This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as (...) business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business. (shrink)

This article begins with three problems of “dual loyalties” in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics—for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved (...) using a theory of professional ethics absent from medical ethics until now though common outside. Employing a physician—rather than an ordinary officer, some other kind of healer, or scientist—is to enter a sort of “Ulysses contract” requiring the physician’s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing on other fields of practical ethics. (shrink)

Suppose an accountant discovers evidence of shady practices while ex amining the books of a client. What should he or she do? Accountants have a professional obligation to respect the confidentiality of their cli ents' accounts. But, as an ordinary citizen, our accountant may feel that the authorities ought to be informed. Suppose a physician discov ers that a patient, a bus driver, has a weak heart. If the patient contin ues bus driving even after being informed of the (...) heart condition, should the physician inform the driver's company? Respect for patient confidentiality would say, no. But what if the driver should suffer a heart attack while on duty, causing an accident in which people are killed or seriously injured? Would the doctor bear some responsibility for these consequences? Special obligations, such as those of confidentiality, apply to any one in business or the professions. These obligations articulate, at least in part, what it is for someone to be, say, an accountant or a physician. Since these obligations are special, they raise a real possibility of con flict with the moral principles we usually accept outside of these spe cial relationships in business and the professions. These conflicts may become more accentuated for a professional who is also a corporate employee-a corporate attorney, an engineer working for a construction company, a nurse working as an employee of a hospital. (shrink)

He notes that parallel to this phenomenon have been developments in the common law of malpractice that give patients a better chance than ever of winning compensation. While these developments benefit patients, Dr. Chapman describes how they have also pointed out a major flaw in malpractice law: the enormous amounts of time and money it takes to bring such cases to court. To overcome these difficulties, Dr. Chapman maintains, the medical profession needs to reconsider the basic concepts on which (...) its ethics rest. No less important is a revision of malpractice law so that it finally begins to serve, fairly and equitably, the purposes for which it originally came into being. Literate, thoughtful, and thought-provoking, Physicians, Law, and Ethics is an important contribution to today's medical care debate. (shrink)

This paper examines the question whether physicians are obligated by their professional ethos to defend a pacifist position. The question is a more concrete and applied formulation of the general thesis that there are what I will call “pacifist professions”: professions whose ethos requires their members to act in a pacifist way. Since the present paper is rather one in applied philosophy than a theoretical one about the foundation of pacifism, it will concentrate on the practical issue of whether and (...) how physicians can execute their profession in or during war. Theoretical questions on the nature and extent of pacifism will be considered only to the extent necessary to treat the main issue. The introductory section will give a short overview of some histori- cal aspects of physicians’ participation in war and show the relevance of the issue with recent examples. The remainder of this section will thus serve to set the stage and to outline the connections between the medical profession and questions of war and peace. The paper will then be divided into three other main parts: the first part will be devoted to defining in a general manner so-called “professional pacifism”. The second part will investigate whether and to what extent the medical profession can be classified as a pacifist profession, and the third part will look at the consequences of such a classification. (shrink)

Walton offers a comprehensive, flexible model for physician-patient decision making, the first such tool designed to be applied at the level of each particular case. Based on Aristotelian practical reasoning, it develops a method of reasonable dialogue, a question- and-answer process of interaction leading to informed consent on the part of the patient, and to a decision--mutually arrived at--reflecting both high medical standards and the patient's felt needs. After setting forth his model, he applies it to three vital ethical (...) issues: acts of omission, the cessation of treatment, and possible side effects of treatments. In the final chapter, Walton shows how his method functions in light of the real-life complexities of the clinical encounter and how it bears on ethical questions concerning health-care policy, attitudes toward treatment and toward the medical profession, reasonableness of expectations, and the setting of realistic goals of treatment. (shrink)

