The values of the Tuke Institute define its nature and the spirit of its mission. Our values include the following (please click on a heading to see its contents):
It is our ethical and evidential belief that medicine and its practice are defined as the “prevention, diagnosis, treatment, and rehabilitation of illness”, determined by the comprehensive needs of the people suffering from illness and not by the views of any particular medical profession: the diagnosis and pharmaceutical treatment of bodily disease is a subset of medical practice and inadequate in itself to meet the needs of the ill.
Given that person-centred medicine addresses the whole person’s needs, we hold as self-evident that adequate medical practice must recognise and value all approaches to the prevention, diagnosis, treatment, and rehabilitation of illness, be those approaches in the physical, mental, behavioural, social, or cultural domains. Consequently, medical professionals consist of nurses, physicians, psychologists, social workers, therapists, educators (etc) in each sub-domain of medicine be it in Western, Eastern, traditional, or conventional forms of medicine.
The standard of medical practice enables people affected by illness to return to the highest feasible level of physical, psychological, and social well-being in such a way they can remain there long-term. This is achieved through respectful, trustworthy, and effective practice that reflects the personal needs and experience of the public affected directly by illness, over and above the personal and professional needs of medical practitioners. This is in the best interests of the public and of medical professionalism. In a healthy society, this standard is a minimum to which the public is entitled as a right.
We hold that socialised medical practice is a human right and in the public’s best interest; as a public good, medicine can not be practised adequately through consumerist or profit-making mechanisms. Consequently, we also value health-effectiveness over cost-effectiveness in the design and provision of medical services.
Transparency and accountability in the design of medical services and in medical practice are essential to the maintenance of trust, cooperation, mutual respect, and mutual responsibility between the public and the clinician. Medical practitioners have a fiduciary responsibility to the public to provide services that demonstrate fully the clinicians’ duties of care and loyalty to the public’s needs above and beyond the clinicians’ own needs; the pursuit of professional or personal self-interest over any member of the public’s medical needs is incompatible with medical practice. Respect and trust depend on the model provided by clinicians’ visible behaviours.
The creation of fully collaborative, mutually facilitative, and health-effective practice relies on understanding the experience of illness. Likewise, competent practice relies on collaboration within and between medical professions; to fail to collaborate is a harm to the public’s welfare. Furthermore, research is essential to furthering the scientific input to medical practice and it is unethical for non-scientists or any one medical profession to restrict access to research participants and research funding.
All people have the capacity to take responsibility for their well-being and should be empowered and enabled to make critical decisions about the nature of the medical services they receive as a means towards this. Facilitating self-responsibility through collaborative practice is fundamental to the purpose of medicine; the abnegation of responsibility by any person is not an excuse for its assumption by another. Informed, skilled, empowered, and self-determining members of the public are most likely to become and remain well, thus reducing their and others’ needs for medical services.
In order to consent to treatment, the public must be aware of the full range of treatments available, even if some are not available through the clinician in question. Competent practitioners are fully aware of – and value equally – the skills offered by practitioners outside their own profession or established tradition. If a clinician is unable to understand the diversity and efficacy of treatments offered by other medical professions, then treatment should be planned and monitored by a trans-disciplinary clinician. Consent to treatment should be ensured explicitly and ethically.
The well-being of medical professionals is of highest importance to adequate medical practice; clinicians who are unwell physically, mentally, or socially may be unable to practice medicine to an adequate standard and have a duty of care to address these issues through their own supervised treatment and supervised practice. Likewise, medical services must also maximise clinician well-being in terms of providing a healthy job environment – and one in which clinician morale is supported through remuneration appropriate to their ability to create optimal outcomes and the length of full-time academic training (not supervised job-experience) required for their position. Clinical supervision aiming to provide personal insight into a clinician’s practice is essential to fitness to practice, regardless of his or her medical profession.
Clinical and research practice in the best interests of the public’s well-being rely on competence, not profession or status. Clinicians and clinical researchers should not practice outside their areas of academically qualified competence. Specialist medical practice should be carried out only by – or under the daily supervision of – clinicians with specialist training that is within their own field of medicine: for example, nurses practising in sexual health must have specialist certification in sexual health and physicians may not offer psychotherapy (even under the supervision of a psychologist) without being independently and fully trained. Equally, medical administration – including management and commissioning – requires training and qualification in order for competence-based administration to be carried out.
Scientific evidence of the effectiveness of practice must reflect the biopsychosocial well-being of the whole person. Clinical research should promote trans-disciplinary research practice. Treatment is based best—but not exclusively—on scientific evidence. While scientific evidence is valued the most in assessing the relative value of treatments, this does not mean that treatments that have not been evaluated—or for which the appropriate scientific methods do not yet exist to evaluate their efficacy—are to be disregarded or devalued as a lack of evidence for a given form of treatment can reflect the political reality of science as a profession, not the medical value of a particular form of treatment. In the absence of an evidence-based treatment—or in the presence of the failure of an evidence-based treatment in a given individual—rationalisable and empirical treatments must be offered.
In order to create standardisation and integration of medical skills, the regulation of medical practitioners should be skill-based not profession-based. The licensing of clinicians to provide therapies that cross professional disciplines – e.g., psychotherapies, pharmacotherapies, physiotherapies, phytotherapies, and surgical therapies – should be regulated by trans-professional bodies relying on only those members who have directly relevant training to the form of therapy in question.
The Institute will seek to explore and test these values in a planned seminar series and will adjust them upon the basis of greater understanding. These values are rationalised in the publications of the Tuke Institute.