Ethical Questions

Our future requires a willingness to explore beyond our quick conclusions of what is “right” and what is “wrong.” How do we proceed when two “rights” are in conflict with each other, or when a good end might depend upon a questionable means (or vice versa)?

Providing safe, effective, and accessible treatment to everyone who wants/needs treatment while also supporting ourselves and our families requires us to face various ethical quandaries. Many ethics classes are short on teaching principles to guide ethical decision-making and are long on lists of rules like “don’t have sex with your patients.”

Marilyn Allen’s recent column on ethics demands our attention. She’s had a significant role in shaping the acupuncture profession, and she teaches ethics. She has power.

The column focused on a discussion about “gainful employment” that has since been removed from the AAAOM practitioner forum.

The forum included colleagues sharing concerns about their debt, and upset at schools that exaggerated the future acupuncture job market while glossing over the skills and financial backing needed for success.

Ms. Allen (who has given considerable funding to the AAAOM over the years) is angry that this discussion was permitted. She insists that it is in the best interest of the profession, and our future colleagues, to keep concerns to ourselves. Even a shared conversation in a practitioner forum is too risky. We “should have shown support for the schools,” she writes.

Ms. Allen proposes the Rotary’s Four-Way test in her column. It’s not my preferred guideline for ethical decision-making, but since she refers to it I’ll use it —

 

1) Is it true? Many graduates of acupuncture schools do struggle to pay off debt. Schools did use misleading data in promotional materials, leading to unrealistic career expectations. The proposed Gainful Employment regulations did raise concerns about acupuncture programs. The forum topic is no longer present to allow for a complete fact check, but my assessment is that much of the content was true.

2) Is it fair to all concerned? What do we mean by “fair.” Who is “all concerned?” And what is “it?” I could write a post on each question. When a topic is being explored by many people, in many settings, does each contribution need to reflect the views and feelings of each stakeholder? Is it unfair to share our personal experiences and opinions about a system in which we have little power and bear the consequences? Is it fair for a membership association to solicit the opinions of its members? My assessment – it was fair for the AAAOM to provide a forum and for practitioners to use it.

3) Will it build goodwill and better friendships? Humans do better when we know we are not alone. Sharing our concerns and our experiences is a way to build community and friendships, which support us in our sometimes isolated professional life. Knowing that other regulated fields share these concerns can also help build goodwill and understanding. If we feel that a friend (or, in this case, a system) is taking advantage of us, does it strengthen the friendship and build goodwill if we speak up, or stay quiet and suffer? Yes, the discussion had the potential to build friendships and goodwill. Ms. Allen’s column, by advocating denial and repression, does not.

4) Will it be beneficial to all concerned? My list of people who would benefit from the conversation, even if it escaped the private forum: current debt holders who feel alone and unheard, schools who care whether graduates are satisfied, potential students who may not have fully explored the economics of entering their dream career, and taxpayers who may not want to subsidize ineffective programs. The discussion isn’t beneficial for the schools that want to keep raking in loan money while avoiding responsibility. Should we be censored for their benefit?

Ms. Allen writes “It is sad when you read an article about the profession that contains negativity coming from inside the profession. Essentially, this is giving the other professions (those looking to treat acupuncture patients) the ammunition they need to diminish acupuncture and attain their own goals.

I say, it’s sad when those with the power to change things for the better instead advocate for a flawed status quo. It’s a danger sign when secrecy is demanded for the good of the group. The Catholic Church and the Penn State Football program are examples of the moral failure that comes with that argument.

Thank goodness we’re dealing with finances and not child abuse. Nonetheless, shutting down conversation and preaching secrecy is neither ethical nor effective. If Ms. Allen wants to uphold acupuncture as the place “where hope and healing meet” then we need to delve into our challenges, not hide them.

