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When Conflict of Interest Threatens the Quality of Education

A few weeks ago, I was invited to teach a one-time, free, community education class on breastfeeding basics.   As an independent, Lamaze Certified Childbirth Educator in my community, I was happy to oblige—recognizing that low-cost or no-cost community health education classes play an important role in any and all communities.  Being passionate about the dissemination of accessible, evidence-based lactation information, I was more than happy to volunteer the information normally apart of my eight-week childbirth preparation series.

But there was a catch.

My invitation to teach came from a neighbor of mine who owns the local baby supply store in town.  While her secondary reason for offering occasional classes on location, in her store was to further her hard-earned reputation as a one-stop-shopping depot for all things baby—even to the point of providing monthly free classes on varying topics of interest to pregnant, nursing and new mothers during which new and expectant women can mingle and make social connections—her primary purpose was to increase store traffic and, therefore, sales.

A sub-section of Lamaze International’s Code of Ethics for Childbirth Educators speaks to the issue of Conflict of Interest:

1.06 Conflicts of Interest

(a)    Childbirth educators should be alert to and strive to avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. When a real or potential conflict of interest arises, childbirth educators should first disclose the conflict to clients and then take reasonable steps to resolve the issue in a manner that prioritizes the clients’ interests and protects clients’ interests to the greatest extent possible.

How did this invitation to teach (on a volunteer basis) a single class challenge the code of ethics I, as an LCCE, have promised to abide by?  The possibility that my instruction would include subversive or overt recommendations of in-store products the store owner hoped I would incorporate into the two-hour class.

“Feel free to stop on by the store a day or two before the class to see what all we have in stock—that way you’ll know which products to mention when talking about breastfeeding,” my neighbor suggested.  “We’ll probably offer some sort of discount the night of the class for anything purchased that evening.”

Should I have been concerned with the amount of sales generated by my overview on the anatomy, physiology, practice and benefits of breastfeeding?  Of course not.  Would I have been in breach of my promise to uphold Lamaze’s Code of Ethics in regards to Conflict of Interest, had I accepted the invitation to teach this class?  Well, let’s see:

Disclaiming a conflict of interest entails confessing any sort of financial reimbursement given to a conference speaker, health care provider, instructor or administrator (or to his/her family member) that might influence his/her decision to use, recommend or employ a certain product, service or practice of care.  So, by definition, because I was not being paid to teach this class, I would not have technically been in breach of my Lamaze Code of Ethics commitment.

The slippery slope, however, became evident in this business owner’s expectation that the content of my presentation would directly entice class participants to buy certain products, based on my recommendations under the guise of authoritative knowledge.  If, for example, I swore by the functionality of the most expensive breast pump in the store—raving about its ability to support the continuation of breastfeeding over long periods, including mother’s-return-to-work-scenarios, and its status as a “must have” product for all moms with infants, despite the previous ten-minute mini-lecture I’d provided on the supply and demand system of lactation—that could have been perceived by my students as advice on a product they “should” have at home in order to succeed at breastfeeding.

If, however, I mentioned and even showed examples of breastfeeding-related products in conjunction with curriculum content—for example, providing a visual demonstration of how to determine a “good” versus “bad” nursing bra in terms of support, proper fit, lack of underwire structure and easy release of cup latch—would this be considered entering the dangerous waters of Conflict of Interest?  I would argue the answer here is, “No.”

Obviously, receiving a monetary kick-back for each sale made of a particular item, or a percentage of total sales on the night of my class would be a brazen breach of ethics on my part and I’m happy to say such an arrangement was never discussed by business owner nor educator.

I did, in fact, go on to teach the one-time class in question—Conflict of Interest and guilt free, and in the presence of a lovely, invested, intelligent, un-coerced audience!

Ethics can be a tricky thing and, I for one, am thankful for Lamaze International’s clear delineation of the Ethical Standards by which it expects its certified educators, employees and agents to abide.  Wouldn’t it be fantastic to see all professional organizations follow suit?

Posted By:  Kimmelin Hull, PA, LCCE

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  1. December 21st, 2010 at 17:09 | #1

    “The slippery slope, however, became evident in this business owner’s expectation that the content of my presentation would directly entice class participants to buy certain products, based on my recommendations under the guise of authoritative knowledge.”

    So why does Lamaze International license and recommend baby toys, women’s body lotions and women’s apparel? Clearly is trying to women to buy certain products based on their recommendations and under the guise of authoritative knowledge.

  2. avatar
    sasha
    December 22nd, 2010 at 17:54 | #2

    i (and i am not certified by Lamaze) have thought about this ethics issue quite a bit in a related context – as a birth educator and a doula i receive (or could if i solicited them) lots of products which i might pass along to my clients. what does it mean if a doula gives a “goodie” bag filled with LLL endorsed samples of Lansinoh? or Mother’s Milk tea? does it mean i am putting my stamp of approval on the products? i am troubled by this but at the same time, i do actually like both of those products and isn’t helping mothers find the resources they need part of my job? sometimes the above mentioned products are really helpful and are far superior to something else she might have tried if she didn’t know better.

    i do give out sample bags (i also include local services which i know and trust- like a very highly respected lactation counselor’s card), my clients seem to appreciate them. i don’t include anything which might promote bottlefeeding or that i don’t personally find to be a good and useful product. (Preggie pops sent me samples, which i didn’t use because they include HFCS).

    i think asking ourselves constantly, “is this ethical?” and “how might this be interpreted by our clients?” is very important when our clients put so much trust in our words and actions. they certainly deserve a high level of thoughtfulness.

    the example i experienced at our local hospital when i gave birth there many years ago serves as a great example: a formula company diaper bag, full of formula and supplies for bottlefeeding – given to every new mother. they no longer give these “freebies” but i’m sure at the time, the idea seemed really helpful. (i threw all of it away, before i left.)

  3. December 22nd, 2010 at 18:09 | #3

    Thank you for your input, Sasha. Your point is a sentient one which I’d like to expand on: if you truly believe in the healthy, helpful aspect of a product/service, providing information on it (or samples of it) to your clients becomes an act of “helping” vs. “promoting.” I suggest asking yourself the basic questions, “Does this product/service support the practices I teach about in my classes as well as the standards established by the organization through which I teach? Do I feel 100% good about recommending this product/service to my students/clients?” If you can answer “yes” to these questions–you’re probably in the clear.

    (And, yes, I agree that including product samples in goodie bags is philosophically equivalent to verbally recommending said products.)

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