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In addition, many admissions committees are trying to preselect students who demonstrate the qualities needed to make tough ethical decisions, including compassion, empathy, reasoning, and the ability to listen and communicate, noted John Prescott, MD, AAMC chief academic officer. Joseph A.

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Ethical issues and quandaries are just below the surface in so many doctor-patient interactions, echoed Elaine C. Express regret or make an apology about an adverse medical outcome? Traditionally, difficult questions were delegated to ethics experts to debate and resolve.

Meyer noted that this approach has its place, but ideally, all doctors and health care professionals should have a working knowledge of ethics so they can flag potential conflicts early on. Otherwise, physicians resort to calling an ethics committee for a consult at the 11th hour when there is little time to reflect and make a thoughtful choice, she said. The best ethics education establishes the connection between ethical actions and better patient outcomes.

Some educators favor weaving bioethical case studies into other courses, as opposed to a stand-alone medical ethics course. But not so much that the integrated curriculum is invisible or ethics is treated like a peripheral issue, Carrese explained. Developing a bioethics curriculum is challenging, though. While the bioethicists identified assisted reproductive technology and preconception genetic testing as priorities in the education of bioethics trainees, the clinicians pointed to abortion, childbirth, contraception, infectious diseases, and sexuality as the areas that most frequently generated ethical questions.

Ethics is complicated today with complex issues like health equity, data privacy, and emerging debates about gene editing. This is not easy because a dilemma does not exist objectively but is in the eyes of the beholder.

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So choosing a story which elicits a dilemma feeling in the participants is deceive for stimulating deliberation and discussion in the group. The dilemma story must be about a behavioral decision which the protagonist must make: Either decide to do this or not to do this. He or she should have no third choice, and should have not much time to rethink or even rearrange the situation.

Moreover, in order to make a discussion possible it is important that the group's opinion on the protagonist's decision is evenly split. If only a very few, or nobody is on one side, there can be no discussion. But don't show disappointment tell yourself that we should be grateful for consens! The content of the moral dilemma story should always be adapted to the experience and the maturity of the students.

The story must not require knowledge which the particular participants do not have. For the teacher, it takes considerable competence and experience to design good dilemma discussion units. But once the teacher understands the basics, he or she will be able to construct good dilemmas on the spot, whenever it fits into the curriculum or seems helpful for other reasons. The approximate times for each step is indicated below. As the teacher gets more experienced he or she may vary this time schedule. Of course, one can offer more. But the additional effect will diminish.

It is wiser to use the resources to offer this learning experience to more people instead of concentrating on a few. It is also more moral and democratic. O ptimal Length of a Session. From my experience and that of many teachers, I regard the optimal length of a single discussion session is 80 to 90 minutes. The scheme below shows a two-hour dilemma discussion. Target Groups. The method of dilemma discussion has been used in a variety of schools and grade levels, with children as young as 10 years of age, and adults from various professional background.

From my own experience of about 20 years and from the experience of many teachers, we know that this method is highly welcome by students and by parents. It can change the whole learning climate of a class to the better, teachers tell me. I have witnessed many very lively and engaged dilemma discussions with students of grade level 5 to 13, college and graduate classes. From systematic evaluation of the impact of moral dilemma discussions the Blatt-method and the KMDD , we know that its best effects are achieved in grades 5 to Yet, high effect sizes have also be found with college and university students.

With another discussion format, the basic didactic principles of the KMDD may also be used with younger children. Conditions for a Good Dilemma Discussion. I have found the following conditions essential for achieving a good dilemma discussion:. It is not necessary that the teacher has studied moral philosophy. Acquaintance with important contributors to this field is helpful.

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I recommend especially the writings of John Dewey, Charles S. Whereas an ethics teachers has been instructed to "know" ethics better than their student, the director of those sessions are more effective if they are learners like their participants. My experience is that the better the teacher is prepared, the less he or she must intervene when the students enter the actual discussion phase. The students will be bored and profit little, if two dilemma discussions are run on the same day or within too short a time interval.

It can be easily adapted too many subjects and pedagogical intentions. Yet, the aims of moral education cannot be reduced to the scope of dilemma discussions. Other learning is as important, e. For the success of moral dilemma discussions, moral sincerity and scruple are of paramount importance. In contrast, such virtues are not necessary for rhetoric success, or may even hinder it. Learning How to Use the Method. I have designed and tested in Colombia and Germany a continuing education program for teachers of all subject areas for training teachers or directors of the Discussion Theater and Konstanz Method of Dilemma Discussion KMDD see flyer.

