August 2007 | Back to Table of Contents

Perspective

Role and Responsibility

By Robert G. Kennedy, Ph.D.

Professionals solve society’s toughest problems.

When we call someone a professional, we often mean no more than that this person does certain things for money, as opposed to an amateur who does them for pleasure or love of the work. If this is all we thought about professionals, we would miss something far more important. Professionals often earn a living from what they do, but what truly distinguishes them is the unique contribution they make to the community.

In every society, the function of some members is to design and implement solutions to old problems and confront the new and unexpected ones successfully. In primitive societies, those people might use magic or elicit the cooperation of spiritual beings. In more developed societies, magic and idolatry are supplanted by the efforts of those who bring specialized knowledge and skill to bear on the problems of everyday life in all its dimensions.

Professionals, in a sense, live on the cutting edge between the tried and true and the new and uncertain. Society depends on them to provide reliable, fixed standards (of health, of justice, of truth, etc.) in situations where the facts are murky or the temptations strong. Their principal contribution is an ability to bring sound judgment to bear on these situations. They represent the best a particular community is able to muster in response to new challenges. By employing their knowledge, they are able to draw an increasing number of problems into the category of the predictable and manageable. Modern society, in many ways, is the product of professional activity.

Nowhere is this more true than in medicine. Physicians are the role models for other professionals. Perhaps in medicine we can see most clearly what it means to make sound judgments in conditions of uncertainty, both in diagnosis and in determining treatment. And we can certainly see how public health, to name one area, has produced dramatic changes in human life everywhere on earth.

Professionals emerge in new areas as we develop new capacities for making sound judgments and, therefore, expanding the areas of life that we can manage routinely. Occupations that were once more simple can become professional. At the same time, professionals in established fields, if they do not play their role well, can devolve into mere technicians.

The ability of professionals to play their role well, to make sound judgments in their areas of competence, depends in turn on three factors: The professional must possess specialized knowledge, make critical commitments, and have a large degree of autonomy in decision making. When these elements are present, and when someone has built on them a capacity for sound judgment, we are justified in speaking of this person as a professional. Let’s consider in more detail what these elements involve.

Specialized Knowledge
At the very heart of professionalism is specialized knowledge, knowledge accumulated and ordered over time by the experience, analysis, and insight of one’s predecessors in the field. It is knowledge that gives its possessor an understanding not only of how things are but why they are. It is also hard-won knowledge that requires time and effort to possess, knowledge that many people cannot achieve. Finally, it is powerful knowledge; and historically those in a position to pass it on have demanded some evidence from students that they are worthy to receive it.

The professional, as a result, is never self-made. The professional is deeply indebted to others. Principal among those others are predecessors in the field who have discovered and systematized the knowledge and passed it on. But the professional is also indebted to the community. Virtually all professional education these days is heavily supported by the community (for example, tax exemptions for universities) because it values the contributions of the professional so highly and because it expects that professionals will be there to serve them when needed.

Professionals are, therefore, obligated to use their knowledge well. Since this specialized knowledge is powerful and can produce great benefits if used well and great evils if used badly, professionals have generally been careful to share their knowledge only with those committed to using it well.

Commitment to Service
To be a professional, to “profess,” is to stand for something in a public context, to make a public promise to the community. The first thing that a professional professes is commitment to address problems according to the principles and practices of the discipline. A physician in North America or Europe, for example, adopts an approach to medicine that is based on the physical sciences and the scientific method. A civil engineer also makes a commitment to abide by a set of standards intended to ensure the safety and integrity of physical structures. Someone relying on a professional knows in advance something about how that person will deal with matters related to their area of expertise.

The second commitment a true professional makes is to serve others. That is, professionals promise to use their special knowledge primarily to serve the public and not themselves. This does not mean that professionals must be selfless. Quite the contrary, they may be well-compensated for what they do. However, their first concern in making decisions must always be the benefit to the person or the community served. Furthermore, they place themselves at the service not only of their friends and neighbors, but of strangers as well. They are public persons and so have an obligation to serve those in need, regardless of personal relationship.

