“If you wish to converse with me, define your terms.”

1. “If you wish to converse with me, define your terms.” Voltaire French philosopher 1694-1798

2. THE CONCEPT OF PROFESSION “What Does It Mean To Be A Member Of A Profession…A Professional?”

3. What Is A Profession? Who AreProfessionals?

4. “Is Social Work A Profession?” Abraham FlexnerSchool and Society1915

5. The Historical Learned’ Professions contrasted with Professional as… “Not An Amateur”

6. Characteristics Of A Profession(al) • Work is primarily intellectual • Work is based in science and learning • Work is practical • Work can be taught and learned • Organized in democratic collegial units • Exist to achieve societally defined goals rather than self-interest of its members.

7. Learned’ Professions • Law • Medicine • Clergy

8. “Knowledge Is Power”Baruch Spinoza Dutch philosopher • Law: Power over Property • Medicine: Power over Person • Clergy: Power over Providence

9. Characteristically professionals ‘profess’ (promise, avow) a technical competency based on a tradition of advanced learning/education for which they will be morally accountable in placing this expertise at the service of society. The concept of profession is deeply rooted in the notion if “making a promise” to‘another.

10. The extraordinary ethical responsibilities of the professional flow from the “power differential” existent between the professional and the person they serve.

11. Professional Relationship is Fiduciary • To be a fiduciary means to stand is a special relationship of trust, confidence or responsibility to another. • Professionals are in a fiduciary relationship due to the power they hold over others; power based in knowledge. They “know” when others do not. • Therefore, others must trust them to use the knowledge they have in their best interest.

12. Professional Ethics… • is based in the moral rule, “do you duty.” • Professional ethics derives from the role professionals assume in agreeing to enter into relationships with other humans to ‘do good’ for them with regard to the unique expertise of the professional.

13. The Nature of the Professional Relationship • Metaphors are figures of speech in which we use a word or expression that is typically used to designate one thing is used to designate another, thus making an implicit comparison; suggestion one idea as analogous to another. “All the world’s a stage.” • Using ‘covenant’ and ‘contract’ as metaphorically to further understand the nature of the relationship between professionals and society

14. TheCovenantofthePhysician by William F. May

15. In its ancient andmost influential form a ‘covenant’ included... • A pledge or promise • An exchange of gifts • A change of being

16. Marriage...A Contemporary Covenant • Pledge or promise: the vows • Exchange of Gifts: the rings • Change of Being: husband/wife

17. Public Health as Covenant... • Pledge or Promise: • Society promises public health a monopoly to practice. • Public health as a profession promises to serve society faithfully and well. • Exchange of Gifts: • Society gives public health professionals a state-supported and heavily subsidized education and the privilege of self-regulation. • Public health gives society its skills and talents.

18. Change of Being • Ordinary individuals become ‘public health professionals.’ • Other individuals become ‘clients.’ • Without ‘clients’ public health professionals could not be such. • Without ‘public health professionals clients could not be ‘clients’ and be the beneficiaries of public health expertise.

19. Descriptive Statements and Performative Statements • There is a distinction to be drawn between descriptive statements and performative statements. • Descriptive statements report a fact: “It is raining.” • Performative utterances do not merely describe, but alter the world: “I, David, take you Phyllis.” • The marriage ceremony is a performative occasion, it changes the world for two people. • The professional relationship is similarly promissory and therefore performative, changing the ordinary relationship between two people to an extraordinary one, based on promise and trust.

20. Covenant Reaffirmed • On an individual basis, each time two individuals/groups meet in which one agrees to be the public health professional and the other the client...to be helped. • The duty of “doing good” for the client is rooted in the prior covenant of the profession with society, as a profession.

21. Reciprocity • The client gives self to the public health professional in order to be the beneficiary of their knowledge in public health. • The public health professional gives self to the client in order to gain the fulfillment of service and receive a fee from which to support self and family.

22. Conceit of Philanthropy • Health professionals consistently proclaim their service to mankind. • This idea of service succumbs to the “conceit of philanthropy” when the professionals relationship to patients is assumed to be gratuitous…rather than reciprocal; is condescending. • There is mutuality/reciprocity in the relationship flowing out of the “covenant.”

23. “The Triple Contract: A New Foundation For Medical Ethics” A Theory of Medical Ethics, 1981 Robert Veatch

24. Triple Contract • Social Contract • Contract Between Society and Profession • Contract Between Professional and Client

25. “The patient-physician relationship is the center of medicine. As described in the patient-physician covenant, it should be a ‘moral enterprise grounded in the covenant of trust.’ This trust is threatened by the lack of empathy and compassion that often accompany an uncritical reliance on technology and by present economic considerations. The integrity of medicine demands that physicians, individually and collectively, recognize the centrality of the patient-physician relationship and resist any compromises of the trust this relationship requires.” Richard M. GlassJournal of American Medical Association, January 10, 1996