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)

Over the past decade, a number of accounting and financial reporting frauds have led to lost stock wealth, destroyed public trust, and a worldwide recession that called for necessary reform. Regulatory responses and systemic reforms quickly followed, and we show that, while necessary, these reforms are insufficient. The purpose of this paper is to forward virtuous professionalism as a necessary path toward restoring financial reporting systems. We take the position of external observer and analyze the accounting profession over time to (...) assess what has transpired within our financial reporting systems. Our analysis reveals that the combined influence of commercialism and regulatory response has led to a systemic decline in accounting’s professional ideals and, as a result, an erosion of public trust. We then propose virtuous professionalism as a necessary process for restoring financial reporting systems based on sociological, professional, and philosophical theories. We argue that virtuous professionalism is necessary for restoring the public servant identity of the accounting professional. We conclude that efforts to restore financial reporting systems should begin with reforms that restore professional identity shaped by virtues. (shrink)

The recent financial meltdown in the US mortgage markets and the ongoing budgetary crises in Europe suggest that we are at an economic and ethical crossroads. What has caused the problems? Do we need to rethink in some fundamental way our ethical notions and some of our practices? These questions clearly are not separable, for, as I shall argue, some of our ideas about corporate responsibilities, technological innovations, and nation states’ ability to regulate corporations have been a cause of the (...) recent problems. Key ethical notions need to be rethought. (shrink)

The central role that the media plays in communicating to the public health research findings has long been recognized (Cassels 2007), and concerns regarding the media's ability to convey health is...

The medical profession contains five “spheres of morality”: clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients’ well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between them (...) frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts. (shrink)

An increasing number of community physicians are involved in clinical research.Indeed, 60 of industry-funded research is now spent on community based trials. This surge in community based clinical trials has increased the number of clinical trials applications submitted to the drug regulatory agencies by pharmaceutical sponsors. Many have argued that the commercial interests connected to the conduct and outcome of these trials also increases the potential for conflicts of interest for participating physicians. The context in which these trials take place (...) increases the potential for a host of practices that infringe on ethical, legal and clinical obligations of physicians For example, financial recruitment incentives may lead to violations of the inclusion criteria and the consent process. It may result in inappropriate recruitment of patient participants and a blurring of the ethically significant distinctions between treatment and research. In some cases, it may be hard to distinguish research from the marketing of new products and attempts to influencing prescribing patterns. (shrink)

Although we think 1 of the basic purposes of journalism is to provide information vital to enhancing citizen autonomy, we also see this goal as being in direct tension with the power news media hold and wield, power that may serve to undercut, rather than enhance, citizen autonomy. We argue that the news media are ethically constrained by proceduralism, resulting in journalists asserting power inappropriately at the individual level, and unwittingly surrendering moral authority institutionally and globally. Anonymity, institutionalization, and routinization (...) cloak power relationships among citizens, journalists and the institutions of which they are a part, ultimately inculcating these distinctly Western values in the global community. (shrink)

The conception of the doctor–patient relationship under Australian law has followed British common law tradition whereby the relationship is founded in a contractual exchange. By contrast, this article presents a rationale and framework for an alternative model—a “Trust Model”—for implementation into law to more accurately reflect the contemporary therapeutic dynamic. The framework has four elements: an assumption that professional conflicts with patient safety, motivated by financial or personal interests, should be avoided; an onus on doctors to disclose these conflicts; a (...) proposed mechanism to contend with instances where doctors choose not to disclose; and sanctions for non-compliance with the regime. (shrink)

This commentary has three parts. The first one is based on fundamental questions in the field of philosophy of medicine, linked to relevant epistemological and ethical considerations in the analysi...

Pro Doernberg and Truog (2023), we recognize and acknowledge five spheres of morality in medicine. We posit that these spheres represent domains of practical engagement, which, as the authors note,...

In this article we revisit the concept of a profession. Definitions of the concept are readily encountered in the literature on professions and we have collected a sample of such definitions. From this sample we distil frequently occurring elements and ask whether a synthesis of these elements adequately explains the concept. We find that bringing the most frequently occurring elements together does not adequately address the reason that society differentiates professions from other occupations or activities -- why there is a (...) concept of ‘profession’ at all. We suggest an alternative approach that attempts to make sense of the concept at a more general level. This more philosophical approach employs analytical tools from Julius Kovesi, Patricia Hanna and Bernard Harrison to address the question of what is the point of the concept. (shrink)

The purpose of this article is to discuss the concept and the content of courses on “social ethics”. I will present a dilemma that arises in the design of such courses. On the one hand, they may present versions of “applied ethics”; that is, courses in which moral theories are applied to moral and social problems. On the other hand, they may present generalised forms of “occupational ethics”, usually professional ethics, with some business ethics added to expand the range of (...) the course. Is there, then, not some middle ground that is distinctively designated by the term “social ethics”? I will argue that there is such a ground. I will describe that ground as the ethics of “social practices”. I will then illustrate how this approach to the teaching of ethics may be carried out in five domains of social practice: professional ethics, commercial ethics, corporate ethics, governmental ethics, and ethics in the voluntary sector. My aim is to show that “social ethics” courses can have a clear rationale and systematic content. (shrink)