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Ethical Responsibilities of Readers

by Traian Mihăescu

The Global Health Journal
Published by Interloquitor, Ltd for International Voice of Health Sciences (IVHS)
Vol.1, Issue 1

Rationale: The ethical responsibilities of readers? This may seem a strange question to explore.
In this article I would like to present the social and cultural context from which I write.
In Romania, the communist political, economic and moral values collapsed and the society is trying to rebuild new structures. The aim is to achieve a participatory society, one in which the individual member actively participates in determining his own destiny. We are moving towards a competitive society - a civilized competition!
In this movement special attention needs to be given to enable people to respond to new requirements. This transition from "Homo sovieticus" to "Homo democraticus" is both a complex and elaborate process. We need not only basic institutional changes but also changes in human attitudes.
This implies the right policy should be to provide incentives for individuals to acquire a sense of participation. A sense of inclusion, implying the recognition of pluralism of behavior, values, opinions, a feeling that society cares about individual rights. Essential premises include the stretch of pluralism and vehicles for expressing the interests of diverse constituencies of the society. To ask for readers' responsibilities could appear strange but in fact it is a common request that can pass unperceived.

Argument: In the domain of scientific editing and writing this imposes the responsibility not only to publish as accurate a text as possible but also to create a readership, a reading culture in science. The proper conduct in today's society is to push people to compete and involve publications in the work of creating new leaders. Creating a new academic excellence in our society and supporting it by a scientific culture has become an important social claim. In Romania it will be unethical not to accept it. So, my aim is to argue that we cannot really increase the ability to express our knowledge without finding ways to provide public debate and reach non passive readers.
In fact, the democratic goals to be achieved by Eastern Europe are:
- Social justice
- Protection of vulnerable persons
- Participation

Participation is a major responsibility the readers must share. Work in cognitive science revealed that reading requires reader's inferential work - a capacity to apply deliberate strategies for interpreting and remembering.
Comprehension is a meaning imposing process. So, a self conscious reader is the one that constructs meaning, does interpretative work and raise questions about presented material. This requires effort on the part of the individual, self monitoring and a disposition for a higher order of thinking.
As physicians, we have the responsibility to be continuous readers. One of the ethical requirements the medical profession has is that "a physician shall continue to study, apply and advance scientific knowledge, make relevant information available to the patients, colleagues and the public"; and; and "a physician shall recognize a responsibility to participate in activities contributing to an improved community". It can be argued that a physician is using unethical conduct if he adopts a passive position toward the medical press. Exigency in reading should be continuously sustained, and critical assessment of data is important. Learning how to read a scientific paper is part of every physicians' education. The quality improvement movement, now recognized by all participants in healthcare, requires the physicians to learn how to work effectively, how to evaluate critically the results of ones own health care activities and those of others and to ensure that needed improvements actually occur. In our society this implies fundamental changes in how physicians learn their science and art during their curriculum. Medical schools must cultivate not only skills for thinking, but also the disposition to use them. Such dispositions are cultivated by participation in social communities that value thinking and independent judgment.
Such communities communicate these values by making available many occasions for such activity and responding encouragingly to expressions of questioning and judgment. This is further aided when there are opportunities to observe others engaging in such thinking activities. Reading scientific journals offers such an opportunity and this activity requires sustained long term cultivation.

In my view a self conscious reader must be a thinker and the thinker's task is to construct meaning and impose structure on information, rather than to expect to accept uncritically data and their interpretation. Therefore, high level performance depends on processes of monitoring one's understanding, imposing meaning and structure, and raising questions about presented material. Readers are supposed to practice deliberate, mindful, or "intentional" reading through a process that activates certain powerful knowledge structures.
The responsible reader is always a creative person, an adventurous thinker that elaborates, adds complexity and goes beyond the given material to construct new formulations of issues. Science itself is not a passive, contemplative acceptance of reality but a means to effect its active reconstruction. Meanings cannot be simply observed like objects in the external world. Organized skepticism and intellectual independence are required because scientific knowledge must not be taken on trust. All presuppositions and all knowledge claims, including one's own, must be continually scrutinized for logical consistency and for empirical accuracy. This again requires participation even if this represents only the process of monitoring one's understanding. It is clear, then, that thinking is driven by and supported by knowledge, in the form of both specific facts and organizing principles. Scientific knowledge in a given field must be supported by scientific journals that serve as a repository of the knowledge that constitutes the current understanding of that field. Between the act of publishing a paper and accepting its contents as a piece of shared knowledge there is a long way full of responsibilities and ethical dilemmas. The point, of course, being that readers are part of this process and they also have ethical responsibilities.

Let me use some more arguments. What I would like to make clear is that the reader has an immoral behavior if he does not agree to accept some duties. Being connected to the world responsively is valuable. Responsive connection to reality is intrinsically valuable.
We can agree that the clearest possible motive for moral behavior is self interest. Or, it is the self interest of the reader to engage in a critical checking of what he reads. Passive acceptance of scientific reports can be conceived as an immoral behavior. The cost of this "immoral behavior" is a value cost. The immoral life is a less valuable life that the moral one, the immoral person is a less valuable being than the moral one. The sanction is a value sanction: the immoral person is not less moral than the moral person, he is simply a less valuable person. This immoral reader does:
- Not care about shared knowledge
- Not care that value is part of the cost to pay
- Not care about value, in itself, as something that diminishes one's own value

There is a penalty to pay even if he doesn't realize it or care about it. Others who understand value will realize how poor he is, even if he, himself, does not.
So, we may conceive the act of publishing as an act of engagement in a moral dialogue, with all physicians being ethically sensitive and practicing ethics. There is an intense need for ethical conduct by everyone involved in healthcare. As a result all health professionals must learn how to read clinical journals. The selected information must be approached in an efficient and effective way permitting the reader to distinguish relevant and valid information from useless documents.
Finally, I consider that a conscious reader must prepare to become a potential writer and this is especially important for health care workers who are supposed to share their knowledge for the benefit of public health.

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