Health Care Freelancers Face Tough Ethics Challenges

By David Ozar and Casey Bukro

Freelancing is a tough way to make a living – even tougher as downsized journalists turn to freelancing.

For writers specializing in health care, it’s especially challenging because of the ethics issues faced in navigating the cross connections between clients who want stories written for them or about them. Or both.

“Ethical guidelines for subspecialties may vary,” Tara Haelle in an email exchange with the Ethics AdviceLine for Journalists.

A freelancer herself, Haelle traced the obstacles in a story that appeared on the Association of Health Care Journalists website.

Tara Haelle
Tara Haelle

Haelle calls it the conflict-of-interest maze: “Ensuring that work for one client doesn’t create a conflict for another, present or future.” Though that might sound simple, Haelle said it isn’t because freelancers work for companies, journalism publications, universities and foundations or as consultants.

Haelle went to several sources, asking how she can avoid ethical conflicts of interests under the conditions in which she works and found that ethical guidelines vary. One source said “there’s no clear answer.” Another said journalists should “decide for ourselves what we think is ethical behavior.”

That sounded like a challenge for the Ethics AdviceLine for Journalists, which has a staff of five university ethicists to answer questions of the kind posed by Haelle.

One of them, David Ozar, is professor of social and professional ethics in the department of philosophy at Loyola University Chicago. AdviceLine asked Ozar to read Haelle’s story and offer his perspective on how he would have answered her call for guidance on ethics.

David Ozar
David Ozar

Here’s what Ozar wrote:

First, I certainly agree with her that the question that she is examining – which I will phrase as, “Is it ever unethical for a health care freelancer to write about closely connected topics (where “closely connected” admits of many possible kinds of connections, of which the author gives a number of examples) for distinct outlets (journalism organizations, blogs, public relations projects, etc.)?” – is appropriate to be considered as a question of professional ethics and important for a freelancer to think carefully about.

Second, I also wholeheartedly agree with her one clear and firm answer at the end of the essay; namely, complete transparency about such situations with the editor (that is of the second and any subsequent outlets) is required.

Third, the principles of AHCJ which she mentions having consulted are a fine example of the kind of guidance a well-crafted set of ethical principles can provide to journalists in a particular area of practice, in this case health care journalism. But no set of principles should ever be expected to resolve every possible challenging ethical decision that could come up; the assumption that, if such a document doesn’t clearly resolve a decision, then any course of action in the situation is just as ethical as any other is not only false, but sets aside one of the fundamental bases of professional ethics, namely the commitment of every member of the profession to make careful ethical judgments in practicing that profession.

[G]o for it if you need the money and don’t worry about it” … in fact is a recommendation to ignore one of the central commitments of a professional journalist.

Fourth, as the author does when the matter is not crystal clear from consulting SPJ and AHCJ’s guidelines (too bad she didn’t call the AdviceLine: we would have given her more help than she got from the SPJ hotline respondent), getting advice from admirable practitioners of the ethics and skills of one’s profession is a valuable contributor to good professional ethical thinking. But it is also important to remember that their comments ought not be considered the final answer any more than some published document. It is the professional journalist who is going to be acting one way or another, so that is who should be making the best judgment she or he can about what ought to be done (or not done).

But what the author’s little essay does not even try to do is explain why situations of conflicting interests are of ethical importance in professional life. The answer has three parts, all of which depend on the fact that every profession and therefore every professional makes a twofold commitment to the larger society. One of these commitments is to practice in such a way that the profession as a whole and each professional individually can be depended on to place the well-being of those they serve ahead of every other interest that might be important to them. Acting otherwise than this can only be justified in exceptional circumstances if ever (which excludes merely fiscal considerations and the personal preferences of the professional). This means that “go for it if you need the money and don’t worry about it” not only fails to get at the ethical issues Tara Haelle is calling attention to, but in fact is a recommendation to ignore one of the central commitments of a professional journalist.

The second commitment every professional makes is that the practical judgments involved in providing professional services will be made as much as possible on the basis of that profession’s specific kinds of expertise. So a second reason why Halle is right to see a serious ethical question here – which is just as important as the first but not mentioned very directly very often – is that one’s professional journalistic judgments – about what is important and what is not, about what might help or harm one’s audience, even about who one’s audience is likely to be, etc. – can be adversely affected by one’s other interests.

