Summary

The concept of collaborative multidisciplinary teamwork is conceived as an important catalyst and site for social and cultural transformation in the provision of health and welfare services. In increasingly diversified and pluralist health care systems, redrawing the parameters of professional practice promised opportunities for new forms of thought and action that would achieve optimal treatment outcomes and improve the experience of care for patients. Driven in part by demands for greater efficiency and effectiveness, the movement towards multidisciplinary teamwork has taken on greater urgency as an instrument by which all health care providers can be rendered more fully productive both in clinical and social terms.

In this chapter, our reflections focus on pertinent connections between legal prescriptions, ethics and teamwork in health care settings. The argument is advanced that some legal and conventional ethics discourses stand in the way of agents developing multidisciplinary collaboration and co-participation. A further contention is that multidisciplinary teamwork would benefit from more adaptive socially founded moral frameworks that emphasise the socio-relational practice of ‘creating ethics’.

Collaborative multidisciplinary teamwork

The concept of collaborative teamwork in health care settings is an indeterminate multifaceted social and moral idea. In policy and practice, teamwork covers a range of historically produced assemblages composed of different practices, ideologies and institutions. Teams can literally be ‘made up’ not only of health professionals but patients, their relatives and carers, self-help groups, representatives of non-governmental organisations (NGOs) and more. Team organisation ranges across interrelated occupational roles, specialities and operational methods, body systems and sites of delivery. In this chapter the term ‘collaborative multidisciplinary teamwork’ is used to describe a discourse that attends to the problems of professional separation, exclusion and hierarchical relations that arrest movement towards cooperation between professions, the integration of professional expertise and the coordination of professional services.

Now widely assumed in the literature is that the health division of labour involves the dominance of one group or culture by another: medical dominance has had and continues to have an enduring and significant influence on the organisation and function of health care services (Adamson et al, 1995). From the 19th century the moral and intellectual universe inhabited by the medical profession was one in which the profession claimed, in the interest of patients, exclusive moral and cognate authority to assess, adjudicate and make judgements about matters that either impacted on the profession or arose from medical techniques (Cott, 1997).