The role of the Colleges in the promotion of ethics
Ethics, morality and deontology in medicine, public matter or private responsibility? The role of Medical Associations and Medical Associations
Gonzalo Herranz, department of Bioethics, University of Navarra, Spain.
lecture in the Illustrious high school Official Medical Association of the Province of Alicante
Alicante, January 25, 1995
Ethical foundation of the management deontological collegiality
The revitalization of Deontology, a priority duty
Greetings and thanks
This morning I spoke to the students of the School of Medicine about Ethics and morals in the current practice of Medicine. And, as if that were not enough, I have to speak about the same thing again, but to a different audience and with a very different approach .
To begin with, I would say that, for some, ethics and morals, and for this case, deontology, are and mean the same thing. The terms, of Greek or Latin origin, refer to the reflection on the right course of action of people, to discern what is good from what is bad, to know and determine what should be done. The DRAE says of ethics that it is the part of Philosophy that deals with morality and the obligations of man. It says of morality that it is the science that deals with good in general, and with human actions in order of their goodness or malice. Of deontology he says that it is the science of duties. I prefer to stay with what our Professional Code says when it defines medical deontology as the set of principles and rules that should inspire the professional conduct of the physician. In a way, morals, ethics and deontology are the same thing.
For others, this is not the case. Morality, with its deontological variant, is not the same as ethics. Morality is a set of principles and values, a conception of life and the world, which must be professed and practiced in a cultural or religious context in order to lead a dignified and good life. And by ethics they understand rather an academic exercise, the art of arguing philosophically on questions of principles and values to be professed and practiced, on dilemmas with no easy solution, on synthetic and complex scenarios, in order to gather arguments, weigh probabilities, and justify such conduct or propose its opposite. Just as morality tends to be singular, that is, universal, believed and accepted by all, ethics are plural, forming parties, groups of opinion, or as they are technically called, metaethical currents, schools, such as utilitarianism, consequentialism, relativism, emotionalism, deontologism, and many more.
In recent decades, and still today, morality has been persecuted, almost discredited. When someone proposed that the right way to proceed in a given circumstance was this or that, he was told to take his moralizing elsewhere, he was branded a caveman, an archaizer or a pontificating pedagogue, and was ignored. Today, as we are seeing, society is strongly de-moralized. And today we are witnessing a prodigious proliferation of changing ethics, of fashions that pass and are replaced by others. A French author has just published a book graduate La valse des éthiques. He says that the points of reference letter have disappeared, the duties have vanished, that we inherit the void. Morality seems to be absent. In its place, ethics are spoken of all the time.
Where do we stand? That is the semantic issue, whether ethics or morals are the same thing or not. Many hours could be spent discussing whether it is possible to live without principles to which to be faithful, whether there is an order goal that has to mark the relations of some men with others, with animals, with nature and with things. Or if it is preferable to take advantage of each one Machiavellianly what is more convenient in each moment, or if money and things are worth more than people, if these can be classified in different categories, so that there are some lives respectable and worthy to be lived and others that lack that fundamental dignity and can be eliminated.
I am inclined to think with the former that ethics and morals mean the same thing and that they are two words that can be interchanged. Since saying ethics is more popular than saying morals, I will go with the flow of time. Whenever I say ethical or ethics I will be referring to that set of principles and values that must be professed and practiced in a constant and sincere way in order to lead a good and dignified life. I will not be referring to the fact that it is impossible to know what is good, that it is all the same as long as you have good intentions, that no one can boast of having found the truth. I slowly and thoroughly read John Paul II's Veritatis splendor. And I think it is a wonderful denunciation of skepticism and the dubious sincerity of soft ethics, so dominant in postmodern society.
I was telling the students this morning that medicine is an intrinsically ethical activity, that one of the reasons that led them and us to dedicate ourselves to it was the aspiration to do a specific good: to serve the sick in that unique way that unites the scientific and the human, the technical and the moral, a way of serving man with the most scientific of the Humanities and the most human of the sciences. Medicine is, by its very nature, a moral task, a matter of human relationship. The physician does not deal only with data of laboratory, with diagnostic imaging techniques, with books: he deals, first of all, with sick men and women. He must be a specialized and competent expert in diagnosing and repairing the malfunctions caused by disease. But he also needs to be an expert in humanity who knows how to respect the uniqueness of each individual, his or her integrity staff.
