Many suggest that professionalism as traditionally understood is all but dead in today's legal marketplace. Some scholars believe that 'professional' orientations based on managerialism and influenced by profitability have seen the demise of the lawyer's traditional professional identity. This paper argues otherwise. A pilot qualitative study of new Australian lawyers indicates that professional ideals can still flourish. Participants both understood the traditional ideals and sought to incorporate them in their own developing sense of professionalism. This paper reviews the (...) experiences of 11 early-career Australian lawyers in their first year of practice. Preliminary results suggest that certain experiences are crucial to developing and retaining a broad sense of professionalism: finding a balance between autonomous/independent work and close mentoring and supervision; realizing that legal practice is not merely a rational and rule-based activity, but one that involves ongoing uncertainty, including the uncertainly of dealing with 'real' people displaying 'real' emotions; and reaching a comfortable 'value convergence' between one's own values and those modelled by colleagues. (shrink)

What purpose is served by renovation or redesign of professionalism, and how successful a process is it likely to be? This article addresses these questions by examining the effectiveness as a professional development mechanism of the imposition of changes to policy and/or practice that require modification or renovation of professionalism. The 'new' professionalisms purported to have been fashioned over the last two or three decades across the spectrum of UK education sectors and contexts have been the subject of (...) extensive analysis, and this article avoids going over old ground and revisiting issues that have already been much debated. Nevertheless, the example of UK government education policy during this period is used as a basis for considering the pitfalls associated with mechanisms for modifying professionalism through a reform and standards agenda. The article's analysis incorporates redefinition and examination of the concept and substance of professionalism and offers new perspectives in the form of three distinct conceptions: demanded, prescribed and enacted professionalism. Exploring the existentialist status of 'new' or 'modified' professionalisms and the relationship between professionality, professional culture and professionalism, it examines how professionalism may be interpreted and utilised for the development of education professionals. (shrink)

This paper draws on recent work by John Clarke and Janet Newman and their colleagues to analyse a relatively coherent governmental project, spanning the decades of Conservative and New Labour government in England since 1979, that has sought to render teachers increasingly subservient to the state and agencies of the state. Under New Labour this has involved discourse and policies aimed at transforming teaching into a 'modernised profession'. It is suggested that this appropriation of both the concept and substance of (...) professionalism involves an attempt to silence debate about competing conceptions of what it might to be a professional or to act professionally. The overall process is thus arguably one of de-professionalisation in the guise of re-professionalisation. (shrink)

Contributed articles presented at a seminar.

The standard approach to the ethics of reproductive technologies starts and ends with the parents’ procreative liberty. There's much more to think about. We should start with the relationship between parents and children.

This new edition of Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals thoroughly updates the highly regarded and groundbreaking first edition, offering the contemporary reader clinical wisdom and ethical guidance for challenging times. As with its predecessor, the second edition features commentaries by leaders in psychiatric ethics, plus two foundational chapters on ethics and professionalism in the field of mental health. These commentaries and introductory chapters provide an overview of essential ethical principles and concepts, (...) the professional obligations of the mental health clinician, common ethical tensions found in practice, ethical aspects of caring for special populations, and ethical issues in professional training and research. The introductory chapters are followed by case-oriented questions and answers on core concepts and topics in clinical care, medical research, and interactions with colleagues and trainees. Topics explored in-depth include authorship, disclosure, and ethical peer review for scientific publications; assisted suicide and euthanasia; professional voyeurism versus patient privacy online and on social media; the appropriate process for reporting an impaired colleague; and problems of burnout, work-life balance, and professional well-being. Professionalism and Ethics: Q & A Self-Study Guide for Mental Health Professionals poses and plumbs critically important ethical dilemmas in a compelling, down-to-earth way for today's practitioners and learners. (shrink)

The AMA Council on Ethical and Judicial Affairs (CEJA) has written a position paper on how social medical use challenges medical professionalism. The report offers persuasive ethical and practical guidelines for nonclinical internet use, specifically for social networking.This commentary provides a framework from which to apply these guidelines, but adds that there may be important situations in which physicians are not able to act in accordance. The guidelines call for professional reporting of questionable online portrayals or behaviors, but this (...) commentary argues that this may be not only cumbersome to implement, but may violate aspects of constitutional rights. While online social networking may in many ways be a new application of old challenges, there may be other aspects that require novel approaches to medical professionalism. (shrink)