We expect from professionals a higher level of dedication than we would from others. At times that means we expect them to work long or unusual hours, or to place themselves at some risk, or to serve when they may not be paid, or to tell the truth no matter how unpleasant, or to do any of a number of other things that we would not always expect of ourselves.

We also need to resist seeing professional practice primarily in economic terms. The relationship between professionals and those they serve is not merely a transaction (which would imply an exchange of equal values) but rather a transformative encounter—one that is personal and benefits the client, patient, or student in more than material ways. Professionals of all sorts must keep in mind that, however much they may be paid for what they do, the real objective and value of their work is not in the thing made but in the well-being of the persons they serve. This conscious focus on the human impact of the work done is another mark separating the professional from the technician.

Autonomy in Decision-making
Autonomy, or self-rule, is the liberty to choose concrete goals and specific courses of action without interference, or at least to make such choices within fairly expansive boundaries. The assumption that underlies the autonomy permitted to professionals is the belief that the circumstances in which they are called on to make decisions are potentially so varied that they cannot be adequately described in advance. In other words, the conditions in which problems present themselves in real life are inherently unpredictable, and so it is not possible to develop routines and detailed plans for coping with every contingency. Instead, we rely on people who thoroughly understand the principles at the foundation of successful solutions to craft a workable plan in the context in which the problem occurs. The value of professionals to a community lies precisely in the ability of the professional to devise successful new plans for new situations. To do this, they must have the freedom to break out of existing patterns when necessary. This freedom, however, is not without restraint, nor is it always present. It must be deserved and preserved.

Ultimately, this freedom also depends on trust. People are willing to permit professionals a great deal of liberty as long as they believe that they can trust them to place the welfare of those they serve ahead of their own interests. This often comes down to a matter of personal contact and faith in a particular person. This is very obvious in medicine, where establishing a rapport with a patient can be critical.

This trust, however, is sometimes betrayed by professionals, and the community is rightly skeptical of the power of those with special knowledge. This knowledge can be used to help or to harm, and sometimes we do not discover which it will be until it is too late. The Hippocratic Oath, the earliest professional pledge we possess, can be read as a detailed promise to honor the physician’s obligations to those from whom he or she learned the art, to practice according to a high standard, and to refrain from taking advantage of opportunities to use the knowledge of the profession to harm others. More broadly, adherence to a standard of professional ethics serves to earn and to preserve the trust necessary for real autonomy.

The Future of Professionalism in Medicine
I submit that the practice of medicine is at risk of becoming merely technical, rather than professional, driven in part by external pressures to control costs and in part by technological sophistication that can seduce us into thinking that technology can substitute for judgment in all cases.

To be sure, bringing what was once uncontrollable into the realm of the routine may well involve the application of technology. But we cannot forget the place of, nor lose the capacity for, sound judgment in the uncertain conditions that will always remain.

The physician-patient encounter is in danger of becoming more of a transaction than a transformative experience as corporate medicine demands higher productivity and lower costs. A hazard of any profession is the tendency over time to see the people one serves as mere objects and, at worst, to use them as instruments for achieving one’s personal goals. Thus, for example, the student becomes just the raw material on which professors exercise their skills and the architect’s clients are just the ones who pay the bills to support her creativity. Patients are never merely the objects of work; they are the reasons for the physician’s work.

There is no guarantee that once an occupation has become professional it will always remain so. Through a combination of factors, its practitioners may lose their capacity to make sound judgments when faced with uncertainty. But if the special knowledge of professionals can be continually nurtured and developed, if commitments can be renewed and honored, and if trust can be deserved, professionalism can be sustained, with the magnificent benefits that it offers to the whole community. MM

Robert Kennedy is professor and chair of the department of Catholic studies and co-director of the Terrence J. Murphy Institute for Catholic Thought, Law, and Public Policy at the University of St. Thomas. He has published extensively on the topic of professionalism.