[Ethical problems in health surveillance].
Surveillance of workers' health in the field of occupational medicine poses substantial ethical problems in view of occupational medicine's complex responsibilities towards workers and employers, preventive and protection services, workers' representatives, public healthcare and preventive medicine facilities, controlling agencies and judicial authorities. Potentially conflicting rights and duties often come into play in this sector. In the last few years various international and national bodies have drawn up codes of ethics or guidelines for the conduct of physicians in occupational medicine, three of which are of particular importance: 1) The International Ethical Code of the International Commission on Occupational Health (ICOH, 1992); 2) The Code of Conduct of the National Association of Company Doctors (ANMA, 1997); 3) The Technical and Ethical Guidelines for workers' health (ILO, 1998). The chief purpose of all these documents is to safeguard the health of workers and to guarantee the safety of the workplace by defining programmes of health supervision to match specific risks. The methods should be non-invasive and should allow for a check or efficiency. The physician is expected to have a high degree of professionalism and up-to-date skills; to be independent and impartial; to be reserved and capable of inter-disciplinary co-operation. On the basis of the above documents, a number of problematic aspects may be appraised concerning the relationship between the occupational health physician responsible for the surveillance activities of the local health authority and the relative company physician. The documents stress the importance of keeping up to date and of quality, fields in which the dominant role played by Scientific Societies is underlined. Finally it is recommended that health supervision be arranged in such a manner as to foster the professionalism and responsibility of the physician in charge rather than the formal implementation of health-care procedures that are inadequate and not in line with up-to-date scientific knowledge.
Toffoletto
F
F
Unità Operativa Ospedaliera di Medicina del Lavoro dell'Ospedale di Desio.
Briatico Vangosa
G
G
Panizza
C
C
D004989:Ethics; D006801:Humans; D007558:Italy; D016272:Occupational Health / Q000331:legislation & jurisprudence*; D009787:Occupational Medicine / Q000592:standards*