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)

In lieu of an abstract, here is a brief excerpt of the content:Finding My Compass*Laura Inter+I was born in the 1980s, and much to my parents surprise, the doctors could not say whether I was a boy or a girl because my body had ambiguous genitalia. They then conducted a chromosome test and the result was XX chromosomes. I was assigned female and only later was diagnosed with congenital adrenal hyperplasia (CAH). Fortunately for me the endocrinologist who treated me did (...) not mention the option of surgery, so my medical treatment consisted only of taking cortisol. Apart from this, from the time I turned one, I was subjected to genital examinations twice a year, during which the endocrinologist would touch my genitals and look to see how they were developing.These unnecessary and intrusive examinations had a profound effect on me. As a young child, I did not understand why I had to lower my pants in front of a stranger—the endocrinologist—and let him touch me. The fact that my mother was present, and approved of this was something that made me feel completely helpless. All this seemed very strange to me; I found it confusing, and terribly uncomfortable, and I just felt it wasn’t right.I remember the doctor always spoke as if I wasn’t right there, and I did not always understand everything the doctor said when I was young, because of all the medical terms he used. I grew up with a feeling of being “inadequate,” of having a sense that something was wrong with me, though I didn’t know exactly what. These exams lasted until I was about 12 years old. Years later, as I began my adult, sexual life, I realized how much those displays had affected me emotionally.I discovered what was “wrong” with me during sex education classes in the first year of high school. There was a class session in which two images were shown: one displaying the external female sex organs, and the other the male sex organs. I noticed that my body was not like either of them. I was very distressed, thinking “I have deformed genitals!” I feared I could not perform sexually as either a man or a woman. I became very depressed. I was sure nobody would want me, that I would never have a relationship. I was unacceptable, “abnormal,” or at least that is what the doctors had said. And in any case my parents never spoke of it, and I didn’t know that I had CAH.Skip forward a few years: I was still looking for answers, I found my medical file and read in the documents “pseudo–hermaphrodite,” and [End Page 95] “congenital adrenal hyperplasia.” I searched the internet, but only found medical opinions that said that in the case of genital ambiguity, the best option was surgery. I wondered to myself: “Why didn’t they operate on me?”I put the question to my parents, and, at fifteen, I found myself being examined once more in the doctor’s office, this time to consider the possibility of a genital surgery which might once and for all, I believed, make me a “normal” person.I have never told anyone outside my family before, but one of those exams was the most humiliating experiences of my life. One doctor wanted to speak with me alone, so she made my mother wait outside the exam room. My mother agreed, thinking that after the doctor talked with me, my mother would be able to be present during the rest of the exam. The doctor asked me questions, some of which made me very uncomfortable: “Do you feel good about being a woman”? Did you ever feel like a man? Why don’t you dress up more, use more makeup? Are you a lesbian? Have you ever had sex? She then said she wanted to see my genitals. I felt awful and wanted my mother present, but I also wanted it to be over quickly, and said nothing. Examining my genitals, the doctor told me they “would not be adequate for sex,” and that she needed to “perform surgery.” Something else that made me uncomfortable was the presence of another doctor in... (shrink)

