Values
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)
1. Definition of medicine
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 people with illness.
2. Definition of medical professions
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.
3. Standard of medical practice
The standard
of medical practice enables people affected by illness to return to
the highest feasible level of physical, psychological, and social
wellbeing 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.
4. Right to medicine
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.
5. Transparency and accountability
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 responsbility
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.
6. Public and professional collaboration
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.
7. Public self-responsibility
All people
have the capacity to take responsibility for their wellbeing 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.
8. Informed consent
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 trandisciplinary clinician. Consent to
treatment should be ensured explicitly and ethically.
9. Clinician job-health and responsibility
The
wellbeing 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 wellbeing 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.
10. Competence-based practice
Clinical and
research practice in the best interests of the public’s wellbeing
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.
11. Evidence-based practice
Scientific
evidence of the effectiveness of practice must reflect the
biopsychosocial wellbeing of the whole person. Clinical research
should promote transdisciplinary 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.
12. Regulation of practice
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 transprofessional 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 its seminar series
and will adjust them upon the basis of greater understanding.