WELCOME
Everyone be welcome to the first journal paper discussion of our new Bioethics Journal Club. I hope this will be but the first of a whole series of articles to be reviewed here by our members. We hope to update this club site with additional journal papers as often as practical. We may not be able to obtain permission for reproduction here of all the articles. Those for which we are unable, we will post an objective summary or abstract written by one of our members. In addition to the discussions generated by the contributions of our club members, we invite our other visitors to this site to post their point of view too.
Followups by our members and comments by the visitors will be in a section below the reviews titled "Followup Comments" and will be formatted so that the most recent dated comments are at the top of the section.
We invite visitors who would care to join and participate in these reviews, adding to our club membership, to do so and write me a bit about yourself to share with our other members. Please also let me know if you have any suggestions for this club.
Now let's get on with the first paper! ..Maurice
Who Is a Real Professional? On-the-Job Altruism
Robert J. Baum, The Park Ridge Center Bulletin, p.7-8 Sept./Oct. 2001
Reprinted by permission of the Park Ridge Center for the Study of Health,
Faith, and Ethics. From The Park Ridge Center Bulletin, no. 23
(September-October 2001).
Who Is a Real Professional?
On-the-job altruism
by Robert J. Baum
The scenes were shocking and saddening. Hundreds of firefighters, emergency medical personnel, and police rushed into the World Trade Center (WTC) on September 11, 2001, never to be seen alive again. These men and women were not coerced to put their lives at risk; they were practicing what they had been trained to do as professionals. And in doing so they reminded us of the most distinguishing feature of the professions, namely altruism, the commitment to put the well-being of others ahead of one’s own interests. In this extreme case, this meant placing concern for others above even one’s own life.
Everyone needs competent professional assistance at critical points in life—often involving long-term quality-of-life or even life-and-death decisions. We turn to lawyers, bankers, financial consultants, and accountants for assistance with our financial well-being. We seek assistance from various healthcare professionals for dealing with physical and psychological problems. We receive spiritual comfort and guidance from the clergy. And we rely upon military and law-enforcement professionals to protect us from hostile attacks on our bodies and property. In all such situations where we must put something that we value highly in the hands of others, we hope at the very least that we can trust those individuals not to exploit the situations to their own advantage. And if it were necessary for our own well-being, we would like it if they would put our interests above their own.
Altruism has always been an ideal rhetorically espoused by most professional groups and wannabe professionals who are seeking monopoly status and the right to be self-regulating. But even a cursory assessment of most of the self-proclaimed professions, including medicine, law, accounting, and banking, makes it clear that self-interested practices dominate, and the token instances of putting the interests of clients first usually involve no significant costs to the professionals.
In the present context, the traditional examples of altruism on the part of professionals appear pallid in comparison with the true altruism displayed at the WTC. The nostalgic image of the white male doctor going off in his carriage in the middle of the night to care for a patient in the patient’s home involves at most the discomfort of lost sleep. We need to look back to the days of the devastating plagues to find physicians putting themselves at real risk of death to minister to their patients. The only other modern-day professionals who are committed to putting the lives of others ahead of their own are members of the military. This includes not only combat troops, but also medics and chaplains. Physicians have generally stayed well behind the combat lines—out of harm’s way—especially since the introduction of the evacuation helicopter.
Some of the most prestigious and highly paid professions in the U.S.—including physicians and lawyers, but not firefighters or police officers—display little significant altruistic behavior. While the U.S. spends by far the most per capita on health care, including the highest incomes for physicians, it is not even in the top ten nations in terms of the quality of health care. And the distribution of healthcare services—particularly of physicians—is a national embarrassment. There is a serious shortage of physicians willing to serve rural and low-income populations, while some economists claim that there is a surplus of physicians in affluent areas. A report issued by the U.S. Surgeon General in August concluded that minorities receive less care for mental illness than does the white population, and the care they do receive is of an inferior quality. The legal profession fares no better as a possible example of altruism.
If there is little evidence of a commitment to altruism in the practice of these professions, maybe lip service to such a commitment can at least be found in their preaching—but we find that they preach what they practice. One looks in vain in the venerated Hippocratic oath for a statement of a commitment to altruism. Instead, we find that the strongest commitment the physician is asked to make is to "hold him who has taught me this art as equal to my parents and to live my life in partnership with him . . . and to regard his offspring as equal to my brothers in male lineage."
Other statements of ideals are similarly restrictive. The Golden Rule is incorporated into the International Code of Medical Ethics (1983)—but it is not directed towards patients: "A physician shall behave towards his colleagues as he would have them behave towards him." And the Declaration of Geneva (1948 as amended 1994) echoes the Hippocratic oath in asserting that "My colleagues will be my brothers and my sisters."