This paper challenges the view that academic professionalism resides in the professional 'autonomy ' of the academic, the 'self-regulation' of academics as an occupational group, and the differential 'status' of academic workers. This still influential notion of academic professionalism, it is argued, leads to institutional stasis. What is required is greater reflexivity by academics in respect of their underlying professional values. In particular the piece challenges the academic community to re-think academic freedom - the bedrock of professional identity (...) within that community - in terms of increased inclusivity: 'freedom for all' rather than 'freedom for academics'. The paper touches on issues relating to practice and organisational structure, but focuses primarily on the need for academics to shift the moral bases of their claim to professionalism. In so doing, it also challenges the post-Dearing consensus that the debate on academic professionalism can be adequately conducted in terms of 'standards' and 'outcomes'. A prime purpose of the paper is to promote debate and discussion by setting a different kind of agenda and by couching that agenda within a different kind of discourse. (shrink)

The dissertation abstract and reflection commentary present the work of Dr. Maryam Kouchaki. The abstract provides an overview of research examining the role of professional identities on ethical behavior. Across a number of studies, this work demonstrates that professionalism, either measured or manipulated, can increase individuals’ unethical behaviors. This dissertation extends prior work on professionalism by examining its psychology and shedding new light on importance of its meanings in driving individuals’ behaviors. Below, the author discusses the reasons for (...) why professionals may engage in unethical behaviors. Finally, the reflection commentary provides insights about the author’s journey as a PhD student. (shrink)

On 1 August 2008 the Lawyers and Conveyancers Act 2006 came into force. It provides the terms of the current regulatory bargain struck between the state and the New Zealand legal profession. Barely 16 months later the profession was served notice that the basis of that bargain might radically change. To an academic lawyer with a practising certificate, this is both a tantalising research opportunity as well as a professionally unsettling prospect. Part 1 of this paper explores the current regime (...) of co-regulation in New Zealand, barely bedded down after substantial reform. Part 2 suggests some potential case studies where such failure to exhibit integrity is egregious and traverses the impediments to researching why such lawyers fail. Part 3 asks whether a wholesale change to external regulation would better advance competency and integrity and reduce lawyer deviancy. (shrink)

Building a coherent discourse on professionalism is a challenge for corporate social responsibility practitioners, as there is not yet an established knowledge basis for CSR, and CSR is a contested notion that covers a wide variety of issues and moral foundations. Relying on insights from the literature on micro-CSR, new professionalism, and Boltanski and Thévenot’s economies of worth framework, we examine the discourses of 56 CSR practitioners in South Korea on their claimed professionalism. Our analysis delineates four (...) distinct discourses of CSR professionalism—strategic corporate giving, social innovation, risk management, and sustainability transition—that are derived from a plurality of more or less compatible moral foundations whose partial overlaps and tensions we document in a systematic manner. Our results portray these practitioners as compromise makers who selectively combine morally distant justifications to build their own specific professionalism discourse, with the aim to advance CSR within and across organizations. By uncovering the moral relationality connecting these discourses, our findings show that moral pluralism is a double-edged sword that can not only bolster the justification of CSR professionalism but also threaten collective professionalism at the field level. Overall, our study suggests paying more attention to the moral relationality and tensions that underlie professional fields. (shrink)

Engineering societies such as the National Society of Professional Engineers (NSPE) and associated entities have defined engineering and professionalism in such a way as to require the benefit of humanity (NSPE 2009a, Engineering Education Resource Document. NSPE Position Statements. Governmental Relations). This requirement has been an unnecessary and unfortunate add-on. The trend of the profession to favor the idea of requiring the benefit of humanity for professionalism violates an engineer’s rights. It applies political pressure that dissuades from inquiry, (...) approaches to new knowledge and technologies, and the presentation, publication, and use of designs and research findings. Moreover, a more politically neutral definition of engineering and/or professionalism devoid of required service or benefit to mankind does not violate adherence to strong ethical standards. (shrink)

In part one of this paper I discuss how issues of combatant misconduct and illegality have led military academies to become more focused on professionalism rather than on the tensions between military ethics and military training. In order to interrogate the relationships between training and ethics, between becoming a military professional and being a military professional, between military professionals and society, I turn to the work of Martin Cook, Anthony Hartle, and J. Glenn Gray. In part two I focus (...) on Cook’s analysis of the conflict between the self-understanding and the expected behavior of military professionals. In part three I focus on Hartle’s analysis of how the experience of alienation by military professionals can help to create the culture of military professionals. In part four I introduce a new theory of professionalism based on the existential and phenomenological philosophy of J. Glenn Gray, which can help us to better understand the philosophical and psychological stakes of what it means to become a military professional. I conclude in part five by suggesting that the most pressing issue in the military is not a lack of professionalism, but a lack of trust. (shrink)

