Practical Ethics in Occupational Health

Peter Westerholm, Tore Nilstun, John Øvretveit

• Publisher: CRC Press
• Year: 2020
• eBook ISBN:
  9781315347844
• Topic: Medicine
• Subtopic: Ethics in Medicine

Explains the NHS as a political environment, and concentrates on understanding the relationships of power rather than on the role of apparent authority. The book presents a range of management frameworks and personal examples to illustrate what a primary-care-led NHS means.

CHAPTER 1

A changing life at work: ethical ramifications

Peter Westerholm

This opening chapter presents an overview of global trends in life at work. It focuses on the occupational health implications of work and thereby on the roles and functions of, and also the expectations placed upon, all the health professionals involved there. The aim is to provide a background to, and perspective on, issues of ethics in occupational health professions, which are described and discussed in greater detail and on a more concrete level later in this book.

We start with a review of the overarching trends in global development that have an important impact on life at work. By so doing, we are reminded of both positive aspects, such as significant improvements in material work conditions, and some negative aspects, such as significant inequalities in health and safety between and within regions and nations of the world. The United Nations Universal Declaration of Human Rights¹ and the International Covenant on Civil and Political Rights² are referred to as cornerstone documents with regard to ethical dimensions of conditions at work. Developments in Europe, with reference to the European Social Charter³ and the framework directive on safety and health at work,⁴ are commented upon in terms of their ethical implications. The changing horizon of occupational health hazards is described, in particular with respect to the emergence of work organisation as a carrier and source of health-determining factors. New conceptions of ethical implications in the arena of occupational health are introduced at this stage. In concluding the chapter, the implications of these changes for the roles of occupational health professionals are discussed. Examples are given of the kinds of ethical questions which arise.

Scope of the work-health relationship: an example

The company is a conference hotel establishment with half a dozen restaurants and bars, and other facilities. It has been reasonably successful on the market, but six months ago the company was taken over in a merger operation by a new majority owner. For many years, the new owner has been running a competing chain of hotels catering for tourists seeking action-holiday programmes. The consequences of the merger are not unexpected. There is drastic streamlining of the organisation, with reductions in staffing and increasing workload for practically everybody. Further cuts are advertised.

The company has a contract with an external health service organisation providing professional occupational health services. At the regular health examinations that form part of the service an increasing prevalence of ill health of many kinds is observed among staff. As well as increasing numbers of back and shoulder pain syndromes, many speak of a loss of meaning or motivation for work and a profound and lasting state of depression.

At the same time, complaints from customers about defects in service quality appear to be more frequent. There is a clear increase in sickness absenteeism in many parts of the new company.

The management of the new company, after consulting its internal bipartite safety and health committee, takes a decision to offer all personnel a programme of workplace health promotion. The programme consists of individual health counselling focusing on back pain control, stress management and lifestyle management (meaning smoking, alcohol, drugs, diet and physical exercise). The contracted occupational health service unit is asked to organise and manage the programme. Further, the stress management programme is to be integrated into training sessions in yoga offered by a specialised school recently established in the vicinity of the hotel.

This is a snapshot of a typical situation confronted by many occupational health professionals both in Europe and worldwide and will be recognised by many readers. It raises a number of substantial ethical questions.

• How are occupational health professionals to position themselves with respect to the requests presented by a client company?
• Do we know what to do?
• Is it the right thing to do?
• Are we the right ones to do it?
• Do we have the requisite competencies?
• What are the ethical implications?

Working life change

Over the last century, material working conditions have certainly improved significantly and this has led to a decrease in work-related diseases largely because of the implementation of technical and hygiene developments. The implication of this situation is that work is no longer necessarily seen as a biblical curse or something to put up with. Rather, work has turned into an important determinant of health, even seen by some as a fundamental human right, with potential for the development of human creativity, independence and health. We see how work can be used for the reintegration and self-sustainment of people with significant handicaps or health defects. This is the positive spiral.

But there is a negative spiral as well, consisting of the damage to health and work ability caused by work or work conditions. At the same time, an unequal distribution of workplace hazards and work-related health disorders can be observed between countries, and also between socioeconomic strata in many countries. The life-expectancy gap between manual workers, on the one hand, and managerial staff and qualified professionals, on the other, is still considerable – and even increasing. Despite improving scientific and technological standards in practically all economic production, we still see examples of forced labour and inhumane exploitation. The initial statement of the International Labour Organization (ILO) World Labour Report from 1993 puts the matter starkly: ‘At the end of the twentieth century many people assume that slavery has been eradicated. Unfortunately this is not so’.⁵ See also the ILO report, Decent Work, presented to the XVIth World Congress on Safety and Health at Work, in Vienna 2002.⁶

Coping with change in workplaces and the organisation of work is the primary challenge facing nations and social partners on the labour market. This applies to public organisations, enterprises and people at work. For obvious reasons, the direction and pace of technological, social and structural change in working life differ between and within countries, regions and segments of the labour market. There are also many types of work and economic activity that do not change very much. The bottom line, however, is that occupational health professionals are confronted with new horizons concerning health hazards, priorities and expectations. They may also encounter new health objectives at work. That is, as well as health hazards, they must also take account of the health-promotional effects and health potentials of good quality of life at work. This can be seen as a public-health aspect of occupational health.

