Professional Ethics: Core Principles and Ethical Codes

This essay delves into the multifaceted realm of professional ethics, providing a comprehensive overview of its core concepts and practical implications. It begins by defining the essence of a profession, highlighting the crucial role of service ideals and scientific training. The essay then explores the concept of professional power, emphasizing the power dynamics within professions and the significance of internal ethics and collegial loyalty. It differentiates between descriptive and normative approaches to professional ethics, emphasizing the importance of a normative perspective in evaluating and critiquing professional practices. Furthermore, the essay elucidates the key requirements of good professional practice, including authority, integrity, and confidentiality. It examines the role of ethical codes of conduct in defining professional boundaries and fostering public trust. The essay underscores the importance of client relationships and the ethical responsibilities professionals have towards their clients, positioning this as a foundational element in the ethical framework. Finally, the essay concludes by emphasizing the importance of good professional practice and the ethical dilemmas that professionals face, highlighting the need for ongoing ethical reflection and adherence to established codes of conduct to maintain the integrity of the profession.

Professional Ethics
T Airaksinen, Universityof Helsinki,Helsinki,Finland
ª 2012ElsevierInc. All rightsreserved.
Glossary
Authority Beliefthatan agentis in such a positionthat
his or her judgmentsshouldreplacethose entertained
by the audience.
Autonomy An abilityto decideon therulesto be followed.
Normativity Whatshouldbe done,in contrastto whatis.
Paternalism Beliefthatpeople’sopinionsof theirown
best interestsare not authoritative.
Power A professional’sabilityto asserthis or her own
will evenwhen an opposingwill exists.
Profession An informalassociationof highlyeducated
peoplewhose trainingis based on scienceand whose
work aims at providinga serviceto theirclients.
Professional expertise Special professionalskills and
knowledge.
Virtue A good and admirablecharactertrait.
The Concept of a Profession
Professionalethicsis theethicsof theprofessionalswho
aremembersof a givenprofession,suchasmedicaldoc
tors, registerednurses,lawyers,teachers,and social
workers.The key point is thatsuchprofessionshave
their typicalserviceideal and scientifictraining.For
example,doctorsaretrainedin universitieswherethey
earn their academicdegree.After that,they can be
acceptedasmembersof theprofessionin theserviceof
theirclientsor patientsand,moregenerally,thepublic.
From a sociologicalstandpoint,serviceandscienceare
bothnecessaryandsufficientconditionsof the profes
sionalstatusandwork.For example,a plumberprovides
a serviceto his clients,but a scientificbackgroundis
missing.No scienceof plumbingexists.A plumberis a
skilledworker.Also,unskilledworkexists.
The professionalstatusisbasedonasciencethathasits
own traditions,methodsof work,researchparadigms,
scientifictheories,andeducationalinstitutions.For exam
ple,in somecountries,Lutheranpriestsforma genuine
profession.Theycertainlyhavetheirownserviceidealas
membersof a charitableprofession.However,theyalso
havetheirowndisciplineandtheology,with its educa
tionalinstitutionsanduniversityfaculties.The keypoint
is thattheologymustnotbea confessionalbutvalue-free
discipline,whichis whattheLutheranuniversityfaculties
claimto be.
Engineersforma professionif wethinkthattheyhave
theirownserviceidealandscience.The lattercondition
is easilysatisfied,buttheformeris moreproblematic.It is
oftensaidthatprofessionalcivil engineersaimat public
safety,welfare,andhealth.If engineershavesufficient
autonomywhentheyrealizethesekey values,theyare
professionals.The problemwith engineersis thatthey
havehardlyanybasictrainingtopromotethesethreekey
values.They do notsystematicallystudyhealthor wel
farequestions,andyetthesesamevaluesarepromotedby
doctors,nurses,and socialworkerswho haveyearsof
systematictraining.Engineersusesuchvaluesasmanifest
idealsthatsignaltheirgoodintentionsratherthantheir
fieldof expertise.This makescivil engineeringa unique
typeof profession.
We canalsoaskwhetherscientificresearchersforma
professionalgroup.This dependson theirserviceideal.
What can it be?Scienceaimsat valid and applicable
theoriesandtheirtesting.This maynotentaila service
idealthatcouldbeformulatedin termsof humanvalues.