As in other societies, medical professionalism in the Peoples’ Republic of China has been rapidly evolving. One of the major events in this process was the endorsement in 2005 of the document, “Medical Professionalism in the New Millennium: A Physician Charter,” by the Chinese Medical Doctor Association (hereafter, the Charter). More recently, a national survey, the first on such a large scale, was conducted on Chinese physicians’ attitudes toward the fundamental principles and core commitments put forward in the (...) Charter. Based on empirical findings from that study and comparing them to the published results of a similar American survey, the authors offer an in-depth interpretation of significant cross-cultural differences and important transcultural commonalities. The broader historical, socio-economic, and ethical issues relating to salient Chinese cultural practices such as family consent, familism (the custom of deferring decisions to family members), and the withholding of medical information, as well as controversial topics such as not respecting patients’ autonomy, are examined. The Chinese Survey found that Chinese physicians supported the principles of the Charter in general. Here we argue that Chinese culture and traditional medical ethics are broadly compatible with the moral commitments demanded by modern medical professionalism. Methodologically and theoretically—recognizing the problems inherent in the hoary but still popular habit of dichotomizing cultures and in relativism—a transcultural approach is adopted that gives greater (due) weight to the internal moral diversity present within every culture, the common ground shared by different cultures, and the primacy of morality. Genuine crosscultural dialogue, including a constructive Chinese-American dialogue in the area of medical professionalism, is not only possible, but necessary. (shrink)

South African Military Professionalism: Some Critical Observations and Threats -- Threats to Professionalism in the United States Military -- Higher Education and the Profession of Arms: Explaining the Logic -- Military Professionalism -- An Organizational Challenge by Itself -- The Challenge of Maintaining Military Professionalism in the Face of Transformation: The Indonesian Army Experience -- Threats and Opportunities for Military Professionalism from Social Media -- The Profession of Arms and the Promotion of Ethics: The profession (...) of Arms and the Challenge of Ethics -- The New Economic Togetherness: Globalization of Economics and Some Implications for Security and the Military Profession -- Displaced Pride: Attacking Cynicism at the United States Air Force Acedemy -- Military Professionalism of the Swedish Armed Forces in the 21st Century -- The Dynamic Five-Factor Model as a Compass for Military Professionalism: A Comparison Between Switzerland and the Netherlands -- Complacency: A Threat to (Canadian) Military Professionalism. (shrink)

The rapid emergence and exploding usage of online social networking forums, which are frequented by millions, present clinicians with new ethical and professional challenges. Particularly among a younger generation of physicians and patients, the use of online social networking forums has become widespread. In this article, we discuss ethical challenges facing the patient–doctor relationship as a result of the growing use of online social networking forums. We draw upon one heavily used and highly trafficked forum, Facebook, to illustrate the elements (...) of these online environments and the ethical challenges peculiar to their novel form of exchange. Finally, we present guidelines for clinicians to negotiate responsibly and professionally their possible uses of these social forums. (shrink)

Healthcare Ethics, Law and Professionalism: Essays on the Works of Alastair V Campbell features 15 original essays on bioethics, and healthcare ethics specifically. The volume is in honour of Professor Alastair V Campbell, who was the founding editor of the internationally-renowned Journal of Medical Ethics, and the founding director of three internationally leading centres in bioethics, in Otago, New Zealand, Bristol, UK, and Singapore. Campbell was trained in theology and philosophy and throughout his career worked with colleagues from various (...) disciplines, including law and various branches of healthcare. The diversity of topics and depth of contributors' insights reflect the breadth and impact of Campbell's philosophical work and policy contributions to healthcare ethics. Throughout his long academic career, Campbell's emphasis on healthcare ethics being practice-oriented, yet driven by critical reflection, has shaped the field in vital ways. The chapters are authored by leading scholars in healthcare ethics and law. Directly engaging with Campbell's work and influence, the essays discuss essential questions in healthcare ethics relating to its methodology and teaching, its intersection with law and policy, medical professionalism, religion, and its translation in different cultural settings. Chapters also grapple with specific enduring topics, such as the doctor-patient relationship, justice in health and biomedical research, and treatment of the human body and the dead. (shrink)