Changes in work design and management strategies occur at three levels.

1. There are socio-economic, political, technological and demographic forces operating at community, national and international levels (trade policies, and the introduction and implementation of information technology).
2. There are macro-level changes at industry, branch or enterprise levels (i.e. technical change, downsizing, outsourcing, etc.).
3. There are micro-level changes in the workplace (i.e. workload, hazardous exposures, participation and support).

And there is another important set of challenges in changing working life, which lies in demographic developments. The industrialised countries of the Western hemisphere face rapid ageing of the workforce, a growing number of migrants, a shortage of young workers and greater mobility of working people.

Globalisation

Globalisation as an economic process implies in essence a combination of the two macro processes of liberalisation of world trade and the introduction of new information and communication technology on a vast and ever-increasing scale (involving all production, distribution and finance). Globalisation as a sociological process involves social activities, such as in the fields of culture, communication and ideas. That information has become raw material, method and outcome in industrial and service processes makes for radical changes in the conditions of existence for enterprises and in the economic life of nations. There are benefits to be reaped in the economic globalisation process and the net effects are generally held to be conducive to wealth creation. There are, however, also effects that are regarded as adverse, such as widening economic gaps between wealthy and less privileged regions and segments of populations.

It is an oversimplification to see globalisation as something that transcends and marginalises nation states. A common misunderstanding is to see it as something that is best avoided. This is hardly possible. Indeed, even publishing this book is an ‘act of globalisation’. Globalisation creates winners and losers, integration as well as fragmentation. It is, in itself, neither inherently good nor bad. There is, however, broad political and scientific consensus that there is an urgent need to strengthen global governance so as to balance its impact.⁷

The employer-employee relationship

Throughout history, a pervasive component of the relationship between employers and employees has concerned aspects related to its nature as a power equilibrium. The employment or contractual arrangement between an employer and an employed person is a bond that divides responsibilities and aims at achievement for the benefit of both parties. An enterprise cannot prosper without the co-operation of its employees. It is also a bond where there are differences in values and interests. One point of potential conflict lies in employees’ rights to safety and health and the right of business to maximise production for reasons of competition. It is here that the most contentious issues arise. It is a prima facie interest of the employer to pay as little as possible in wages and to minimise other costs for the work to be done. But this applies only up to a point. Well-paid and well-looked-after staff perform better. If, however, pay and work conditions do not offer a competitive advantage, an employer accepting these costs will soon be driven out of the market. The nature of the power balance is subject to various, more or less developed, mechanisms of state control in most countries. The controlling mechanisms, commonly regulated by legislation, aim at maintaining the accountability of enterprise owners and the trust of workers and their representatives, the general public and the other stakeholders involved.

Work and human rights

In recent decades the moral principles underlying the concept of human rights have been canonised in universal instruments of an authoritative nature. Since some of them have implications for the relationships between human work, economics and health, reference will be made to some important ones. A document of distinguished importance is the Universal Declaration of Human Rights, adopted by the United Nations Assembly in 1948.¹ Paragraph 1 of Article 23 of the Declaration contains the following statement: ‘Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment’.

A document of almost equal strength and global prestige is the Universal Declaration of Human Responsibilities, proposed in 1997 by the InterAction Council, a body of 30 former heads of state and ex-prime ministers from all regions of the world.⁸ The Declaration has been conceived as a basis on which the United Nations human rights declaration might be amended. The InterAction Council emphasised human obligations for several reasons. The primary motive of the Council was to achieve a balance between the notions of freedom and responsibility, both of which have important moral implications. Whereas rights relate more to freedom, obligations are associated with responsibility. Responsibility, as a moral quality, thus serves as a natural, voluntary control of or counterpoint to freedom. Freedom cannot be exercised without limits in any society. Unrestricted ec...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• About the editors
• About the Contributors
• Acknowledgements
• 1 A changing life at work: ethical ramifications
• 2 Ethics, research-informed practice and quality improvement
• 3 Ethical analysis
• 4 The ethics of risk assessment
• 5 The ethics of workplace interventions
• 6 Workplace health surveillance
• 7 Health examinations on new employment: ethical issues
• 8 Work disability assessment in the Netherlands
• 9 Sickness absence management
• 10 Reducing sick leave: swimming upstream – positioning and multiple loyalties
• 11 A case of workplace drug and alcohol testing in a UK transport company
• 12 Alcohol abuse in the workplace: some ethical considerations
• 13 Blood-borne viruses as workplace hazards
• 14 Workplace rehabilitation
• 15 Insurance medicine and work-related diseases: some ethical and legal aspects
• 16 Recognition of work-related diseases
• 17 Workplace genetic screening
• 18 Occupational health research
• 19 The ethics of health and safety services: a trade union perspective
• 20 Employer attitudes to ethics in occupational health
• 21 Whistleblowing
• 22 Education in ethics
• 23 Ethical occupational health management and organisation
• 24 Professional codes of ethics
• 25 Concluding remarks
• Index