To aimatvalidnewtheoriesis nottoprovidea serviceto
thepublicbuttoadvancescienceasit is today.Of course,
it mayhappenthatscienceis beneficialto mankind,as
manypeoplethink.However,it canalsobe arguedthat
muchof scienceis actuallybanefulto uswhen,forexam
ple,it is usedto builddoomsdayweaponsandpolluting
industry.The presentalarmingenvironmentalconditions
aredependenton theadvancementof scienceandengi
neering.Scienceis partof theindustrialbusinesscomplex
thatpollutesextensively,but if we wantto correctthe
situation,weneedmorescientificresearch.It seemsthat
the aimsof scienceare logicallyindependentof the
humangood.Therefore,scientistsarenot professionals
in thesamesenseas,for example,doctorsor teachersare
professionals.
Administrationis alsoa fieldof professionalwork.Do
administratorshavetheirownserviceidealanda setof
associatedvalues?Primafacie,theansweris in thenega
tive.Administrationis supposedto put into effectthe
valuesanddecisionsof someauthority,withoutadding
anythingtoit.An ethicaladministratoris unselfish,objec
tive,efficient,andcompetent.An administratorhasno
personalgoals.Administrationdoesnotservetheprofes
sion’sown valuesbut the valuesof the authority.The
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Professional Ethics 617
mainvaluesof administrationareinstrumentalin nature.
It is an instrumentalprofession,whichmeansit is nota
full profession.Theseexamplesemphasizethe autono
mousvalue-basedserviceidealof a professionandthus
theirethicalbasis.
Professional Power and Internal Ethics
All professionswieldsocialpowersimplybecauseof their
expertiseandrareabilityto serve.No othersocialgroup
canreplacethem.Also,it is in theinterestof theprofes
sionto maintainandcultivateits powerposition.This
aspectof professionallifeinterestssociologistsmorethan
ethicists.However,professionallifecannotbeunderstood
withoutmentioningthepowerof professionsandtheir
intrinsicinterestin maintainingit.
Professionalassociationsservemanyfunctions,but
theyalwayslookaftertheirpowerbase.They call out
siderswho maypretendto do the samework theydo
charlatans,amateurs,andtricksters,andtheytrytooutlaw
them.Doctorshavebeenverysuccessfulin doingthis,
whereasteachershavebeenmuchlesssuccessful.Another
aspectof professionalpoweris the normsof collegial
loyaltythatprotecttheprofessionagainstvarioustypes
of accusationandnegativeclaims.Professionalsaresup
posedto supporttheircolleaguesin crisissituations.We
cansaythatanyprofessionhasits internalethics.These
specifyhowa professionalis supposedto dealwithcol
leaguesin thosemattersthatarenotrelatedtotheservice
theprofessionis supposedto provide.Suchethicsspecify
howtheycooperateandshareinformation.Internalethics
andcollegialloyaltyareespeciallyrelevantin crisissitua
tions,suchasin malpracticecases.
The Normative Point of View
A sociologicalaccountof professionalismandtheprofes
sionsis usefulwhenwedevelopprofessionalethicsfrom
thenormativepointof viewin philosophy.Professional
ethicscanbe approachedfromtwo directions:descrip
tivelyandnormatively.Insteadof normativity,we may
alsotalkaboutprescriptivity.
We canstudyprofessionsbymeansof empiricalsocio
logicalmethodsandaskwhattheprofessionsin factdo
andwhatvalue-relatedbeliefstheprofessionalsactually
hold.We mayalsoaskwhatthevaluesarethatthepublic
expectsprofessionalsto serve.For instance,whatarethe
valuesthatlawyersin facthold?To answerthisquestion,
it is necessaryto asktherepresentativesof theprofession
whattheythink.This requiresempiricalresearch.We can
alsostudytheprofessionalpracticesandtryto inferwhat
valuesare guidingsuchwork.Are teacherscaringor
punitive,aretheypermissiveandsupportivein class,or
are theydemandingand authoritarian?Suchpractices
mayrevealthehiddenvaluesof theteachers.
