Is bioethics consultation a profession? Withfew exceptions, the arguments andcounterarguments about whether healthcareethics consultation is a profession haveignored the historical and cultural developmentof professions in the United States, the wayssocial changes have altered the work andboundaries of all professions, and theprofessionalization theories that explain howmodern societies institutionalize expertise inprofessions. This interdisciplinary analysisbegins to fill this gap by framing the debatewithin a larger theoretical context heretoforemissing from the bioethics literature. Specifically, the question of whether ethicsconsultation is a profession is examined fromthe (...) perspectives of trait theory, Wilensky''sfive-stage process of professionalization,Abbott''s interdependent system of professions,and Haug''s deprofessionalization thesis. Whilehealthcare ethics consultation does not meetthe criteria to claim professional status,neither could most professions pass these idealtheoretical standards. Instead of a yes or nodichotomous response to the question, it ismore helpful to envision a professionalizationcontinuum with sales clerks or carpenters atone end and medicine or law at the other. During the past decade healthcare ethicsconsultation has been moving along thiscontinuum toward greater professional status. (shrink)

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, (...) proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about (...) the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

Many researchers have identified a process they call ‘deskilling’, which they use to describe the daily experience of teachers who have been gradually losing control of their own labour within ‘low‐trust’ workplaces. Conversely, other scholars have found that under similar conditions, some teachers have their own ways of dealing with it which leads them towards a process of ‘reskilling’. This study is an attempt to explore the actual teachers’ perceptions towards their daily practice within the context of educational decentralization, a (...) neglected area of research which needs to be further discussed and explored. This paper uses data gathered from seven schools in Guangdong Province, China as a case study to show that educational decentralization in China not only results in teachers being deskilled because indirect control is still being maintained, but also provides a small number of teachers with a competitive working environment to reskill their pedagogical techniques and educational knowledge, and to pursue good practices in teaching under the pressure of competition. All in all, educational decentralization provides a context in which teachers can experience either deprofessionalization or reprofessionalization. (shrink)

The purpose of this paper is to review the rising influence of commercialism in American medicine and to examine some of the consequences of this trend. Increased competition subverts physician collegiality, draws hospitals into for-profit ownership and behavior, and leads clinical investigators into secrecy and possibly into bias and abuse. Medicine faces a deprofessionalization evidenced in loss of control over the clinical setting and over self-regulation. Health care becomes a commodity relying on cultivation of desires instead of satisfaction of (...) needs, even as many basic needs go unmet. Patients become consumers empowered with lawsuits and the connection of medicine to the relief of suffering is attenuated. Medical encounters are increasingly impersonal, dominated by specialization, technology, and bureaucracy. Patients are losing their physician-advocates to new conflicts of interests, physicians are losing their impulse to charity, and trust in the doctor-patient relationship and in medicine generally is eroding. (shrink)

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The ideal physician is confident, empathic, forthright, respectful, and thorough. These ideals allow us to define broadly "the excellence" of being a physician. At the core of these ideals is the ability to be empathic. Empathy exhibits itself in attributes of an individual's moral character and also in actions that actualize and support (...) communal life. Empathy, however, can be diminished or even lost and must be nurtured on an ongoing basis. The development of ethical physicians is strongly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. Creating a clinical environment that is ethically nurturing and sustaining is an indispensable component of practicing medicine. (shrink)

The article examines the problem of correlation between the “knowledge society” and “knowledge practice,” based on analysis of the phenomenon of security expertise as a part of political expertise. In the article, we consider the relationship between politics and security and demonstrate under what circumstances security becomes politics. It is noted that at present the concept of security has become very multifaceted and includes various spheres, from military-political to informational and humanitarian. We defines security expertise, list its key parameters, origin, (...) its institutionalization and practices. Special attention is paid to the characteristics of the main schools in the study of security expertise problems. Their general ideology and inherent problems are analyzed, including the correspondence of the quality of the expertise to recognized standards of scientific knowledge. We explain why security issues appeal to experts and result in numerous studies. We raise an issue of causes that may lead to possible deprofessionalization of security expertise. We identify a number of institutions with an expert status in the field of security and explain the global growth of analytical centers specializing in security expertise. A brief description of such analytical centers and their main features is given. We look into examples of practical impact of expertise on political decision-making, and possible mechanisms of expert support. It is concluded that expert analysis can exercise direct impact on political processes, and the experts become influential shadow participants. On the one hand, this may contribute to adopting more balanced decisions, but, on the other hand, it may result in deprofessionalization of experts who will try to adjust to the demands of politicians. Thus, in the sphere of security expertise, one of the results of the formation of a “knowledge society” is a decrease in the autonomy of the scientific sphere, which has a side effect in the form of deprofessionalization of knowledge. (shrink)

Modern dialogue of society and science proceeds in the conditions of social media distribution and the convergence of scientific knowledge. This processes change system of mass information and communication channels between scientific actors, leaders of public opinion and organizers of public initiatives. The conflict between an elite normativity of a scientific discourse and an egalitarian normativity of a public discourse takes the new forms. Authors show how in large quantities extending practice of civil expertise, based on civil journalism (a blogosphere (...) and social networks), interrupt into procedures of scientific examination. Active inclusion of civil experts became an attribute of transdisciplinary science. The main feature of this type of science is operational decision making in the conditions of uncertainty. However transition of transdisciplinary science to a phase of the technoscience defines convergence borders of the formal and informal knowledge. Technoscience takes root into the vital world as a magic “black box” for the inhabitant. Authors believe that the transdialogue formed by transdisciplinary scientific experts and deprofessionalized leaders of civil journalism is complicated by deficiency of epistemological competence of civil experts. One of the problem is inclusion the electronic media practices in production and the social circulation of scientific knowledge. Using rather known, but not yet entered in the field of philosophical scientific research examples of direct influence of civil experts on processes which in a former communication order were intra scientific, authors realised a research of the new aspects of modern science expanding a traditional subject of philosophy of science and technology. (shrink)

