In Search of an Ethic of Medical Librarianship* BY HELEN CRAWFORD, Former Librarian Middleton Health Sciences Library University of Wisconsin Madison, Wisconsin ABSTRACT Why is the literature on the ethics of librarianship so sparse? Some of the codes of ethics proposed or officially adopted during this century are examined, with an informal commentary on the reasons why they seem to have aroused so little sustained interest and discussion. Attention is directed particularly to library-user relationships and to some of the unique ethical situations in medical libraries.

confrontation, the withdrawal from involvement in cooperative ventures, even the failure to correct when correction is needed. I do not recall having had any formal introduction to library ethics in library school, although we must have been warned as job seekers of our responsibilities. I can recall hearing, on my first job, student assistants at the circulation desk teasing a fellow student who had asked for a book on fatherhood. (Forty-five years ago this could still arouse a blush). Long before the right to privacy became a cliche, I instinctively felt that the young man's right to confidentiality had been infringed upon. I can also recall my discomfort when any library policy was discussed in a social setting. I was not sufficiently informed (or, perhaps, sufficiently in agreement with the policy) to defend it, yet silence seemed to indicate assent. Preparing library staff members to meet these situations requires something more than lofty statements on confidentiality and loyalty. Even more appalling to me in the early years (though I did not experience it personally) was the acceptance of a traditional feud between cataloging and reference departments. It was general knowledge that in some libraries they were not even on speaking terms. With neither philosophical nor legal competence, I have approached the subject somewhat anecdotally, in the expectation of tolerance for the old-timer's tendency to moralize. However, I do not look back with regret on the "good old days": Library practice is more oriented now to its social responsibilities and more sophisticated in interpersonal relationships than it was when I was a novice.

ETHICS is a flexible term that has been applied to a range of behavior from life-and-death decisions in medicine to office etiquette. Society's efforts to formalize these concepts have led to codes of ethics for individual professions and for a variety of relationships in labor, commerce, and, increasingly, politics. For the whole of a professional life approaching fifty years, I have been vaguely disturbed by the lack of attention to ethical guidelines for librarians. There has been much discussion of professional status in this half century, but only sporadic attention to the obligations that professional status implies: responsibilities to employer, to colleagues, to the public served, to the profession, and to society at large. Altruism and the desire to serve do not automatically equip the new recruit to recognize and respond to ethical challenges; yet most books on library administration and the third edition of the Handbook of Medical Library Practice have no index entry under "ethics." There is indeed a kind of embarrassment in raising the subject. Most of us are too conscious of deficiencies in our professional relationships to risk supervision of other people's morals. We are conscious of opportunities missed through fatigue or pressure of work, the moments of impatience, CODES OF ETHICS the clinging to the comfort of routine, the inattenIn these days when ethical codes sprout like tiveness to signals of discontent, the avoidance of weeds, the need for a medical library code of ethics is highly questionable. Nothing seems less *Presented October 20, 1977, at a meeting of the profitable to me than mumbling platitudes with Upstate New York and Ontario Regional Group of the Medical Library Association, at McMaster University our toothless jaws. However, some attention must Health Sciences Library, Hamilton, Ontario. be given to efforts to develop an acceptable code Bull. Med. Libr. Assoc. 66(3)July 1978

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because they have inspired most of what has been written on library ethics. In fact, many of the pertinent articles have been written by members of various committees charged, often unsuccessfully, with formulating codes [1-5]. The indifference of the membership at large to the issue is obvious from the meager literature. We cannot consider professional conduct without acknowledging the issue of professionalism. For good or evil, librarianship is not a profession in the same sense that law, medicine, and architecture are. The authority and the accountability are different. As Graham puts it:

"professional roles and rules", observes that "medicine, law, engineering and religion offer periodic examples of the human capacity for grievous misbehavior" [8]. I believe we can agree that the librarian's potential for inflicting injury is smaller. The code of professional practice adopted by the membership of a professional society to safeguard and delimit the rights of individual clients absorbs some of the impact of disagreement by formulating principles of good practice and insulating the practitioner from challenge on generally accepted standards. Goode summarizes this principle:

