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The Professional Ethics Toolkit is an engaging and accessible guide to the study of moral issues in professional life through the analysis of ethical dilemmas faced by people working in medicine, law, social work, business, and other industries where conflicting interests and ideas complicate professional practice and decision-making.
Written by a seasoned ethicist and professional consultant, the volume uses philosophical ideas, theories, and principles to develop and articulate a definitive methodology for ethical decision-making in professional environments. Meyers offers the benefit of his expertise with clear and practical advice at every turn, guiding readers through numerous real-world examples and case studies to illustrate key concepts including role-engendered duties, conflicts of interest, competency, and the principles that underpin and define professionalism itself.
Following the format of The Philosopher’s Toolkit, The Professional Ethics Toolkit is an essential companion to the study of professional ethics for use in both the classroom and the working world, encouraging students and general readers alike to think critically and engage intelligently with ethics in their professional lives.
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Veröffentlichungsjahr: 2018
Cover
Title Page
Acknowledgments
Introduction
Opening Thoughts
Being and Acting Professional
Definition and Listing
Cases
REFERENCES
Part I: Theory, Concepts, and Ethics Reasoning
1 Historical Overview and Definitional Questions
1.1 Some History
1.2 Defining “Professional”
1.3 A Working List
1.4 Types of Professional–Client Relationships
REFERENCES
2 A Model of Ethics Reasoning
2.1 Relativism, Absolutism, and Contextualism
2.2 Deontology
2.3 Utilitarianism
2.4 Context, Context, Context
2.5 Ross and Pluralistic Deontology
2.6 A Model of Ethics Reasoning
2.7 Moral Principles
2.8 Case: Cutting Corners
REFERENCES
Part II: Concepts, Principles, and Norms within Professional Environments
3 Autonomy and Respect for Persons
3.1 Autonomy in the World
3.2 The Hard Work of Being Autonomous
3.3 Case: Which Autonomous Voice?
REFERENCES
4 Beneficence and Non'Maleficence
4.1 Beneficence
4.2 Non‐Maleficence
4.3 Cases
REFERENCES
5 Competency
5.1 Systematizing Confidence
5.2 Case: Sanctioning a Colleague
6 Confidentiality and Privacy
6.1 Privacy
6.2 Privacy as a Moral Root of Confidentiality
6.3 Practical Considerations
6.4 Cases
REFERENCES
7 Conflict of interest
7.1 Definition
7.2 Types of Conflicting Inducements
7.3 Structural Conflict of Interest
7.4 Cases
REFERENCES
8 Fidelity, Honesty, and Role‐Based Duties
8.1 Promises
8.2 Honesty
8.3 Cases
REFERENCES
9 Formal Justice, Bias, and Allocation of Resources
9.1 Arbitrary Features
9.2 The Complexity of Justice
9.3 Formal Justice
9.4 Bias
9.5 Distributive Justice
9.6 Cases
REFERENCES
Epilogue: Democratization and the Changing of Professions
Some History
Democratization
Transforming Society and the Professions
REFERENCES
Index
End User License Agreement
Cover
Table of Contents
Begin Reading
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CHRISTOPHER MEYERS
This edition first published 2018© 2018 John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication Data
Names: Meyers, Christopher, 1957– author.Title: The professional ethics toolkit / by Christopher Meyers.Description: First edition. | Hoboken, NJ, USA : John Wiley & Sons Ltd, 2018. | Includes bibliographical references and index.Identifiers: LCCN 2017047294 (print) | LCCN 2017052284 (ebook) | ISBN 9781119045175 (pdf) | ISBN 9781119045182 (epub) | ISBN 9781119045168 (cloth) | ISBN 9781119045151 (pbk.)Subjects: LCSH: Professional ethics.Classification: LCC BJ1725 (ebook) | LCC BJ1725 .M49 2018 (print) | DDC 174–dc23LC record available at https://lccn.loc.gov/2017047294
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To my family, in gratitude for the inspiration and joy you provide every single day.
I am indebted to the many students and working professionals who have, over the years, helped me to explore and better understand the issues discussed in this book. I also am thankful to colleagues for serving as a sounding board for ideas. And I am especially grateful to Hugh LaFollette, whose encouragement and good editing were instrumental to my engagement with professional ethics.