This is the root of medical ethics. In order to fully assume one's responsibility and face up to problems that are sometimes - not always, of course - fraught with tremendous dilemmas, it is not enough for the doctor to have intuition or that sort of primary instinct, made up of good intentions and a medical sense of smell, that desire to follow the customs of medicine in general. It is necessary, then, for the doctor to stop and think, and to be able to articulate, before himself, a rational basis for his actions.
I used to tell students that after making a mistake, and it is inevitable to make them from time to time, it is not enough to go on as if nothing had happened. Every mistake that a doctor makes requires, even if no one has warned him, that he stops to reflect, to look for the circumstances that led to it, to study the procedures to ensure that it does not happen again. If the error has been manifest, he must also ask the patient's forgiveness. This is the only way to lead a healthy moral life, not to become a hypocritical cynic. This is ethics or morality, something very practical, which makes our life more conscious, more deliberate, more chosen.
I concluded by saying that in order to lead a full life it is essential to care for, educate and keep our conscience alive and awake. By conscience we can understand the immediate, intuitive capacity to judge the morality of our actions; the privileged gift of knowing, as we go along, while we act, if our actions and the motives that impel us to act are right or not. It is our guide with the condition that the judgments of our conscience are the result of a correct training, of a serious reflection, made some time ago and applied with sensitivity to each status, new or old, until it becomes a stable habit, a virtue. Moral life depends on how awake our conscience is, on our capacity to discover nuances, to ask ourselves questions. Ethical reflection is not a matter for philosophers or experts: it concerns us all. Ethics is as consubstantial to medicine as science itself. This is an intrinsically ethical business .
Being here this afternoon, I see that I have not deceived you. We are in a high school of Physicians and I would like to continue the reflection on ethics, morals and deontology taking as a point of support the article 3 of the Code of Ethics and Medical Deontology in force. This article reminds us that the O.M.C., that is, all physicians, the Colleges and the Colleges, have assumed as a priority goal the promotion and development of professional ethics, and that we must devote special attention to disseminating the knowledge of the precepts of the Code and that we are all committed to ensuring compliance with it.
In other words, collegial life does not take place in a moral vacuum, but in an ethical-deontological atmosphere. We have a vast field of freedom, but we also have rules to inspire our work. I often speak of the Code as the rules of a sport that does not inhibit creativity, but is there to inspire: the greats of sport have not felt constrained by the obligatory rule , on the contrary, they have found in it an impulse to refine their style, to play a clean game. Medical-collegial deontology is not a marginal issue.
These are the two points I would like to address: First, the moral foundations of the public commitment to give priority attention to ethics. In the second point I want to allude to how the Colleges and also the Members, alone or associated, can make their public obligation to give ethics that priority place among their concerns a reality.
Ethical foundation of the management deontological collegiality
There is no unanimity as to what is the basis of professional ethics and, in general, the legal status of professional organizations. This is, in essence, a far from simple question, in which questions of Constitutional Law, social policy and community ethics are intertwined. In recent months, this topic has been passionately discussed in professional circles, on political platforms and in high courts of justice. It is not easy to summarize the different points of view. I believe that approaching the problem from a historical perspective can help us to understand its terms.
The Codes of Professional Conduct, the bodies in charge of promulgating them, and the bodies responsible for their disciplinary oversight, are the result of a long historical evolution of more than two thousand years, result . There has been, on the one hand, a long selection process and codification of norms and criteria with which physicians, spontaneously at first and then institutionalized, have wanted and continue to want to self-regulate the internship of the profession. And, simultaneously, there has been a historical evolution of the responses that society has been giving to its relations with physicians: a history in which concessions (of rights, privileges and special jurisdictions) are intertwined with demands and responsibilities (of human dignity, of scientific quality, of moral rectitude, of disciplinary action).
It is logical that there are marked differences from one country to another in the extent and intensity of ethical self-regulation of the medical profession. In the last two centuries, it has evolved along different lines in Anglo-Saxon countries and in countries that have based their law on the Napoleonic code. But, in any case, and reducing the question to its most general terms, it can be said that the deontological codification was born and has been growing as result of a social pact: society has given to the medical corporation the exclusive power to grant, to those who meet the due qualifications, the licence to practice medicine, on condition that it was the same corporation who established the ethical rules for the competent and correct exercise of the profession and controlled the professional conduct of the doctors.