Recent debates have led some to question the legitimacy of physicians refusing to provide legally permissible services for reasons of conscience. In this paper, I will explore the question of whether medical professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all medical services. I will argue that they do not. I will also argue for an approach to dealing with intractable moral disagreements between patients and physicians that gives both parties veto power with (...) regards to participation. Finally, I will respond to three objections to allowing physicians broad freedom to act on their consciences: such allowances would violate the conscience of the patient, would lead to unfairness, and would thwart important societal goals. (shrink)

For at least the past several decades, medicine has been embroiled in a crisis concerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professionalism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-à-vis these questions is examined and analyzed chiefly in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their (...) writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolving health care network must also be considered. To that end, I first discuss the genesis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensified during the twentieth century, particularly in terms of medicine’s ultimate scientification and eventual commercialization, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for addressing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defining itself in terms of the professionalism for each of the other professions within the health care network. (shrink)

Vegetius' Epitoma rei militaris, in its discussion of Roman military recruitment in the Late Empire, provides a list of professions deemed unsuitable for military service. Among those groups associated with a lack of manly virtus are piscatores. This article aims to provide a rationale for Vegetius' ostensibly puzzling rejection of men involved in fishing activity by analyzing the antiquarian sources that colored his perception of Roman morality. The treatment of the piscatores thus reinforces the notion of Vegetius as a continuator (...) of reactionary discourse on traditional Roman mores, even though late antique attitudes towards masculinity were clearly changing. (shrink)

It might seem at this point that I am courting a contradiction: If antiprofessionalism is a form of professional behavior and if professional behavior covers the field , then how can I fault Bate for using antiprofessionalism to further a professional project? By collapsing the distinction between activity that is professionally motivated and activity motivated by a commitment to abstract and general values, have I not deprived myself of a basis for making judgments, since one form of activity would seem (...) to be no different from or better than any other? The answer is no, because the consequence of turning everything into professionalism is not to deny value but to redistribute it. One deconstructs an opposition not by reversing the hierarchy of its poles but by denying to either pole the independence that makes the opposition possible in the first place. If my argument that there can be no literary criticism or pedagogy that is not a form of professionalism, it is also that there can be no form of professionalism that is not an extension of some value or set of values. Whereas before one was asked to choose between professionalism and some category of pure value , the choice can now be seen as a choice between different versions of professionalism, each with its attendant values. To say that antiprofessionalism is a form of professional behavior is not to have closed the discussion but to have identified the basis on which it can continue by identifying the questions that should now be asked: What kind of professional behavior is antiprofessionalism? and What are its consequences? The answer is that, at least in its literary form, it urges impossible goals and therefore has the consequence of making people ashamed of what they are doing. The psychological distress that marks this profession, the fact that so many of its members exist in a shamefaced relationship with the machinery that enables their labors, is in part attributable, I think, to literary antiprofessionalism, which is, as a form of professional behavior, almost always damaging. Stanley Fish’s most recent work is “Wrong Again: A Reply to Ronald Dworking,” Texas Law Review . His previous contributions to Critical Inquiry include “With the Compliments of the Author: Reflections on Austin and Derrida”. (shrink)

Every business and organization today needs to impress stakeholders with its ethics policy. Universities, Ethics and Professions examines how this emphasis on ethics by the professional world is impacting universities, institutions that have long been key contributors to ethical reflection and debate, and shapers of ethical discourse. Changing objectives, globalization, and public concerns continue to bring professionalism, and commercialization, into the dialogue about what ethics mean on campus. Universities, Ethics and Professions offers an in-depth examination of the changing landscape of (...) academic ethics, with case-study analysis from sociologists, educationalists, management specialists and philosophers. As professionalism becomes an integral part of university teaching, training, and research, this book considers the impact on the ethical practices of academics, and explores the importance of universities remaining sites of open discourse on ethics in the future. (shrink)

The strengths and weaknesses of the discipline-based organization of our professions can help us understand both the enormous successes of our civilization and its equally spectacular failures. Placing engineering and other professions under greater public scrutiny is recommended as a first step toward addressing our deep structural economic, social, and environmental crises. Doing so can facilitate university reforms to adjust the discipline-based approaches to scientific knowing and technical doing, to permit future graduates to make decisions with better ratios of desired (...) to undesired effects. In the meantime, our war on ourselves rages on. (shrink)