One respected author on conflicts of interest sees this connection with expert professional judgment as the hallmark of a genuine conflict of interest: “P (whether an individual or a corporate body) … has a[n ethically important] conflict of interest if and only if (1) P is in a relationship with another person requiring P to make a judgment in the other’s behalf and (2) P has a[n]…interest tending to interfere with the proper exercise of judgment in that relationship” (Davis, M. “Conflicts of Interest” in Encyclopedia of Applied Ethics, vol.1, ed. R Chadwick. London: Academia Press, 1998; pp. 585-595).

The key is to carefully evaluate conflicting interests to determine if they will produce harm [or] interfere with the exercise of one’s professional judgment.

It is important to add a person is not unprofessional as a journalist simply because one experiences interests that might conflict with the well-being of one’s audience or the exercise of one’s professional judgment. The truth is that we all have lots of different kinds of concerns, and the fact that these interests can conflict with one another is an unavoidable part of life; having conflicting interests is, taken by itself, neither professionally ethical nor unethical. As the social philosopher Dennis Thompson points out, professionals often have “necessary and desirable” interests that are not directed to the person being served. Thompson calls these interests “secondary interests,” and calls the interests of the person served that are of specific concern to the professional the professional’s “primary interests in the situation” (Dennis Thompson, “Understanding Conflicts of Interest,” New England Journal of Medicine, 1993, v.329, pp. 573-576).

It is therefore not really very helpful for professional guidelines to say that conflicts of interest are simply to be avoided. While the AHCJ Statement of Principles, for example, does say a bit more than this, a statement just like this is the header; and the Code of Ethics of the Society of Professional Journalists includes this directive: “Avoid conflicts of interest, real or perceived.” This advice is not helpful because many conflicts of interests are irrelevant to one’s professional life. The key is to carefully evaluate conflicting interests to determine if they will produce harm or loss to one’s audience in some fairly direct way or if they will interfere with the exercise of one’s professional judgment as a journalist.

For the freelancer who has the opportunity to be paid for writing about closely connected topics for distinct outlets almost certainly “has a[n] … interest tending to interfere with the proper exercise of judgment in that relationship.”

The third reason why situations of conflicting interests require careful ethical thinking on the part of the conscientious professional journalist is that the commitment to the audiences it serves must include a recognition of and respect for the audience’s ability to make their own judgments about what a journalist produces. Assuming one’s audience is ignorant and/or wholly passive is inconsistent with the profession’s commitment to serve the public’s wellbeing first of all. Therefore the journalist who is practicing with conflicting interests that might produce harm or loss to the audience or that might interfere with the exercise of the journalist’s professional judgment must be transparent with his or her audience about these conflicting interests.

[I]ntense commercialism … has made many journalists’ audiences cynical about the existence of professional expertise.

Since the ideal relationship between a professional journalist and the audience is that her or his journalistic judgments are informed above all by the profession’s distinctive expertise and are motivated by the professional’s commitment to serve their well-being first of all, the professional should be practicing on the assumption that this is how the audience will receive his or her product and therefore the audience must be alerted if there are conflicting interests at work that are ethically problematic, so the audience can then make its own judgments about the journalist’s work product. This is why the SPJ Code of Ethics adds, “Disclose unavoidable conflicts,” to its guidelines for such situations. The situation here is analogous to one in which the use of deception in investigative reporting really is the only way to protect the public from genuine harm. There too the reporter must be transparent about the deception so the audience has all the data it needs to properly judge what is reported.

Admittedly, the impact of today’s intense commercialism, which is affecting all the professions significantly, has made many journalists’ audiences cynical about the existence of professional expertise in general and about the strength of professionals’ commitment to the well-being of those served by the professions. But this is not a good reason to step aside from making one’s own work as a journalist as professionally expert and properly motivated as one can and assuming that her or his audience is taking the same view of what the journalist produces. Moreover, if a journalist were in fact feeling uneasy about being transparent with her or his audience about a conflicting interest in this way, then this concern should itself be considered a “red flag” that the situation deserves very careful ethical evaluation before proceeding.

Keeping these three points in mind – the professional’s commitment to the audience’s well-being, the commitment to create one’s work product as fully as possible in accord with journalism’s specific expertise, and the consequent obligation to be transparent about potentially compromising conflicts of interest – will provide the conscientious professional journalist with a set of fairly concrete ethical tests to apply in situations where conflicting interests are present, including situations in which the journalist has an opportunity to be paid for writing about closely connected topics for distinct outlets.

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