Doctor New: "My patient doesn't want to come in any more. He hasn't had pain or significant signs for several weeks. I think we should let him go."
Dr. Boss: Look, this is the way things are done. Our goal is to get help to people who need it. If we can't stay in business, our patients don't get care. You're the one who knows what's best for patients. Don't you care about your patients?"
Ferrell and Gardiner say, "A boss who wants the employees to lie, cheat or steal to achieve a company goal is in a strong position to reward unethical behavior. Young employees, in particular, say they do as they're told to demonstrate loyalty in matters of judgments of morality."1
A widely known experiment defined the parameters of an average person's moral integrity. In an experiment by Yale Psychologist Stanley Milgram, an authoritative professor in a white lab coat explained to ordinary individuals, who were really the subjects of the experiment, that he was conducting an experiment on the effects of punishment on learning. He then simply ordered them to administer progressively higher, tortuous, potentially lethal doses of supposed electric shocks to fake "experimental subjects," who would scream progressively louder and then eventually fake unconsciousness.
Amazingly and unexpectedly, 65 percent of these individuals were easily tricked into administering torture. When the experiment was repeated with a casually dressed "graduate student," only 15 percent of them similarly followed the orders. A person in authority is extremely powerful in influencing individuals to engage in acts they normally would not consider.2
The Milgram experiment did not also involve the power of money to influence unethical behavior. In reality, the authority with the appeal to a higher purpose situation is compounded with the power of the economic situation of the new doctor. Learning to cheat in the practice of chiropractic is not a simple matter.
My point here is the power of authority is such that the majority of people will not stop themselves from torturing others, risking killing them, if they are told there is a higher purpose and the person directing them is authoritative in manner and dress. This has been shown experimentally.
Misuse of authority exists in our profession. The purpose of this discussion is not to assign exclusive blame anywhere. This is one aspect of the problem. There will be other articles for other aspects.
I invite doctors to discuss their own unethical behavior when, in retrospect, they feel they were doing the unethical behavior based on the power of authority of another doctor of chiropractic and the explanation of its higher purpose. Write letters to this paper. You can call me personally concerning your dilemmas if it might be of interest to readers of future articles. I am particularly interested in specifics and numbers, rather than generalizations.
Bring up the subject with your friends or at professional meetings. We need to focus on these shortcomings, and confess how we learn to lie and cheat.
Since bosses and those in authority can easily and powerfully create unethical behaviors in others, it is the special responsibility of the profession, as a whole, to see to it that bosses and those in authority are ethical influences. How can we do this better? It's not going to be simple, though we wish it would be. The chiropractic schools, our professional organizations, our practice managers, and even our researchers should formally study the role of chiropractic associateships in forming unethical behavior in our profession.
References
- Ferrell OC, Gardiner G: In Pursuit of Ethics: Tough Choices in the World of Work. Smith Collins Co. P.O. Box 20258, Springfield IL 62708, (800)345-0096, P.31.
- Ibid, pp 13-15.
Linda S. Elyad, D.C.
San Rafael, California