They are, at best, good partial representations of the content of the profession's norms and obligations. The full content of these norms is the fruit of an ongoing dialogue between the expert group and the larger community, on whose recognition of expertise and grant of professional autonomy the expert group depends for its status as a profession.
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Therefore, the effort to answer such questions as "What professional norms apply to this situation? Determining a profession's norms is therefore a much subtler enterprise than it might seem. Even the well-known moral categories of autonomy, beneficence, maleficence, and justice are only a useful starting point. Another way to examine a profession's norms is in terms of nine categories of professional obligation that have been identified from studies of numerous professional groups Ozar and Sokol.
Each of these categories provides a set of questions about a profession's norms for use in personal reflection on one's obligations, in scholarly study, and in professional ethics education. Every profession has a chief client or clients, which is a category or categories of persons whose well-being the profession and its members are chiefly committed to serving. The English language does not have a satisfactory generic noun to refer to the person or class of persons whom a profession serves. Beneficiary is etymologically correct but is clumsy and typically associated with trusts or insurance.
Client is too commercial in its connotations, but it seems better than any other term for present purposes. For some professions, the identification of the chief client seems quite easy. Surely, one might say, the chief client of a physician and a nurse, for example, is the patient. But who is the chief client of a lawyer?
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Is it simply the party whose case the lawyer represents or to whom the lawyer gives advice? Lawyers are told and they announce in their self-descriptions and codes of conduct that they have obligations to the whole justice system; therefore, there are things that they as professionals may not ethically do, even if doing them would advance the situation of the party they represent or advise.
Once this sort of complexity about the chief client is noticed, even those cases that initially appear simple prove more complex. The physician and the nurse must attend not only to the patient before them, for example, but also to those in the waiting room or to the other patients on the hospital unit, and so on. In fact, they have some obligations to all the patients in the institution where they work, or to all their patients of record if they are in private practice. They also have significant obligations to the public as a whole; for example, they are obligated to practice with caution so as not to spread infection from patients they are caring for either to themselves or to other patients.
In all cases, this question about the chief client is one of the first questions that must be asked if a particular profession's obligations are to become clear: Whom does the profession principally serve?
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Every profession is focused only on certain aspects of the well-being of its clients. The professions' rhetoric to the contrary, no professional group is expected by the larger community to be expert in their clients' whole well-being or to secure for its clients everything that is of value to them. There is, rather, a certain set of values that are the focus of each profession's expertise, and it is the job and obligation of that profession to work to secure these values for its clients. These values can be called the profession's central values.
Most professions are committed to pursuing more than one central value for clients. For example, whatever other values are central for a given profession, the value of client autonomy is ordinarily a central value as well.
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Efficiency in the use of resources may have a similar standing. In any case, if there is more than one central value for a given profession, the question can then be asked whether these values are all equal in rank, or whether the members of the profession are committed to choosing them in some ranked order when they cannot all be realized at once. For example, the values proposed as the central values that the dental profession is committed to pursuing for its patients, in order of decreasing importance, are: life and general health; oral health understood as appropriate and pain-free oral functioning ; patient autonomy i.
Every profession needs to ask and answer the question: What are its central values? What specific aspects of human well-being is it the task of each member of this profession to secure for clients? And if there are more than one, which takes precedence? The point of the relationship between a professional and a client is to bring about certain values for the client that cannot be achieved without the expertise of the professional.
To achieve this, the professional and the client must both make a number of judgments and choices about the professional's interventions. This third category of professional norms addresses the proper roles of the professional and the client as they make these judgments and choices. In addition, because the ideal relationship is described in regard to fully functioning adults, a profession's norms must also include how its members are to interact with clients who are not capable of full participation in decision making about professional interventions.
Such clients might include children, the developmentally disabled, and persons whose capacity to participate is diminished by fear, illness, or other conditions. Most sociologists who study professions mention "commitment to service" or "commitment to the public" as one of the characteristic features of a profession. Similarly, most professional organizations' codes of ethics and other self-descriptions give clients' best interests or service to the public a prominent place.
But these expressions are subject to many different interpretations with significantly different implications for actual practice. Consider, for example, what could be called a "minimalist" interpretation of this general norm.