In a certain sense, a code of medical ethics is a guide of professional conduct that contains the ethical commitments that physicians publicly make to society as a whole, in order to guarantee everyone an adequate level of quality in their professional services. From this agreed exchange of concessions and guarantees between society and the professional corporation derives, on the one hand, the public nature of the Code and the system of professional discipline that is annexed to it and, on the other hand, the conscientious recognition by each physician that his or her professional freedom and autonomy must move within the ethical coordinates established by the Code. This legitimizes the Medical Corporation and the Code. This social commitment gives rise to codified deontology.
The article 3 is part, and a very important part, of the answer that the O.M.C. gives to the Spanish society in exchange for its own existence and its rights and powers. When the General Statutes state in the different paragraphs of its article 1º that the committee General, and the Official Colleges of Physicians, enjoy, within their own and peculiar scope of action, separately and individually, full legal capacity and capacity to act; when the O.M.C. is conferred the exclusive representation of the medical profession, the O.M.C. is conferred the exclusive representation of the medical profession, the O.M.C., and the O.M.C., and the O.M.C. is conferred the exclusive representation of the medical profession. the exclusive representation of the medical profession, the organization of the professional activity of its members and the defense of their professional interests within the scope of skill ; when it imposes the obligation to become a member on all physicians who wish to practice the profession in any of its modalities, the General Statutes are making an inventory of the rights and privileges that society confers on the O.M.C., to which the O.M.C. responds with its solemn commitment, to which it responds with its solemn commitment to fulfill the purposes for which it has been constituted: the regulation, within the scope of its skill, of the practice of the medical profession and its exclusive representation; the defense of the professional interests of its members; the safeguarding and observance of the deontological and ethical-social principles of the medical profession and of its dignity and prestige; the promotion, by all means within its reach, of the constant improvement of the scientific, cultural, economic and social levels of the members; and, finally, the partnership with the public authorities in the achievement of the right to the protection of the health of all Spaniards and in the most efficient, fair and equitable regulation of the health attendance .
These are the contents of this social pact. To the charge that the society makes to the doctors organized in corporation that they are the only ones who can legitimately practice medicine, the medical corporation commits itself to regulate the professional work of its members, assuming for it the duty of self-regulation. This duty must be performed with responsibility and diligence. The article 3 of the Code tells us that the O.M.C. places it at the center of its interests, and proclaims that this commitment is paramount, it cannot yield to any other.
The content of this article and the Philosophy underlying it is broadly consistent with the Declaration of Madrid on Professional Autonomy and Self-Regulation, promulgated by the World Medical Association association in October 1987. It is worth considering for a few moments the points of this important Declaration, as they are of immediate concern to us. The two reasons for its adoption are stated in the preamble: the importance of autonomy and self-regulation for the medical profession worldwide; and the keen awareness of the problems and obstacles that oppose them everywhere. In the first points of the document, it is established that the core reason for professional autonomy consists of the need to guarantee to all that physicians, in caring for and treating their patients, can make their professional judgment in complete freedom. Professional autonomy, in addition to being an essential component of medical care, is also a benefit owed to the patient, even a patient's right. For this reason, the World Medical Association association and the National Medical Associations should strive to maintain and guarantee such autonomy.
With autonomy thus founded, the need for professional self-regulation arises as an inevitable consequence. This must exist independently of the legal norms or any other subject that the State may impose on physicians, since it is a moral response. "Parallel to these standards," says the declaration, "the medical profession assumes a continuing responsibility for self-regulation. The Declaration alludes to the scientific component of that responsibility, to improve the technical quality of the care provided and the skill and skills of the physician providing that care. Only physicians have the expertise to make appropriate assessments and recommendations to ensure the quality and skill quality of care provided by other physicians. This requires improving medical internship by research that conforms to ethical standards.
Physicians should be sensitive to the important role that control of expense plays in the equitable and efficient delivery of medical services. "The control of the expense physician," concludes this part of the Declaration, "cannot be invoked as a pretext for denying the sick the medical services they need. But neither should the abuse of technology be permitted, since it not only increases the cost of medical care, but also impedes access to it for those who truly need it".
The following is the most interesting part of the Declaration. On the one hand, it insists on the need to exercise the professional discipline : "The professional activities and conduct of physicians must always be within the limits set by the professional codes of ethics in force. Violations of ethics must be promptly corrected. This is a responsibility that National Medical Associations should fulfill effectively and efficiently through timely action." manager And medical organizations are urged to publicize to society the nature and efficiency of the ethics jurisdiction: "The association World Medical Association and National Medical Associations should also make known to the general public the existence of an effective system of self-regulation by the medical profession. The public should know that it can rely on such a system with regard to the honest and objective assessment of problems in the practice of medicine and in the care and treatment of patients." The association World Medical Association believes that it is necessary to gain the public's trust on a daily basis, because such trust is the only effective protection against the spread of state interventionism. "Professional conduct manager, at the individual level, and an efficient system of self-regulation at position of each country's medical association are indispensable means of assuring the public that patients can receive quality medical care attendance provided by competent physicians."