The normativeor prescriptiveapproachis notempiri
calbutphilosophicalin thesensethatitsproblemscannot
be solvedby meansof sociologicalmethods.We areno
longerinterestedin whattheprofessionalsthemselvessay
abouttheirvaluesor howtheyactuallybehave.The focus
is nowon thequestionof howtheprofessionalsshould
behaveandhowtheyoughtto treattheirclients.Whatis
theiridealcodeof conductlike?Suchan approachto
valuesandnormsis relativelyindependentof thefacts
of professionallife.However,theethicistsmustof course
knowenoughaboutthe actualprofessionallife andits
practicessothattheycanapplytheresultsoftheirinquiry
tofacts.Thisalsomakescriticismpossible.The normative
approachallowsusto sayhowprofessionallifeshouldbe
conducted.
The normativeapproachto professionalvaluesallows
oneto criticizeprofessionallife andpractices.This takes
placebycomparingwhatshouldhappenandwhatin fact
happens;thegreaterthegapis, themoretheprofession
deservesto be blamed.However,anyonewhocriticizes
professionallife needsto be carefulnot to demandtoo
muchor to presentthecriticismfroman unrealistically
utopianpointof view.Onemustalsobecarefulwiththe
facts.Professionallife may presentreal challengesto
understandinganddescription.Professionalssometimes
thinkthatonly a qualifiedmemberof theprofessionis
ableto understandthem,andthereforethedevelopment
of professionalethicsshouldbetheirownresponsibility.
However,enlightenedmembersof the publicmustbe
consultedas well becausethey are also stakeholders
whosewelfareandhappinessdependon theprofession
in question.
The Requirement of Good Professional
Practice
The followingarekeyrequirementsof goodprofessional
practice:authority,integrity,trustworthiness,responsibil
ity, confidentiality,informedconsent,nonpaternalism,
andhighstandardsof work.It mustberememberedthat
a professionalalwaysservesthe clientsand promotes
somegoalsthatareimportantto them,suchas health
(doctorsandnurses),justice(lawyers),personalautonomy
(psychologists),and humandevelopment(teachers).In
thatspecialsense,allprofessionalworkfocusesessentially
on care.The clientis in a situationthatis sodemanding
thathe or shecannotmanageit personally.The profes
sionalpromisestotakecareof it.This is theserviceheor
sheprovides.Moreover,professionalwork is often,or
perhapsalways,of sucha naturethattheclientdoesnot
fully understandwhatthe professionalis doing.The
lawyers’languagemay be incomprehensibleand the

618 Professional Ethics
biologicaltheoriesappliedby a doctormaybetoodiffi
cultforthepatientto comprehend.This entailsa relation
of trustbetweentheprofessionalandtheclient.The key
requirementsof this crucialrelationshipare explained
next.
Ethical Codes of Conduct
Any professionis boundto haveits ownofficial,explicit
ethicalcodeof conduct.This maybea quiteshortman
ifestationof theirgoodwillandintentionsby meansof
listingthe key valuesand dutiesas they themselves
understandthem.The code may also be a detailed
accountof the assumedethicalpracticesillustratedby
casestudiesand variousexamples.The mainpointis
thatthe professionpublishesits own codeof conduct
andrequiresthatits membersknowit, recognizeit, and
staycommittedtoitsgeneralspiritaswellasitsdetails.It
is assumedthatthiskindof codemakestheprofessional
valuesmoretransparentfromthepublic’spointof view.
Thus,it increasesthepublictrustin theprofession.
The problem,of course,is thatthecodeis writtenby
themembersof theprofessionitself,whotendtoseetheir
ownworkin thebestpossiblelight.It is sometimessaid
thatthecodelimitsthefreedomof theprofessionals,but
thisis nottrue.It doesnotentailanyrestrictionof free
dombecausethe professionals,as professionals,should
anywaystaywithintheboundsof professionalwork.No
onehastherightto do anyimmoralthings,andthusthe
codedoesnot restrictfreedom.The codeis alsouseful
becauseit definesthelimitsof professionalexpertiseand
thusprovidesa definitionof theprofession.
Authority
A professionalpersonis an authorityto the client.An
authorityis anagentwhosejudgmentreplacesthatof the
clientwhenthe authorityrevealsit. Professionalsare
typicallyepistemicauthoritiesto theirclients.For exam
ple, whenan attorneysaysto the clientthatthe case
cannotbewon,a rationalclientchangeshisopinionand
withdrawsthedemands.A patientis subjectivelycertain
thatshehascancer,butwhenthedoctorsaysthatit is not,
thepatientchangeshermind.The clientneednotdothis
blindly and thus the professionalshouldexplainand
justifythecasefirst.