Opening Thoughts
Being and Acting Professional
Definition and Listing
Cases
Notes
References
I was recently enjoying lunch with a couple of high‐ranking police officers when the following exchange took place:
OFFICER ONE:
ME:
OFFICER TWO (laughing out loud):
OFFICER ONE:
OFFICER TWO:
Good chuckles ensued all around, but their clever play on words captured a key problem with the topic of this book – just what do we mean by professional ethics? Consider the following statements, all of which rely on a different meaning of the term:
“Muhammad Ali became a professional boxer in, after fighting for six years as an amateur.”
“That painter sure did a professional job, don’t you think?”
“Prostitution is the world’s oldest profession.”
“You can count on Jones gardening: we are the most professional in town.”
“Sam sure is a professional complainer.”
“Did you hear Gabriela passed her licensing exam and is now a professional engineer?”
You probably recognize each of the different senses and have probably used several yourself. Despite some clear overlap, the meanings attached to the different uses vary so much that no single ethics conversation could effectively apply to all – the specific ethical duties attached to professional boxing, for example, differ widely from those of engineering.
This book focuses on the last meaning, that is, on the formalized sense of professional. It does so for two reasons. First, the other meanings all derive from the last in that they appeal to some version of a higher standard, one worthy of additional pay or respect. Even the fifth usage gets at the idea that Sam is a really good complainer. That is, they are at least loosely tapping into the common understanding that to be a professional is to possess a normative commitment to higher quality.
Second, the very goal of this book is to make explicit that normativity, the moral foundation at the core of professionalism. In short (for now), the thesis of this book is that to be a true professional, unlike other economic activities, is to be dedicated to a client relationship grounded in trust: trust in the professional’s competence and in her commitment to place the well‐being of her client at the forefront of their encounters.
Think of it this way:
You’re in the market for a new car so you go to a local dealership, settle on a model, and, after some haggling, agree on a price. Thrilled with your shiny new toy, you happen to run into your buddy Omar a few days later who, lo and behold, has just bought the same model! In discussing the options you each purchased, Omar says, “I guess you didn’t read the Consumer Reports review.” You agree that you didn’t and he goes on to explain that they concluded this model doesn’t need such add‐ons as rust coating, an extended warranted, or sealcoat paint – all items that you now realize you got suckered into buying by the very persuasive salesman. You also learn, to your great annoyance, that Omar also paid considerably less for his, even taking into account those add‐ons.
Now compare that story to this one:
A month later you go to visit your orthopedic surgeon to discuss the pain in your knee. She explains that it’s almost certainly torn cartilage and orders an MRI to confirm. It comes back positive for a very small tear, one that’s still attached to the original meniscus. Upon discussing your options, she persuades you to undergo a procedure in which she will remove the torn piece and also shave the underside of your kneecap to remove any rough spots. That shaving will cause some real tenderness for at least a week, during which time you’ll need to be on crutches – which her office is only too happy to sell you, along with special compression socks and bandage wraps.
You agree to proceed and all goes as planned. You are on day six of recovery, still on crutches, when you have dinner with your cousin and her new husband, an orthopedic surgeon. Naturally the conversation turns to your injury and you explain your procedure. The more you talk, the more surprised he looks, until he finally cuts in and says, “I truly hate to tell you this, but the standard of care for the type of tear you have is not to operate. Rather, the goal – so long as you can deal with the discomfort – is to leave everything intact, since removing cartilage often leads to later arthritis. Further, while such kneecap shaving can help in extreme cases – that is, when there is significant malformation – from everything you’ve described, your situation doesn’t even come close.”
What would be your respective reactions to these cases? If you are like most, in the first you’d be angry and annoyed – partly at the salesman, but even more at yourself for not doing your homework. You know that the salesman’s goal is to make as much off the sale as possible, just as yours is to get it as cheaply as possible. You even thought you’d done a pretty good job in the haggling; realizing that you haven’t, you kick yourself and vow to do better next time.
In the second, however, wouldn’t you feel deeply betrayed? You thought you could trust the surgeon to know what she was doing and not to be trying to make extra money off you. After all, you were dependent on her to help you with something really important: your health and mobility. What was that license on her wall about if it was not a guarantee that she was a professional?
