resources were infinitely available, it is impossible to condition a worker to every possible set of signals for every possible event. Education of the worker and his natural set, such as the family and peer group to which the worker belongs, enhances both understanding and the ability to act in preventing or reducing risk. Therefore, it is a specification of generic rights. Choosing an appropriate location where the worker decides or consents to a risk is a critical factor in assuring an ethical outcome.
Many decisions such as the acceptance of hazard pay should be made, if they are to even approach being truly voluntary, only in a milieu other than a synthetic setting such as the place of work or a union hall. Family, peer group and other natural sets may provide less coercive alternatives.
Making this choice ethically requires the most neutral or non-coercive setting possible. If these settings are not available, the decision should be made in the most relatively neutral place associated with the most relatively neutral synthetic set or agency that can protect the empowerment of the worker and his or her natural set.
The importance to the well-being of a worker of cultural and ethical values found in his or her family, peer group and community underline the importance of protecting their involvement and understanding as ethically based elements in the empowerment process. Most of us, even physicians, scientists and engineers, have been educated in primary school to understand axiomatic methods. It is not otherwise possible to understand arithmetic and geometry. Yet many consciously confuse assumptions and facts which can be, but are not always, the same in an effort to impose personal social values on a specific course of action or inaction.
This is most obvious in how information is presented, selected, organized and interpreted. Use of words like accidents and safe are good examples. We have discussed accidents as events that do not occur in nature. Safe is a similar concept. If this is done unknowingly, it is a simple mistake called a semi-logical fallacy.
If it is done consciously, as is too often the case, it is a simple lie. The confusion with invariable reality of sets of axioms, models of scientific explanation or assessments of data, seems to be concentrated in the setting of standards. Axiomatic concepts and methods in regulation, the validity of which are assumed and commonly confused with incontrovertible truth, include:.
These axioms usually are discussed as if they are the truth.
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