Challenging questions and ethical obligations: the ethics of everyday practice > 21 January 2015

Suzanne Shale

Abstract 1

Is there a cure for dishonesty?

Dishonesty in health practitioners unsettles us. A quotation often attributed to philosopher Friedrich Nietzsche hints at why this is: “I’m not upset that you lied to me, I’m upset that from now on I can’t believe you”. We worry that one act of dishonesty – which may in itself do little harm – will be followed by another, and another, and that in the end great harm will be done. And we wonder whether there is any cure for the defect of character that dishonesty represents.

Dishonesty is a problem for the health professions, which are built on a foundation of trust. Up-to-date and comprehensive statistics on disciplinary action against health practitioners are hard to come by, but about half of the cases brought by the GMC concern issues of ‘probity’. Practitioners who lack clinical skill are offered remedial support, but there is almost no meaningful provision for practitioners who have been found to lack probity. Is remediation possible? Or is a bad egg always a bad egg?

I will describe an intervention that I have been developing called ‘Restorative Review’. Practitioners who have approached me to help them have been advised to “attend a course in medical ethics”. They doubt they will be ‘cured’ this way, and they are probably right. I hope and believe that the one-to-one work I do with them is more effective, but this is almost impossible to prove.

This presentation will situate the particular, and important problem of remediation for probity within the wider question of how we think about ‘moral character’ and ‘moral education’.


Abstract 2

Protection or peril? Using hidden cameras and other ‘remote’ technologies in social care.

We propose a panel discussion to explore ethical issues surrounding the adoption of technologies – such as fall detectors and hidden cameras – aimed at preventing harm to people in residential and home care.

Recent debates about the rights and wrongs of using hidden cameras to prevent abuse in residential care settings have drawn attention to the challenges of providing personal care to vulnerable people in private places. There are different approaches to thinking about the ethics of remote technologies, and we intend to explore how far these different approaches take us. A standard principles-driven analysis might weigh client privacy against concerns for their welfare, a socio-ethical analysis might focus on our understanding of behaviour in closed institutions, and a different approach again would ask how far using technologies intrudes into, supports, or reconfigures home life.

The three panel members are Michael Dunn, Murray Anderson Wallace and Suzanne Shale, and we aim to add a fourth panelist from a provider organisation.



Suzanne Shale works as an independent consultant in the fields of healthcare ethics, patient safety, and healthcare leadership. She is author of Moral Leadership in Medicine: Building Ethical Healthcare Organizations (2012). Suzanne is Ethics Advisor to the NHS England Patient Safety Steering Group. Website:


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