Thus, ethical regulation is both a public and a private matter. It is a collective responsibility and a commitment staff. It is not a second-tier matter, but a primary issue. We should devote our best energies to it.
The revitalization of Deontology, a priority duty
I was saying that the second point of my talk was about how the Associations and also the Members, alone or associated, can make their public obligation to give deontology a priority place among their concerns a reality.
Let us return to article3 of the Code. In it, the Medical Association undertakes to disseminate the knowledgeof the Code. It will do so on two fronts: at home and in society.
It must offer its members, by means of the continuous deontological Education , an ever more precise knowledge of the precepts of the Code, and it must use all its energy to make this the nerve of the professional performance of the members. The deontological Education is a topic core topic , in my opinion. It was discussed at the III National congress of Deontology Commissions. This resulted in an ambitious program of action that, it seems to me, is almost ready to be launched.
It must also make it known to the public, so that they know what level of conduct is required of physicians. The task of disclosing the Code is part of the social pact: deontology is an essential element of the consideration that the medical corporation offers in exchange for the power it receives to organize the practice of medicine. To keep it hidden is to do like the lazy servant in the Gospel parable who put his talent in a handkerchief and hid it underground. The Code is an extraordinarily interesting book for patients and their families. If the Code were in the waiting rooms of outpatient clinics, private practices, hospitals and clinics, the sick would feel safer. They would undoubtedly admire the ethical generosity of the profession. And, above all, they would help us to be better physicians by reminding us of the commitments we have made to them.
The patient is the physician's natural ally. Whatever the structure and organization of the national or regional health systems, the truth of medicine will remain at meeting between doctor and patient. It is not only the physician who has to persuade the Administration to remedy the shortcomings of the services. It is true that, aware of his professional duties to the community, the physician is obliged, as stated in article 5.1 of the Code, to seek the greatest efficiency of his work and optimal performance of the means that society places at his disposal, and to participate, personally or through his representative bodies (O.M.C., medical unions), in the study and implementation of programs that seek a fairer distribution of resources. It will have to exert pressure with legitimate and human means so that the public treasury adequately finances health expenses, and so that everyone receives the care they need.
They must ensure, by deontological mandate - as stated in article 5.2 of the Code - that the healthcare system complies with requirements of quality, sufficiency and maintenance of ethical principles. And it must exercise the duty, risky but obligatory, to denounce its deficiencies when they may affect the correct care of patients. The socialization of medicine has been, perhaps, one of the greatest advances in medicine in our time. In my opinion, it is the greatest glory of contemporary medicine. It is also an irrefutable testimony to the social responsibility of physicians. And yet, it is also a bottomless pit of frustration, because, insidiously and barely perceptible, it has result been a graveyard of physicians' freedoms and responsibilities.
Contractual or statutory relations between ministries of health and physicians have evolved, in general, in an unsatisfactory manner. However, the Code does not relieve physicians of their duty to persevere in their efforts to ensure that the health care system meets the quality, adequacy and ethical standards required by requirements . To this end, they need to exercise more intensely their role as health informants, which is one of the most profitable ways of investing the physician's time and knowledge. And he also has the ethical obligation to identify the deficiencies of the healthcare system and play the role of social conscience. This obliges him to denounce the technical and moral deficiencies of the health system, a denunciation that must be made truthfully and without exaggeration. It is in the interest of the general public and patients, one by one, to know whether they are suffering major cutbacks in the services they receive, whether the care they should receive is too far apart from the care they actually receive.