Going to Scale. Keeping in mind the cautioning note above , and the need of thorough training in this method, the Konstanz Method of Dilemma Discussion may be used as part of the core curriculum for all students and teachers. I believe that after twenty years of development and research, we should think about scaling-up the use of the KMDD. To facilitate the process of scaling-up the method, I recommend. Scaling-up of the KMDD is already taking place in many parts of the world. Information on the KMDD has been requested from individuals and institutions of more than 70 countries.

Similar and Alternative Methods. The following clarification is not meant to speak against any the mentioned methods; for many purposes they may be very well suited. But although both concepts are proteanly resistant to precise formulation, there are nevertheless significant and illuminating tensions, as well as interesting differences of emphases, between them.

First, then, one consequence of regarding a given occupation as a vocation rather than as a profession turns on the idea of significant continuity between occupational role and private values and concerns. Thus, it is common for the incumbents of so-called vocations the ministry, nursing and teaching to regard themselves, rightly or wrongly, as people whose lives are totally given over to the service of others parishioners, patients, pupils in a way that leaves relatively little room for the personal or private—and has, indeed, in the case of more than one vocation precluded any possibility of marriage and family.

In this respect, moreover, even if it should turn out that the time-honoured professions are able enough to match any traditional vocational devotion to service, the idea of profession does seem to be a more impersonally regulated one, and has often been constructed—in the alleged interests of clients—upon very precise separation of professional from personal concerns.

From this perspective, the lawyer or doctor may for reasons of professional detachment precisely seek to avoid that affectively charged concern for the personal welfare of others which is often characteristic of a good nurse, or that devotion to the promulgation of partisan doctrines and values which may be the measure of a good priest.

Ironically, this idea of significant vocational continuity between personal and occupational concerns and interests has probably been one reason why traditional vocations have been less well financially rewarded than the professions. It may even have been feared that raising the salaries of ministers, nurses or teachers would attract the wrong kind of people, those of a mercenary disposition, into the vocations.

At all events, there can be little doubt that teaching has often been regarded as a vocation, that it has also been regarded as the kind of occupation which people enter for love rather than money, and that it has also frequently been woefully underpaid. But there are also different ways in which teaching has been regarded as a vocation or, to put it another way, teaching has been liable to diverse vocational comparisons.

On this view, probably deepest entrenched in the traditions of public, grant-maintained and grammar schools, teaching is regarded as a very high calling indeed. This perspective inclines to conceive the teacher as someone who can in principle be looked up to as an exemplar of the very highest culturally enshrined standards and values, and as someone who possesses a range of virtues more than a set of skills.

Here, the contrast between vocational and professional views of teaching comes into sharp relief with respect to the ways in which teachers might attract criticism for failing to live up to the standards of their calling. One reason for including such views among types of vocationalism, moreover, is that a certain anti-professional stance—as we shall see later in this book—has been a recurring theme of such radicals. This is on the grounds that: first, it conduces more to the self-serving interests of professionals than the needs of clients; second, it has the concomitant effect of depersonalising and dehumanising education.

Professional conceptions However, although one need not doubt that most contemporary career teachers would readily identify and sympathise with at least some of TEACHING AND EDUCATION 13 these vocational priorities, it is arguable that there has over the years been a marked shift towards conceptions of education and teaching of more professional than vocational temper: conceptions, that is, which are more inclined to observe a fairly clear distinction between the private or personal, and the public or professional, and to define the occupation of teaching in terms of prescribed skills and rules of conduct.

There are, moreover, some fairly weighty reasons for this. For one thing, there are legitimate concerns reinforced perhaps by some of the worst excesses of radical and progressive attitudes in state schooling—about educational accountability to the practical needs and interests of parents, employers and the wider community. The point is that whereas the cultural custodian view is tailor-made for circumstances of cultural homogeneity in which teachers are required not only to transmit but exemplify a commonly shared set of values or virtues, circumstances of greater cultural heterogeneity and value diversity conspire to render any such conception at best inappropriate and at worst invidious.

It is for precisely this reason that the question of the neutrality of the teacher, and a corresponding perceived need to develop a conception of professionality which observes a clear line between professional obligations and personal commitments—in the interests, among other things, of avoiding indoctrination—has been a burning issue of post-war liberal philosophy of education. In this connection, we may first observe an important distinction of modern treatments of this question between restricted and extended professionalism.

