A Critical Interpretive Review of the Theoretical Literature Related to Healthcare Codes of Ethics.

Abstract

Codes of ethics have a long history in healthcare and, for many, are important documents. Codes however have also been extensively criticized for a range of reasons, from the guidance they provide to their meta-ethical assumptions. This review sought to explore the theoretical literature to critically examine the function of codes in healthcare, with a particular focus on their strengths and shortcomings in relation to these functions. A systematic search was combined with a critical interpretive review. The final sample included twenty-four papers. Results of this synthesis suggest that codes fulfil multiple purposes, from providing guidance on ethical issues, to assertions about acceptable and unacceptable behaviour, to establishing and maintaining the status and identity of the professions. Codes also fulfil a number of social purposes, conveying information to the public and others. The extent to which a code does each of these things varies substantially however. We discuss these functions in relation to the many critiques that have been advanced in relation to these documents. We then put these findings into conversation with the broader literature on codes and discuss the challenges that this presents for normative analysis, namely in needing to first identify what a code should do before assessing its shortcomings. If the primary purpose of a code of ethics is to provide guidance, many fail here, the devil is in the detail however. To what extent should codes provide guidance?