Discussions of college faculty professionalism most often address the ethical responsibilities or failures of "professors." Yet the majority of college faculty are not "professors," and work in conditions that preclude or prevent acting in accordance with high-minded statements like the AAUP's Statement on Professional Ethics, In addition, ignorance of the actual working conditions of both tenure-track and tenuous-track faculty has induced a crisis of ethical responsibility for all college faculty. Because official statements about college faculty professionalism neglect the (...) reality of college faculty work, the ethical responsibility of faculty requires a new basis. (shrink)

Objective We conducted a process evaluation to (a) assess the effectiveness of a new problem-based learning curriculum designed to teach professionalism and scientific integrity to biomedical graduate students and (b) modify the course to enhance its relevance and effectiveness. The content presented realistic cases and issues in the practice of science, to promote skill development and to acculturate students to professional norms of science. Method We used 5-step Likert-scaled questions, open-ended questions, and interviews of students and facilitators to assess (...) curricular effectiveness. Results Both facilitators and students perceived course objectives were achieved. For example, respondents preferred active learning over lectures; both faculty and students perceived that the curriculum increased their understanding of norms, role obligations and responsibilities of professional scientists. They also reported an increased ability to identify ethical situations and felt that they had developed skills in moral reasoning and effective group work. Conclusions These data helped to improve course implementation and instructional material. For example, to correct a negative perception that this was an ‘ethics’ course, we redesigned case debriefing activities to reinforce learning objectives and important skills. We refined cases to be more engaging and relevant for students, and gave facilitators more specific training and resources for each case. The problem-based learning small group strategy can stimulate an environment whereby participants are more aware of ethical implications of science, and increase their socialisation and open communication about professional behaviour. (shrink)

This article views the Hippocratic Oath from a new perspective and draws consequences for modern health care. The Oath consists of two parts, a family-like alliance where the teacher of the “art” is equal to a father and a set of maxims how the “art” is to be practiced. Self-commitments stated before the gods tie the parts together and give the alliance trustworthiness. One might call this a proto-profession. Modern physicians form a similar alliance. Specific knowledge and skills and specific (...) action guiding rules are elements of a profession but its trustworthiness rests on a combination of professional autonomy and public control. In order to be granted autonomy the profession must show some effort in enforcing its specific rules and in order to do so its members need to be convinced of the intrinsic value of their profession. Whereas in antiquity physicians acted as single individuals the modern alliance is shaped by division of labour. Physicians use each other and other professions by mutual consent and the health care system as means in the diagnostic-therapeutic process. As any actor is reponsible for the means he uses physicians are co-responsible accordingly. Thus, professional conduct now entails care for the organisation of the alliance as detailed in the “Charter on Medical Professionalism”. The effort the profession gives to this task will confirm its trustworthiness. (shrink)

In this issue of CQ, we are pleased to inaugurate a new Department, Professionalism, with an article by Jeffrey Blustein entitled “When Doctors Break the Rules: On the Ethics of Physician Noncompliance.” The article examines the ethical dilemmas physicians face when they believe that promoting the best interests of patients requires them to break one or more institutional rules.

Responsibility and professionalism are increasingly issues of concern for professional associations, employers and educators alike. When bad things happen, professionals are often held personally accountable for complex situations. Professional Responsibility and Professionalism advances our approaches to professional responsibility from individual-centred, virtue-based prescriptions towards understanding and responding effectively to the multifaceted challenges encountered today by professionals working in dynamic complexity. The author applies a sociomaterial examination to specific examples drawn from different professional contexts of practice. She examines important implications (...) for what professional responsibility and accountability might mean individually and collectively, and what it might be becoming when demands increasingly conflict, and when we accept that capacities for action are performed into existence in emergent and precarious webs of both human and non-human forces. The chapters explore some of the most prominent questions in professional responsibility, including: What does professional responsibility, and accountability, mean in the escalating complexities and conflicts confronting today's professionals? How does professional responsibility become developed and enacted, and through what social and material entanglements? How should responsibility be determined in multi-agency and interprofessional practice? What happens when professional decisions are delegated to software algorithms and diagnostic instruments? How are new governing regimes of professional work, such as innovation imperatives, excessive audit and logics of blame and scapegoating, reconfiguring responsibility? How can professionals respond simultaneously to individuals in need, the obligations of their profession, the demands of their employer and an anxious society? A major concern addressed by each chapter, and the book as a whole, is educating professionals in and for responsibility. Specific dilemmas and strategies are offered for educators in universities, workplaces and professional development contexts who seek new approaches to helping professionals learn to critically understand and practise responsibility today. This book will appeal to a wide audience of education researchers and post-graduate students studying professional practice, professionalism and education across a wide range of disciplines. Health professionals, professionals working in private practices, such as law, architecture and engineering, newer professions such as social work and policing, and educational professionals at all levels will find stories and strategies reflecting key issues of their practice in this detailed exploration of professional responsibility and accountability. (shrink)