The restricted version, however, conceives the skills and contractual obligations of the teacher somewhat more along the lines of trade expertise than professional knowledge—the expertise, one might say, of plumbers and electricians rather than doctors or lawyers. For the most part, restricted teacher expertise is taken to follow from familiarity with national or local policy guidelines and mastery, probably more in the field than the academy, of technical skills.

The responsibilities of restricted professionals are therefore almost exclusively defined in terms of technical competence, and more or less direct accountability or conformity to the requirements of external authority. To this extent, although we may still speak of restricted teachers as more or less professional according to their conformity or otherwise to such requirements, restricted professionalism scores poorly on that criterion of occupational autonomy which is often held to be a key ingredient of the professional lives of doctors and lawyers.

On this perspective, teachers are to be regarded, along with general practitioners or legal advisors, as possessors of a socially valued specialist expertise which requires lengthy education and training—precisely because teaching requires educated capacities for independent judgement, rather than mere training in obedience to authority.

Thus, just as we might well regard it as unacceptable for politicians or the general public—anyone other than those properly educated in complex issues of medicine and health care—to direct the decisions of doctors on important matters of medical policy and practice, so it could be considered inappropriate for TEACHING AND EDUCATION 15 politicians or employers to dictate to teachers what is or is not worthy of inclusion in the school curriculum, or what kinds of knowledge and skill are crucial for the professional conduct of teaching.

On this view, the teacher should be regarded as someone who, by virtue of a sophisticated professional education, is well qualified to exercise a higher understanding of the nature of learning and pedagogy in meeting the particular and local needs of individual children in particular educational circumstances. Notoriously, however, recent general erosion of professional autonomy, and a marked shift to more centrally prescribed training programmes, has almost certainly been fuelled by mounting contemporary political and public mistrust of what has sometimes seemed an arrogant professional reluctance to acknowledge any public accountability.

In this respect, however, an alternative strategy for bridling professional power, also a familiar feature of the recent political landscape of British and other liberal democracies, has involved surrendering control of professional activities to market forces.

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Ironically enough, such strategies for the control of professional monopolies in education and more widely were first proposed, in the form of voucher systems, by educational radicals of the s. But such ideas have been given a more recent neo-liberal lease of life in the form of such proposals as local or devolved management, which make school funding crucially dependent upon attracting parental custom in a climate of educational market competition. One effect, for example, can be seen in the growing popularity of inservice courses for professionals focused upon more managerial, particularly economic-administrative, aspects of schooling.

Analogies with teaching: similarity and difference Thus, at the end of a line of more or less plausible comparisons between teachers and priests, nurses, social workers or therapists, plumbers and doctors, we come finally to a systematic political attempt to cast the teacher in the role of the small businessman. Which of these conceptions, one might ask, is correct? Clearly, the question is unhelpful. One reasonable response is that teaching is assimilable to none of these occupations, it is simply what it is—teaching. Indeed, the pioneer of post-war educational philosophy, R.

However, as we saw in our initial exploration of the technical, aesthetic and moral dimensions of the activity of teaching, the educational project in which teaching is implicated is clearly a complex matter which might stand to be illuminated by cautious comparisons with some of these occupations. From this viewpoint, one would venture to suggest that an important lesson about educational professionalism is indeed contained in the custodial insight that the notion of an adulterous teacher is in its own way as professionally questionable as that of a drunken minister.

Similarly, few can deny that teaching is an activity which is at least like nursing or midwifery to the extent that it involves a significant dimension of affective care and support; the good teacher is invariably someone who is able to win the confidence and trust of those in his or her charge. It is also interesting to note that a comparison with midwifery is central to perhaps the first notable western philosophical exploration of educational initiation. Furthermore, even if there are considerable dangers in any overstated comparisons between the teaching world and the business world, there can be no doubt that the management of modern schools is a complex fiscal and administrative matter which may stand to profit so to speak from lessons from the business world.

Moreover, there is much to be said for the view that schools do need to be more mindful than they may formerly have been of the best hopes and aspirations of parents for their children, and to be appropriately accountable to the practical needs and interests of the wider community and economy. What then of the idea that teachers are to be compared to or included in the same category as such time-honoured professionals as doctors and lawyers?

