Accountability Health Article

ACCOUNTABILITY

Professionals in any field can be called upon to justify their professional actions. The criteria against which they can be held accountable are those embodied in the normative standards of their particular profession. These standards are expressed in ethics guidelines or codes of conduct for each specialty area within public health. They also may be embodied in law. Likewise, other professionals engaged in public health work, including physicians, policy makers, and corporations, are accountable according to their own professions' codes of conduct.

If any undesirable consequences result from a health professional's work, every effort must be made to undo the damage, without dismissing or denying the problem. Consultation with other professionals or a professional organization can be helpful. Furthermore, various assessment techniques are available to help ensure that one's work is serving its intended purpose.

People can defend themselves against accusations of malpractice of any kind when they can show that they have behaved in an ethical fashion consistent with professional standards. Documentation helps in defending one's actions and makes a person's professional actions "transparent" or easily assessed. Transparency is necessary because accountability may involve defending one's actions or decisions to a professional or legal authority. Because public health professionals are ultimately responsible to the people they serve, transparency and accountability generally mean that processes and criteria for decision making are available for public inspection. Public health researchers have a duty to make their research practices transparent to the scientific community.

In a research context, researchers commit to maintaining the confidentiality of information provided by study participants. The process of informed consent provides assurances to this effect and provides both documentation and transparency. If a research participant discovers that a friend has received information that could only have come from a confidential research study, then the researcher could be called to account for a breach of confidentiality. By virtue of the written consent, the research participant would have grounds to hold the researcher responsible, and the transparency provided by documentation makes it possible to do so.

For two reasons, confidentiality and transparency do not generally conflict in public health. First, transparency relates to the process of data collection, analysis, and archiving, whereas confidentiality relates specifically to the data (i.e., the content). Second, any apparent conflict between confidentiality and transparency is always easily resolved because confidentiality trumps transparency, except in the rare circumstance where the researcher is legally required to breach confidentiality.

COLIN L. SOSKOLNE

LEE E. SIESWERDA

(SEE ALSO: Codes of Conduct and Ethics Guidelines; Confidentiality; Ethics of Public Health; Informed Consent; Practice Standards)

BIBLIOGRAPHY

Gellermann, W.; Frankel, M. S.; and Ladenson, R. F. (1990). Values and Ethics in Organization and Human Systems Development. San Francisco: Jossey-Bass.