According to this interpretation, a professional would have an obligation to consider the well-being of the client as only one of the professional's most important concerns. This is called a minimalist interpretation because if any less consideration than this were given, the client's well-being could not be said to have any priority at all for the professional. On the other hand, according to a "maximalist" interpretation, the professional has an obligation to place the well-being of clients ahead of every other consideration, both the professional's own interests and all other obligations or concerns that the professional might have.
It is doubtful that either of these interpretations accurately represents what the larger community wants or understands in this matter. Professional obligation almost certainly requires that members of a profession accept certain sacrifices of other interests in the interest of their clients. On the other hand, even if it were only for the sake of assuring a continued supply of professionals to meet its needs in the future, the larger community certainly would not actually require the commitment of a member of any profession to be absolute or to impose the utmost of sacrifices for the sake of the client's well-being in all circumstances.
The actual content of professional obligation in this respect lies somewhere in the middle. Each professional group therefore has, as an element of its obligations worked out over time in dialogue with the larger community, an obligation to accept certain kinds of sacrifices, certain degrees of risk in certain matters, and so on. For health professionals there is a degree of risk of infection, accepted in order to serve their clients.
In other professions it may be primarily a risk of financial loss, social loss, or criticism. In any case, it should be a part of reflection on every profession's ethics and a part of all professional ethics education to raise this issue and to try to identify the kinds and degrees of risk that are part of that profession's obligations. Every professional is obligated both to acquire and to maintain the expertise needed to undertake her professional tasks, and every professional is obligated to undertake only those tasks that are within her competence.
Competence is probably the most obvious category of professional obligation.
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It is also the easiest to describe in a general way. For if a professional fails to apply his expertise, or fails to obtain the expertise for undertaking some task, these failures directly contradict both the point of being an expert and the very foundation of the larger community's award of decision-making power to the professional in the first place. But determining what counts as competence on the part of a member of a given profession, both in general and in relation to specific tasks, is a complex matter.
In practice, and almost of necessity, detailed judgments about requisite expertise are left to those who are expert—to the profession itself.
But the larger community usually requires that explanations be given regarding the general reasoning involved. In particular, the community should understand the risk—benefit judgments involved in every determination of minimal competence. For as the level of competence identified as the minimum acceptable in some matter is raised, the relative availability of that level of expertise to the profession's clients will fall, and these trade-offs should be made in dialogue with the larger community, not unilaterally by members of the profession alone.
Each profession also has norms, mostly implicit and unexamined, concerning the proper relationship among members of the same profession in various matters and also among members of different professions when they are dealing with the same client. Some elements of the proper relationship between a family practitioner and a renal specialist, for example, are not matters of etiquette, but they bear directly on the medical profession's ability to achieve its proper ends.
The same is true of relationships between physicians and nurses, dentists and dental hygienists, dentists and physicians, and so on, when they are caring for the same patient, and between architects and engineers when serving the same client. Some aspects of these relationships are dictated by each professional's obligation not to practice beyond her competence and so to seek assistance from other professionals when a particular matter requires expertise that the first professional does not possess.
But other aspects of co-professional relationships are also governed by professional norms, though they are rarely explicit. For example, how should coprofessionals communicate with a client about their differing recommendations for the client when these differences derive not from differing interpretations of the facts, but from differing philosophies of practice within their different professions or from their professions' different or differently ranked central values?
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The activities of every profession also involve diverse relationships between the profession as a group, or its individual members, and persons who are neither co-professionals nor clients. These relationships may involve the larger community as a whole, various significant subgroups, or specific individuals. Every profession, precisely because it is permitted to be self-regulating, for example, owes the larger community the effort needed to carry out this task conscientiously. This includes providing and monitoring educational programs and institutions in which new members of the profession receive their formation as professionals; monitoring the collective activities of members of the profession in their various professional organizations to make sure that these organizations act in ways consistent with the other professional obligations of the members; and having measures in place to monitor and correct incompetent or other professionally inappropriate practice on the part of individual members of the group.
Each profession has an educational obligation to the larger community. The reason is that both through actions of its individual members and through collective actions, every profession functions as the principal educator of the community regarding those elements of the profession's expertise that the lay community needs to understand in order to function effectively in ordinary life.