Conflict of Interest

In general terms, a conflict of interest is a situation in which two or more interests may collide. The context in which these conflicts are most often discussed is business or economic activity, when the person who must make a decision—whether an executive or an employee—cannot guarantee objectivity or impartiality.

However, conflicts of interest (COIs hereafter) are not limited to the business or economic context. The earliest reference to the concept of conflict of interest is found in a local newspaper in the southern United States, the Southern Literary Messenger, which used the term in 1837 (Oxford English Dictionary), and this reference does not pertain directly to economic matters. Generally speaking, a COI refers to circumstances in which a person in a given role (for example, a physician) cannot guarantee that their decisions are not in some way compromised—that is, that they have not been or will not be affected in their objectivity and impartiality.

Such objectivity, in effect, relates to what is expected of that role itself, namely, the end(s) that identify it and guide its decisions. Those ends are, for example, the health and recovery of patients in the case of a physician. In this sense, a COI is basically explained in relation to the concepts of purpose and objectivity in the decisions of a person in a given role, as well as in the existence of third parties who have something to demand in terms of objectivity and impartiality from those who fulfill that role. Thompson (2017), along these lines, explains that a COI arises under conditions in which professional judgment about a primary goal (such as a patient’s welfare or the validity of a study) could be, or be unduly influenced by, a secondary interest (such as financial gain). Under these conditions, therefore, the objectivity of the decision cannot be truly verified by a third party, and there can be no assurance that the professional has acted ethically. It should be noted that this relationship between a professional and a third party is possible insofar as it is established on conditions of trust, and this, in turn, is only possible to the extent that there is manifest objectivity and impartiality in the decisions of the person who fulfills a professional role. In other words, for the relationship between the person who has a specific role and third parties to take place, there must be objectivity on the part of the professional (manifest fidelity to the ends that identify that role) and trust on the part of the third parties who relate to them. Otherwise, if there is no trust, the relationship is impossible or very precarious because there are no guarantees that the professional has taken, is taking, or will take honest or integrous decisions.

Now, as we have said, objectivity in decision-making is given by the clear manifestation of the pursuit of certain primary ends by the person who fulfills a professional role. More specifically, every professional role is defined by primary ends which, although they may include other secondary ends, cannot coexist with ends that are directly opposed (in conflict) or that hinder the attention and dedication expected to those primary ends. What are those ends and how can they, in a COI situation, come into conflict? To identify those ends, we must consider that every professional role is associated with certain primary ends that third parties or stakeholders usually assume conventionally (by custom, rule, deduction, or general agreement) and that, for those same third parties, are the ends that should guide the decisions of anyone in that professional role—such as the health of patients in the case of a physician. On the other hand, every professional role concomitantly has certain secondary ends—i.e., ends that are not necessarily in conflict with its primary ends nor are immediately illegitimate, but are almost always necessary, as in the case of a physician’s fees. Money or prestige are, in this sense, secondary or instrumental ends (MacIntyre, 2016) with respect to which there is normally a legitimate personal interest. Moreover, every person has more than one role in their life. Thus, the physician, for example, must balance non-contradictory primary ends, such as a patient’s health and the care of their children when that person, in addition to professional obligations, has parental responsibilities. These can indeed be considered non-contradictory, although they could restrict the attention due to a primary end, which does not necessarily constitute a COI. But there can be cases of people who, in different roles, assume primary ends that are in conflict or contradictory—such as the hypothetical case of a court judge who is also president of a political party.

As noted earlier, being in a COI situation entails the inability to guarantee the objectivity of past, present, or future decisions—that is, decisions that are not compromised relative to the ends expected of those who hold specific professional roles. This occurs because a person in a professional role simultaneously and manifestly has various ends that are in some way incompatible with regard to involved third parties. Such incompatibility or conflict can arise in at least three situations: i. Primary ends incompatible A person who has multiple roles that are identified with primary ends incompatible with each other is in a serious COI situation and, in that case, must recuse themself from one of those roles. This is the case, for example, of someone who holds executive positions in competing companies. ii. Coexisting primary ends A person who has multiple roles identified with coexisting primary ends should recuse themself when the roles are confused and cannot be distinguished by third parties. For example, a university professor should not teach or grade their own child. iii. Crossed secondary ends The problem of secondary ends in COI arises when they relate to different primary ends. This occurs, for example, when a physician is also a shareholder in a pharmaceutical company. Being a doctor and an investor are not immediately incompatible primary ends. But when the secondary ends are crossed (such as a physician prescribing medications from their own company), one cannot assert that, as a physician, they fully fulfill their purpose, which is the health of their patients.