Professionalsaretypicallynotcommandingor norma
tiveauthorities.The policearea commandingauthority.
As such,policeareauthorizedto issueordersandcom
mands,unlikea doctoror a lawyer.The clientis always
freetoleavethesituationandpersonallydenytheauthor
ity of theprofessional.A doctormaybeableto command
nursesin hospitalenvironmentsbut not the patients.
A doctoris alwaysin theserviceof thepatient.A teacher
may commandchildren,but then the teacheris
authorizedby theparentswhoarethemainclients,and
theteachers’rightto commandis strictlylimitedat all
times.The policehavetherightto kill.
Autonomy
Professionshavea fairlylargedegreeof autonomywhich
is theresultof theirspecialexpertiseandtheimportance
of their serviceideal.Autonomydependsmainlyon
expertise.Professionshavetheirown highlydeveloped
scientificdisciplineson whichtheirmembers’education
is based.The professionorganizesmuchof itsowntrain
ing andeducation;it hasgatekeeperswho controlthe
entryto the professionalranks,andas a corporationit
observesandcontrolsits members’ethicalpracticesand
legalproblems.
Professionshavea monopoly,or nearmonopoly,on
thekindof servicestheyprovide,andtheyarenormally
quitereadyto repudiateanycompetitionin theirown
field.Professionalscanalsoinfluencethelegislationthat
governstheirworkbecausetheymustbeconsultedin all
mattersthatdealwiththeprofessionin question;no one
elseis competent.Any stateadministrationthatcontrols
the work of a givenprofessionhiresmembersof the
professionto do partof thiswork.Modernprofessions
are thereforerelativelyautonomouscollectiveagents.
This makestheirethicsa cruciallyimportantissue.
Personal Integrity
Professionalsareimmuneto theexternaldistractingfac
torsthatmayinfluencetheirwork andunderminethe
relevantprofessionalauthority.A teacherdealswithall
thechildrenon an equalbasisevenif someparentsare
richandfamousandothersarenot.Someparentsmaybe
aggressiveanddemanding,somequietandsubmissive,
but the teacheris not influencedby suchexternaland
irrelevantfactors.A doctordoesnotrecommenda certain
medicineto patientsjust becausethe producerof the
medicineoffersa bonus.A psychotherapistdoesnotfall
in lovewithanattractivepatient,or if thishappens,the
therapistdoesnotshowit in anyway.
The ethicalguidelinesarespecifiedin connectionwith
theideathatprofessionalismandpersonalintegritypro
tect the professionalfrom possible aberrations.
Professionalintegritymeansone’sabilityto resisttemp
tationsevenin difficultsituationsin whichthe risk of
retributionis negligible.
Loyalty
Loyaltyis oneofthekeyconceptsofprofessionalethics.It
meansa strongandunconditionalcommitmentto some
specialpeople.A loyalpersondoesnotrejecttheobjects

Professional Ethics 619
of loyaltybut,rather,servestheirinterestsin anunselfish
manner.This is anessentiallycounterfactualfeelingand
emotion:Evenif theobjectofmyloyaltyactedagainstmy
valuesandinterests,I wouldsupportthatperson.Loyalty
crossesthe bordersof my own bestinterests.A loyal
personis willingto makesacrificesin favorof another
personto whomoneis loyal.
The ideaof loyaltyis closelyconnectedwiththeold
ideaof a professionasa calling.Professionalsweresup
posedto be totallyunselfish,benevolentpersonswho
sacrificedtheirownbestinterestsin orderto helptheir
clients.Nursesand socialworkersare goodexamples.
Modernprofessionalsare still supposedto be loyal to
theirclientsevenif the old ideaof a callingdoesnot
applyin anyinformativesenseanymore.However,some
tracesof it canstillbeseenin professionalethics.
A professionalhasseveralloyalties,whichmustbe
rankordered.His or herobjectsof loyaltyaretheclients,
professionalcolleagues,andthepublic,in thatorder.All
professionalspledgemoreor lessofficiallyandexplicitly
toservetheirclientsassatisfactoryaspossible.The values
theyserveby usingtheir specializedcompetenceand
expertiseare the valuesof the clientsand,to a lesser
degree,of the public.For instance,healthis a public
value,but a rarecanceris a problemfor one unlucky
individual.Justicebelongsto all of us, but an attorney
servestheclient’sinterestswithrespectto thelaw,which
is anembodimentof justice.Professionalsarealsoloyalto
theircolleaguesandtheirprofessionin general.