Is restructuring an underhanded way to make the rich richer and the poor poorer? Or is it necessary, although bitter, medicine for an ailing economy? In The Ethics of the New Economy: Restructuring and Beyond, professionals from the fields of philosophy, ethics, management, as well as those representing the groups affected by restructuring, tackle thorny ethical issues. Referring to concrete case studies, these timely essays discuss a variety of topics, including justified and unjustified restructuring; employers’ obligations during the restructuring process; (...) equity issues; the rise of part-time employment; the effects of restructuring on communities; the internal risks faced by restructuring corporations; deprofessionalization in health care; the consequences of restructuring in the developing world; philanthropy and cause-related marketing; corporate “judo” and restructuring; and responsible and irresponsible restructuring. (shrink)

The occurrence of earthquakes is usually ignored or discounted as an environmental issue, but the environmental relevance of the science of earthquake prediction is demonstrable. The social consequences of such predictions, when they are accurate, and even (once a general pattern of accuracy has been achieved) when they fail, have implications of such varied environmental issues as land-use control, building codes, social and economic costs (for predictions made when no earthquake occurs or for failures to predict earthquakes which do occur). (...) Lay members of the public are more directly involved in programs of earthquake prediction than in almost all other instances of scientific prediction, if only because the scientific findings require public participation in order to have any effect at all. Attention must be paid, accordingly, to the effect of specific public and social values on the practice of earthquake prediction-ranging from such broadly based ones as conceptions of the general relation between man and nature to narrower ones like the cost-benefit analysis of a program of earthquake prediction itself. Because of the close connection between the efficacy of earthquake prediction and public attitudes, moreover, certain questions concerning the social character of “normal” science and the deprofessionalization of scientific institutions are highlighted in this context. (shrink)

_In _The Teacher Insurgency_, Leo Casey addresses how the unexpected wave of recent teacher strikes has had a dramatic impact on American public education, teacher unions, and the larger labor movement._ Casey explains how this uprising was not only born out of opposition to government policies that underfunded public schools and deprofessionalized teaching, but was also rooted in deep-seated changes in the economic climate, social movements, and, most importantly, educational politics. With an eye to maintaining the momentum of the insurgency, (...) the author examines four key strategic questions that have arisen from the strikes: the relationship of mobilization to organizing; the relationship between protests and direct action; the conditions under which teacher strikes are most likely to be successful; and the importance of “bargaining for the common good.” More broadly, Casey examines how to organize teachers for collective action, focusing on four discourses of teaching: teaching as nurturance; as professionalism; as labor and craft; and as a vocation of democratic intellectual work. (shrink)

The elementary, liberal form of democracy has been criticized for being purely political, predominantly representative, centralistic, involving struggle for power among oligarchic political parties, maintaining professional politics and domination of wealthy classes. A more rational and radical form, the council democracy, is projected as a historically possible and better alternative. It extends democratic principles to economy and culture, combines direct participation with representation, replaces centralism with federalism, develops political pluralism without ruling parties, deprofessionalizes politics, and dismantles any monopoly of power. (...) In the light of existing historical experiences the structure of council-democracy is analyzed, possible solutions of crucial practical problems indicated, and different strategies of its realization are examined. (shrink)

The elementary, liberal form of democracy has been criticized for being purely political, predominantly representative, centralistic, involving struggle for power among oligarchic political parties, maintaining professional politics and domination of wealthy classes. A more rational and radical form, the council democracy, is projected as a historically possible and better alternative. It extends democratic principles to economy and culture, combines direct participation with representation, replaces centralism with federalism, develops political pluralism without ruling parties, deprofessionalizes politics, and dismantles any monopoly of power. (...) In the light of existing historical experiences the structure of council-democracy is analyzed, possible solutions of crucial practical problems indicated, and different strategies of its realization are examined. (shrink)

The papers in this number of the Journal originated in a session sponsored by the American Philosophical Association's Committee on Philosophy and Medicine in 1999. The four papers and two commentaries identify and address philosophical challenges of how we should understand and teach bioethics in the liberal arts and health professions settings. In the course of introducing the six papers, this article explores themes these papers raise, especially the relationship among professional medical ethics, the "long history" of medical ethics, and (...) bioethics. The tendency of bioethics to deprofessionalize medical ethics is rejected, in favor of an historically informed professional medical ethics. It is suggested that bioethics should be critically reconsidered from the perspective of medical ethics as professional ethics. (shrink)

The neo-liberal reform of the university has had a huge impact on higher education and promises still more changes in the future. Many of these changes have had a negative impact on academic careers, values, and the educational experience. Educational technology plays an important role in the defense of neo-liberal reform, less through actual accomplishment than as a rhetorical justification for supposed “progress.” This paper outlines the main claims and consequences of this rhetorical strategy and its actual effects on the (...) university to date. (shrink)