New physicians have been carefully selected by the medical establishment and have been intensively indoctrinated over a six- to ten-year period with the values that the profession has chosen to pass on to them. That is why the graduates of U.S. medical schools do not go into practice in the places where they are most needed—that is, they do not make career choices that would place patients’ interests above their own. This is consistent with the American Medical Association’s (AMA’s) list of seven "essential" Principles of Medical Ethics, which include the assertion that physicians "shall be free to choose whom to serve . . . and the environment in which to provide medical services." But none of the AMA’s seven principles come near to suggesting that physicians should put the interests of patients above their own.
The nation is today united in wanting to pay a tribute to the altruistic professionals who in practice put the interests of others above their own—sometimes at infinite cost to themselves and their loved ones. We can pay our tribute in part by being more thoughtful about which groups we honor with the title of "professional." We need to place at the top of the list of professions those which place the highest value on commitments to the well-being of others. In addition to firefighters and enlisted military personnel, we should include near the top of the list schoolteachers, social workers, and similar professionals whose annual income is less than the monthly income of many physicians, lawyers, and bankers, and who regularly use their own money to meet the needs of their students and clients. Even if these groups are not rewarded financially, one hopes they would be given recognition on a regular basis while they are still with us—unlike the altruistic professionals at the World Trade Center.
A society in which the most-honored professionals are those who practice a willingness to sacrifice the most for the well-being of others might even be one which is less likely to evoke the degree of hatred that underlies many acts of terrorism.
_______________________________________
Robert J. Baum (rbaum@ufl.edu) is Professor of Philosophy at the University of Florida, Director of the UF Center for Applied Philosophy and Ethics in the Professions, and editor of two professional ethics journals.
THE REVIEWS
By Member Joe Russo, joe24_1999@yahoo.com
Who is a Real Professional?
Dr. Baum tries to answer this question by setting
up a hierarchy of professions based on their practice
of altruism. I believe there are some major flaws in
his hierarchy approach based on his emphasis on
altruism as a necessary and possibly sufficient
criteria of professionalism, reliance on "being in
harms way" as a measure of altruism, and the existence
of counterexamples to his proposed "true" professions.
Altruism, although ideally a basic foundation of
all the professions, is not necessary or sufficient to
being termed a professional. Professionalism is
defined formally more in terms of proficiency in
performing a task, and having a working body of
knowledge in the mechanisms and applications of that
task. This includes everyone from the tax accountant,
working on the financial aspects of a business to the
physician who needs to manage a patient with
multi-system disease. Each case requires an
individual who is able to not only perform a rote
task, but apply their knowledge to a new situation.
Firefighters, Schoolteachers, and the other of the
"true" professions according to Dr. Baum also fit in
this profession category as they too have knowledge in
their field of expertise. However, by definition,
being a professional does not require altruism.
Unfortunately there are many professionals who put
their own gain before those of their clients, this
seems to be more a question of personal morality and
ethics rather than non-professionalism.
Altruism can be expressed in many terms in the
practice of a profession and need not be tied in
certain terms or graded with "being in harms way".
Each of the professions is skilled and trained to
perform their duties in a specific manner and
environment. While those emergency service teams
involved at the WTC undoubtedly went above and beyond
their call of duty in response to such a momentous
disaster, we can't forget that in fact their were also
teams of physicians and nurses who also were on
stand-by and rushing to the scene as well. At the
core of this being in harms way issue, is the training
issue. Firefighters and EMS services are highly
trained at being first-responders to a wide variety of
disaster situations and that is where they perform at
their best. Physicians and other of the medical
personnel are not as skilled at on the scene care,
eventhough in extreme cases (Oklahoma city, WTC...etc)
we see doctors performing on site amputations to save
lives. Being in harms way does not equal altruism,
instead in many situations rises above it and defines
a whole new level of service to others in the case of
combat, or the heroes of the WTC disaster. Altruism
is simply a desire to help others however strongly or
lightly expressed. It can be argued that simply
choosing a profession that directly impacts the lives
of others is altruistic at least in a superficial
sense.
Aside from the altruism issue, we can envision
many counterexamples to the professions that Dr. Baum
would place at the top of his hierarchy. Namely, that
while it is true that many physicians are needed in
low income areas, the same may be said about
schoolteachers who often choose to be in affluent
school districts over inner city districts. Many low
income areas that require volunteer firefighters in
place of a professional force are also in want of many
more members. Issues of salary, which may be debated
infinitely seems to play no role in who we should call
a professional although it comes into play in the
altruism argument.
In summary, I believe we can't make some
hierarchy of professions or exclude professions based
on altruism. Instead we should take a closer look at
the ethics of the individuals that practice the
profession and especially those of the leaders of the
field. This will be more fruitful in terms of getting
at the root of the "self-serving" professional who is
after personal gain rather than the "self-less"
professional whom we all got much more familiar with
following the September 11 tragedy.
