Any chiropractor who has not been in a coma for the past year is aware of the Mercy Conference that occurred in early 1992. It was an attempt by member of the profession to bring together all schools of though within chiropractic, to develop a set of standards of care for the entire profession. Before it was even officially published, the straight part of the profession decided to have its own conference, calling it the Wyndham Conference, but for a slightly different reason, to set standards only for those chiropractors who call themselves straight. Unlike Mercy, Wyndham did not present their standards to be for everyone, just the straights. Just before Wyndham took place, the International Chiropractors Association announced at their annual meeting that they had rejected the Mercy document and would be creating their own set of standards of card. Will there be others, and if so, will they destroy the entire concept of setting standards of care for the profession? Even if the writing of more documents purporting to be a standard for the profession does not undermine the process, changes in the document will surely affect its intent. The Mercy document is already going through changes based upon the lawyers’ criticism, the ICA rejection, and all the individuals whose toes it stepped on. The Wyndham Conference left the meeting stating that theirs was a “living document” and would change. So like our state laws, our standards will change. What’s the purpose of these documents? Do we really need them? Here is the principle: Those without a philosophy or set of principles will not adhere to prescribed standards of care. Those with principles don’t need them.
The aspect of the profession that has no philosophy or principle by which to guide their actions needs clear, strong, definitive standards, prescribing and limiting their actions. But these are the type of people who will not abide by them. They will bend them, distort them, circumvent them and change them every chance they get. Invariably the standards will degenerate to the lowest common denominator in the profession until there are no standards at all. With the Mercy document, it is already evident. Many practitioners and advocates of new, unusual and untested techniques and procedures are upset because the standards of care have all but eliminated their procedures as valid. Perhaps some of them are valid, but where do you draw the line? This concept is evident with the profession’s furor over scope of practice which is really nothing more than a standard of care. The practice of chiropractic, what is acceptable, ethical and legal has changed over the years. If anyone had suggested twenty years ago that chiropractors should be dispensing drugs or manipulating under anesthesia, it would have been shocking. Now most D.C.’s accept it, perhaps not for themselves, but as the direction the profession is going. In Pennsylvania for many years chiropractors were not allowed to call themselves “chiropractic physicians.” The state board prohibited it. Now apparently, they have succumbed to pressure from the profession and have said it is permissible. (Although they are supposed to represent the people of the commonwealth, not the interests of the profession.) The point is those without a philosophy are not capable of setting a standard of care that will benefit anyone but themselves.
On the other hand, we have the Wyndham document for straights, those who claim that their practice is guided by principles which have been incorporated into a philosophy. If our practice is based on a philosophy, why do we need standards of care? Is a protocol, procedure, technique or concept consistent with our philosophy? If so, it is acceptable. If not, we reject it. Do we need a consensus to decide what is philosophically correct and acceptable? Can consensus even decide that a technique or procedure was incorrect (it almost did at Wyndham). Would that have stopped a philosophically sound, principled chiropractor from practicing it? I think not. What we need to do is establish a philosophy and then allow people to make decisions and act based upon that philosophy. Instead, we too often dictate to people how they should act. In defense of the Mercy and Wyndham Conferences, it will be said that developing standards of care is not the idea of the profession, but has been mandated by the federal government. This is absolutely true. But like so much of governmental bureaucratic endeavors, it does not solve problems, it just created new problems. In theory, it will regulate the actions of unprincipled chiropractors. In practice that will never happen. In theory it will have no affect on principled chiropractors (those who practice based upon philosophical constructs). In practice I fear it will do just the opposite. Standards of care, laws, regulations or whatever you call them are not made for the honest, the principled individual. He/she needs none because he/she functions according to an internalized set of standards. Laws are made for unprincipled people, to inhibit their actions which are potentially destructive to society. The problem arises when in an effort to accomplish their purpose, laws or standards go too far in inhibiting the freedom and the constructive actions of principled people. That may be an end result of the Mercy and Wyndham documents and whatever others may come.
One final thought, it would seem that either a standards of care document is unnecessary for the practice of principled, straight chiropractic or if it is needed, then we have an admission that some members of the straight community are not as philosophically sound or as principled as they should be. That is a big problem and if it exists, having a standards of care document is only treating the effects, not getting to the cause. The cause is that members of the straight community do not act consistently with their philosophy, or their knowledge of the philosophy is so lacking, they do not see the inconsistency of their actions. Those causes must be addressed and a standards of care document is not the solution. The bottom line is that people who are mixers, who have no philosophy, need to be led by standards of care. People who claim to be led by a set of principles can only be hindered by a consensus document that dictated their actions. v9n1