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A Social Contract for Medical Librarians?

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I continue to read Wicclair’s Conscientious Objection in Health Care. In the second chapter he, somewhat doggedly, examines multiple ethical theories of the health professions. The formula is: name a theory, describe it, show how it does not necessitate a position of conscience absolutism (that one’s conscience must over rule all other factors in every decision), nor does it necessitate a position professional incompatibility (that one’s professional duties must over rule, in every case, the dictates of one’s conscience).

Inadvertently, the chapter gives a pretty good overview of the ethical theories which guide moral decision making in the medical professions. I can’t help but think about my own “profession.” (I suppose I really should make an effort to finish reading Preer’s Library Ethics.) What are the grounds upon which the medical library profession has established its codes? How is it that medical librarians navigate ethical dilemmas? Or, that is, what self-knowledge as a librarian guides them through these dilemmas?

Do medical librarians have an “internal morality” … one grown organically from the nature of the services that we provide?

Do medical librarians have an understood social contract? In other words, does society expect something from us in exchange for granting us professional authority? (Which begs the question: what do people expect from us?)

Or … do we (merely?) practice, by association, borrowing the ethical frameworks of our institutions? Hospitals, clinics, academic medical centers?

I suppose I am still struggling to understand who medical librarians are as a profession. Depending on the circumstance the medical librarian may be professionally embedded in clinical care, teaching students, conducting health research, or providing the services which are common to all libraries. Thus, it would seem, that no one ethical or professional self-conception would guide them.

I also worry that efforts to transform the profession–such as re-branding ourselves as “informationists”–will serve to alienate the professional from the historical practices which guide ethical reasoning … but that is a digression for another day.

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Written by Jere

May 14, 2012 at 12:14 pm

Rebeginning again and reading

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I have read less of the history of medical libraries that I had planned. I have read less of everything than I had planned, but that is a fact of life. I am 3 pages deep (and months stalled) into Gertrude L. Annan’s “The Medical Library Association in Retrospect, 1937-1967” (Bull Med Libr Assoc. 1998 Apr;86(2):270-8.). I vaguely recall an impression that the beginnings of the profession were inauspicious, born of print-based indexes, and (later) necessitated by unfriendly databases. And the whole thing leads one to wonder, what would be the state of medical libraries were it not for the creation of the NLM? But I’ll return to that train later.

Now I am reading “ethics.” And the saddest sentences of the day (after noting that physicians making “justice-based” refusals may be said to be acting on conscience only if they meet three criteria: 1. they have a core set of moral beliefs; 2. justice is one of those beliefs; 3. providing care would conflict with the doctor’s concept of justice), Mark Wicclair writes:

Without questioning the sincerity of physicians with justice-based objections to providing medical treatment, it is unlikely that many will satisfy the second condition. If a person’s conception of justice is among her core moral beliefs, she is likely to experience guilt, remorse, loss of self-respect, and/or shame if her actions are incompatible with her conception of justice. Regrettably, however, injustice is something that many physicians and non-physicians alike have learned to tolerate and live with.

Wicclair, M. R. (2011). Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press. p.8.

Written by Jere

May 1, 2012 at 11:20 am

Posted in Conscience, Ethics, Libraries

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