In professions where codes of ethics seem to have at The code embodies the terms of an implicit contract least some small effect on professional practices (as law, between the professional and society, by which the medicine) certain conditions exist: 1) there stands at the professional [sic] agrees to prevent its members from excenter of things, a fairly complex, personalized client- ploiting a potentially helpless layman and in return professional relationship (usually involving a fee); 2) receives many privileges [9]. there is a certain amount of independence on the part of the professional (he is rarely closely supervised, and is The literature on library codes indicates that rarely responsible to anyone to a greater degree than he enforcement powers they become lacking is to his client); 3) there exists a clear-cut body of professional technique and practice held in common by exercises in futility. They aim to state eternal all practitioners; 4) finally, there is a professional verities, but they reflect the preoccupations of association with real power-powers of enforcement and their time, particularly the sensitive areas. I can powers of certification [6]. conceive of no better sampling of the library cliContrast these requisites with the library's rela- mate than a review of these efforts over the decades of this century. Comments volunteered in tionship to its so-called clients: 1. In libraries the client relationship is, to use a period of personnel shortages are fretful over Bogie's chilling words, "faceless and imper- violations of employment contracts. When a sonal and routine" [7]. The library's authority buyer's market develops, emphasis shifts to the is vested in its institutional administration, or protection of employee rights. However, the perhaps in a committee representing the li- earlier codes are administratively oriented and the brary and the clientele. Professional control rights of subordinates are scantily represented. Also, it is only in recent years that the obligations over conduct is tangential. service to a wide clientele have been emof 2. There is a hierarchy of supervision in libraries, and the need for courage under pressure phasized rather than a one-to-one relationship with the

client. 3. The "clear-cut body of professional technique and practice held by all practitioners" is neither clear-cut nor universal. 4. Different segments of the library profession are represented by different professional associations, none of which have any power of enforcement except through persuasion or a certification program endorsed by some governmental authority. It should be noted that the codes which seem most effective have a quasi-legal standing between the professional schools, on the one hand, and the licensing boards and similar legal controls, on the other. The professional schools play what has been called a gate-keeping role, initially screening candidates for the profession. Moore, writing on 332

asserted. I cannot resist quoting almost in full one of the earliest proposals, by a public librarian named Mary Wright Plummer, who in 1903 formulated a statement called "The Fourth Essential":

Doctors, lawyers and ministers, college professors, officers of the army and navy, have a certain code which presupposes that they are gentlemen and wish to remain such. A breach of this etiquette strikes at the foundations of their order. Librarians and educators in general have their code still to make. The fact that these codes are for the most part unwritten, makes them no less binding; they are like debts of honor, which, although unrecorded, must be paid first of all debts. If we were making a code for librarianship, what would it have to be to help that calling to rank among the professions? Surely the following would be some of its requirements: We must have dignity, and if we have to advertise, we must be careful how we do it.

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We must have humility. All boasting of ourselves or of our work is out of place. We must realize our individual limitations and be willing to learn before we try to teach. We must consider our work one of humanity, and must be ready, like doctors, to attend to pressing cases, in season and out of season. Too rigid holding to one's hours savors of the trades-union. We must believe in our work, quietly and not ostentatiously. We must suppress our natural tendencies, where they conflict with the best interests of the profession, and, if necessary, be willing to give up the work for the good of the work. I hear that my methods are antiquated, that I prefer ruts and my own comfort to the service of the public. It is plainly my duty not to resent this without self-examination, and if I find it true, either to infuse more energy and self-denial into my character or to yield my place to some one who can fill it worthily. We should say to ourselves, Am I, personally, a credit to librarianship, and if not, what is wrong with me? Am I helping to make librarianship a profession, or am I hin-

dering [10]?

