Ethics and skeptics: what lies behind ethical codes in occupational health.
OBJECTIVE
Ethical codes, or systems, are conditioned and their enforcement is permitted by social processes and attitudes. In occupational health, our efforts to adhere to our own ethical frameworks often are undermined by forces and interests outside the field. Failure to acknowledge the profoundly social nature of ethical codes impedes our ability to anticipate consequences, to legitimate decisions based on utility and benefit, and to find social structures that support, rather than invalidate, our view of ethical behavior. We examine three sets of social philosophies.


METHODS
Jane Jacobs, the visionary urban planner, has written Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics, which is a restatement in modern terms of a critical passage in Plato's most important dialogue, the Republic. She (and Plato) postulate two major ethical systems, renamed here the "guardian system," which is characterized by loyalty, cohesiveness, and confidentiality, and the "marketplace system," which is characterized by trade, decentralization, and shared information. Occupational health, in this formulation, often runs afoul of the guardian mentality and also may be subject to inappropriate negotiation and compromise in the marketplace system. George Lakoff, a semiotician, has written Moral Politics: What Conservatives Know That Liberals Don't, which argues that there are two fundamental social paradigms based on concepts of the family. One, which he calls the Strict Father, emphasizes discipline, the positive aspects of taking risks, and the need to individuals to be self-sufficient. The other, which he calls the Nurturing Parent, emphasizes empowerment, the positive aspects of security, and the need for community and relationships. Occupational health practice violates aspects of both and therefore is supported by neither. Classical Chinese thought involved many schools of thought, including Confucianism and Legalism. It has been suggested that Confucianism provides little support for government regulation or occupational health, however this is questioned.


CONCLUSIONS
Occupational health may improve its standing as a social priority by recognizing and maneuvering within social frameworks that accomodate it, rejecting social frameworks that invalidate it, and reinforcing positive cultural trends within society that support it.
Guidotti
Tee L
TL
Division of Occupational Medicine and Toxicology, Department of Medicine, School of Medicine and Health Sciences, George Washington University Medical Center, Washington, DC 20052, USA. eohtlg@gwumc.edu
D002681:China; D005060:Europe; D006801:Humans; D028681:Moral Obligations; D009656:North America; D016272:Occupational Health; D009787:Occupational Medicine / Q000941:ethics*; D010686:Philosophy, Medical