Thus upward accountability tends to emphasize the legal aspects of one' accountability. The practitioner should understand that this upward accountability is not, or should not be, one sided. The nurse and midwife have, for example, rights as well as duties under the employment law. Upward accountability should be empowering for practitioners, although regrettably it is often disempowering. Perhaps practitioners underestimate their power to rectify the balance in their favour.
Accountability runs downward to the patient.
This is emphasized in professional ethics. This is what common moral sense would also tell us, since they very rationale of health care is the help which people need for the health difficulties which they encounter in their lives. Downward accountability entails the empowerment of patients and clients and a partnership understanding of the professional-client relationship. It is downward accountability which informs such ethical imperatives as respect for confidentiality and informed consent. Accountability also runs sideways to colleagues and other professionals.