John Oliver’s piece on Rehab specifically mentions a situation where the owner of a well-known treatment program also owns two major online businesses that review and rate treatment programs– including his own. That’s a textbook example of a possible conflict of interest, one that certainly should have set off warning bells.
There’s more than one definition of conflict, and the legal definitions can be quite involved. For our purposes, I’ll just pick one: Any situation in which an individual or corporation (either private or governmental) is in a position to exploit a professional or official capacity in some way for their personal or corporate benefit. Obviously, being able to give your own business a five star rating on a supposedly independent consumer website could be construed as an unfair advantage. It isn’t necessary to prove this advantage exists. It’s the presumption of advantage that matters to your customers.
How are such apparent conflicts resolved? There’s more than one way. Some examples:
- Disclosing the relationship between the two businesses openly. Example: When an article dealing with Amazon shows up in the Washington Post, it’s usually accompanied by a note explaining that the two companies share ownership.
- Recusal, or removing the conflict by stepping away from any involvement in one or more of the ventures. Example: The Attorney General recusing himself from involvement in the investigation of the Trump campaign. This was not popular with his boss, but it was the ethical thing to do.
- Divesting, or removing the potential conflict by selling or separating from one of the businesses.
There are other remedies as well. Conflicts of interest can also occur in professional relationships. For instance, a clinician who works for two competing providers in the same community, thus putting patient privacy and confidentiality at risk. Many programs have a policy prohibiting this without formal approval.
During accreditation, organizations develop ethical codes that address business and contractual relationships, marketing and promotion, and related subjects. A few examples of language from same:
“Executives, Board members, and employees shall not seek to benefit directly or indirectly from the use of inside information, or to profit from a position of authority.”
“The organization shall not enter into an agreement that involves any form of fee-splitting or paying for referrals.”
“The organization shall not seek advantage through use of unfavorable information about competitors.”
“Where questions arise about possible conflicts, professionals are responsible for seeking guidance from program administration.”
When complete, these codes often run several pages in length. It’s very different from the early days in the field, when most programs got by with a list of a dozen do’s and don’ts. That no longer suffices.
Of course, a code of ethics is useless unless someone’s around to monitor and enforce it. So programs must have a clearly defined procedure for investigating and resolving ethical complaints– which can come from patients, families, employees, referral sources, visitors, business partners, and other providers. It takes planning, and once it’s done, ongoing training to make sure everyone understands their role.