Although comparing teachers to doctors and lawyers is no less fraught with hazards than other analogies, I shall argue that the comparison is not entirely inappropriate—and, more importantly, that there is enough to the comparison to sustain a significant discourse of professional ethics with regard to educational practice.

I do think, as we shall see, that there are difficulties about thinking of teaching in the same professional terms as medicine or law. It seems likely that teachers cannot realistically aspire, even in principle, to quite the same degree of professional autonomy as doctors or lawyers, and one reason for this is that, although the social and economic implications of the educational project seem to be as serious and significant as those of medicine or law, there is not the same degree of asymmetry between professional and lay expertise in the case of teaching as with medicine or law. Thus, although the general public have no less a vested interest in the state of health and justice than they have in the education of their children, they are less well placed than doctors or lawyers to pronounce authoritatively on the rightness or wrongness of this or that esoteric aspect of medical or legal practice.

Moreover, irrespective of expertise, members of the public are in another sense more entitled to their own perspectives in any disagreement with educational professionals. If, for example, a child is suffering from a serious medical condition for which the only clear remedy is surgical intervention, it would be irrational or irresponsible of a parent to take him or her instead to a faith healer.

However, it may be neither irresponsible nor irrational of a parent to reject the verdict of an educational professional on what a child needs by way of knowledge or discipline, in favour of an alternative considered view of human flourishing. In short, the professional word does not seem as final in the case of education and teaching, as it clearly can be in matters of medical or legal practice—although again the line here is, as I shall also argue, by no means hard and fast.

Moreover, it will be central to the present case that the need for a high degree of ethical sensitivity on the part of educational professionals arises precisely from the essentially contested character of the educational enterprise: the fact that there is much debate and controversy about the point and purpose of education, and about what in the nature of human flourishing it should be concerned to promote.

For irrespective of any and all reasonable points of comparison between teaching and such other occupations as the priesthood, nursing, social work, plumbing, medicine and commerce, it should also be clear that there are tensions and potential inconsistencies between such comparisons, and that there could be no possible reconciliation of all of them in one coherent conception of educational professionalism. Moreover, even if it is possible to achieve some kind of general reconciliation of the vocationalism of cultural custodians with more recent conceptions of professionalism, there would still clearly be differences over matters of professional and other authority between any such position and that of educational radicals and progressives, for whom the very language of professionalism seems anathema.

And so on, and so forth. These are some of the issues which we shall need to revisit in the following chapters. What is now required, however, is a closer look—with particular regard to questions of the professional status of education and teaching —at concepts of profession and professionalism as such. Is it appropriate to regard teaching as a profession? It is tempting to suppose that this question is of little moment, if not actually meaningless. For one thing, it might be said with some justice that the line commonly drawn between professions and non-professions is a quite artificial one.

For another, it may be also said with even more justice that an occupation does not have to be regarded as a profession in order to be the focus of moral issues; for that occupation to be, in other words, one to which questions of professional ethics are relevant. But although I think that there is something to both these claims, I nevertheless think that the question of the professional status of teaching is an important one, and that however we answer it has significant implications for our precise conception of the ethical issues which it characteristically engenders.

Indeed, we are already able to see from the last chapter that different ways of conceptualising teaching—as a vocation like priesthood or nursing, a profession like medicine, or a trade like plumbing—can have significant implications for thinking about the character and extent of the moral and other responsibilities of teachers. Hence, in this chapter, we shall attempt to sketch a rough-and-ready account of what it might mean for an occupation to qualify for the status of profession—an account which, moreover, emphasises the centrality of ethical or moral concerns and considerations.

And subsequently, in Chapter 3, we shall try to see how the occupation of teaching or the practice of education stands with respect to this account. In this sense, professionality and professionalism are the requirements of a particular class or category of occupation which is usually taken to include doctors and lawyers, may well embrace teachers and clergymen and other members of socalled vocations —but traditionally excludes plumbers, joiners and other tradesmen.

It may be doubted, all the same, whether there is much substance to such general categorial distinctions between types of occupations. Indeed, it seems to be a fairly common sociological view that such distinctions reflect little more than differences of social or class status —perhaps a relic of medieval guild or other restricted practices.

Indeed, on a radically sceptical version of this view—which we shall shortly examine in a specifically educational version—the so-called professions are to be distinguished from other occupations almost exclusively in status seeking and self-serving terms. It therefore seems worth asking what might have served to distinguish those occupations commonly regarded as professions from other occupational categories.

