Intended for healthcare professionals

Education And Debate

Education and debateShared ethical principles for everybody in health care: a working draft from the Tavistock GroupIntroductionA shared statement of ethical principles for those who shape and give health care

BMJ 1999; 318 doi: (Published 23 January 1999) Cite this as: BMJ 1999;318:248

Shared ethical principles for everybody in health care: a working draft from the Tavistock Group

The expansion in healthcare delivery over the past 150 years has exacerbated many of the ethical tensions inherent in health care and has created new ones. To answer these problems, many groups of healthcare professionals have established separate codes of ethics for their own disciplines, but no shared code exists that might bring all stakeholders in health care into a more consistent moral framework. A multidisciplinary group therefore recently came together at Tavistock Square in London in an effort to prepare such a shared code.

Members of the Tavistock Group are listed at the end of this article


  1. Richard Smith, editora,
  2. Howard Hiatt, professor of medicineb,
  3. Donald Berwick, president (
  1. aBMJ
  2. bBrigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
  3. cInstitute for Healthcare Improvement, 135 Francis Street, Boston, MA 02215
  1. Correspondence to: Dr Berwick

    The great medical sociologist Elliot Freidson defined a profession as “an occupational group that reserves to itself the authority to judge the quality of its own work.” He asserted that professions earn that right, in part, through their relationship of trust with the people they serve. Thus, a tight bond exists between the identity of professionals and the self regulatory rules through which they assure that they can be trusted. For professions, ethics and identity are inseparable.

    For this reason, among others, professional codes of ethics have a long and distinguished history. New physicians take an oath of professional conduct whose origins are ancient, for example, and the American Medical Association, whose members face regulations and pressures from managed care, has framed a code of ethics for physicians in managed care settings. The American Hospital Association has created a committee on ethics to define ways for hospital executives to formulate codes of conduct. Nurses defend the core role of nursing in the care of the whole person through the American Nurses' Association's code for nurses with interpretive statements.

    These separate, discipline based codes of ethics often mark the highest aspirations of the professions they guide and, as such, they deserve our respect. …

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