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Subject:
From:
Liz Brooks <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 5 Oct 2000 11:06:44 EDT
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Nikki – your situation of the IBCLC who also wants to volunteer as a lay
counselor is a good example of the "gray area" that IBCLCs face in the
ethics and conflicts-of-interest arenas.

Very few IBCLCs are reported to the Ethics and Discipline Board of the IBLCE
for violations of its Code of Ethics.  When researching this topic for a
talk I presented last Spring at the LCs in Private Practice conference, I
learned that one complaint had been filed in 1997, two in 1998, and one in
1999.  (The IBLCE's Code of Ethics is our list of rules – our "musts;" the
ILCA Standards of Practice are our goals – our "shoulds.")

So I pose ethics and conflicts concerns this way: does it pass the smell
test?  Taking into account all the factors of the situation, does something
just not ring true?  It may not rise to the level of a Code of Ethics
violation.  It may not even rise to the level of a violation of the ILCA
Standards of Practice.

We are a new profession -- and we are being judged by a public that is
largely unfamiliar with the concept of lactation consultation, and wholly
unaware of the training and certification required to earn "IBCLC."  My
concern is that the actions of a tainted few will be imputed to our group as
a whole.

It will be difficult to craft a policy for the nursing moms' group that can
account for all the shades of gray.  Assume an IBCLC who wants to volunteer
as lay counselor for local group.  Her work as a hospital LC exposes her to
nursing newborns exclusively.  She would like more experience working with
older dyads. Volunteering her time for the local nursing moms' group is a
good way to "give back" some of her education to the community ... and to
expand her clinical knowledge of the older nursing baby.  Most of us would
agree that this is a sound, ethical way to support, promote and defend
breastfeeding.

What if the same IBCLC has a pump rental station ... and she tells all the
moms on her counseling list that she sells/rents "the pumps they'll surely
want to have."  Is it starting to smell?  What if the IBCLC includes the
names and numbers of other rental locations?  Is the aroma gone now?  What
if the IBCLC has several moms with gavage-fed preemies?  Doesn't the IBCLC
have a duty to give these moms accurate information about where to obtain a
pump that will protect mom's milk supply and offer the gold standard to her
tiny baby?  I smell home-baked bread now!

All of which begs the question: will the IBCLC identify herself as such when
in her lay counseling role?  If so, surely the mom will think, "Oh, goody, I
have a real expert here on the line."  But doesn't that create a
professional relationship (however uncompensated), obligating the IBCLC to
"require and obtain consent to share clinical concerns and information with
the physician ... before initiating a consultation?" (Code of Ethics
Principle No. 23 -- one of our "musts.")

All of us are *required* by the Code of Ethics to "remain free of conflict
of interest while fulfilling the objectives and maintaining the integrity of
the lactation consultant profession [Principle 9]."  But you can only
evaluate the potential conflicts on a case-by-case basis.

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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