An important part of the debate over physician-assisted suicide concerns moral duties that are specific to physicians. It is sometimes argued that physicians, by virtue of special commitments rooted in the nature of their profession, may never intentionally kill a patient, and that therefore, whether or not assisted suicide may be justifiable, it can never be right for a physician to take part in such an act. I examine four types of argument that have been offered in (...) support of this conclusion, and find that none succeeds. Each attempts to show why the duty to conserve life must be unconditional for physicians, yet a consideration of the ways in which contemporary medicine has evolved shows that such a duty is now no more fundamental to the profession than a duty to relieve suffering, which may in some cases override it. (shrink)

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds. The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference, Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of medicines (...) escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient. Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over 'me too' drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions. The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a corporate enterprise or remain a patient welfare centered profession. A third approach involves an eclectic resolution of the two. Such amount of patient welfare as also ensures profit, and such amount of profit as also ensures patient welfare is to be forwarded. For, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. According to this approach, medicine becomes a patient welfare centered professional enterprise. The various ramifications of each of these approaches are discussed in this monograph. (shrink)

Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act (...) on one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”. (shrink)

This second edition of _Professions in Ethical Focus_ comprises over seventy-five readings complemented by twenty case studies with corresponding discussion questions. These resources are organized into several thematic units, including “conflicts of interest,” “honesty, deception, and trust,” “privacy and confidentiality,” and “professionalism, diversity, and pluralism.” An alternative table of contents is also provided, identifying readings that bear on particular professions such as engineering, journalism, medicine, law, and policing. The book’s introductory unit offers short selections from classic and contemporary ethical theory, (...) including non-Western traditions. All of the readings have been introduced by the editors and carefully excerpted for relevance, always with the needs of student readers in mind. (shrink)

Recent professional guidelines published by the General Medical Council instruct physicians in the UK to be honest and open in any financial agreements they have with their patients and third parties. These guidelines are in addition to a European policy addressing disclosure of physician financial interests in the industry. Similarly, In the US, a national open payments program as well as Federal regulations under the Affordable Care Act re-address the issue of disclosure of physician financial interests in America. (...) These new professional and legal changes make us rethink the fiduciary duties of providers working under new organizational and financial schemes, specifically their clinical fidelity and their moral and professional obligations to act in the best interests of patients. The article describes the legal changes providing the background for such proposals and offers a prima facie ethical analysis of these evolving issues. It is argued that although disclosure of conflicting interest may increase trust it may not necessarily be beneficial to patients nor accord with their expectations and needs. Due to the extra burden associated with disclosure as well as its implications on the medical profession and the therapeutic relationship, it should be held that transparency of physician financial interest should not result in mandatory disclosure of such interest by physicians. It could lead, as some initiatives in Europe and the US already demonstrate, to voluntary or mandatory disclosure schemes carried out by the industry itself. Such schemes should be in addition to medical education and the address of the more general phenomenon of physician conflict of interest in ethical codes and ethical training of the parties involved. (shrink)

L’évolution de la société se traduit dans le langage. Au Moyen Âge, notairesse, tutorresse et défenderesse rendaient visibles, dans les textes, l’épouse et la femme agissant dans la société. À notre époque s’emploient des noms, tels infirmière, institutrice et vendeuse, qui ne sont pas neufs. Simultanément, comme la femme accède à des professions réservées aux hommes, s’installent des appellations féminines nouvelles telles que (la) juge, (la) pénaliste, présidente, consœur, avocate, magistrate, huissière, enquêtrice. Au Québec, en Suisse, en Belgique et en (...) France, des textes officiels recommandent la féminisation. Celle-ci suscite les passions parce qu’elle touche aux traditions, au savoir-vivre, aux préjugés, au souci d’égalité et surtout à l’identité de la personne. Même si des raisons culturelles et sociales freinent l’évolution des mentalités, la progression de la féminisation dans l’usage constitue un fait linguistique remarquable. (shrink)