The surgery case is intentionally extreme, to pull out the key differences between strictly commercial or instrumental dealings and fiduciary ones. In the former the primary motive of both parties is self‐interest; each is trying to gain something off the other. Done well, both sides gain, but one knows to approach them with eyes open; caveat emptor – buyer beware – is the basic rule of the game.
In fiduciary relationships, by contrast, while self‐interest is also present, the foundation of the relationship is a partnership, one intended to help you meet a vital need. In this type of encounter, you are dependent on the surgeon to be an expert and to treat you in a manner that places your well‐being at the forefront. In return, you have committed yourself to treating her with respect, including being honest and forthright in your interactions and compensating her fairly for her work. When that trust is broken, you feel particularly betrayed – by her and by the system that granted her the authority, and the state license, to work as a physician.
As we shall see in subsequent chapters, any number of factors have arisen over the last few decades that challenge this somewhat idealized model of professional ethics. Still, even if it has become clear that clients in professional/client relationships should also do their homework – if for no other reason than that it is unlikely the professional will sufficiently know what is most important to you, what your most vital needs are – it is still the case that, as a general rule, you can in fact trust professionals more than you can trust someone who is merely in it for the commercial transaction.
Importantly, however, being a professional is not the same as acting professionally. Not all those who meet the formal criteria (see Chapter 1) always act with expertise and in their clients’ best interest. And, of course, many of those whose work does not entail any of those criteria do their work with great integrity and treat their customers fairly and with dignity and respect. On the former point, as I write this there is a disturbing essay (Anonymous, 2015), with accompanying editorial (Laine et al., 2015), in the Annals of Internal Medicine that describes abhorrent medical behavior, clearly beyond the pale of any ethical human encounter, let alone a professional one.
That it was professionals (the story describes sordid actions committed by two senior‐level physicians), that is, people to whom are entrusted that which is most important to individuals – in this case, the patients’ bodies – makes it all the worse. But it also made headlines precisely because they were committed by professionals and were thus by far the exception to the rule.
This book will show why such behavior is the exception. In Part I, I describe how a professional norm rooted in deep ethical standards emerged, largely as a way of distinguishing professionals from pretenders, a move that also came with the great economic benefit of a monopoly on practice. I also recommend a model of ethics reasoning for addressing tough ethical problems, one based upon some of the classic approaches to ethics theory. Part II, the bulk of the book, explores some key concepts (e.g., role‐engendered duties, conflict of interest, and competency) and their connection to core problems in professional ethics. In the Epilogue I discuss how the idealized model of professionalism has undergone major transformation as part of a society‐wide movement that “democratized” key institutions. Some of these changes have been for the good – enhancing, in particular, client autonomy and informational power; some have caused serious ethical damage, for example, the commodification of the professional–client relationship.
Before engaging all those topics, however, we need a working definition of “profession” in order to capture a meaning that incorporates the core standards that distinguish formal professions from other occupations or jobs. Hence: To be a professional is to be an expert, skilled at the provision of vital services, while also holding a normative commitment to their clients’ well‐being.
Chapter 1 provides a brief history of the emergence of that definition, with emphasis on the development of formal professions. I show how these activities both naturally emerged in response to increasing complex social systems and were artificially designed for the mutual benefit of professional and client. The argument in this chapter also makes it clear that the professional/non‐professional distinction is too stark. We’re really talking about a continuum in which some occupations clearly fit the criteria, some are in the process of formally professionalizing, and some meet the criteria more or less marginally (or not at all). Again, though, being a professional does not guarantee that one will treat their clients with dignity and respect (or vice versa); the characterization is partly historical, partly sociological, and partly an exhortation – a reminder to those who fit the criteria that they are engaged in a calling, dedicated to a vital social service, with corresponding social and economic rewards and associated duties.
One last point about terminology: the words “ethics” and “morality” are also subject to multiple uses and meanings. For example, many folks think of “morality” as something very personal, connected to family and religion, while “ethics” is more objective, connected to social structures or organizational settings. In philosophy we generally use the term “ethics” to mean the application of moral theory, both of which are potentially objective. I follow that meaning here, to the point that there are places where the terms are used near synonymously.