This special section deals with the new professionalism movement. The interest in the term “professionalism” has been growing steadily in medicine, and the word now seems to be everywhere. However, bioethicists have lagged behind our colleagues in medicine and nursing in explicitly contributing to this movement. This special section adds to the effort to catch up.

Since public schooling was introduced in the nineteenth century, teachers in many western countries have endeavoured to achieve professional recognition. For a short period in the latter part of the twentieth century, professionalism was seen as a discourse of resistance or the ‘enemy’ of economic rationalism and performativity. However, more recently, governments have responded by ‘colonizing’ professionalism and imposing ‘standards’ whereby the concept is redefined. In this study, we analyse transcripts of interviews with 20 Queensland teachers and conclude (...) that teachers’ notions of professionalism in this second decade of the twenty-first century are effectively reiterations of nineteenth century disciplinary technologies (as proposed by Michel Foucault) yet are enacted in new ways. (shrink)

The crisis of the contemporary world is also a crisis of professionalism, the inevitable growth of which has created new problems both international and domestic.

The rapid pace of technological change constantly gives rise to new ethical dilemmas, and engineers must be as well versed in societal values and ethics as they are in the technical concepts of their disciplines. _Ethics and Professionalism in Engineering_ provides a practical introduction for engineering students that emphasizes ethical decision-making. McCuen and Gilroy situate engineering ethics in the wider context of business and environmental ethics and guide students through case studies emphasizing value conflicts often encountered in engineering.

Recent social developments, such as demographic change, skill shortages and new medical technologies, have necessitated a transition in the traditional roles of health-care professions. New forms of division of labour and inter-professional health-care education are emerging while at the same time ethical challenges, such as corruption and conflicts of interest, have to be mastered. This book addresses historical, conceptual and empirical aspects of professionalism and inter-professionalism in health care from an international and interdisciplinary perspective. The work is divided (...) into five sections: historical and societal aspects of health care professions; learning and teaching medical professionalism; transformation of health care professions; professional leadership and team decision-making in health care; and ethical challenges to health care professionalism. The final chapter integrates the main ideas and perspectives on health-care professionalism which have been developed throughout the book and highlights how the work in the diverse disciplines is interrelated. The book will be a valuable reference for the many researchers and students with an interest in medical ethics, professionalism and comparative systems of healthcare. (shrink)

At the peak of his career, Esteve Terradas (1883–1950) played a major role in the science and technology policy of the Franco regime. Supervising the creation of a new aeronautical centre and a state electrical company, he developed a liberal programme under an authoritarian regime. This paper explores the development and intersection of his private and public lives.

BackgroundMedical professionalism has been developing in the Peoples’ Republic of China as one way to better address perennial and new challenges in healthcare in an ever-changing society. Among many recent developments in this area is promotion by the national Chinese Medical Doctor Association of the principles and values contained in the international document, “Medical Professionalism in the New Millennium: A Physician Charter.”ObjectiveTo discover Chinese physicians’ attitudes toward and understanding of medical professionalism.MethodologyThe authors distributed a self-reporting questionnaire that (...) included 34 statements and four case scenarios concerning the general principles of medical professionalism: the primacy of patients’ welfare, respect for patients’ autonomy, promotion of social justice, and professional self-regulation. The questionnaire included controversial issues such as the role of the family in decision making and reporting medical errors. A total of 2,966 practicing physicians, randomly selected from the Chinese Medical Association database, were surveyed, and 1,198 valid questionnaires were returned. Our sample covered 23 provinces and 51 cities throughout the Peoples’ Republic of China.ResultsMore than 80 percent of the physicians who responded agreed that the physician-patient relationship should be a relationship of trust founded on professional altruism, and that informed consent is necessary. More than 95 percent agreed that physicians should promote professional self-regulation as well as social justice. More than half agreed with the principle of the primacy of patients’ welfare (62.8 percent), and that physicians have a responsibility to report medical errors and incompetent colleagues (51.0 percent). In certain cases, a great majority of Chinese physicians favored familism and paternalism.LimitationsThe study does not include data on how Chinese physicians practice medical professionalism, or the perspectives of physicians working in smaller cities and in rural areas.ConclusionsBased on responses to the survey, Chinese physicians strongly support the majority of the fundamental principles and responsibilities of medical professionalism, including dedication, altruism, social justice, self-regulation, and informed consent. However, their support for the primacy of patients’ welfare as a general principle, and the physician’s responsibility to report medical errors and incompetent colleagues, is relatively low. To help advance medical professionalism in the People’s Republic of China, professional development programs and medical ethics education should not only emphasize the general principles involved, but also formulate guidelines on how these principles can be carried out in practice. (shrink)