By Member Debra Buckler, DBuckler@kcom.edu
Hello! Thanks for sharing the article. I do have a few comments on the article.
I looked up the word professional in Webster's dictionary and found it to mean persuing a profession, pertaining to a profession or meeting the standards of a profession. The word profession meant learned occupation. I did not see altruism in either definition. As a physician, I would like to think that physicians, in general, are alturistic and have found many of them to be. I would be 'practicing' in a state of denial if I said that all (or even most) physicians are. But, as you pointed out, altruism is not a requirement in the Hippocratic oath or is it a requirement for medical school graduation. I suspect that altrusim is not the norm for many professions, including philosophy professors.
I agree that those persons who risk their lives for others, like so many did on September 11, deserve tremendous respect and admiration for their work. I do not, for a minute want to dilute my personal regard for those who risk their lives for others. So, while the term professional is appropriate based on Webster's definition, the term HEROISM is the term that needs to be applied to altruism to this degree.
By Member Dennie Raviv, Dennie@rr.co.il
As a practicing Registered Nurse and an Instructor of Nursing, I find it
interesting that the word "caring" is not referred to at all in the article
with reference to the medical and other "real" and generally more lucrative
professions. Florence Nightingale thought medical therapeutics and "curing"
were of less importance to patient outcome and willingly left this realm to
the physician. The arena she considered which was of the most importance;
"caring", was assigned to the nurse. The concept of "caring" continues to be
to be the exclusive province of the caring professions such as nursing,
teaching social work and in reference to the article, firefighters and
policemen. They would not be able to display altruistic behavior if they
were not able to put the safety of others before their own which I view as a
way of caring (and not a characteristic traditionally attributed to
policeman). The idea that Doctors "cure" and Nurses "care" has lead to a one
dimensional understanding of care and seems to have put it on a low rung on
the professional hierarchy. Though there is tons of literature supporting
the idea that the traditional female characteristic of caring is a direct
cause of the low value of the professional rank, we see that the altruism
required of certain traditionally male professions also influence
professional standing.
Is altruism necessary as a professional requirement? That is a hard one.
Though every profession provides it's members or should provide a "safe"
work environment there is no argument that a nurse or doctor can better
protect themselves from certain hazards and dangers than say a fireman/woman
or policeman/woman. However, certain dangers are a known part of the health
professions and to act professionally is to acknowledge the obligations of
each profession which often may endanger the provider.We see this less often
when it comes to banking and accounting.
If caring were part of the Hippocratic oath, and more important, a more
dominant part of medical school curriculum, I'm sure all the other
discrepencies and questionable professional behavior mentioned by Dr. Baum,
would be less problematic.
By Member John Loofbourow, lufboro@jps.net
Dr. Baum's commentary seems to me to be quite out of focus. Out of focus, because altruism has scant relationship to professionalism. The heroic behaviour witnessed on Sept 11 was, in my view, neither simply altruistic nor professional. Ordinary people often react in extraordinary ways in the face of crisis. Professionals, after all, are just ordinary people who are skilled and experienced in some particular way. Buckler's term, heroism, is more appropriate to describe the acts of many on Sept 11, 2000; people were just doing their job, and suddenly reacted to that cataclysm in heroic ways. Each and all, including those who fled from the choking dust and smoke, have that potential, whether we are professionals or not.
I grant that noble slogans and standards are sometimes self-serving. Duh... People are usually quite human, after all. I grant that organizations, professional or otherwise, do tend to high sounding sloganeering in their own self-interest; (Again, Duh.) ...like teachers, truckers, farm workers, bioetheticians, or philosophers. Like students, and those considered "blue collar workers", those ingenuously called "Working Americans", as if the rest don't work. Some, like Richard Dawkins, author of "The Selfish Gene", may even hold that parents work in self-interest when they sacrifice for their own children or families, though that seems a bit of a stretch to me. As on Sep 11th, when an attack seems to be directed at us all, or most of us, we tend to defend ourselves more altruistically, with greater understanding that we are defending one another. The best prior example in my lifetime has been WWII. Altruism? Perhaps. But also it’s logical collective self interest in response to a perceived threat.
Throughout Baum's piece one must swallow the stale gruel of internecine envy and hatred, until the last spoonful. I quote:
"A society in which the most-honored professionals are those who practice a willingness to sacrifice the most for the well-being of others might even be one which is less likely to evoke the degree of hatred that underlies many acts of terrorism”.
Not so subtly, a nice piece of blame for Sept ll is portioned out to the "most honored" Americans. In our relatively wealthy and powerful country, we may at times appear, or be, arrogant, solipsistic, and ignorant. But those failings are certainly not limited to the "honored". With all due respect to professorial professionalism, I hope the good doctor will consider going back to the ethical kitchen to cook up something a bit more life sustaining; or at least tasty.
John Loofbourow
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