“Is Social Work A Profession?” Abraham Flexner School and Society 1915
The Historical Learned’ Professions contrasted with Professional as… “Not An Amateur”
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.
Learned’ Professions Law Medicine (Dentistry as a specialty) Clergy
“Knowledge Is Power” Baruch Spinoza Dutch philosopher Law: Power over Property Medicine: Power over Person Clergy: Power over Providence
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.
The extraordinary ethical responsibilities of the professional flow from the “power differential” existent between the professional and the person they serve.
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.
Professional Ethics… is based in the moral rule, “do you duty.” Ethics in dentistry derives from the role dentists assume in agreeing to enter into relationships with other humans to ‘do good’ for them with regard to their oral health. Our curriculum is an attempt to make explicit those “professional duties.”
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
The Covenant of the Physician by William F. May
In its ancient and most influential form a ‘covenant’ included... A pledge or promise An exchange of gifts A change of being
Marriage...A Contemporary Covenant Pledge or promise: the vows Exchange of Gifts: the rings Change of Being: husband/wife
Dentistry as Covenant... Pledge or Promise: –Society promises dentistry a monopoly to practice. –Dentistry promises to serve society faithfully and well. Exchange of Gifts: –Society gives dentists a state- supported and heavily subsidized education and the privilege of self-regulation. –Dentistry gives society its skills and talents.
Change of Being Ordinary individuals become ‘dentists.’ Other individuals become ‘patients.’ Without ‘patients’ dentists could not be ‘dentists.’ Without ‘dentists’ patients could not be ‘patients’ and the the beneficiaries of oral health.
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.
Covenant Reaffirmed On an individual basis each time two individuals meet in which one agrees to be the dentist or healer, and the other agrees to be the patient...to be healed. The duty of “doing good” for the patient’s oral health is rooted in the prior covenant of the profession with society, as a profession.
Reciprocity The patient gives self to the dentist in order to be the beneficiary of oral health. The dentist gives self to the patient in order to gain the fulfillment of service and receive a fee from which to support self and family.
Conceit of Philanthropy Health professionals (dentists) 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.”
“The Triple Contract: A New Foundation For Medical Ethics” A Theory of Medical Ethics, 1981 Robert Veatch
Triple Contract Social Contract Contract Between Society and Profession Contract Between Professional and Patient
“The patient-physician (dentist) relationship is the center of medicine(dentistry). As described in the patient-physician (dentist) 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 (dentistry) demands that physicians (dentists), individually and collectively, recognize the centrality of the patient-physician (dentist) relationship and resist any compromises of the trust this relationship requires.” Richard M. Glass Journal of American Medical Association, January 10, 1996