ABSTRACTThis article investigates empirically the ethical values of law students in Hong Kong in their final two years of legal education. It first analyses the demographics of these law students before examining their responses to different ethical dilemmas. The findings suggest that feminisation has taken place in Hong Kong law schools. The study also found that a new generation of law students is emerging in Hong Kong that put more emphasis on the value of work-life balance. Finally, the article argues (...) that common law education has enhanced the professionalism of law students in Hong Kong and has contributed to their development of such professional values as ‘professional integrity’, ‘obedience to the law’ and ‘civil duty’. (shrink)

BackgroundSocial networking sites (SNSs) have penetrated all aspects of health care professionals’ (HCPs’) professional and private lives. A new term, e-professionalism, has emerged, which describes the linking of traditional values with this new dynamic online environment for HCPs. The four aims of this study were: (1) to examine their SNS prevalence and usage habits, (2) to examine their perception of e-professionalism, (3) to develop an e-professionalism assessment compatibility index and (4) to investigate their tendencies and differences in (...) values of the e-professionalism assessment compatibility index (ePACI).MethodsA cross-sectional study was conducted among MDs and DMDs in Croatia via email using a questionnaire. The questionnaire was distributed to all MDs and DMDs who were members of their respective chambers. In addition to descriptive statistics, Chi-square or Fisher’s exact test when appropriate, t-test, ANOVA and Mann–Whitney U tests were used to determine differences between groups. A principal component analysis (PCA) with varimax rotation was used to investigate dimensionality. Results of the PCA were compared to the coding based on the Social Media e-Professionalism rubric in order to create the ePACI.ResultsOf the 1013 gathered responses, 753 were from valid SNS users and suitable for further analysis. Facebook (91.6%) and Instagram (63.1%) were the predominant SNSs used. Both groups have a good understanding of e-professionalism. The newly developed ePACI deviates slightly in the “conservative” direction in the cases of both, MDs (t506 = 19.033, p < 0.001) and DMDs (t245 = 12.991, p < 0.001). HCPs who are older (r = 0.308, p < 0.001), who have fewer SNS profiles (rs = −0.142, p < 0.001), and who access their profiles less frequently (r = −0.166, p < 0.001) have statistically significantly more conservative ePACI values.ConclusionsMDs and DMDs in Croatia are frequent SNS users, with Facebook and Instagram being the main SNSs used. Both groups have a good understanding of e-professionalism. The newly developed ePACI deviates slightly towards the conservative side regarding perception of the e-professionalism content for both groups. The development of the ePACI, and its subsequent usage in further research, will have a direct influence in its validation, gathering comparable data, and be able to direct efforts in oversight, regulation and education. (shrink)

This paper draws on recent re-conceptualisations of the notions of 'care' and 'caring' (Noddings, 1992; Tronío, 1993) to explore data from semi-structured interviews with the parents and key workers for about twenty children under three who were attending two London children's centres. Located in an environment of frequent new policy initiatives, including an advocacy of parental partnership, it seeks to describe the ways that these adults construct their mutual relationships, and the difficulties which may attend this process. Class and cultural (...) differences, as well as conflicting understandings of 'professionalism' are shown to inform the development of the 'triangle of care', with potential consequences for the care and welfare of the small child on whom the relationship is focused. (shrink)