Trustworthiness and Virtue
A professionalpersoncanbetrustedbecauseof personal
trustworthiness.It canalsobesaidthatanethicalprofes
sionalis virtuousand thereforealso trustworthy.By
virtue,we meanherean admirablecharactertrait,such
as wisdom,courage,justice,benevolence,andmodesty.
All theseareneededin professionallife becauseof its
demandingnature.Whentheyreflecton thevirtuesthat
aremostattractiveto them,nursesmaywell emphasize
their courageand justicemorethanbenevolenceand
love.
Professionalethicsdemandsthatall professionalsare
clearabouttheethicalrequirementsof theirposition,and
therelevantreflectionmaywellbecarriedoutby using
the notionof virtue.The questionis, Which are the
virtuesthatarerequired?The professionalmayalsoask,
Do I reallypossessthem?
A trustworthypersonis theonewhosevalues,skills,
andvirtuesaresuchthatthepersoncanbetrustedin the
widestvarietyof circumstances.The patienttells the
nursesan importantsecretand thinksthatthereis a
goodreasonto believethatthenurseskeepthesecret.
The patientalsothinksthatthenursesarereliablein the
sensethattheydo whattheypromiseto do.The patient
canrely on them.By trust,it is meantthata trusting
personneednot thinkthatthe trusteewill disappoint
himor her.In otherwords,thetrusterneednotbepre
paredfor theworstto happen.Trust allowsfor degrees,
and one’strustin a professionalis sometimesalmost
unconditional.If the degreeof trustis low, boththe
professionalandtheclientshoulddosomethingtocorrect
thesituation.
Responsibility and Duty
It is theprofessional’sfirstdutytoobeythelaw.However,
moraldutymustbe recognizedas well.A professional
personacceptstherelevantdutiesin all thecasesthatare
withinone’scompetenceandjurisdiction.Whena doctor
or nurseseesanaccidentvictimon thestreet,it is one’s
responsibility,or duty,to providehelp.A bystanderhas
no similarmoralresponsibility,althoughit is recom
mendedthat one tries to help. What the law says
dependson manydifferentfactors.
Responsibilityentailsone’sdutiesin the following
sense:If onedoesnot do one’sduty,oneis heldto be
responsiblefor a moralwrongandcanbe blamed.We
may say that responsibilityis a notionthat connects
abstractdutyto theconcretehumanworldof decisions
andactions.Professionalshavetheirtypicaldutiesandare
responsiblefor thecorrespondingactions.It is thetea
chers’dutytokeepdisciplinein theclass;if theyfailtodo
so, we hold themresponsibleandblamethemfor the
ensuingproblems.
We can distinguishbetweenthreedifferentsources
of responsibility:accountability,competence,and care.
First,if a professionalpersonis guiltyof carelessnessor
someothertypeof malpractice,he or shecanbe held
accountableanddeservessometypeof blameandpun
ishment.The failure to do one’s duty resultsin
retribution.
Second,responsibilitycanbe basedon competence.
A headsurgeonis responsiblefor the successof the
operationon the groundsof superiorcompetence.A
teacheris responsiblefor the successandhappinessof
the studentsbecauseof professionalknowledgeand
ability.Competenceis alwaystestedfirstandthenthe
relevantresponsibilityis offeredto the professionalin
question,whoacceptsor rejectsit freely.
The thirdformof responsibilityis care.Nursespro
vide careto their patients.Imaginethata numberof
patientsaredistributedamonga numberof nurseswho
areinstructedtoprovidecaretothem.Nowthenursesare
responsiblefor theirpatientsin thesensethattheymust
providewhattheyneed.Carelogicallyentailspersonal
responsibility.Elementaryschoolteachersrepresenta
goodexample.

620 Professional Ethics
Confidentiality
A professionalis a trustedandresponsibleauthoritywho
providesthecaretheclientneeds.This requiresconfi
dentiality.The professionallearnsthe client’sintimate
andpersonalsecretswithoutwhichtheclientcannotbe
served.Ideally,the client truststhe professionaland
thereforedaresto revealthe secrets.Notice that the
professionalis not a commandingauthoritywho can
order the client to revealthe relevantsecrets.For
instance,a doctorcanjustaskfor full personalinforma
tion,but the patienttellswhatshewantsto tell. The
doctorsaysthatfull informationmakesit possibleto do
a betterdiagnosis,butagainthisis onlya recommenda
tion,nota command.Lackof trustmakesit difficultfor
thepatientto revealpersonalinformation.A majorfacil
itatingfactorhereis a moreor lessreasonedbeliefabout
confidentiality.
