Ethically Operationalizing Professional Discretion through an Ecological Structures of Virtue Approach
Thursday, October 12, 2023
4:00 PM – 5:15 PM ET
Location: Atlantic (Third Floor)
As part of their positions, healthcare professionals are charged to use their expertise and skills in the service of health. Implicit in the ability to successfully carry out this charge and fulfill its associated duties is the appropriate and ethical exercise of discretion. The field recognizes the value of prudent judgment and the provision of space for discretion for its benefit to both health outcomes as well as the wellbeing of healthcare professionals. However, it struggles to delineate the conditions for the appropriate exercise of discretion and particularly fails to appreciate or balance its effects at multiple levels. In part, this is because many arguments focus on the individual without sufficient attention to how they are influenced by the environments in which they are formed and operate and, in turn, how their actions affect those environments beyond their immediate interactions. Yet, discretion inherently requires attention to context and questions of structure-agency.
An ecological definition of discretion analyzed through Daly’s structures of virtue theory helps us utilize insights from health behavior theory to see discretion as rooted in professional identity; manifested through actions which exert technical and moral jurisdiction to uphold or deviate from scope, role, or mechanism; and enforced through policies, statutes, and professional codes. Such an approach helps us operationalize discretion by placing value on both actors and environments; providing space to understand influencing factors; and identifying causal pathways we can use to encourage good character reinforced by behaviors and social norms and protected by structures.