Journal of medical ethics, 1986, 12, 64-65

Debate 1

Professional ethics
R S Downie Professor of Moral Philosophy, Glasgow University

In his article Professions as the Conscience of Society This argument is seriously confused (3). The confiusions
Paul Sieghart (1) makes a number of points about the arise from the running together of empirical, conceptual,
nature of ethics, about law and about human rights. I and moral claims. When he says that in the professional
wish however to concentrate some critical comments on relationship 'altruism is paramount and self-interest has
the central area of his argument - his account of no place' (my italics) Mr Sieghart seems to be making
professional ethics (2). empirical claims about how professionals in fact behave,
I shall begin with his point that the principal feature of just as when he refers to expectations of self-interest in
a professional relationship is the gross inequality of the market he seems to be making an empirical claim.
power between the client and the professional - 'the But as a matter ofempirical fact it is not obviously true to
patient or client is weak, vulnerable and in need of help; say that all professionals are altruistic whereas all other
the professional is strong, skilful, and specially qualified occupations are self-interested. Doctors and lawyers in
to help'. When Mr Sieghart says that this is 'the principal particular have had a bad name throughout history for
feature' of a professional relationship I do not know being more interested in their-fees than in- their patients
whether he means that it is a sufficient condition of one. and clients. It may be however that this interpretation is
If he does he is mistaken, for if I take my car for servicing, unfair, and that Mr Sieghart's thesis is a conceptual one.
or if I ask a surveyor to look for dry rot in my roof, or if This second interpretation is supported when he speaks
I ask my travel agent to recommend a hotel then I am in of altruism as the distinguishing mark of a 'true'
the same sense vulnerable to the good will of others as I profession or says that 'by definition' the client is weak
would be if I asked my lawyer to arrange for the and the professional strong. In other words, on the
conveyance of a house or if I asked my doctor to check my conceptual interpretation the thesis is that, whatever
blood pressure - in each case I have the needs and they actual doctors or lawyers may do, the doctor qua doctor
have the skills. It may be however that all Mr Sieghart and the lawyer qua lawyer aim at the good of their clients
means is that 'gross inequality' of vulnerability/skill is a whereas other jobs aim at self-interest. But this will not
necessary (but not sufficient) feature of the professional serve either to distinguish professionals from others.
relationship. Even that is arguable however, for if Certainly it is true that the doctor qua doctor aims at
anything is a profession music is, and it is only in some alleviating suffering and not at self-interest, but equally it
trivial sense that the 'gross inequality' or 'vulnerability/ is true that the mechanic aims at repairing cars and not at
skill' analysis could be applied to a performer/audience self-interest, and the baker aims at baking and not at self-
situation. It will indeed be an implication of my general interest. If it is replied that the mechanic and the baker
position that it is not possible to find features which are are also businessmen and as businessmen must aim at
sufficient for defining a professional relationship. their own profit, then that again is necessarily true, for
Mr Sieghart attaches much greater weight to a second aiming at profits is what businessmen by definition do.
point about the professional situation characterised in But equally doctors or lawyers are fee-earners and in the
terms of inequality of power; that 'altruism is paramount same sense earning fees is what fee-earners necessarily
and self-interest has no place', whereas 'in every other do. And people in all occupations must in the same way
market in the supply of goods or services .. . no one will be businessmen or fee-earners and make a profit, or they
expect you to behave otherwise than as an ordinary will not be able to live. If the point is thirdly that, mrrally
supplier of scarce skills in an open market - that is, to speaking, doctors and lawyers ought not to aim at self-
pursue your own self-interest, provided only that you interest in the form of exorbitant fees, then that is true,
practise no overt deception. This, as it seems to me, is and equally those in other occupations ought not to aim
what ultimately distingtishes a true profession from any at self-interest in the form of undue profits. In other
other trade or occupation.' words, there is nothing to distinguish the professional
from other occupations in terms of the criteria of self-
Key words interest and altruism; the moral point is simply the one
on which we can all unite - we ought not to be unduly
Professions; professional ethics. self-interested.
 Debate 1: Professional Ethics 65