It is also sometimes said that some occupations— such as medicine doctoring and the law—count as full professions by dint of fulfilling most or all of these criteria, whereas others—teaching or nursing perhaps—count merely as semi-professions 2 by virtue of satisfying only some of them. Though, as we shall see, the force of this distinction may turn in part on whether the criteria are meant to be descriptive or prescriptive. At all events, it is clear that an ethical dimension of professional practice features quite explicitly in the third criterion—as well as implicitly in others; moreover, once we begin to explore conceptual connections between the criteria, it should become clear that all are implicated in the ethical in ways which serve to lend a distinct character to professional as opposed to other occupational concerns.

The ethical dimensions of professional engagement How, then, do we begin to put all of this to work in distinguishing the idea of profession from other occupations and professional from other occupational concerns? We could start with a very basic observation about professional practice; namely, that it is precisely and primarily, like any trade, a matter of intelligent practice.

But one difference upon which a distinction between profession and trade might here be said to turn is—as indicated in point ii above—that professional training cannot be solely a matter of hands-on apprenticeship in the manner of carpentry or hairdressing; a surgeon or a doctor is rightly required to have mastered a good deal of complex —perhaps scientific—knowledge, information, theory and hypothesis before he or she is allowed to practise on patients.

Moreover, there would appear to be a link -though by no means a straightforward one —between the theory implicatedness of professional practice and the need for professional autonomy as specified in point v above. Indeed, while it is because the professional is liable to encounter novel problems and dilemmas to which there are not established or cut-and-dried technical answers that he or she requires thorough acquaintance with the best which has been thought and said on such potential difficulties, professional theory is by the same token more often advisory than precisely prescriptive—and responsible professional decision depends in a large part on the quality of personal deliberation and reflection.

So v is connected to ii mainly via the idea that although the professional needs to act in the light of independent thought, this must mean thought informed by principles of intelligent professional practice. But now, in so far as thorough mastery of the theories, principles and skills presupposed to effective professional practice is likely to be a sine qua non of admission to full professional status, point iv would seem to be linked to ii —for, to be sure, it is often regarded as crucial to fixing the boundaries of what shall be counted as acceptable conduct, and to ensuring control over standards, that professions should be organised to restrict entry and deal with professional ineptitude; the British General Medical Council is an example of a professional organisation established to achieve these goals for the medical profession.

All the same, this hardly serves to identify what is distinctive of professional organisation—since there were formerly guilds for achieving these ends for trades. The key idea regarding professional organisation would seem to relate more to the consideration that mastery of theories, principles and skills cannot be sufficient for fitness to practise, since it is quite possible—indeed, too often happens—that a professional with proper and adequate theoretical knowledge and skill nevertheless behaves inappropriately towards a patient or client.

It is this consideration which brings us more directly to the idea expressed in point iii that there is an important ethical or moral ingredient to professional organisation, whereby someone may be judged unfit to practise professionally because, despite their possession of relevant theories and skills, they lack appropriate values, attitudes or motives. On this view, any profession worthy of the name ought to be governed by a code of professional ethics which clearly identifies professional obligations and responsibilities by reference to the rights of clients or patients.

What is a code of professional ethics? From this point of view, doctors are enjoined to eschew abuse of their power or authority for the financial, sexual or other exploitation of patients.


Thus stated, the idea may be regarded as a notable anticipation of the basic theme of a much later influential moral theory which claims that one should always treat people as ends in themselves rather than as means. Although we should not for a moment deny that there are virtuous tradesmen or salespersons, or that the moral dimension of service to others is often acknowledged in nonprofessional occupations, it is arguably not as centrally implicated in such spheres as it is in professional practice—or, if it is, this might well be a reason for elevating what have hitherto been regarded as trades to the status of professions.

For one thing, although a builder renowned for the effectiveness of his skills may also be honest and fair, he is not less likely to be highly rated qua builder on the grounds that he shortchanges or sleeps with his clients—whereas these would be reasons for regarding doctors, lawyers or teachers as bad exemplars of their respective occupations. Again, whereas a good professional is one who is scrupulous in observing and meeting what he or she takes to be the exact needs of patients—giving, as it were, full value for money—the automobile or snake oil salesman of the year might just be the one who manages to sell the shoddiest goods for the highest profit to the largest number of gullible customers although a good salesman is for purely commercial reasons also likely to want to avoid a reputation for this.