Informed Consent
Muchhasbeenwrittenaboutinformedconsent,namely
theideathatnothingcanbedoneto thepatientwithout
personalagreementon thebasisof full informationand
knowledgeofthecase.This isakindofself-evidentaxiom
thatgovernsallprofessionallife.It is thefoundationofthe
client’srights.If professionalsprovidea serviceto their
clients,it is clearthatit cannotbe donewithouttheir
consent.It is illogicalto thinkotherwise.However,there
areproblems:The clientmayneedprofessionalservice
butis unableto sayso,or theclientcannotunderstand
whattheprofessionalis goingto do.The patientmaybe
unconscious,or a clientof a lawyermaynotunderstand
thecomplicationsof thecase.In bothcases,therequire
mentof informedconsentis problematic.Manysolutions
havebeensuggested;forinstance,theclient’strusteemay
beconsulted.
Anti-Paternalism
A paternalisticmeasureis onethataimsattheclient’sbest
interestsevenwhentheclientdoesnotagree.This is, of
course,highlyproblematicbecauseprofessionalworkand
caresaredesignedtohelpandbeaservicetotheclient.The
questionis this:Cantheprofessionaloperationin question
beclassifiedasaservicetotheclientdespitethefactthatthe
clientdisagrees?Is theclientalwaysanauthorityin one’s
owncase?Or is theprofessionalin somecasesa normative
authoritywhohasa client-independentrightto determine
whatis the rightactionin this case?This questionis
normallyansweredin thenegative.
Supposea religiouscommunitybelievesthatblood
transfusionsareradicallysinful.A childneedsbloodor
otherwisethechildmaydie.Shouldthedoctorsresorttoa
paternalisticstrategyandgiveblood,or shouldthedoctor
respecttheparents’opinion?Aftera carcrash,a victim
absolutelyforbidsthedoctorto undresshimpubliclyso
thathis woundcanbe dressed.Whatshouldthedoctor
do?Perhapsthedoctorthinksthattheaccidentvictimis
soconfusedthattheutteredwordsaremeaningless?This
is to saythatlateron thevictimwill be gratefulto the
doctor.It is possibleto distinguishmanydegreesof
paternalism,rangingfromsoftto hard.Sometypesof
paternalismarenotacceptable,butsomemaywellbe,as
thecaseof theaccidentvictimshows.The basicruleis
thatpaternalismshouldbeavoidedin mostcases.
High Standards of Work
A professionalalwaysaimsat thehighestpossiblestan
dardof work.A medicalpatienthastherightto getas
goodcareaspossible.Here,theserviceidealandscientific
educationandtrainingof theprofessionalsmeet.A pro
fessionalhasthe abilityand competenceto providea
high-qualityservicebecauseof theeducationandtrain
ing.However,thisis notenough.A professionalmustalso
bewillingandhighlymotivatedtowork.Anyprofessional
needscontinuoustrainingto keepone’sknowledgeand
skillsuptodate.Goodprofessionalsareproudof thehigh
standardsof theirwork.Professionalassociationsmonitor
thestandardsandprovidetrainingfor themembers.The
clientshavethe right to assumethatthe professional
standardof workis ashighaspossible.Otherwise,they
could not trust the professionals,whosework then
becomesmoredifficultor evenimpossible.
Multiprofessional Networks
We havestudiedtheethicalcoreof professionallife,but
nowattentionmustbepaidto itsfringes.In thecore,one
findsanindividualdoctortreatinga sickchildin a remote
housein thecountryside.The doctoraloneis responsible
for thetreatmentandall of itsconsequences.In thecore,
we find a lawyertalkingto clientsbehindcloseddoors.
