Professional Ethics

A commentator of considerable renown was expressing concern over our dissolving ethics in the United States during the postwar period and identifying the scapegoat as “the younger generation,” that segment of our population that questions the validity of our entire system of ethics to the consternation of their parents. The writer alluded to the conflicts in religion and philosophy and the explosion of scientific knowledge. He noted that the most popular philosophy teaches the young modern that the test of validity is “workability.” He further observed that those who have lived long enough have become reconciled or hopeless over the situation, but that the young who saw the poverty, the social injustice, and the emotional maladjustment between the individual and society did not accept that this was the way things had to be. The writer argued that it was the older generation who had sowed the wind and the younger who would reap the whirlwind, concluding on the ominous note that, “Never has the road been wilder nor the signposts fewer.” These remarks gained considerable currency in that they were published in the Atlantic Monthly by a no less quotable source than James Truslow Adams…in 1926!

In a recent address, Dr. James T. Laney, President of Emory University, expressed concern over what some have diagnosed as serious deficiencies in professional education and a corresponding decline in professionalism. He voiced dismay that traditional values were being displaced by career objectives associated with instant gratification of the good life—unbridled liberty and the pursuit of self-interest. To counter such drifts, it is as important for a faculty to provide worthy models of how to live as it is how to learn. In the inculcation of a professional ethos, schools should engender moral sensibility, restraint and commitment befitting a noble profession that is dedicated to serving the public trust beyond the selfish interests of the individual. Concern about our public image is not limited to the veterinary profession, but is symptomatic of a greater disaffection with all health professions. For a decade now, greater emphasis has been placed on accountability, grievance hearings, complaint investigations and due process. There has been rising public anxiety about the behavior of all professionals, the size of the health industry and moral dilemmas created by medical and technological breakthroughs. The health professions have been the object of increasing debate about everything from the high cost of health care to the depersonalizing of the patient. Legalistic remedy has become the court of first instance rather than last resort, and good medicine is defensive medicine regardless of the expense.

Why all this public attention to a normally quiescent branch of philosophy that has traditionally been an in-house concern dealt with in the process of policing our own ranks? Is not this the province of medicine that requires no instruction and brooks no trespass by the laity? Has not the professional degree long been accorded an unchallenged social cachet? The thinly veiled disdain for soft disciplines, together with a tradition of empiricism and positivism,1 has only served to heighten suspicion about any possible value of public discourse about biomedical ethics. However, there are always grounds for concern against what has been called the omnipotent paternity of physicians, which, when self-reliance reaches self-sufficiency, is easily construed as professional arrogance. This is especially true if viewed as a threat to the autonomy and dignity of the patient.

Contemporary Biomedical Ethics

In contrast to the patient-centered ethic, the veterinarian is accustomed to having to translate his3 role in manifold ways to human health, environmental safety and animal agriculture, as well as to the welfare of the patient. Humanitarian concerns and economic realities have always been interwoven, though not always coherently so. There is an increasing interaction between ethics, law and regulation, which appears to favor individual rights at the expense of the public interest. This situation is at least partially obscured by confusion between law and morality, the distinction often being left up to the court, with no little posturing by the government. This overuse of the language of rights trades heavily on the natural leanings of American individualism, which in this latter day seems to flourish paradoxically in the context of pluralism typical of the makeup
of our modern society, where individual interests have come to supersede the public interest. The rugged and self-reliant individualism of yesteryear sought only opportunity to engage in free enterprise and required of the government but to guard the coast and tote the mail. Today, this has been supplanted by the self-interest groups that seek more and more federal assurances and entitlements, provoking George Will to refer to this as “the Age of Entitlement.”

Intramural Relations

Whether it be members of a family or of a profession, conflicts are precipitated by divergent personalities and circumstances. Practitioners complain about their colleagues’ unprofessional behavior in unscrupulous business practices and disparagement of professional reputations. Institutional clinics are criticized for failure to communicate promptly with the referring practitioner, for failure to request referrals from clients or for disregard of any referral policy at all. Particularly sensitive nerves are the perceived condescension or outright criticism of the practitioner in front of students as well as clientele, and the discourteous treatment of valued clientele who have been carefully and properly referred. On the other hand, practitioners are faulted for using institutional clinics as dumping grounds for hopeless cases and deadbeat clients, for making little effort to provide complete or accurate case histories and for failing to provide follow-up care and reporting when the patient is returned home. Some doctors appear too ready to collect a fee for providing expert testimony in court proceedings against a colleague, or for providing a second opinion in a contested insurance claim.

Specialty boards are counseled to allow alternative pathways for the admissions process so that they are less liable for litigation on the grounds of discrimination or restriction of free trade and health care competition. Denial of degree, of license, of certification or any evaluation that may be translated as working papers must be careful to show proper respect for due process and to make public knowledge that institution’s appeals procedure for filing grievance by anyone who construes such denial as a violation of his/her civil liberties.