Can we honestly say that this quaint statement is outmoded? It is out of step with modern aggressiveness in library publicity, for instance, and in defending employee rights, but it describes a person who is in a service occupation in order to serve. In 1922 Charles Knowles Bolton, librarian of the Boston Athenaeum, in consultation with a number of distinguished colleagues, proposed a well-reasoned and literate code [11]. The emphasis on administrative responsibilities, and particularly on lines of authority and loyalty, indicates some of the tensions between increasingly able and confident professional librarians and their governing bodies. In these days a warning would scarcely be necessary that "a librarian should not ally himself with one trustee to the exclusion of other members of the body from his confidence." The librarian's duty to the staff receives meager attention by Bolton, except for recognition of the responsibility to offer staff members an opportunity to advance and the obligation to provide fair and balanced recommendations. The obligations of the staff to the library are more clearly expressed. For example: An assistant should not allow personal antagonisms within the library to injure efficiency, nor should the staff tolerate a cabal of congenial spirits that tends to break up the membership into groups ready at hand for rivalries and jealousies.

In 1946 Helen Haines, a prominent library educator, made similar observations on some of the Bull. Med. Libr. Assoc. 66(3)July 1978

hazards of internal relationships: .. . I would rank as of foremost ethical importance ... self-discipline and self-development. Personality ... without self-discipline is often more of a liability than an asset. ... For their relationship with their fellow workers, I would offer a single ethical directive: Banish feelings. Nothing is more deadly than feelings-fatal, ferine, feminine feelings-that weave a network of petty bickerings, misunderstandings and heartburnings among all who indulge in them [12].

In looking up this article, I ran into an artless report on "Popular images of librarians" which quotes a library user: "The fact that you seldom find a librarian who can really smile seems to be due to the fact that they are constantly on their feet" [13]. The image of a contentious librarian whose feet hurt is not appealing! Thirty years later another library educator, Martha Boaz, observed: The term "ethics" is a misnomer if used in the strictest definition of the word. Actually professional ethics refers, in large part, to the rules of etiquette developed in the profession to govern the professional contacts of members with each other and serve as a method of es-

tablishing internal discipline.... The codes of ethics of most professions are mixtures of general moral principles and of definite rules of conduct. Attempts of professions to relate the individual to the wider community mark an important step forward [14].

In this context the current code of the Institute of Professional Librarians of Ontario is a wellconceived guide to the professional conduct of the individual librarian [15]. The ALA Code of 1939 [16], not the first adopted but the most ambitious, defines in its preamble the groups to which the librarian owes responsibility: The library as an institution exists for the benefit of a given constituency, whether it be the citizens of a community, members of an educational institution, or some larger or more specialized group. Those who enter the library profession assume an obligation to maintain ethical standards of behavior in relation to the governing authority under which they work, to the library constituency, to the library as an institution and to fellow workers on the staff, to other members of the library profession, and to society in general.

The third provision hedges on giving teeth to the code: This code sets forth principles of ethical behavior for the professional librarian. It is not a declaration of prerogatives nor a statement of recommended practices in specific situations.

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In the years intervening between the adoption of this code and the efforts of a series of committees to revise it in the 1960s and 1970s, much of the meat of the earlier code was absorbed by other statements, such as the Library Bill of Rights and the Freedom to Read Statement. Standards of employment practice were beginning to be recognized as superseding some aspects of a code of ethics. The result was a compressed code of only six provisions, preceded by an explanatory introduction, approved by the ALA Council in 1975 [17]: A Librarian Has a special responsibility to maintain the principles of the Library Bill of Rights. Should learn and faithfully execute the policies of the institution of which one is a part and should endeavor to change those which conflict with the spirit of the Library Bill of Rights. Must protect the essential confidential relationship which exists between a library user and the library. Has an obligation to insure equality of opportunity and fair judgment of competence in actions dealing with staff appointments, retentions, and promotions. Has an obligation when making appraisals of the qualifications of any individual to report the facts clearly, accurately, and without prejudice, according to generally accepted guidelines concerning the disclosing of personal information.

The Draft Statement of Professional Responsibility of the California Library Association-California Society of Librarians is an interesting work elaborating the ethical considerations underlying five principles and fifty-three subheads [18]. The draft code of the Association of Law Librarians [19], is in many ways the most pertinent to medical librarians, illustrating not only the complications inherent in dealing with a legalminded profession and a highly concentrated publishing enterprise but also the difficulties that plague efforts to be specific and to cover every contingency. The number of law librarians with law degrees raises severe problems of conflict of interest and of the attorney-client relationship. The section on the law librarian's relationship to the patron offers an illuminating parallel to the medical library that provides medical information to laymen. The specter of status is raised by one provision in the section on the relationship to the patron: The law librarian generally should refrain from demeaning activities, and therefore should politely decline the doing of subprofessional or of patrons' work, which is requested by the patrons, regardless of the patron's position.

