This paper critically examines the proliferation of conflicts of interest (COI) discourse and how the most common conceptions of COI presuppose a hierarchy of primary and secondary interests. I show that a form of professional virtue or duty is commonly employed to give the primary interest normative force. However, I argue that in the context of increasingly commercialized healthcare neither virtue nor duty can do the normative work expected of them. Furthermore, I suggest that COI discourse is symptom of rather than solution to the problems of market forces in contemporary medicine. I contend that COI, as it is commonly conceived, is an inadequate concept through which to attend to these problems. It is used as a procedural short-cut to address ethico-political problems. That is, it is an economic and policy concept expected to do significant moral and political work. Like most short-cuts, this one also leads to entanglements and winding roads that fail to reach the destination. As such, I suggest that we need a different set of ethico-political tools to address normative fluidity of medical practice in the absence on a primary interest.
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I wish to acknowledge the helpful anonymous reviews of this paper. They assisted in sharpening some of the points and clarifying others. I also wish to acknowledge Dr Quinn Grundy, Dr Jane Williams, Professor Ian Kerridge and Associate Professor Wendy Lipworth for the various conversations and debates over the past few years that contributed to refining some of the ideas presented in this paper.
I receive funding from the Australian Research Council (DE170100550).
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Mayes, C. After Conflicts of Interest: From Procedural Short-Cut to Ethico-Political Debate. Bioethical Inquiry 17, 245–255 (2020). https://doi.org/10.1007/s11673-020-09971-0
- Conflicts of interest
- History of medicine