I recently wrote an extensive article on the ethics of medical strikes. When, at the end of it, I wondered about the possibility of creating arbitration bodies that would serve to prevent the risk of medical strikes, attention I mentioned the role that professional organizations and patients' representatives should play alongside ministry managers and trade unions. I say to this purpose that "patients should also have a place in these arbitration committees. Since they are the ones who suffer most during a strike, they should be vitally interested in playing a leading role in its prevention. Up to now, they have been systematically reduced to the status of suffering passive subjects, stone guests at the negotiating tables. There is reason to suspect that the participation of patient representatives could help in the effective prevention, or rapid resolution, of conflicts. Patients and their families cannot limit their influence on health care programming to their ephemeral role as citizens voting in elections. Election campaigns are operations of collective obfuscation, where the really important issues are often not seriously addressed. It is necessary to create channels through which patients can effectively intervene in health policy". It is essential for this that physicians have informed them objectively and clearly about where the shortcomings of the system lie, what difficulties obstruct the proper delivery of services, what shortcomings affect the quality of care for which physicians cannot compromise. I repeat: the patient and the physician are two natural allies, they form a natural alliance that neither the advances of science nor the evolution of health policy will be able to dissolve, because it is a human and deeply moral relationship. It is necessary to give an ethical channel to this friendly relationship by means of realistic information on the state of health care, by means of cooperation to achieve the ethical improvement of the system. requirements This is the best way to fulfill the task of ensuring that the national health system meets the requirements of quality, sufficiency and maintenance of ethical principles, as set out in article 5.2.
The medical complaint should always be of a positive nature. It should seek to remedy deficiencies, never to overturn the health care system. The complaint must be made by the individual physician and also by the different medical organizations, through coordinated actions of the physicians of a health center, of a collegiate section, of a high school or of the C.M.O. itself. Too long experience, unfortunately, sample that doctors' complaints are not always well received by the public authorities, who not only ignore or scorn them, but sometimes take reprisals against the complainants.
The Code is very ambitious, almost utopian, in some of its articles. Article 40.1 states that "the Medical Association shall strive to ensure that the ethical standards of this Code are respected and protected by law". The reality is, unfortunately, much less than this desire. Certainly, the EGOMC, in its article 2,2, and the article 2,2,b of the ECG, indicate that the committee General, when it is a question of norms for the scope of the State, or the Colleges or their Groupings, for the respective territorial scope, will have to inform preceptively the projects of Law and the legal dispositions of any rank that refer to the general conditions of the exercise and the professional function. And the article 3,4 of the same EGOMC establishes that one of the aims of the Organization is "the partnership with the public powers in the attainment of the right to the protection of the health of all the Spaniards and the most efficient, fair and equitable regulation of the health attendance and the exercise of the Medicine...". But recently, the President of committee General complained that he found out from the newspapers about the Government's decisions related to matters defined as mandatory report .
It is therefore the duty of managers and members of the profession to demonstrate to the authorities and legislators the great social and professional values of the deontological rules and regulations, so that they are respected and recognised by laws and regulations of lower rank, and to prevent them from eroding the necessary freedom and corresponding responsibility of physicians. ruleIt is true that the mandate of article40.1 seems impossible to fulfil at a time when governments and legislators tend to consider that the mandate they have received from the electorate confers on them such broad and sovereign authority that they are dispensed from the elementary prudence of seeking the views of professional or social bodies on legislation being prepared. The C.W.O. remains, however, obliged to defend and promotedeontological values. In order to be the valid interlocutor of patients and doctors before the public authorities, it needs to enjoy an indisputable moral prestige in the eyes of society. It will only achieve this if it combines the quality of its reports on the professional issues raised with impeccable conduct in the performance of the social function that society itself has entrusted to it.
In bad times, all's well that ends well. It is logical that many doctors have to suffer for their fidelity to the ethical rules. Therefore, article 40.2 of the Code applies: "The Collegiate Organization will defend the Members who are harmed because of their compliance with ethical principles". This article includes a serious commitment of the C.M.O. to protect the freedom of members who reasonably dissent or claim conscientious objection to provisions or orders that clash with the ethical principles of the profession. Experience in other countries, and also in our own, sample unfortunately shows that, sooner or later, objecting physicians or those who criticize the system tend to be subjected to pressure and discrimination by other colleagues or by those who run the institutions in which they work.
It is a basic principle in general ethics that there can be no moral life without freedom. And likewise, it is a basic principle of professional ethics that there is no responsibility staff without independence. Therefore, any action that seeks to diminish the freedom of the physician, whether it be his freedom to prescribe or his freedom of conscience, is antideontological. When the Code obliges those who direct the O.M.C. to protect its members from harm because they are faithful to their ethical-professional convictions, it is not only applying to the collegial context the Constitutional Law to ideological freedom (article 16 of our Fundamental Law: "The ideological freedom... of individuals and communities is guaranteed" ....). No one may be forced to declare their ideology, religion or beliefs") and to not be discriminated against on this basis (article 14: "Spaniards are equal before the law, and no discrimination may prevail on the grounds of birth, race, sex, religion, opinion or any other condition or circumstance staff or social"). It also does so in order to comply with the statutory duty of the Associations to "defend the rights and prestige of the members... if they are the object of harassment, undermining, disregard or disrespect in professional matters" (article 34 of the EGOMC) and to protect the right of the members "to be defended by the high school or by the committee General when they are harassed or persecuted because of their professional practice" (Art. 42, b of the EGOMC). To a certain extent, article 40.2 generalizes, to other situations, what article 27.2 of the Code states about the protection of conscientious objectors to abortion and other interventions in the field of human reproduction.