As the field of clinical bioethics has moved from its pioneers, who turned their attention to ethics problems in clinical medicine and clinical and animal research, to today’s ubiquity of university degrees and fellowships in bioethics, there has been a steady drumbeat to professionalize the field. The problem has been that the necessary next steps—to specify the skills, knowledge, and personal and professional attributes of a clinical bioethicist, and to have a method to train and evaluate mastery of these standards—are (...) lacking.Ordinarily, the path to professionalism in medicine starts with the intellectual pioneers. Then come those who develop early experience in clinical settings. Then comes the specification of the skills, knowledge, and personal and professional attributes needed to perform the activities of the new specialty or subspecialty. And only then, after a method to train and evaluate levels of mastery from novice to advanced practitioner has been developed, comes credible credentialing and certification/licensing.Unfortunately, the field of clinical bioethics has skipped these steps. Rather, a credential, that is, the Healthcare Ethics Consultant (HEC) certification, was created by a small group within the bioethics professional association, the American Society of Bioethics and Humanities (ASBH), without community agreement or necessary input. Further, the testing of processes to train HECs and to evaluate their levels of mastery of competencies was prematurely forwarded as sufficient evidence of competence in clinical ethics. That is, the credential, offered by the ASBH for a fee, upon passing an exam based on how many hours one has been involved in clinical consultation, about which there is no field agreement on how such consultations ought to be conducted and for which only controversial standards have been set, is being touted as evidence of competence in clinical bioethics. In their article, “Competencies and Milestones for Bioethics Trainees,” Sawyer and colleagues identify the central weakness of these claims to professionalization and provide the field the first substantive assessment tool and method to train and evaluate competencies. The tool these authors present is the real next step forward for true professionalization of the field of clinical bioethics. (shrink)

The article examines the new discourse on medical professionalism and responsibility through the prism of conflicts among moral values, especially with regard to truth-telling. The discussion is anchored in the renaissance of English-language writing on medical ethics in the 18th century, which paralleled the rise of humanitarianism and the advent of the word “responsibility”. Following an analysis of the meanings of the value of responsibility in general and in medical practice in particular, it is argued that, similarly to the (...) Aristotelian notion of equity, responsibility of care is a second-order value, which corrects virtues, laws and norms in exceptional circumstances. Virtues and practices of the second order, such as responsibility and deliberation, bear especially on professional doctoring, which includes a commitment to give priority to the good of the patient over one’s own good. It is argued that, in situations of conflict, and particularly conflicts between personal moral identity and the good of patients, the fundamental professional commitment is to critical and rational deliberation and to the cultivation of psycho-moral flexibility. This leads indirectly to moral growth and strengthening of professional character. (shrink)

This essay discusses the question of health in the Kingdom of Hungary during the Age of Enlightenment. It explores the relationships and tensions between central theories of medical police and the local expectations of government administrators, as well as those between academic or official knowledge and implicit or alternative knowledge about health. The reigns of Maria Theresia and Joseph II marked the moment at which particular kinds of folk and practical knowledge about healing became visible and above all legible. This (...) is to be seen in the enormous rise in book production, which in itself represented an ‘approved knowledge’ that found legitimation in new academic and bureaucratic institutions, such as the reformed medical faculty of the University of Vienna, the newly-founded medical faculty at Tyrnau, the establishment of a health department within the Hungarian Statthalterei, as well as in the emission of royal legislation supporting the agendas of the new enlightened science of ‘medical police’. (shrink)

In this contribution, we argue that three related developments provide economic, environmental and social challenges and opportunities for a new responsible professionalism in the food chain: (1) the Anthropocene; (2) the bio-based economy; (3) Precision Livestock Farming. These three interrelated developments indicate a transition in the way we understand the role and function of the food chain on the micro-, the meso- and the macro-level. This transition can be understood in two fundamental different ways, namely either as an extension (...) of technocratic management beyond the micro level to the meso- and macro-level of the food chain, or as a transition to a new responsible professionalism. We argue that the technocratic approach is not able to address the socio-ethical issues that come along with these three development, and argue for a new responsible professionalism in the agri-food chain in the Anthropocene based on normative and action competence. (shrink)