Thus one might conclude that, whereas a good tradesman or salesperson is first and foremost someone who is procedurally skilled— irrespective of any other virtues—a good professional has also to be someone who possesses, in addition to specified theoretical or technical expertise, a range of distinctly moral attitudes, values and motives designed to elevate the interests and needs of clients, patients or pupils above self-interest. On such a view, any full professional initiation must require, alongside training in theoretical and technical knowledge, some explicit instruction in the moral presuppositions of professional involvement—possibly extending to systematic initiation into current formal theories of deontic usage.

In the event, there appear to be different ways in which those responsible for professional education have recently sought to acknowledge and accommodate the ethical dimensions of professional engagement. Second, as we shall shortly consider more closely, the competence models of training which have recently overtaken professional preparation in such occupational spheres as teaching and social work aim to combine instruction in the technical skills of good practice with the cultivation of a range of attitudes and values more often than not apparently secondary to the specification of technical skills reflecting the top-down decisions on what is or is not acceptable in the way of proper professional conduct of central and local authority guidelines.

In short, either professional ethics is conceived as an extra theoretical component in courses of professional education, or the ethical aspects of professionalism are reduced to just so many extra practical competences to be quasi-technically acquired through training. Some attention to the only criterion of professionalism which we have not yet considered, however, may serve to cast suspicion on both these ways of incorporating the ethical into the professional. On the face of it, criterion i above—that professions provide an important public service—seems trivial to the point of vacuity.

After all, there could hardly be any occupation which does not count as an important public service in some circumstance or other. Indeed, if my kitchen is flooded because of a burst water pipe, it is likely to be a more urgent matter that there is a plumber near to hand than that there is a doctor or lawyer in the vicinity.

So the first criterion clearly stands in need of some filling out if it is going to do much in the way of serious conceptual work. One possible way of giving greater content to this dimension of professionalism, however, is to recognise that the services provided by professionals —adequate health care, legal access, educational provision, and so on—appear to constitute human necessities of a kind that the services of a hairdresser, joiner, electrician or builder do not.

Of course, we should probably distinguish here between different kinds of necessity: given basic human needs for food, shelter and clothing, those trades and services which supply these are to that extent essential. But beyond problems of house-less heads, unfed sides and looped and windowed raggedness, human flourishing is also clearly liable to be undermined by the absence of an adequate health service, educational or judicial system—or what we might call civil necessities. In this connection, it is significant that the kind of services that professionals are in business to provide have increasingly come to be regarded as human rights; thus, just as post-Enlightenment philosophers have been prone to speak of basic human rights to life, liberty and freedom of thought and association, so many of the services now under the control and direction of the more or less established traditional professions—health care, legal aid, arguably education, and so on—are apt to be characterised as welfare rights.

And, while the moral and metaphysical status of rights continues to be a matter of serious philosophical dispute, there can be no doubt that talking of rights to education, health care and legal access seems to make more sense than talk of rights to good plumbing, hairdressing, car maintenance or an annual holiday abroad. Indeed, as already noted, perhaps the best philosophical handle we are likely to secure on the righthood of health care, education and legal redress is in terms of a notion of what is necessarily or indispensably conducive to overall human flourishing; whereas it is, one might say, merely contingent to such flourishing whether one has a new car, a Swiss watch or a decent manicure, it is something close to a necessary truth—something true, as some philosophers would say, in all possible worlds—that human life per se is bound to be impoverished in circumstances where disease, injustice and ignorance are rife and their remedies in short supply.

It is presumably in the spirit of some such consensus that Aristotle4 maintained we deliberate in practical matters about the means rather than the ends of action; thus, in principle at least, the physician deliberates not about whether but how he should heal, the lawyer not about whether but about how he should promote justice, and so on. But, of course, in another sense—a sense which is precisely connected with our uncertainties about appropriate means in just such spheres—it is exactly about these otherwise agreed preconditions of human flourishing that we do deliberate.

Thus, though no sane person could doubt that it is a bad thing to be diseased, oppressed or ignorant, very sane and sensible people do debate about what constitutes genuine or adequate education, justice or health care. Again, we may raise the point about the contentiousness of professional as distinct from other concerns by noting that although we can attach real sense to the idea of a philosophy of law, health or education, we should be hard put to make much of a going concern of any philosophy of plumbing, hairdressing or cooking—and this is precisely because serious questions arise in the former but not in the latter cases about what these concepts actually mean.