Here are three cases to think and talk about as you read the next couple of chapters.1 Consider, in particular, what makes them cases about professional ethics and not just ethics problems generally, and see if you can reach some consensus on how they should be resolved.
California, like nearly all states, has explicit legislation that grants health‐care professionals the right to exempt themselves from the provision of services that violate their conscience. California also provides a positive right to health care for all wards of the state (e.g., state and county prisoners), including the right to all legal reproductive services. It tasks counties with providing the medical care necessary to fulfill that right. This obviously has the potential to create a catch‐22. On the one hand, counties are legally obliged to provide, for example, abortion services, but it is possible that all qualified physicians will exercise their right to conscience‐based exemption (Meyers and Woods, 1996).
You are the new head of the California licensing board and have been presented with a petition to amend the existing conscience clause to make it harder to obtain an exemption. (Current law merely requires the professional to state that he or she has an “ethical, moral, or religious objection” to participating in the provision of those services.) You are seriously considering it, but are deeply torn. You recognize that being a physician in California is a privilege, one that comes with tremendous social benefit and correspondingly strict role‐based duties. But you also find it troubling to demand that someone participate in a medical practice that he or she finds morally objectionable.
How should you resolve this conflict?
You are a licensed attorney who handles almost exclusively criminal defense cases. You are approached by the family of a man who has been charged with a particularly brutal rape and murder. You strongly consider declining – right now you just don’t have the emotional energy to manage this high‐profile and very public case – but the family convinces you that the charges are a racially motivated travesty of justice (the suspect is African American, the victim a young white). You meet with the defendant and immediately establish an affectionate rapport. The more you talk and the more you investigate the case, the more persuaded you are that he is in fact being rail‐roaded and you are very confident that you will be able to convince a jury.
You go to meet with him the day of opening arguments, however, and it is like he’s a different man: angry, spiteful, he uses foul language and is abusive toward you and the guards who ushered him into the consultation room. After just a few minutes he says, “You know I did it, right? That bitch was just a tease who deserved everything she got. Thank goodness you’re such a hot lawyer who’s gonna get me off.” Five minutes later, though, he’s back to being the sweet gentle man you’ve come to know.
You are sickened, literally retching, at this turn of events. But you also recall that the psychological evaluation you ordered early on found nothing unusual and you know that the judge will never let you recuse yourself at this late date, given the prejudicial impact that would have on the already seated jury. You can’t throw the case – doing so would violate your role‐based duty to zealously represent your client and could get you disbarred – but you also can’t imagine helping to put this guy back on the street.
What should you do?
You are the lead engineer on a public works project to rebuild a major bridge over a salt‐water bay. The associated road is one of the busier ones in a very busy city. The traffic disruption will be severe, so the bridge has to be finished as quickly as possible. And, because it is a public project, the budget is, of course, very tight; your bosses (one of the nation’s largest engineering firms) have made it crystal clear that the profit margin is tiny. In short, there is pressure from every quarter. If you screw up, there will be serious consequences; if you succeed, it will be a career‐making project.
You are just completing final designs and overseeing the last of the major purchases. Sam, your purchasing manager comes to you and notes that you “just missed the window on the cheaper price for those high‐quality bolts that we were ordering from the Swiss manufacturer. Evidently there’s some major new undertaking in southern China and that firm has already put in a higher bid than we budgeted for. Because we were already in discussions, the manufacturer has given us the choice to match it and they’ll complete the sale, but we have to decide by tomorrow. The new price, though, is a dollar more per bolt.” You slump in your chair, knowing that cost puts you well over target. Sam explains that you could easily enough get lower‐quality bolts produced, ironically, by a Chinese company, and they are even cheaper than what you had budgeted for the Swiss‐made version.
You’ve already gone to your boss a couple of times to discuss budget and timing concerns; after the last meeting she forcefully said, “Look, Joe, I don’t want to be bothered by all these details. They are your responsibility – please handle them yourself from now on.”