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One reason that ethics seems to play such a small role in our discipline is that librarianship is a service occupation, and there seems to be an impression that, if there is no profit, there is no possibility of ethical conflict. Selling of library books occurs sporadically, but it is a far from risk-proof way to make money. Library budgets and institutional accounting systems being what they are, opportunities for financial profit are not prevalent. However, it is instructive that an unratified draft code of 1968 incorporates an article with half a dozen provisions dealing with profit opportunities and conflict of interest (for instance, in the siting of a building). Corrigan and Galvin [20] also cite the ethical hazards of consulting on library buildings. Opportunities for minor profit that do occur would seem to be controllable by prudence and good accounting systems, rather than by formal codes. There seems to be an assumption that anyone deliberately entering a service profession is automatically equipped with all the skills to deal equitably with both public and colleagues. We are likely to assume, also, that a set of rules for the public and a procedure manual for internal functions will take the place of a real orientation of staff members. The vogue for instruction in human relationships and behavior changes is evidence of today's effort to provide some theoretical grounding and case study to reinforce good intentions. ETHICS IN THE MEDICAL LIBRARY Because of its specialized clientele and limited subject field, the medical library escapes some of the pressures on the public library-for instance, problems of censorship, conformance with local norms, and commitment to serve all elements of society. The ethical problems of a medical library are less conspicuous, and even trivial, in comparison with controversies that can shake a community. However, the narrower the responsibility, the more justification for seeking refinement of service. The remainder of this paper is concerned mostly with library-user relationships. As a preliminary to this paper, I queried a number of colleagues on incidents that colored their opinions of libraries. I asked a very friendly and capable public librarian what was the most troubling experience he had had in other libraries. His immediate response was "apathy, complete apathy." A library school administrator deplored the casual disregard of confidentiality in the daily Bull. Med. Libr. Assoc. 66(3)July 1978

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activities of reference departments. (The hazards of this carelessness are very apparent to special librarians, and medical librarians should take them to heart). One distinguished administrator was still incensed, after half a century, at a colleague on his first job who gloatingly reported his errors to the head librarian. This type of talebearing violates departmental solidarity and introduces tension, without furthering learning. A retired librarian still recalls with resentment the fine levied for the late return of a reserve book she had carried back through a blizzard. On two different occasions a library school administrator had faculty members resign after the start of a semester to accept more prestigious appointments. A medical librarian with the most disarming courtesy met, not outright hostility, but a superior smile for her unfamiliarity with a library's arrangement. (This is in line with the smug superiority of the resident of Cairo, Illinois, toward the stranger who has no reason to know that it is pronounced Caro.) Most of us have experienced either complete indifference or bristling suspicion upon introducing ourselves in other libraries. I recall with some amusement Dean Louis Round Wilson's description of his effort to gain access to a book in a special collection from what he termed "the vestal virgins" charged with its care. The trauma he experienced was apparent even a generation later. All of these put-downs-the superior half smile, the blank stare of indifference, the cold glare of suspicion, the shrug that says "I can't be bothered," the down-turned mouth of the discouraged-can be more troubling than words because they cannot be answered in kind without abandoning some of one's own standards. I always have an urge to ask, "Do you enjoy your work as a whole? If not, what are you doing here?" There is something in operation in all these instances that I call membership in the "ingroup"; you may note that none of my sample cited incompetence. However, indifference, inattention, incivility, inconsiderateness, inflexibility, intolerance, and, finally-a particularly destructive category-injustice may rankle through a lifetime. I once heard an authority on civil rights warn that the great cases on liberty of the press were fought on behalf of cantankerous and far from noble characters. In medical libraries we are dealing with a group of users with the habit of command, impatient for results, sometimes subtly insulting in their failure to accept the librarian as a professional colleague. The librarian, on the other hand, often harried and shorthanded, has erected Bull. Med. Libr. Assoc. 66(3) July 1978

