It is so hard to understand ethics! It's not as easy as we would like to assume
- we need Ethics Specialists to teach us - I know we had a wonderful talk when I
lived in St. Louis from various specialists in Ethics and Medicine. Perhaps we
need this sort of input in ILCA conferences.
If one is part of a culture or religion that spells it all out for you, there is
rarely any disagreement - but the Lactation "culture" is now developing and
growing and many of us are growing and developing with it. Some problems seem
to have such cut-and-dried answers - but do they?
* LC's should not receive money from a formula company even when they ask you to
help them make a tape on breastfeeding.
I know this is an accepted statement - in fact, I also have refused this
type of offer on those grounds. Still I wonder if a trained person doesn't do
it, it will get done by one who is not trained. Will we then be thrilled to
point out all the inconsistencies - feeling very proud of ourselves refusing
their money - and forgetting that the tapes WILL be distributed and WILL be
viewed by many people.
Would it be more ethical to offer to review their material and refuse $$?
Does that then give our work less value?
What about a company which makes breastfeeding products and also
distributes bottles and nipples? Who's money is "pure" enough for us to accept?
Only a patients? Only a government agency? Only a hospital which does not get
any gifts at all from any formula company?
* LC's should not sell or rent any item that she is not sure is in the best
interest of the client.
What if the client comes in insisting on wanting some item - shield,
pump, and you give her all the information at your disposal and you know either
you sell it to her or she'll go to the nearest drug store and get it herself -
without the benefit of your continued follow-up. This happens often in the
hospital with moms who are being discharged and want to buy a pump. I
discourage the use of pumps but if she insists, should I not sell her the brand
I have which I have confidence in or let her go to the drug store and buy the
latest ... pump (some which look the same as they did when I delivered 25 years
ago!)?
So many have come in after buying (for $300) the whole ____ (not a swear
word) system - pump, sterilizer, shields, bottles, etc. Then I need to correct
things without talking badly about the company! (a separate ethical issue).
Yes, I rent Medela pumps, yes, I sell equipment (Medela and White River), and I
work for a hospital and a grant - I get paid for 10 hours a week by the hospital
that has over 300 births a month and get paid 25 hours a week for the grant. I
work over 50 hours a week. All funds coming from pump rentals and sales go to
the non-profit organization that pays me. I'm not getting rich on breastfeeding.
But even if I were - I live in a capitalistic country (even here in Puerto
Rico)and it's allowed!
Last night I stayed until after 8:30pm at the hospital ( I live over an hour
away and started my day at 9:00am) as I would not be in this weekend (I have a
support group this morning), and two moms with breast pumps lent to them by the
hospital were going home and needed to know about the pump rental program we
have - as well as where else to get one (Dr. Parrilla's office is open on
Saturdays) if she didn't want to arrange for one right then...
Perhaps I was just trying to make money on them...
The great thing about being an LC is how different we all can be and how we can
each make our mark - and our income - doing that which we enjoy and which we
are good at - whether home visiting, running groups, selling pumps, teaching,
creating educational programs for professionals and moms, creating advertising
material that will appeal to others, doing research, pushing public policy, etc.
Not everyone was meant to be a specialist in a hospital - and how sad if that
were the only service available!
I love learning what all of you are doing and what has worked for you - that you
make money with it is not the issue - that you are willing to share the
information demonstrates to me a level of professionalism and ethics (willing to
share information about the competition was the message of the old Christmas
movie "Miracle on 42nd Street" - I still cry with it) which other professions
would envy.
Thanks for you Lactnetters and our founders - keep us all together - but we do
need, I think, to learn more about ethics. Especially as it relates to our
profession. Any takers?
Jeanette Panchula, RN, IBCLC, LLLL, BA-SW
Puerto Rico
Proyecto Lacta: http://netdial.caribe.net/~prlacta/
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