You’ve heard mixed reports about the cheaper bolts. From all accounts, the vast majority are first rate, but the occasional one is reportedly of lower quality – low enough that they may not be able to hold up to the corrosive salt air. You talk with your assistant, another highly respected engineer, who says, “Come on, Joe. Going over budget is just not an option here and in this short time frame, I don’t see where else we can cut corners. We’re at the bone as it is. Get the cheaper ones – you’ll look good for coming in under budget and you can just alert maintenance to keep an eye on them.”
What should you do?
Anonymous. 2015. “Our Family Secrets.”
Annals of Internal Medicine
163 (4): 321.
Laine, Christine, Taichman, Darren, and LaCombe, Michael A. 2015. “On Being a Doctor: Shining a Light on the Dark Side (Editorial).”
Annals of Internal Medicine
163 (4): 320.
Meyers, Christopher, and Woods, Robert. 1996. “An Obligation to Provide Abortion Services: What Happens When Physicians Refuse?”
Journal of Medical Ethics
22 (2): 115–120.
1
Many of the cases in this book are versions of, or inspired by, ones I have struggled with over my career. Identities have been altered to protect privacy.
Unlike some case‐based approaches to practical or professional ethics, the assumption here is that one cannot effectively address ethical problems without two key foundations: conceptual clarity on core concepts and their relevance to different professional concerns; and a method for reasoning through tough ethics problems.
Part II is devoted to that conceptual analysis while here, in Part I, we will explore a reasoning model. First, we need to get a clearer picture of the general topic of professionalism. As noted in the Introduction, this book treats “professional ethics” as a distinct area within the broader categories of practical and theoretical ethics; that is, to study either of those fields is not necessarily to study professional ethics, given its narrower focus. See, for example, the extensive work in business ethics, where there is only limited overlap to concerns that are specific to professional ethics.
Thus, Chapter 1 provides a review of the historical circumstances that resulted in professions – not all societies have them, after all – along with the specific normative connotations that come with that status. From there, Chapter 2 develops a method of ethics reasoning. Emphasizing ethics reasoning is, admittedly, in contrast to the approach most common to ethics texts, wherein readers are introduced to key thinkers, that is, the “he argued, and then he argued, and then he argued” approach. Readers are shown why these great thinkers are so interesting and important, and then, in each case, given a list of reasons as to why the theory will not work. Connections between the theories are typically treated as mere contrasts, not as areas of agreement. This too often produces a kind of roller‐coaster effect: students read Aristotle and are convinced that he is right, until they read Kant and find him conclusive, and then Mill, and Ross, and Rawls, and so on. It is no surprise then that students often give up on theory: “If these really smart folks can’t get it right, who am I to try to figure out the correct theory?” Ethics reasoning is thus reduced to mere or ad hoc reactions or, worse, to naive relativism.
Here, the goal is to give readers guidance in genuine practical ethics reasoning, while also emphasizing the best insights of all the major theorists. It is hoped that these insights will give readers ample opportunity to rely upon the approach they find most valuable. But I also stress that the grand insights provided by each of the major traditions in fact complement the others far more than they conflict. The method urges that, carefully done, in particular with sufficient attention to the complex array of facts present in any ethics issue, those insights can be melded into a process for making sense of tough ethical problems, even for finding better answers to those problems – better if not always best answers. No method, to my mind, can guarantee the latter, but it can distinctly narrow the choices, excluding those that are clearly wrong, and give good reasons in defense of a few, often a very few, better ones.
1.1 Some History
1.2 Defining “Professional”
1.3 A Working List
1.4 Types of Professional–Client Relationships
Notes
References
Not only are there myriad ways in which the term “professional” is used, but there has also been a marked increase – nearly 700 percent – in published instances of the term between 1800 and 2008.1 It has clearly become a common part of our vocabulary, though with mixed meanings.
To see why our definition of professionals – as experts skilled in the provision of vital services, who have a normative commitment to their clients’ well‐being – is key to an understanding of professional ethics, it helps to get a sense of how professions formally emerged in history. This review shows that the process of formal professionalization occurred for two key reasons:
There were vital needs that existing service systems did not adequately address. Medical practice, as we shall see, serves as the paradigm.
Professionalization enabled the relevant groups to assure clients that they can trust that their practitioner had the relevant expertise and ethical commitment.