 

 

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

14 thoughts on “Ethical Questions

  1. I don’t suppose anyone has saved a copy of the forum posts for us to read. I long ago stopped following the AAAOM ( hind sightedly and admittedly a mistake) and did not read it. Also, another indication of the danger of fleeting digital media to keep us informed.

    • Well, I’m not sure it was a mistake…. In any case, I didn’t save it. And, let’s just say, I’ve learned that sharing information from “closed” sites in other venues can have some negative consequences.

  2. This is an amazing post. And I agree fully, we should be talking about these very real challenges not hiding them. I wish there was a more open forum for that discussion without getting flack.
    Thanks for posting this and I hope every acupuncturist reads it.

  3. Thank you for writing this. Ms. Allen stands at the door with these other “leaders” as a gatekeeper of the acupuncture profession. Since I started school in the late 1990’s with high hopes of my chosen vocation, I have watched the acupuncture profession flounder and flail. Unfortunately, recently, the profession seems to be even more disintegrated. A dearth of cohesive leadership and abundance of infighting with a lack of insight into the concerns of actual practicing acupuncturists make our so-called “leadership” ineffectual at best and damaging at worst. Whether or not this misdirection is intentional or just meant to save their own skins is questionable.

    Ms. Allen has hit a new low with this recent opinion piece. She is obviously aligned with the the acupuncture schools which have decimated the acupuncture field through outrageous tuition fees and by conveniently omitting the reality of what a student faces after their graduation. The veiled threat of “defamation” in the article is oppression at its finest.

    It seems the acupuncture profession stands at a juncture point as to direction. Either the forces gather and true leadership emerges or the disintegration continues, possibly limping along for a while before it gets swallowed by the medical mainstream.

    • It is striking that the only response to the Gainful Education rules, at least that’s obvious to most observers, has been a massive CYA effort from the schools and leaders. Lots of excuses about why the disconnect between educational expenses and income shouldn’t matter, about why it shouldn’t reflect on the schools, and why it isn’t their fault. There’s not been any evidence that the profession leaders as a whole are looking at how to make things better for Acupuncturists or future Acupuncturists.

  4. Great post, Elaine! Transparency and sober self-examination is our only hope of survival.
    It’s frankly sad and ridiculous that someone as (supposedly) influential in the acupuncture world as Allen would advocate for pretending all is hunky dory and burying our heads in the sand, and that she think denial of big core problems would lead to a more respected profession.

    • Thanks, Tatyana! There are several problems with the article — among them the knee-jerk support of the schools and then pretending that ethics demands silence, even though her arguments don’t even meet the standards she thinks we should apply.

      As for her influence, she’s given plenty of money to the AAAOM over the years. And I’m willing to bet that her upset over the forum is what got it pulled. Also, she’s editor-at-large of AT, the same publication which pulled Lisa Rohleder’s column on Community Acupuncture because it was a “danger to the profession.” Which would be especially ironic if the rumors are true that she’s on the board of Modern Acupuncture. I suspect she’s had far more impact than we know.

  5. Supporting the schools is what got us into this mess. My clinic trains acupuncturist’s a sustainable way to have a profitable business that will gain acknowledgement from the community because it serves the community. It achieves both and when a practitioner is successful at the clinic then we look into further career development opportunities for them. It has been my contention for well over a decade that those who lived off of us, the schools and the associations including the NCCAOM were lazy and did little to make sure we were a strong profession that they could grow off of as well. They were so concerned about the head that they did not notice the health of the body. I feel bad for the schools newest recruits, the doctoral candidates, who will find themselves not only dealing with lies from the schools about their future, but from a tough group of colleagues who survived in this environment who will just not cede territory to them based on title and also from state governing bodies who are slow to act and not receptive to acknowledging doctoral status.

    • Suggesting that talking about these problems is dangerous is a sign of just how broken we are. If our position is so tenuous that honest discussion about our problems is risky, then we’re doomed.

      The more time I spent with Allen’s piece, the more disgusted I became.

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