However, the most to be feared are not the blatant deprivations of rights, but the subtle and refined systems used to break the moral resistance of those who do not bow to the wishes of those in charge. There are legal channels to counteract serious reprisals (dismissals, transfers, opening of files). But there is no other channel than the deontological one to defend against subliminal forms of ideological torture or non-scandalous discrimination, which depend on the discretionary decision of the administrators of the system, such as the assignment of unpleasant schedules or tasks, or the preterition at the time of distributing opportunities (permissions for congresses, funds for research, participation in commissions).
It is time to finish. There are many matters that press urgently and absorb the energies and time of the directors and members. As a result, ethics receives less attention than it needs for its own sake, and less attention than is required by the statutory norms. By a very natural psychological mechanism, a general attitude of mild skepticism has developed regarding the institutional significance of the deontological function. It also happens that the deliberate ignorance of the deontology professed by a growing issue of the officials who control the public health care management and limit, often without any possible appeal, the professional freedom of the physician is increasingly intense. To this must be added the fact that the last twenty promotions of graduates in Medicine have not studied more than a few rudiments of Deontology. By virtue of these and other factors, awareness is gradually spreading, report but diffuse, that the Code of Ethics does not apply in many institutions dependent on Insalud or some autonomous communities.
The way out of this status, which is becoming critical, lies in revitalising ethical action. This is not so much in the sense of launching an operation to tighten up the ethical control of the profession - it is enough for us to serenely apply what is prescribed by our General Statutes - but rather to overcome, by means of a continuous deontological Education, the passivity or indifference that is currently the dominant trend. There is an urgent need to demonstrate to the membership the full inspirational force of the Code in order to raise the inseparably human and technical quality of professional practice.
Every manager, when participating in a session of the board of the high school, should remember that the "safeguarding and observance of the deontological and ethical-social principles of the medical profession and of its dignity and prestige" is one of the fundamental purposes of the W.H.O.. This can have a multiplying effect on the deontological effectiveness of the collegial management and contribute to making it a reality that the O.M.C. assumes as one of its primary objectives the promotion and development of professional deontology, devoting its preferential attention to disseminating the knowledge of the precepts of this Code and obliging itself to ensure its compliance.
Part of that commitment should be the maintenance of a group deontological subject study, a club, lively and not necessarily formal, friendly and diverse, where the ethical problems of the profession are analyzed and debated. General and professional publications already have regular sections dealing with issues, problems and cases of medical ethics and its wide frontier with medical law. But also the everyday problems, the anecdotes that one hears, the news in the press, even the text of advertisements and of the professional advertising should be the object of reflective attention. A Physicians' high school should not feel complete without a study and deontological discussion club, which would have, in relation to the Deontology Commission, a diverse and complementary function, closely fraternal but independent.
Part of the ethical commitment of high school consists of respecting and supporting the opinions of the Ethics Commissions, maintaining a cordial and open dialogue with them, which also explains the reasons that lead to fail or modify the opinions that they have prepared with so much dedication and skill. Only if there is this frank and sincere relationship between Boards and Commissions, will it be possible to overcome with dignity the inevitable differences between them, which arise from the different perspectives with which they contemplate the collegial reality.
Clearly, the application of disciplinary measures is an unpleasant task. But if, as is to be hoped, these decisions are informed by due justice, probity and impartiality, the moral prestige of the Colleges and the fulfilment of the corporate duty to ensure the human and scientific quality of the profession is assured in the long run deadline. This is a task that we cannot cede, as is increasingly the case, to the Administration of Justice.
The deontological, ethical and moral issue is, perhaps, the most important business that the W.C.O. is involved in. It is a corporate and public matter, as well as a private responsibility. The colleges have a great role to play in the revitalization of the study and the discussion deontology. They will play it effectively if they welcome the concerns and meet the needs of all those, young and not so young, who want to study and discuss the profoundly human aspects of medical behavior.