Both of these brought obvious advantages to clients. They now had skilled practitioners to whom they could turn for assistance with vital needs, and there was a greater likelihood that those needs would be effectively addressed. Practitioners similarly benefited. They acquired a monopoly over their services, with corresponding increases in wealth, social status, and power.
Those benefits also motivated any number of service‐driven activities to claim professional status; even without the state‐sanctioned monopoly of licensing, to call oneself a professional is to lay claim to an associated cachet, with its economic and status benefits. Too often, however, this was a mere declaration, without the requisite training, skills, and normative commitment that were associated with the profession. Consider the near‐ubiquitous self‐designation as “professional” by everyone from gardeners to hairdressers to, yes, car salespeople.2 And it is at the heart of the familiar expression “Prostitution is the oldest profession.” The idea here is the largely sardonic one that people have been willing to pay for such services for as long as there have been people. Regardless of whether the claim is historically accurate, prostitutes, as will soon become clear, meet very few of our criteria for professionalism, nor, for that matter, do most athletes, gardeners, beauticians, or car salespeople.
Furthermore, all too often even the groups that formally professionalized allowed power and status to get in the way of fulfilling their true professional commitments. This straying from the ethical foundations on which formal professions were built has led to a recent reinforcement of those foundations, demonstrated in reinvigorated ethics curricula in undergraduate and professional programs and books like this.
I acknowledge from the outset that our definition of a professional as an expert who is skilled in the provision of vital services and who retains a normative commitment to his clients’ well‐being – is somewhat artificial, especially given that the most common meaning in ordinary language attaches professionalism with pay: to be a professional, per ordinary language, is to be paid for those services. This is exemplified in the distinction between an amateur and a professional athlete in sports. The latter are paid to compete while the former do it, presumably, for the love of the game.
Although the compensation component is the most pertinent to the meaning employed in each of the examples noted above, there is also at least an implied understanding that the “professional” designation grants distinction. Such persons are better than their amateur counterparts; they have more experience‐based expertise and are committed to an ethical norm that prioritizes clients’ needs. In short, to self‐designate in this way makes for great marketing. Such people believe, and probably rightly so, that when they promote themselves as professionals potential consumers of their services will at least unconsciously trust them to do well by them.
While such trust is often warranted regardless of whether the individual or company meets the formal criteria (section 1.2), there is no structural reason to assume that this going in, whereas with the formal professions, trust is the default. It is because the formal professions have emerged in human history in response to changing vital interests and with strict, carefully designed credentialing processes underlying their creation and continued practice.
That trust is often warranted regardless of formal status is, in fact, a key thesis of this chapter, indeed of the whole book. While our definition and associated criteria will allow us to easily identify definite professions, the concept will also admit of degrees, ranging from clear profession to marginal, emerging, or non‐professional work activity. Furthermore, that someone meets the definitional criteria does not guarantee that she will always act professionally. I have, for example, known and worked with too many university professors who were at best marginally competent and who treated their student‐clients as means to an end, whereas my long‐time gardener is as skilled and as honest as the day is long; he has always done his job professionally, while those professors failed in the key normative criteria.
Backing up, then, who were the first professionals? Consider the root of the term “to profess about matters of vital importance.” Hence the first professionals were spiritual advisers, who provided wisdom and guidance on an issue of, arguably, incalculable importance: one’s relationship with the divine. And they did so from a socially sanctioned position of competent authority and thereby of trust. Their role also gave these early clergy social status; they were typically held in great esteem, often with the corresponding benefits of enhanced material comforts, features that continue to be common to contemporary professionals. Further, archeological records reveal that human cultures from the earliest times relied on such trusted and authoritative voices.
Once clergy – or more accurately, the learned, since members of this group were among the very few who received a formal education and were literate – started branching out into other areas of vital human interest, they sustained commitments to their original, if also evolving, religious foundations. For example, early medical practitioners, particularly in Egypt and the Far East, were as much religious clergy as they were physicians, and their medical practices were richly infused with religious ritual, side by side with empirically and scientifically developed cures. Early educators had a similarly religious focus. For all the noise about Socrates’ impiety, the charges against him were mainly about his corrupting the youth about the wrong gods, not about turning them into atheists. Plato similarly infused deeply and richly religious themes into all his dialogues.