A compilation of selected papers presented at the 1989 Charles S. Pierce International Congress Interest in Charles Sanders Peirce (1839-1914) is today worldwide. Ernest Nagel of Columbia University wrote in 1959 that "there is a fair consensus among historians of ideas that Charles Sanders Peirce remains the most original, versatile, and comprehensive philosophical mind this country has yet produced." The breadth of topics discussed in the present volume suggests that this is as true today as it was in 1959. Papers (...) concerning Peirce's philosophy of science were given at the Harvard Congress by representatives from Italy, France, Sweden, Finland, Korea, India, Denmark, Greece, Brazil, Belgium, Spain, Germany, and the United States. The Charles S. Peirce Sesquicentennial International Congress opened at Harvard University on September 5, 1989, and concluded on the 10th—Peirce's birthday. The Congress was host to approximately 450 scholars from 26 different nations. The present volume is a compilation of selected papers presented at that Congress. The philosophy of science and its logic are themes in the work of Charles Peirce that have been of greatest interest to scholars. Peirce was himself a physical scientist. He worked as an assistant at the Harvard Astronomical Observatory from 1869 to 1872 and made a series of astronomical observations there from 1872 to 1875. Solon I. Bailey says of these observations, "The first attempt at the Harvard Observatory to determine the form of the Milky Way, or the galactic system, was made by Charles S. Peirce....The investigation was of a pioneer nature, founded on scant data." Peirce also made major contributions in fields as diverse as mathematical logic and psychology. C. I. Lewis has remarked that "the head and font of mathematical logic are found in the calculus of propositional functions as developed by Peirce and Schroeder." Peirce subsequently invented, almost from whole cloth, semiotics - the science of the meaning of signs. Ogden and Richards, the British critics, say that "by far the most elaborate and determined attempt to give an account of signs and their meanings is that of the American logician C. S. Peirce, from whom William James took the idea and the term Pragmatism, and whose Algebra of Dyadic Relations was developed by Schroeder.". (shrink)

Religious voices were important in the early days of the contemporary field of bioethics but have now become decidedly less prominent. This is unfortunate because religious elements are essential parts of the most foundational aspects of bioethics. The problem is that there is an incommensurability between religious language and languages of public discourse such as the “public reason” of John Rawls. To eliminate what is unique in religious language is to lose something essential. This paper examines the reasons for the (...) marginalization of religion in bioethics, shows the limitations of Rawls’s notion of public reason, and argues for a more robust role for theology in articulating a new language for public discourse in bioethics. (shrink)

Dual Use Research of Concern constitutes a major challenge for research practice and oversight on the local, national and international level. The situation in Germany is shaped by two partly competing suggestions of how to regulate security-related research: The German Ethics Council, as an independent political advisory body, recommended a series of measures, including national legislation on DURC. Competing with that, the German National Academy of Sciences and the German Research Foundation, as two major professional bodies, presented a strategy which (...) draws on the self-control of science and, inter alia, suggests expanding the scope of research ethics committees to an evaluation of DURC. This situation is taken as an occasion to further discuss the scope and limits of professional self-control with respect to security-related research. The role of RECs as professional bodies of science is particularly analyzed, referring to the theoretical backgrounds of professionalism. Two key sociological features of professionalism – ethical orientation and professional self-control – are discussed with respect to the practice of biomedical science. Both attributes are then analyzed with respect to the assessment of DURC by RECs. In conclusion, it is stated that issues of biosecurity transcend the boundaries of the scientific community and that a more comprehensive strategy should be implemented encompassing both professional self-control and legal oversight. (shrink)

The arguments against managed care can be divided into two general clusters. One cluster concerns the way managed care undermines the ethical ideals of medical professionalism. Since those ideals largely focus on the physician-patient relation, the first cluster comes under the rubric of micro-ethics; namely, the ethics of individual-individual relations. The second cluster of criticisms focuses on macro-ethical issues, primarily on issues of justice and policy. By reviewing these arguments, it becomes clear that managed care does not easily fit within (...) traditional modes of ethical analysis. It poses a radical challenge to current medical and socio-political norms, and even resists the distinction between micro- and macro-ethical domains, a distinction that reflects the private/public distinction. Managed care organizations call for a third way, an inter-ethic for middle level organizations. The essays in this Journal provide a first step in this radical reassessment, laying the foundation for an organizational ethic that is responsive to the realities and promise of managed care. (shrink)

