Another question that is sometimes posed is whether a previous or current user of illegal drugs should be subject to job discrimination by employers. It is argued here that the ethical response should be that no discrimination should take place against either previous or current users of illegal drugs if it occurs during off-duty time and off the establishments premises, as long as the person is otherwise fit to perform the job. In this respect, the employer should be prepared to make a reasonable accommodation in the arrangement of work to a current user of illegal drugs who is absent for purposes of counselling, treatment and rehabilitation. Such a view is recognized in Canadian federal human rights law, which prohibits job discrimination on the basis of disability and qualifies alcohol and drug dependence as a disability. Similarly, French labour law prohibits job discrimination on the basis of health or handicap unless the occupational physician determines the person is unfit for work. American federal law, on the other hand, protects previous illegal drug users from discrimination, but not current users.
An employer is faced with difficult ethical choices when dealing with a worker who uses, or who in the past has used, illegal drugs. The question, for example, has been raised as to whether an employer should dismiss a worker who is arrested or convicted for illegal drug offences. If the offence is of such a serious nature that the person must serve time in prison, evidently the person will not be available for work. However, in many cases consumers or small-time pushers who sell just enough to support their own habit may be given only suspended sentences or fines. In such a case, an employer should ordinarily not consider disciplinary sanctions or dismissal for such off-duty and off-premises conduct. In some countries, if the person has a spent conviction, i.e., a fine that has been paid or a suspended or actual prison sentence that has been completed in full, there may be an actual legal bar against employment discrimination towards the person in question.
In explaining the principles of an ethical analysis the focus has been set on health information and health-related information in individual records such as health records and personnel files. There are, however, both in the practice and in the science of occupational health, other types of information which may, in their generation, processing and use, involve ethical considerations and even conflicts of ethical principles. Such information can, however, usually be analysed using the ethical principles of autonomy, beneficence and equity as points of departure. This applies, for example, in hazard assessments and risk analysis. In a situation where, for instance, relevant information on a health hazard at work is deliberately withheld from the employees, it is to be expected that ethical analysis will demonstrate clearly that all three basic ethical principles are violated. This applies regardless of whether or not the information is judged to be confidential by one of the stakeholding partners involved. The difficulty arises when the information involved is uncertain, insufficient or even inaccurate. Widely differing judgements may also be at hand concerning the strength of the evidence. This, however, does not alter the fundamental structure of the ethical issues involved.
The ethical questions and dilemmas arising in the practice and science of occupational health derive from the collection, storage, analyses and use of information about individual persons. Such processes may be carried out on a routine or ad hoc basis with the objective of improving the health and life quality of employees or the working conditions at the workplace. These are, in themselves, motives which are of fundamental importance in all occupational health work. The information may, however, also be used for selective practices, even of a discriminatory nature, if used for instance in hiring or making work assignments. Information collected from health records or personnel files has, therefore, in principle a potential to be used against the individual in a way which may be unacceptable or regarded as a violation of basic ethical principles.
Lastly, it is emphasized that ethical analysis is a tool for examination of practices and optional strategies of action. It does not provide blueprint answers to what is right or wrong, or to what is thought to be acceptable or not acceptable from an ethical point of view. It provides a framework for decisions in situations involving the basic ethical principles of autonomy, beneficence, maleficence and equity.
The concept of acceptable risk, widely if not universally used in the setting of standards, is a form of risk allocation by caste. It depends upon the assignment of a risk differential based on calculating the risks of past work practice or prevalent exposure to a toxic substance or hazard in the workplace. This common practice accepts and promotes unnecessary risks by arbitrarily assigning, for example, an acceptable risk ratio of one death per thousand in setting a permissible exposure level for workers, compared to one death per million for other members of the same community.
There is another ethical role for a workers natural set. Choosing an appropriate location where the worker decides or consents to a risk is a critical factor in assuring an ethical outcome. Many decisions (such as the acceptance of hazard pay) should be made, if they are to even approach being truly voluntary, only in a milieu other than a synthetic setting such as the place of work or a union hall. Family, peer group and other natural sets may provide less coercive alternatives.
Thus, continued use of the consent doctrine in codes of professional behaviour, as in protecting the worker from the dangers of genetic testing, is unethical because a facade is created that doesnt fit the modern context of a culture westernized and made global by international data banks served by linked telephones and computers. The practice should be discarded and replaced with codes made effective by assumptions that fit the real world coupled with socially and legally enforceable protections.
Providing an economic incentive to accept an unnecessary risk known to a worker, employer or governmenteven as the result of a fairly negotiated contractis always immoral. It is just compensation, if adequate, to a workers family when the risk can be justified and when a worker has equal alternative employment available without stigma. Making this choice ethically requires the most neutral or non-coercive setting possible.
It is clear, for example, that the incorporation in codes of ethics of the widespread doctrine, an axiom, requiring voluntary, informed consent prior to privacy-invasive procedures (such as genetic testing) is irrational. The consent is seldom really voluntary or informed. The information conveyed is seldom certain or complete (even in the mind of the scientist or physician). Consent is usually obtained under socially (or economically) coercive conditions. The promises of the researcher to protect privacy and confidentiality cannot always be kept. The professional may be socially and legally protected by codes that incorporate this doctrine, but the worker easily becomes the victim of a cruel hoax resulting in social stigma and economic duress due to job and insurance discrimination.
If these settings are not available, the decision should be made in the most relatively neutral place associated with the most relatively neutral synthetic set or agency that can protect the empowerment of the worker and his or her natural set. The importance to the well-being of a worker of cultural and ethical values found in his or her family, peer group and community underline the importance of protecting their involvement and understanding as ethically based elements in the empowerment process.
Moral axioms bring the framework of judgement to the level of practice, to the shop floor. An example is the common practice of developing professional codes of ethics for corporate physicians and other professionals. They are drafted to protect generic rights and their specifications by bridging gaps in knowledge, to organize experience and to permit us to act in advance of morally or scientifically certain knowledge.