Professions as moral projects Since professional services purport to conduce to human flourishing via the promotion of health, legal entitlement, social security or whatever, they are philosophically problematic in the manner of moral concepts—precisely because they are themselves moral projects; thus, professionals are from the outset involved in the practice of activities and endeavours whose ends and purposes are matters of genuine ethical controversy. Appreciation of the ethical, in short, must lie at the heart of any professional understanding and deliberation worthy of the name.

But if we are right in taking this to be a direct implication of our enhanced construal of the first criterion of professionalism, it must have consequences for our understanding of other criteria. Consider, first of all, criterion ii : that professional competence cannot be merely practically acquired but requires significant theoretical knowledge.

How the Four Principles of Health Care Ethics Improve Patient Care

But aside from the consideration already adduced that any idea of a straightforward link between theory and professional practice is itself problematic—since competing theories may well lay claim to our allegiance in a given professionally problematic situation —the very idea of professional theory seems prone to ambiguity. Clearly, however, principled reflection on such perspectives is not theoretical in anything like the same sense as natural or social scientific theory; indeed, in the spirit of an important distinction pioneered by Aristotle,5 we may observe that what is here called theory is often enough a matter for normative or evaluative rather than scientific or theoretical reflection, focused on the pursuit of what is good rather than upon the discovery of what is true.

Again, as we shall later try to show, this is not to endorse any strict postHumean distinction between fact and value—for clearly human values and the success of our projects must be in some sense influenced by considerations about how things are in a world independent of our wills; but, because human goals and aspirations are often practically inconsistent, the evaluative or normative is considerably underdetermined by the evidential in human affairs and inferential relations between theoretical or truth-focused reflection and evaluative deliberation are far from straightforward.

But just as educational deliberation involves highly complex interplay between the evidential and the evaluative, so it appears on closer scrutiny do forms of theoretical reflection in such areas of professional concern as medicine and law. Hence, we may include among fundamental professional questions for example : what are to be counted as genuine illnesses for the purposes of institutionalised medical treatment, what should be regarded as conduct to be criminalised for the protection of society rather than as personal preferences of more private than public concern—as well as, arguably, how we may justly frame educational policy in the light of individual differences of ability.

But though these are questions to which the facts of the matter are clearly relevant, and upon which theory and evidence may be brought to bear, they cannot be decided by the application of theory in this sense in any straightforward instrumental or technical way. First, consider the cruder competence conceptions of professional preparation. Whereas competence conceptions of nonprofessional trades and services are usually little more than lists of skills to be mastered, competence models of professional training, especially in such areas as education and social work—where there has been much central pressure to adopt them—have generally acknowledged both the significance of theory for professional practice and the need for some kind of moral preparation via the cultivation of right attitudes and values.

Nevertheless, it is common for such models to conceive professional expertise as a matter of the acquisition of a kind of technology—of a repertoire of skills based upon the findings of value-neutral social-scientific research—to which some notion of the cultivation of right interpersonal attitudes and values is added as an apparent afterthought.

Indeed, since it is the whole point of a competence model to try to identify uncontroversial skills and attitudes which are likely to be needed by any professional come what may, it is hard to see how such a model could proceed otherwise. But from what has already been said about the essential contestability of the goals of most professional conduct, it seems implausible to view professional expertise in this technicist way—and, as we shall see, it is rare to find anything much in the way of detailed specification of value-free technical skills in lists of professional competences for teachers.

Indeed, skills of teaching and discipline appear to be context-dependent to the extent that what counts as such a skill on one educational conception might not so count on another. Moreover, lists of professional attitudes and values—honesty, devotion to duty, respect for others—are also offered as though there are completely uncontroversial and agreed interpretations of such qualities and dispositions.

Moreover, in pretending to a professional consensus which does not really exist, it discourages healthy professional disagreement about aims and methods, which is vital both to the development of professional autonomy—that mature independence of judgement mentioned in criterion v —and to wider informed debate about matters of general public concern. But is this not precisely a case for the introduction into programmes of professional preparation of specific professional ethics courses in which ethical specialists can explore with trainee professionals the complexities of professional dilemmas?

To be sure, since much is likely to turn here upon the nature of such courses—particularly perhaps upon their relationship to other parts of the professional curriculum—the idea of such specific ethical components should not perhaps be condemned outright. But there can also be little doubt that such ways of dealing with the ethical implications of professional involvement are liable to be distortive or misleading in a not entirely dissimilar way to the reductive strategy of competence models.