a structure of rules to protect all borrowers, which the borrowers view as a barrier. My successor, Virginia Holtz, has a sign on her office door (the inside of her office door) that reads, "To err is human. To forgive is not library policy." The delight with which most administrators greet this slogan acknowledges the uncharitable charity that often accompanies the rule-making authority. As infuriating as dealing with them may be, I would like to put in a word for the library's problem users-the arrogant, the overdemanding, the rulebreakers, the inept user who hides his ignorance behind a stuffed shirt, and the outright stinker. It is easy to be pleasant and accommodating to the well-mannered and grateful user, but the real test is to not treat the troublemaker in kind. Meeting a bully with smiling firmness and consistency may so surprise him that he becomes, if not a friend of the library, at least a more cooperative borrower (in a perceptive article on "Stress and strain in academic librarianship," Guy Lyle uses a phrase I like: "an attitude of cheerful resolution" [21]). Let me also add a word on behalf of the apology. No one is immune to error; and it is hard to do battle with an antagonist on his knees. Records are not always right, and it is well to leave oneself an out when pressing claims. To forgive may not be library policy, but it is politic because the face saved may be one's own. How many of you have considered that medical libraries are in a monopoly position within their immediate communities? They have the technical materials and specialized staff and control access to the bibliographical apparatus of their discipline. They are service agencies, but insulated from the direct influence of their users by their place in the institutional hierarchy, and thus open to the dangers that monopoly and bureaucracy are said to nurture: arrogance, monolithic resistance to change, substitution of rules for flexibility. I have one more anecdote which I tell not in boastfulness but in sadness. A graduate student wrote a farewell note to the library to say that he would not have received his doctorate without the help of the library staff. "I have worked in many libraries," he wrote, "but this was the first time I felt the library staff were on my side." This saddens me because I have never known a professional group more devoted to the idea of service and more willing to study new techniques to improve it. I can only hazard a guess that the increased size and impersonality of our operations have intruded less-informed and less-motivated staff between librarian and user.

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I have another reason for suggesting some sensitivity raising. In medical libraries, more than in other institutions, we are training users not only of our facilities but of other facilities as well. How harshly or considerately we treat a medical or nursing student today may affect not only alumni support for our future library building, but also may determine the kind of support that deans and faculty or hospital administrators will give to other libraries. The influential faculty member who is coddled at the expense of other borrowers may become a problem to a whole series of librarians in other institutions. The modern generation of MEDLARS searchers (the contemporary equivalent of Dean Wilson's vestal virgins guarding the portal of knowledge) may well do more for the image of the medical library than all our efforts in public relations. User and librarian share in this modern mystery through the face-to-face interview, the painstaking search of the maze, and the suspense of waiting for the oracle to respond. It is odd that a technical advance should have such a humanizing effect. Other medical library activities involve ethical judgments. The interlibrary loan system has always offered fertile ground for infractions by both borrowing library and patron. It is shocking to discover a faculty member, fully informed on the conditions of a loan, casually xeroxing a book that had been lent in the original because it was too fragile to be copied. Heavy reliance on other libraries for material that should be bought locally is an imposition. The development of the consortium system will put new strains on the unselfishness and sincerity of participants. We do not always weigh the ethical considerations in book selection. How should scarce funds be allocated to the various clienteles served: For example, should several hundred dollars each year go to a journal for a single research project or toward heavier duplication of reserve books? On the other hand, should the majority need always dominate, or should special areas such as the history of medicine receive some consideration? Are medical school libraries speaking up on the necessity of library support of the off-campus teaching centers and for the relief of the local hospital libraries on which this added burden is imposed [21]? Medical libraries at all levels must also come to grips with the issue of patient education. Some years ago an article indicated that hospital staff i. training were infinitely more comfortable when dealing with the physical ills of patients than when

