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News Bulletin : ADA News Bulletin December 2010
39 DECEMBER 2010 Members of the profession claim the right to judge the demands of employers or patrons and the laws of the state, and to criticize or refuse to obey them. That refusal is based not on personal grounds of individual conscience or desire but on the professional grounds that the basic value or purpose of a discipline is being perverted...there is...still some popular foundation for the professional's claim of license to balance the public good against the needs and demands of the immediate clients or employers. Transcendent values add moral substance to the technical content of disciplines. Professionals claim the moral as well as the technical right to control the uses of their discipline (Freidson, 2001, pp. 221--222). Professionals cannot escape ethical considerations due to the asymmetry of their knowledge and the attendant power that such knowledge brings. Knowledge and its applications may be put to uses of good or evil. It is up to the professionals to safeguard that knowledge not only through exclusivity and credentialing, but by ethical refusal to use their knowledge or allow it to be used in ways that harm or do not help humanity. Ethics are the essence of professionalism -- or the "soul of professionalism," as Freidson puts it. Abbott says on the topic of globalisation: "At present, professionalism seems to hold its own...But it may ultimately lose out to organisations" -- a state of affairs that will lead to "a much weaker control of work by the professions themselves" (Abbott, 1988, p.325). This would be a loss of independence, resulting in ethical degradation, and it might spell the end of professionalism. An example is the profession of medicine in western countries. The mid-twentieth century was something of a Golden Age for modern medical practice (Freidson, 2001). Practitioners of the profession -- doctors -- were in control. They operated what amounted to small independent businesses throughout the land. They staffed hospitals but were not beholden to hospitals for their employment. They charged what they deemed their services were worth, and patients paid it out of pocket. Once managed health care arrives and begins dictating what is to be paid for by whom, both doctors and patients lose some of their independence. Patients no longer choose their doctors. Rather, they choose from a network of providers listed by an insurance company. Some insurance companies determine how much medical treatment a patient should receive -- without a doctor having seen the patient. Do the doctors working for insurance companies who recommend such limited courses of treatment have the independence to exercise full medical judgment? Or are they required, if they want to keep their appointments, to make diagnoses and recommend treatments favourable to the insurer's -- not necessarily the patients' -- best interests? This scenario is playing out in not dissimilar ways in many other professions. If the professions indeed become dominated by organisations that employ their practitioners -- or by the profit motive itself -- independence of thought and conscience may be irrevocably lost in the trend. The profession and professionalism will be compromised, perhaps terminally. Professionals must be attached to, and actuated by, a transcendent ideal in order to maintain their integrity, and even their existence. What must be resisted are the forces of false rationalisation, of desiccated efficiency, that tarnish the offerings of organisations. And self-destructive forces operative at the heart of professionalism itself -- notably, imbalanced preoccupation with prestige and profit -- must also be checked. The essence of professionalism is its integrity -- a sense of being beholden to use its asymmetrical knowledge and the attendant power for the greater good of humanity and in service of truth. As long as professionals and professions hold on to this essence of professionalism -- even, and especially, in an age of globalisation -- they will survive and flourish, and professionalism will fulfil its role in serving humanity. As such, professionalism is not only relevant in today's world -- it is indispensable. CONCLUSION Professionalism is more relevant in today's world than ever before. As knowledge increases exponentially, specialisation of and access to knowledge are also proliferating, leading to the emergence of many neo-professions with concomitant claims to the power, prestige and profits accorded to the traditional professions. An understanding of what professionalism is, its characteristics and obligations, is important in the face of these new realities. This understanding must both include and go beyond regulation by professional bodies and/or governments. This essay maintains that ethical considerations and obligations lead to and maintain trust on the parts of those served and are the essence of professionalism. There is no definition of professionalism -- even a rough outline of professionalism's characteristics -- that does not include a central component of ethics and altruism. The need for ethics and altruism to direct professional skills is pressing because of the asymmetrical knowledge that professionals enjoy in relation to others. Knowledge is power, and where power is wielded, ethical concerns come into play. Professionals are expected to be ethical towards the individuals they serve and altruistic towards society as a whole. This tacit expectation of ethics and altruism leads to trust. The individual and society have a right to trust implicitly that the professional will adhere to standards that are, in many ways, unenforceable except for the professional's sense of professionalism. Herein lies an unresolved conundrum. Thus, professionalism involves not only knowledge and expertise -- skills of the head and hand -- but also the virtues of trustworthiness and altruism -- attributes of the heart. With head, heart and hand working in concert to benefit individuals and society with his or her specialised expertise, the professional person exercises what has always been recognised as the hallmark of professionalism and its summation: integrity. On the foundation of professional integrity, a professional not only performs specialised services, but he or she increases the trust quotient in a society, lowering transaction costs and enabling the invisible handshake of trust -- about which Adam Smith spoke -- to energise the market along with the invisible hand. Professionalism contributes to economic growth and social mobility. It also affords wider access to education, as more specialized knowledge stimulates tertiary education. Professionalism is more crucial now than ever before to society's economic, social and moral wellbeing. The impact of professionalism on society is both wide and deep. Its essence defines and directs many of society's endeavours in an ever more interdependent, informed and complex world. ACKNOWLEDGEMENTS I thank Don Larkin, President of Professions Australia, for suggesting that I write this essay, June Saunders for her dedicated research and drafting assistance, and David Parnham for his helpful comments on the role of the church and his skilful editing. Rob Moodie, Helen Laburn, Caron Beaton-Wells, Stuart Hamilton, Michael Gill and Friedrich Blase each contributed to the work in various ways, including pointing to the paucity of continental European and Asian sources and warning against elitist overtones. Moreover, I thank all those who have taught me the essence of professionalism in the halls of the academy and in practice. Source: Professions Australia. Reprinted with kind permission of Professions Australia. References supplied with this article are available on request from email@example.com
ADA News Bulletin November 2010
ADA News Bulletin February 2011