Decision-making tools

These 4 generic tools are designed for health professionals working as:

  • individual clinicians
  • members of clinical teams
  • teachers and researchers
  • committee members, employees of and advisers to organisations such as professional colleges and societies, hospitals, universities and community and for-profit organisations

The tools are to assist health professionals in:

  • recognising when there could be a real or perceived conflict involving interests of the profession and those of for-profit organisations
  • distinguishing between a duality and a conflict of interest
  • managing possible and established conflicts of interest
  • confirming that they are comfortable about establishing, continuing or changing the terms of a relationship with a for-profit organisation

The tools may be adapted to suit the specific needs of individuals and groups of practitioners within particular organisations and institutions.


Tool 1: Identification of dualities
Tool 2: Identification of conflicts of interest
Tool 3: How should this conflict of interest be managed?
Tool 4: Additional questions


1. Identification of dualities

Key question

In a particular decision making setting in which I am involved might I be facing a duality of interests?

Settings in which the question might arise

The question might arise for any health professional involved in making decisions in is or her work in the context, for example, of patient care, population health activities, research, teaching or membership of a committee of a professional association, health care institution or government committee, where the decision might be affected by a personal or financial interest.

Specific questions for individuals involved in discussions or decisions relating to their roles as health professionals
  • What are the interests that are guiding or directing me as I consider this decision or participate in discussion about it?

  • Are there any financial relationships outside this decision-making setting that could have a bearing on the position I might take?

  • Are there any personal relationships that might affect my decision?

  • Are there any personal motivations or beliefs that might limit or obstruct my open consideration of the issues I am expected to take into account here?

  • In this setting, in relation to a particular issue or decision, are my various interests pulling me in two directions at once?

  • Might some professional colleagues consider that some of my interests could conflict with my primary duty or responsibility here?

  • Might some laypersons (e.g. family, friends, students, patients, community members) feel that one or more of these interests could inappropriately affect the way in which I am considering the matter?

  • Might the relevant professional college or society consider that one of my interests might conflict with the interests that arise from my role within it?

  • Might the relevant employer or funder consider that there could be conflicting interests that influence a position I take or a decision I make?
If the answer to any of the above is ‘yes’, has the matter been discussed with:
  • those who might perceive the existence of a duality of interest, especially professional colleagues in institutions, colleges and societies?

  • the college, professional society or a responsible body within the institution?

2. Identification of conflicts of interest

Key question

Is this duality a conflict of interest?

Specific questions for organisations, committees or other bodies to which a duality has been declared
  • Do any of the personal interests - pecuniary or non-pecuniary – that the individual concerned has declared conflict with or undermine the interests inherent in the role the individual is occupying in, for example, this clinical relationship, committee or position of authority?

  • Could there be a perception among patients, research participants or community members that any of these personal interests – pecuniary or non-pecuniary - conflict with what they are likely to assume to be the individual’s primary duty within this role?

  • Are any of these interests (pecuniary or non-pecuniary) of the professional society or institution relevant to this decision or discussion in conflict with those of any of the other communities with which the individual is involved, including patient care, research, administration or business?

  • Could there be a perception among patients, research participants or community members that any of the interests of the professional society or institution relevant to this decision or discussion conflict with those of any of the other communities to which the society or institution has a responsibility?
If the answer to any of the above is ‘yes’, has the matter been discussed with:
  • those who might perceive the existence of a duality of interest, especially professional colleagues in institutions, colleges and societies?

  • the college, professional society or a responsible body within the institution?

3. How should this conflict of interest be managed?

Key question

Given that it has been judged that a conflict of interest exists involving a particular health professional, what steps should now be taken to manage it?

Specific questions for organisations, committees or other bodies managing a conflict that has been identified
  • Is the conflict of a pecuniary or non-pecuniary nature?

  • Does it reflect opposing duties linked to different social roles?

  • Is it a consequence of interests associated with personal relationships, goals or career ambitions?

  • What are the risks associated with this conflict?

  • What are the worst outcomes that could result from it?

  • Are there individuals whose wellbeing may be placed at risk if the conflict is not effectively resolved?

  • How would this conflict be regarded by members of the community who place their trust in this health professional?

  • Taking the answers to the above questions into account, what actions are necessary? They may include the following possibilities:
    • no action necessary
    • acknowledgment of the conflict but allow the conflicted individual to continue to participate in the decision or discussion process
    • require that the individual relinquish one of the roles generating the conflict at the point where the conflict occurs
    • require that the individual fully relinquish one of the roles generating the conflict
    • establish other mechanisms – such as assistance from an independent third party – to circumvent any risks associated with the conflict

4. Additional questions

These are to be considered before initiation, continuation or change of a personal or organisational relationship:

  • Are the individuals involved familiar and comfortable with the organisation’s corporate history and business practices?

  • Are they confident that the relationship will not result in any actual or perceived loss of professional independence?

  • Is the proposed association genuinely linked to clinical care, research, further education or ongoing professional development?

  • How would patients, patients’ families and carers, students, professional associations, colleagues, employers and the broader community regard any such association?

  • Are the individuals involved prepared to be scrutinised by colleagues and by the public as to the propriety of this association?

  • Would they be comfortable about this association being publicised on the front page of the newspaper, the internet, blogs, social media, court cases, in films or in radio or television programs?

Feedback invited

Suggestions and critical comments from all members of the community are welcome at any time. Email us at ethics@racp.edu.au


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