The ‘new normal’, caused by the Covid-19 pandemic, has made ethics mainstream. Each of us is now a potential victim and vector of a potentially lethal virus. Each of us is now aware of our capacity to harm – and help – others. Each of us has had to consider the impact of our actions and omissions in a context of uncertainty, unpredictability and anxiety. Doing the right thing, during the pandemic, involves weighing a range of personal and professional considerations and reflecting on – and justifying – the decisions we make.
Dealing with competing priorities
Health and social care professionals have had to reconsider priorities and adjust their practices to minimise harm, to benefit others and to be as fair as possible in the allocation of expertise and resources. Regulators have also had to reconsider competing priorities, adjusting their practices to continue protecting the public and, at the same time, to protect their staff, those involved in fitness to practise processes and registrants who provide health and social care. Regulators’ websites have, for example, directed registrants to guidance and resources relating to mental and physical wellbeing, provided information on emergency Covid-19 temporary registers, fast-track of final year students to registration and approaches to fitness to practise referrals and hearings.
Slow ethics and the art of regulation
Governance and research-related activities at the Professional Standards Authority have continued during the pandemic with ongoing engagement with health and social care regulators (see latest research). Just prior to the UK lockdown, I had the pleasure of attending part of the 2020 Professional Standards Authority’s Academic and Research Conference in London on the theme of ‘Regulation in the Future: Will it matter?’ The conference presentations and discussions were stimulating and suggestive of regulators’ commitment to engage in, and learn, from research and from each other.
My contribution to the conference was on the theme of ‘slow ethics and the art of regulation’. I began by citing Donald Schon’s Educating the Reflective Practitioner (1987 p.3):
In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the application of research-based theory and technique. In the swampy lowland, messy, confusing problems defy technical solution. The irony of this situation is that the problems of the hard, high ground tend to be relatively unimportant to individuals or society at large […] while in the swamp lie the problems of greatest human concern.
We now find ourselves in the swampy lowlands of a pandemic with much to be gained from engagement with a ‘slow’ approach. This approach prioritises and values: stories, sensitivity, solidarity, scholarship, space and sustainability.
Inviting, and listening, to stories from registrants, care-recipients and employers enable regulators to better understand – and respond to – the ethical complexity of the pandemic. An appreciation, for example, of the experiences of registrants committed to delivering the best possible care to Covid-19 patients when personal protective equipment (PPE) was inadequate. The experiences of care-recipients, for example, who were often unable to have direct family support when critically ill and who were enabled to communicate creatively with family, thanks to the creativity of registrants. The experiences of employers, for example, who are uncertain how to proceed should a registrant decline direct patient contact due to heath concerns. Such listening inevitably increases regulatory sensitivity and is likely to lead to meaningful engagement with the reality of health and social care practices now and in the future.
Another outcome from such engagement is the development of solidarity. A review of regulators’ websites show that health and social care regulators are engaging with similar pandemic issues and have much in common as they demonstrate commitment to public protection, registrant guidance and employer support in challenging circumstances. Evidence of regulatory solidarity is evidenced also by recent online discussions, including those facilitated by the Authority.
Amidst the initial fast responses to the pandemic, the focus was on operationalising processes and facilities that responded, in the best possible way, to the needs of those who succumbed to Covid-19. Now there is the opportunity for space and time to consider more the role of regulation in global emergencies and to revisit the theme of the 2020 Authority conference – What might this mean for the role of regulation in the future? And will it matter?
Year on year, the Authority’s conference showcases an increasing body of interesting and important scholarship by health and social care regulators. Year on year, I am struck by how much there is to learn from each other regarding regulatory functions. There are common themes and questions, for example, regarding the promotion and sustainability of professionalism before and after registration and also the role of professional codes and ethical guidance.
And so, I wonder….
Might the time now be right to develop further regulatory solidarity and consider more radical initiatives such as a shared code of conduct across health and social care professions? Or perhaps, a shared evidence-based approach to student selection? Or even, a shared approach to ethics education for UK health and social care professionals?
If the pandemic has taught us anything, it is that there is much common ground amongst regulators and much to be gained from focusing on interprofessional teams, and interprofessional learning. Such collaborations will start with regulatory solidarity.
Ann Gallagher, works at the International Care Ethics Observatory, University of Surrey and is the author of Slow Ethics and the Art of Care.