We argue that the practice of engineering does not exist outside the domain of societal interests. That is, the practice of engineering has an inherent (and unavoidable) impact on society. Engineering is based upon that relationship with society (inter alia). An engineer’s conduct (as captured in professional codes of conduct) toward other engineers, toward employers, toward clients, and toward the public is an essential part of the life of a professional engineer, yet the education process and professional societies pay inadequate (...) attention to the area. If one adopts Skooglund’s definition of professional ethicsI (how we agree to relate to one another), then the codes of professional conduct lay out a road map for professional relationships. As professionals, engineers need to internalize their codes and to realize that they have a personal stake in the application of codes as well as the process of developing the codes. Yet, most engineers view professional codes as static statements developed by “others” with little (or no) input from the individual engineer. Complicating the problem, questions of professionalism (such as ethics) are frequently viewed as topics outside the normal realm of engineering analysis and design. In reality, professional responsibility is an integral part of the engineering process. (shrink)

The need for increased civility has been a recurring theme in conversations about lawyer professionalism in the United States and Canada over the last several decades. In addition to having many advocates, however, the civility movement has also been subject to criticism. In large part, the critiques made to date have focused on the problems or risks created when civility rules or guidelines are enforced against lawyers. This article takes a different focus to provide a complementary, yet distinct critique. The (...) object of analysis is the discourse of the civility movement. More specifically, the assumptions and concepts of lawyer professionalism embedded in our conversations about civility are explored. Upon review, the discourse of the civility movement reveals a dominant narrative framed in terms of competing masculinities: the aggressive, testosterone fuelled Rambo-lawyer is cast as the anti-hero to be vanquished against renewed calls for the return of the gentlemanly Atticus Finch. I argue that this 'Rambo-Finch narrative' is hostile to inclusive understandings of lawyer professionalism in three inter-related ways: (1) it renders women and other 'outsider' lawyers largely invisible; (2) it romanticizes past discriminatory concepts of lawyer professionalism; and (3) it reflects anxieties about the destabilization of traditional, exclusionary claims or modes of authority in the legal profession. The exclusionary understandings of lawyer professionalism contained in the Rambo-Finch narrative should be of concern to those interested with improving gender equity and diversity in the legal profession as there is good reason to believe that this discourse translates into 'real world' consequences in how 'outsider' lawyers are viewed and treated within the legal profession. (shrink)

The ethnic-Chinese business is often characterised by a central role of the family both in the structure of the firm and in its corporate culture. This has political, social as well as cultural reasons. The centrality of the family in business has its advantages and disadvantages. On the one hand, it enables a fast, efficient and flexible process of decision-making. On the other hand, it often contradicts modern business professionalism. The younger generation of ethnic-Chinese business actors tend to preserve crucial (...) elements of such family-centred characteristics. Yet, globalisation drives them to transform their business style, lessening its dependence on family resources and adopting more-modern professional ideas. Changes in current political situation, religious-cultural trend, demography and education contribute to making possible the transformation. (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

Geographical features and cultural traits influence the character of big-mountain tourism in Alaska. This research considers the intersectionality of wilderness and frontier concepts on tourism culture, examines guides’ and clients’ motivations for participation, and relates these influences to the larger phenomena of tourism generally and nature tourism specifically. The findings show that Alaska’s big-mountain tourism is globalized in its political and economic scope. Guides imagine themselves as pioneers on a last frontier of mountain pursuits, notions that relate well to images (...) depicted of the region in literature and promoted by the tourism industry. Clients, on the other hand, come to Alaska because of its exceptional geography and unique mountain sporting culture, but are not as enamored with the mythos of the frontier. (shrink)

Some of the most significant policy responses to cases of fraudulent and questionable conduct by scientists have been to strengthen professionalism among scientists, whether by codes of conduct, integrity boards, or mandatory research integrity training programs. Yet there has been little systematic discussion about what professionalism in scientific research should mean. In this paper I draw on the sociology of the professions and on data comparing codes of conduct in science to those in the professions, in order to examine what (...) precisely the model of professionalism implies for scientific research. I argue that professionalism, more than any other single organizational logic, is appropriate for scientific research, and that codes of conduct for scientists should strengthen statements concerning scientific autonomy and competence, as well as the scientific service ideal. (shrink)

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)