International law is not merely a set of rules or processes, but is a professional activity practised by a diversity of figures, including scholars, judges, counsel, teachers, legal advisers and activists. Individuals may, in different contexts, play more than one of these roles, and the interactions between them are illuminating of the nature of international law itself. This collection of innovative, multidisciplinary and self-reflective essays reveals a bilateral process whereby, on the one hand, the professionalisation of international law informs discourses (...) about the law, and, on the other hand, discourses about the law inform the professionalisation of the discipline. Intended to promote a dialogue between practice and scholarship, this book is a must-read for all those engaged in the profession of international law. (shrink)

Dialectic IV convenes contributions with new takes on the long held proposition that architects are providers of design services. They service everyone from the status quo all the way to the subaltern. We know well how architects have historically fashioned themselves to be able to procure the most valued building commissions a people have to offer. There are temples, churches, and shrines, palaces and private villas, and surely monuments, state institutions, and corporate headquarters. But how have the members of the (...) same profession managed to fashion themselves as the custodians of the public good? (shrink)

It seems commonly assumed that presenting data is value-neutral. The data is what it is, and it is for those assessing it to make judgments of value. So a chart of earnings just tells us what a company has earned. The chart does not tell us whether the earnings are a good or bad sign. That valuation is to be made by those looking at the chart and is independent of the chart itself. This view of the relation between presentations (...) of data and value judgments is mistaken. Presentations are value-laden in at least two ways. How we choose to represent data is itself an ethically loaded value-judgment, and, second, presentations cause responses, including value-laden judgments. We shall first look at how hard it can be to get inside a profession to be able to understand the problems those in that profession face so we can represent it properly. We shall then examine a case where a failure to understand the problem led to a mistaken moral judgment that has taken on a life of its own because of the power of how the problem is mistakenly presented. (shrink)

Les vocations sont des chemins que la mémoire trace après-coup pour donner sens au parcours singulier qui nous mène de l'enfance à l'âge adulte. Aux lisières de l'adolescence, je me voyais chauffeur de train ou de taxi, même si je rêvais surtout de devenir journaliste. Je voulais écrire pour raconter ce que je voyais, pour rendre compte d'événements dont j'étais le témoin. L'essentiel était de prendre la route, d'explorer quelque chose qui n'avait été qu'entrevu ou d'en parler d'une manière originale. (...) La recherche en philosophie et l'enseignement de cette discipline devinrent mon métier. Sartre a raison de dire qu'on rate toujours sa vie, qu'on ne devient jamais celui ou celle qu'on aspirait à devenir. Les points d'arrivée ne sont pas forcément des points d'aboutissement. On croit achever quelque chose alors qu'on a creusé une brèche dans son devenir. Les crises, existentielles ou intellectuelles, peuvent avoir du bon. Elles réveillent le sens de la révolte, elles aiguisent l'envie d'un nouveau départ, elles invitent à d'autres commencements. Ce livre est le récit d'une tentative pour inaugurer dans ma quelque chose de neuf en la racontant. Un écrivain n'est pas quelqu'un qui vit de son écriture. Ce n'est qu'un nom, utile pour désigner celui qui ne sait pas ce qu'il est mais aspire seulement à exprimer quelque chose de lui-même"--Page 4 of cover. (shrink)

The paper deals with the critical questioning of the relation between legitimate imposed legal obligations and the rights to refuse these obligations based on the right of the freedom of conscience, i.e. conscientious objection. The critical perspective that is applied to conduct the questioning is a legal profession because, in Croatian legal culture, there is no articulated answer to the question of how to reconcile these two obligations within the legal profession. The paper draws on the comprehension of (...) John Rawls’s theory of conscientious objection since it is a systematic analysis of justice that shall submit subjective understanding of the good to the principle of right. In practice, the focus is on the grounds for acknowledging conscientious objection among lawyers as well on the obstacles to exercising this right. (shrink)