Mr Sieghart suggests a second distinguishing mark of for defining a profession - the concept changes
the professional - that he serves a 'noble' cause. The historically and is unclear at the edges. For example, if
argument for this is not clear, but it seems to have two surgery, say, is now a profession, it was not always
strands in it, the first ofwhich goes somewhat as follows. thought to be so. Secondly, supposing we do set up a
Doctors and lawyers could sometimes further their own concept of a profession we cannot (logically) derive from
interests, or indeed the interests of their patients and it any account either of how professionals do in fact
clients, by wrongful practices such as poisoning or the behave, or of how they morally ought to behave, far less
deception of a court. But they have a duty not to do so. the conclusions that they do in fact or ought to behave
The origins of this duty could lie in the fact that as better than shopkeepers. Thirdly, moral duties are one
members of the same species we have duties not to harm and the same for all of us; the shopkeeper has a duty not
each other. But this principle does not hold in the real to overcharge us and so has the lawyer, the mechanic
world, as for example in the business community. The ought not to lie about what he has or has not done to our
duty must therefore derive from a criterion applicable to car, and the doctor has the same duty not to lie about
professionals but not to others - namely, that they serve what he has or has not done to our body. It is true that a
a 'noble' cause, such as health or justice. doctor has a much greater range of moral problems than
But the 'noble' cause criterion will not serve this a mechanic, but then a schoolteacher will have a greater
purpose, not just because it is too vague to be ofhelp, but range of moral problems than a lawyer. The range of the
also because it seems to apply much more generally than moral problems does not suggest that there are different
Mr Sieghart would welcome. For example, the farmer standards for settling them, or that we should pretend
could be said to serve the noble cause of sustaining life, that there is a special sort of morality, 'professional
and the manufacturer or retailer of undergarments could ethics', which applies to some sections of the community
be said to serve the noble cause of ministering to our but not others. Fourthly, the idea of 'professional ethics'
comfort, and the travel agent the noble cause of self- is not only redundant but pernicious, for it serves to
development.... The solution may be to drop the idea protect lawyers and other professionals from public
of 'noble cause' in this context and return to the more disquiet about their practices. If the standard of
familiar idea, which Mr Sieghart rejects, that we have professional practice in law and medicine is improving
duties not to harm each other because we are members (which I do not assert) it is more as a result of consumer
one of another. Mr Sieghart rejects this because it does pressures such as patients' rights movements,
not hold in the real world. No doubt this is true in the competition in such matters as conveyancing, a better
sense that people - businessmen, lawyers, doctors etc - educated public, journalistic investigations, and other
do not always in fact do what they morally ought to do, 'market-orientated' devices than by 'professional ethics'.
but that does not invalidate it as a moral criterion. As an example of 'professional ethics' let us remember
It may be however that Mr Sieghart would wish to that when there was a public outcry against virginity tests
stress the second strand in his argument here. He hints at carried out by doctors at Heathrow Airport on Asian
the idea that occupations in the free market are women mumigrants a spokesman for the Ethical
necessarily in a competitive situation, and a competitive Committee of the British Medical Association (BMA) (4)
situation is one which encourages the pursuit of self- said that whereas such tests may have been morally
interest and recognises no duty not to harm a competitor, wrong there was nothing unethical about them! My
whereas professionals are not in competition with each conclusion expresses a profound cynicism about the
other and pursue a noble cause instead. In reply to this professions, but I am not more cynical about them than
argument we can say that competition need not be Mr Sieghart is about business, and indeed every other job
morally bad if it is concerned with providing the best except law, medicine and the priesthood.
service at the lowest price. If as a result of the competitive R S Downie is Professor ofMoral Philosophy at Glasgow
process someone goes out of business it is tendentious to University. His books include: Respect for Persons,
suggest that they have, in some morally culpable way, 1969; Roles and Values, 1971 and Caring and Curing,
been harmed. Moreover, competition has in the past and 1980.
does still exist even in the professions. The extent of it
turns largely on the extent of the professional monopoly, References and notes
how fees are paid etc. The legal profession, in Scotland (1) Sieghart P. Professions as the conscience of society.
at least, even allows discreet advertising! This does not at Joumal of medical ethics 1985; 11: 117-122. See also:
all imply that doctors or lawyers do not or ought not to see Anonymous. Medicine, profession and society [editorial].
themselves as serving 'noble' causes, but they have no Journal of medical ethics 1985; 11: 59-60.
(2) 1 shall not tollow Mr Sieghart in including the priesthood
monopoly of noble causes. as a profession for whereas it has some features in
Various conclusions are suggested by this critique, all common with professions it is essentially different.
of which require more argumentation than is appropriate (3) The confusions were first pointed out by Plato, Republic
in a discussion note. First, it is difficult, perhaps 346.
impossible, to provide necessary and sufficient criteria (4) As quoted in World medicine 1979 Mar 10:99.