_Professionalism and Ethics in Teaching_ presents a thought-provoking and stimulating study of the moral dimensions of the teaching professions. After discussing the moral implications of professionalism, Carr explores the relationship of education theory to teaching practice and the impact of this relationship on professional expertise. He then identifies and examines some central ethical and moral issues in education and teaching. Finally David Carr gives a detailed analysis of a range of issues concerning the role of the teacher and the managements (...) of educational issues. _Professionalism and Ethics in Teaching_ presents a thought-provoking and stimulating study of the moral dimensions of the teaching professions. (shrink)

What is healthcare professionalism? -- Teaching and learning healthcare professionalism -- Assessing healthcare professionalism -- Identity-related professionalism dilemmas -- Consent-related professionalism dilemmas -- Patient safety-related professionalism dilemmas -- Patient dignity-related professionalism dilemmas -- Abuse-related professionalism dilemmas -- E-professionalism-related dilemmas -- Professionalism dilemmas across national cultures -- Professionalism dilemmas across professional cultures.

_Professionalism and Ethics in Teaching_ presents a thought-provoking and stimulating study of the moral dimensions of the teaching professions. After discussing the moral implications of professionalism, Carr explores the relationship of education theory to teaching practice and the impact of this relationship on professional expertise. He then identifies and examines some central ethical and moral issues in education and teaching. Finally David Carr gives a detailed analysis of a range of issues concerning the role of the teacher and the managements (...) of educational issues. _Professionalism and Ethics in Teaching_ presents a thought-provoking and stimulating study of the moral dimensions of the teaching professions. (shrink)

This paper attempts to clarify the meaning of the term ‚professional’ in its current use in our daily lives, mainly by making use of Weber’s discussion of the Protestant work ethic and rationalization. Identifying professionalism primarily as a particular lifestyle, it questions whether professionalism is a virtue to be encouraged or an alienated way of life. Rather than conclusively answering this question in the affirmative or negative, it contends that professionalism is an evolving concept, and endeavors to capture and formulate (...) a favorable understanding of it which would foster less alienating and more fulfilling ways of doing business. It concludes by observing structural similarities between alternative managerial approaches and different conceptualizations of professionalism. (shrink)

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has (...) defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society. (shrink)

According to the Market Failures Approach to business ethics, beyond-compliance duties can be derived by employing the same rationale and arguments that justify state regulation of economic conduct. Very roughly the idea is that managers have a duty to behave as if they were complying with an ideal regulatory regime ensuring Pareto-optimal market outcomes. Proponents of the approach argue that managers have a professional duty not to undermine the institutional setting that defines their role, namely the competitive market. This answer (...) is inadequate, however, for it is the hierarchical firm, rather than the competitive market, that defines the role of corporate managers and shapes their professional obligations. Thus, if the obligations that the market failures approach generates are to apply to managers, they must do so in an indirect way. I suggest that the obligations the market failures approach generates directly apply to shareholders. Managers, in turn, inherit these obligations as part of their duties as loyal agents. (shrink)

This report takes a broad approach to answering the overarching question, "How can the U.S. Air Force best improve the professionalism of its personnel?" The authors examine the definition of professionalism and what it means in the Air Force. They then look at past actions the Air Force, the U.S. Department of Defense, and other U.S. military services have taken dating back to the last substantial Air Force initiatives related to professionalism. In the absence of objective metrics specifically intended to (...) measure professionalism, the authors examined statistics of cases in which professionalism was lacking, as evidenced by documented violations of the Uniform Code of Military Justice. For subjective metrics, the authors looked at trends in attitudes related to professionalism from surveys of civilian federal employees and uniformed service members. They then examined a selection of courses and seminars to understand the Air Force learning opportunities currently being offered and how they relate to the Air Force strategic road map for professionalism and instructional practices more conducive to building Air Force professionalism. Finally, the authors examined the literature on organizational culture and change to identify how the Air Force might effect changes on this dimension. The report offers key findings and conclusions from these investigations and provides recommendations for further actions to support the effort to enhance professionalism across the Air Force."--Publisher's description. (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)

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the (...) meaning of “professionalism” itself, thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism. (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)