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dealing with the social problems. Medical librarians are in this position with regard to patient education: Our holdings, our book selection habits, our reference tools, and our professional orientation are all geared toward support of scientific work. We are uncomfortable with patients and their relatives and with laymen in general, uneasy at intruding upon the doctor-patient relationship, and fearful of doing harm. Our hospital library colleagues are ahead of the rest of us in dealing constructively with the layman's need for medical information [22], but they should not have to deal with it alone [23]. A panel on Ethical and Legal Issues in the Dissemination of Health Information to the Health Care Consumer at the Medical School Library Group meeting at the 1978 conference is a hopeful sign. As is true of many ethical issues, much of what has been said here boils down to good manners, acceptance of one's obligations, and integrity. Everyone who remembers his initial exposure to a medical library with pleasure and gratitude is better prepared to be a lifetime friend of libraries. So, as a conclusion to this sermon, let me turn to a sermon of three-quarters of a century ago when Robert Louis Stevenson wrote: There is an idea abroad among moral people that they should make their neighbours good. One person I have to make good; myself. But my duty to my neighbour is much more nearly expressed by saying that I have to make him happy-If I may [24].

REFERENCES 1. ANDERSON, J. Ethics: the creaking code. Libr. J. 91:5333-5335, Nov. 1, 1966. 2. Can we commit ourselves to a code of ethics? ALA Bull. 62: 511-514, May 1968. 3. Discussion of proposed code, prepared by the Committee on Ethics. Law Libr. J. 67: 528-540, Nov. 1974. 4. FETROS, J. C. The search for a code of ethics. Am. Libr. 2: 743-746, July/Aug. 1971. 5. ROTHSTEIN, S. In search of ourselves. Libr. J. 93: 156-157, Jan. 15, 1968. 6. GRAHAM, N. In: Bogie, T. Discussion in Dallas. Libr. J. 92: 2127-2130, June 1, 1967. 7. BOGIE, T. M. Discussion in Dallas. Op. cit. [ref. 61. 8. MOORE, WILBERT ELLIS. The Professions: Roles and Rules. New York, Russell Sage Foundation, 1970. p. 118. 9. GOODE, WILLIAM. Librarianship. In: Vollmer, Howard M., and Mills, Donald L., eds. Professionalization. Englewood Cliffs, N.J., Prentice-Hall, 1966. p. 41. See also: Goode, W. The librarian from occupation to profession. Libr. Q. 31: 306-318, Oct. 1961. 10. PLUMMER, M. W. The fourth essential. In: Bolton [see ref: 11]. p. 138. 11. BOLTON, C. K. The ethics of librarianship: a proBull. Med. Libr. Assoc. 66(3)July 1978

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12. 13. 14. 15.

16.

17. 18. 19.

posal for a revised code. Ann. Am. Acad. Pol. and Soc. Sci. 101:138- 146, May 1922. HAINES, H. E. Ethics of librarianship. Libr. J. 71: 848-85 1, June 15, 1946. FORM, W. Popular images of librarians. Libr. J. 71: 854, June 15, 1946. BOAZ, M. Does the library profession really have a code of ethics? Spec. Libr. 59: 354, May 1968. Inst. Prof. Lib. Ont. Quart. 17: 88-91, July-Oct. 1975. Code of ethics for librarians. ALA Bull. 33: 128-130, Feb. 1939. Repr. in: Am. Libr. 2: 746, July 1971. Statement on professional ethics, 1975. Am. Libr. 6: 231, Apr. 1975. RQ. 15: 241-244, Spring 1976. Professional responsibilities and ethics. American Association of Law Libraries code of ethics. Draft. June, 1974.

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20. CORRIGAN, D. D., AND GALVIN, H. R. Library building consulting: problems and ethics. ALA Bull. 62: 505-510, May 1968. 21. LYLE, G. R. Stress and strain in academic librarianship. Libr. J. 93: 158-161, Jan. 15, 1968. 22. WEST, R. T., AND HOWARD, F. H. Area health education centers and health science library services. Bull. Med. Libr. Assoc. 65: 368-376, July 1977. 23. ROTH, B. G. Health information for patients: the hospital library's role. Bull. Med. Libr. Assoc. 66: 14-18,Jan. 1978. 24. STEVENSON, ROBERT Louis. A Christmas Sermon. New York, Scribner, 1900. p. 14.

Received November 29, 1977; revision accepted March 20, 1978.

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