This article suggests that the notion of an educational ‘trading zone’ is an analytically helpful way of describing a space in which ideas about learning and teaching are shared within and between disciplines. Drawing on our knowledge of anthropology and the Humanities, we suggest three possible reasons for the limited development of such zones within academia in the UK and US. The first is the relatively low status of education as a discipline, and its perceived dependence on individualist theories of (...) learning drawn from psychology. The second is that disciplinary pedagogies are often deeply embedded in academic identity and practice, making engaging with an educational ‘trading zone’ an epistemologically unfamiliar habit. A final, and more overtly political, reason is the strategic resistance of many faculty members to engaging with the new visions of teaching ‘professionalism’ offered by ‘faculty development’ and ‘training’ units within universities. We end by exploring whether the emerging debate around the ‘scholarship of teaching and learning’ might circumvent some of these barriers. (shrink)

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants (...) voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty. (shrink)

Higher education continues to see a shift toward online course delivery. Many professional graduate programs offer online courses when content does not necessarily require face-to-face contact. The use of movies to teach ethics and professionalism to medical students is not a new pedagogical approach. At a university in the United States, a shift in a tracked physical therapy curriculum triggered a course in ethics and professionalism to be delivered earlier in the program, leaving students without prior clinical experience (...) before starting the course. The instructor revised this online course using movies to provide context for the topics covered making them relatable to physical therapy practice. This article describes student reactions to the implementation of movies into this course. Students valued the addition of the movies as they provided context using relevant health care situations, ultimately helping them relate the concepts to the physical therapy profession. (shrink)

Abstractabstract:In The Trusted Doctor: Medical Ethics and Professionalism (2020), Rosamond Rhodes presents a new theory of medical ethics based on 16 duties she considers central to medical ethics and professionalism. She asserts that her theory is "bioethical heresy," as it contradicts established "principlism" and "common morality" approaches to ethics in medicine. Rhodes advocates the development of parallelism between clinical and ethical decision-making and a systematic approach that emphasizes duties over principles and rules to facilitate the development of a (...) "doctorly character" among medical decision-makers. Rhodes further asserts that her theory and approach necessitate the cultivation of virtues contained in Aristotle's Nicomachean Ethics. But Rhodes's insistence that "medical professionals," not just doctors, are covered by her theory is open to critique, as is her conflation of ethic and morals, especially around the question of the "doctorly character" upon which her duty-based theory hinges. This assessment argues that applicants to medical schools and allied health training programs be screened for specific virtues—honesty, diligence, curiosity, and compassion—to facilitate reinforcement of these pre-professionalized inclinations throughout the habituation processes of medical training. This would increase the probability of turning fear and hope to cure and care via reasoning and affective models performed within an ethical medical framework—even while what this ethical framework should reference remains under debate. (shrink)

There is a palpable malaise in American medicine as clinical practice veers off its moorings, swept along by a new commercialism that is displacing medical professionalism and its attendant moral obligations. Although the sociology of this phenomenon is complex and multifactorial, I argue that this move toward medical commercialism was accelerated by the abortive efforts of the Clinton Administration's Health Security Act. Through an analysis of performative speech I show that, although the Clinton plan drew on many strands of (...) speech about healthcare, it favored the discourse of health policy and health economics over that of clinical practice and professionalism. Though the Clinton plan failed, this new vocabulary of health economics has led us to imagine a new descriptive framework, which has commodified healthcare and commercialized the clinic. (shrink)

The materials consist of a co-authored, peer-reviewed book, a co-authored, peer-reviewed book chapter, 30 single authored peer-reviewed journal papers, and 15 co-authored peer-reviewed journal papers, of which I was the lead author on 8 papers. There are 32 papers from Australasian journals, at least two of which are also regarded as international. 22 papers are published in international journals. The co-authored book was favourably described in his foreword by Justice Michael Kirby of the High Court of Australia. The refereed chapter (...) is contained in an issue of the Australian Legal Monographs series. The papers constitute a body of work in Australasian and international contexts in a field which is relatively new to academic achievement, broadly understood as philosophy of medicine, medical ethics and health law. The journals in which the papers are published include two of the most highly regarded bioethics journals in the world, Australia’s leading medical journal, the two leading world medical education journals, Australia’s leading journal for health and medical law, and the Torts Law Journal, an Australian journal which is recognized as one of the world’s leading journals in the field of tort law. (shrink)

In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center. This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue. The specific details, and conceptual rationale, behind the New York-Presbyterian Hospital’s graduated credentialing plan are shared as is their evolution and ratification within the context of (...) institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation. (shrink)

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos (...) on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military-civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency. (shrink)

Is conscientious objection necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is. Here, we outline...