For courses covering professionalism in any nursing or health program offered in colleges or universities, vocational schools, hospitals, high schools, or through on-the-job training. A balanced introduction to the standards and skills needed to succeed in health care Professionalism in Health Care: A Primer for Career Success is a full-color, engaging, conversational text that helps students understand the common professional standards that all healthcare workers need to provide excellent care and service. It brings together complete coverage of these and other (...) crucial soft skills: work ethic, character, relationships, teamwork, communication and etiquette, honesty, cultural competence, personal image, personal health and wellness, and more. (shrink)

The professionalism movement has animated medical education and practice; an extensive literature expresses and categorizes many interpretations of the concept (Hafferty 2006a; Hafferty and Levinson 2008). The inception of the current wave of the movement was in the American Board of Internal Medicine's Project Professionalism. In the face of threats from the growth of managed care and public concerns about conflict of interest, the ABIM's "Physician Charter" called for the profession to publically commit to values of patient welfare, social justice, (...) and respect for patient autonomy (Brennan et al. 2002). The concept of professionalism, or the physician as occupying the role of professional, has taken hold in .. (shrink)

Albert Dzur proposes an approach he calls "democratic professionalism" to build bridges between specialists in domains like law, medicine, and journalism and the lay public in such a way as to enable and enhance broader public engagement ...

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in this multifaceted competency. (...) Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

The GDC’s recent third edition (interim) of The First Five Years places renewed emphasis on the place of professionalism in the undergraduate dental curriculum. This paper provides a brief analysis of the concepts of ethics, professionalism and fitness to practice, and an examination of the GDC’s First Five Years and Standards for Dental Professionals guidance, as well as providing an insight into the innovative ethics strand of the BDS course at the University of Glasgow. It emerges that GDC guidance is (...) flawed inasmuch as it advocates a virtue-based approach to ethics and professionalism, and fails to distinguish clearly between these two concepts. (shrink)

We agree with McCullough, Coverdale and Chervenak1 that ‘medical educators and academic leaders are in a pivotal and powerful position to role model’ to counter ‘incivility’ in medicine, which can include ‘dismissing’ or ‘demeaning others’. They note that ‘women may be at greater risk for experiencing incivility compared with men’, as may other individuals who experience ‘patterns of disrespect based on minority status’. The authors promote ‘professionalism’ and ‘etiquette’ to foster civility within medicine. Yet theory and experience suggest that medical (...) educators and academic leaders are also in powerful positions to mobilise these concepts to perpetuate exclusions from, and biases within, medicine, upholding racist, sexist and ableist norms. Feminist methodology reveals how ethical theorising historically excluded views and experiences of marginalised individuals and groups and provides frameworks for interrogating supposedly universal norms. Presuming dominant values and experiences reflect universal ones can further marginalise already oppressed groups and individuals. A feminist analysis reveals how ‘professionalism’ or ‘etiquette’ are historically shaped by white or male identity and experience, including norms of attire, hair, accessories, speech or behaviour. Part of the hidden curriculum of medicine becomes intuiting how leaders implicitly or explicitly define ‘professionalism’. McCullough et al define ‘professionalism’ in medicine as ‘sustained commitments to scientific and clinical excellence… making the protection and promotion of health-related interest the physician’s primary concern …. (shrink)

Professionalism as ideology: a socio‐historical analysis of the discourse of professionalism in nursingFor most of this century, extensive and heated discourse has surrounded defining, conceptualizing, and implementing nursing professionalism. These discussions, for the most part, have approached professionalism as a set of universal, unchanging, objectively‐measured criteria. This study explores professionalism as an ideology; an image drat a social group gives of itself to itself, as a community with a history and identity. Analyses of eight decades of the American Journal of (...) Nursing identify ways that the language of professionalism gives meaning to changing and competing social structures through rationalization and legitimation. The study further identifies how change has often been illusionary, illuminating how the language of professionalism has served to legitimate, and conceal reality. Identifying and understanding how political, social, and economic domination and asymmetry are rationalized and legitimated through language and ideology will allow nursing to demystify constraints and coercion in the delivery of health care.School of Nursing Graduate Faculty, Kent State University, Kent OH 44242, USA. (shrink)

Bringing expert knowledge to bear in an open and deliberative way to help solve pressing social problems is a major concern today, when technocratic and bureaucratic decision making often occurs with little or no input from the general public. Albert Dzur proposes an approach he calls “democratic professionalism” to build bridges between specialists in domains like law, medicine, and journalism and the lay public in such a way as to enable and enhance broader public engagement with and deliberation about major (...) social issues. Sparking a critical and constructive dialogue among social theories of the professions, professional ethics, and political theories of deliberative democracy, Dzur reveals interests, motivations, strengths, and vulnerabilities in conventional professional roles that provide guideposts for this new approach. He then applies it in examining three practical arenas in which experiments in collaboration and power-sharing between professionals and citizens have been undertaken: public journalism, restorative justice, and the bioethics movement. Finally, he draws lessons from these cases to refine this innovative theory and identify the kinds of challenges practitioners face in being both democratic and professional. (shrink)

Over the last 50 years, the term professionalism has undergone a widespread expansion in its use and a semantic shift in its meaning. As a result, it is at risk of losing its descriptive and analytical value and becoming instead simply an empty evaluative label, a fate described by C. S. Lewis as ‘verbicide’. This article attempts to rescue professionalism from this fate by down-sizing its extension and reassigning some of its work to two other ethical domains, introduced as the (...) neologisms organizationalism and sur-moralism. Professionalism is defined as a morality based in system of obligations that are assumed by physicians over the course of their professional training and which primarily refer to two groups: patients and colleagues, including trainees. Organizationalism is also a morality, but the obligations are owed to the employing organization and on different grounds. A third ethical domain, here called sur-moralism, comprises actions that are not based in obligations. They are discretionary and potentially meritorious; they cannot be required by the profession or organization. This article presents a conceptual model of the three ethical domains and the shifting borders between them. One practical benefit of this typology is that physicians can more accurately understand the nature and sources of obligations that they are asked to accept, and when necessary prioritize them. Another is that physicians will be able to describe the potential tension between the three domains and understand how and why the borders between them can move. Both should help physicians to be more ethically oriented to their work settings. (shrink)

This article examines the (bio) ethical and professionalism issues that may arise in the context of medical practice in low and middle income countries (LAMIC), and the challenges this poses for medical regulatory bodies in the regions, in upholding ethics in professional practice. A quadrangle of source of the problems given rise to the breach of ethics in medical practice is identified, and suggested steps, based on ethical principles and concept, is proposed towards the resolution of the problems presented. As (...) LAMIC progress to improve the health of its population, this endeavour should occur hand in hand with contemporary medical ethics theories, taking in context the region’s ethnographic and cultural beliefs and practices. (shrink)

Medical educators invoke professionalism as a core competency in curricula. This paper criticizes classic definitions. It also identifies some negative traits of medicine as a profession. The call to professionalism is naive nostalgia. Straightforward didactics in professionalism cannot do the desired work in medical education. The most we can say is that students should adopt the good aspects of professionalism and the profession should stop being some of what it has been. This is a platitude. If the notion is to (...) be more than shallow, each student and practitioner will have to engage in much dialogue, reflection and refinement over many years. (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)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

(1981). Professionalism in education and physical education: A reply to David best. British Journal of Educational Studies: Vol. 29, No. 2, pp. 152-158.

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (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)

The author contends that overworking residents cannot be ethically justified. There is evidence that overwork is detrimental both to the resident and to the patient. In addition, thu argument that working long hours is essential to maintain medicine's status as a profession is analyzed. The claim cannot be supported by definitions of professionalism. Although Flexner's definition does specify altruism as an essential component, it does not justify long working hours for residents. Altruism is obligatory in some limited cases, but only (...) when it is required to fulfill some contractual obligation. Keywords: professionalism, altruism, residency, medical education CiteULike Connotea Del.icio.us What's this? (shrink)