Here,onlythecorevaluesof theprofessionalmayinflu
encetheoutcomeof themeeting.However,doctorsalso
workwithregisterednurseswhohavetheirowntraining
andassociatedvalues.The nurseshavetherightto their
ownprofessionalopinions.Theyhavetheirownmethods
of work.Thesemaybe almostthesameasthedoctor’s
valuesbut not quite.Their conceptof healthmaybe
different.Their ideasof careand its virtuesmay be
slightlydifferent.However,theyneedto worktogether
andforman ideaof the commonethicalbasisof their
work.This is whatcanbe calledthefringeethics.Both
professionshavetheirowncoreethics,buttheysharea
common,appropriatelyconstructedfringe.
For instance,doctorsandnursesneedto agreehowto
treata patient’svery seriouswound.The nurseis an

Professional Ethics 621
expertin thefield,butthedoctorpossessesauthority.Can
thedoctorstilldecidealoneregardlessof thefactthatthe
nurseknowsbetter?From the standpointof care,the
answeris in the negative,but from the standpointof
administrativeauthority,theansweris in thepositive.
The solutionto thisproblemmaybereachedby rea
soningasfollows:The nurseknowsbetterandtherefore
thisopinionconcerningthecaremustprevail.This fol
lowsfromthenormthatplacesthepatient’shealthasthe
mainvaluein thesituationin whichcareis consideredor
given.The doctor’sprofessionalinterestsmaybefocused
on maintainingtheprofession’sadministrativelyandleg
ally justifiedpower and authorityover the nurse.
However,thenthe doctoris wrong,at leastwhenone
thinksethically.
By thetermmultiprofessionalnetworksis meantthe
factthatthemodernprofessionalworksasa memberof a
teamthatconsistsof manyprofessionalbutalsononpro
fessionalmembers.This mayalsobe a networkwhose
membersarenot presentat oneplacebut who forma
digitallyconnectednetwork.This canbecalleda multi-
professionalnetwork,but it mustbe keptin mindthat
suchnetworkscontainmanytypesof workandactors.
A successfulpracticerequiresthatall theagentsareable
to cooperateseamlesslyandavoidconflictsof interestat
alllevels.The typeofconflictweareinterestedin here,of
course,is a moralconflict.Manytypesof moralconflicts
exist,rangingfromuncertaintiesof conductto serious
disagreementsthatthreatenthe very existenceof the
teamandnetwork.
Supposea teamconsistsof themembersof different
professions:administrators,businesspersons,engineers,
and skilledworkers.They all carryinto the situation
their own expertise,experience,expectations,values,
and commitmentsthatare all somewhatdifferentand
evenconflicting.As a responseto this situation,three
differentattitudesseemto be possible:(1) One cansay
thatnosystematicor damagingmoralconflictsmayoccur
becauseall the differentprofessionalcodesof ethical
conductfundamentallyagree,(2) theydo notagreebut
wecanrankordertherelevantvalues,and(3)theconflicts
arerealso thatthenetworksin questionmustbe mon
itoredby someexternalauthorities.Let usexamineeach
propositionseparately.
Supposetheteamconsistsof therepresentativesof a
service-orientedprofession:administration,business,and
engineering.Here,thesuggestionis thatwhenanethical
problemoccurs,all the differentethicscodesthatthe
membersof theteamcarryinto thesituationwill ulti
matelyagree.All moralconflictsareonlyapparent.For
example,a childin a privateschoolis talentedbutviolent
sothatsometeachersdemandthechild’sexpulsionfrom
theschool.The responsibleteacherthinksthatin termsof
professionalduty, the studentshouldbe helpedand
allowedto correctherbehaviorandstayin school.The
administratorpromisesto helpby reorganizingthestu
dent’sschedulein orderto makeit lesstaxing.The
treasurerpromisesfundsto providesomeextracounsel
ing.No conflictseemsto occur.This intuitionis next
generalizedoverall thesimilarsituationsandtheconclu
sionis thatno realconflictsmayoccur,if thesituationis
interpretedcorrectly.
The secondpropositionis that real conflictsmay
occur.For instance,theprofitmotiveof privatebusiness
conflictswith the demandsof care.The clientcannot
pay;hence,thecaseis justanexpensivecostfactorto the
companythatprovidestheservicein question.Here,the
relevantvaluesmustberankorderedso thatno conflict
prevails.We maysaythatcareis moreimportantthan
financialconsiderations,andthuscaremustbegivenand
paymentdeferred.Or we maysaythatthe company’s
businessinterestscomefirst, and the careshouldbe
deniedor at leastminimized.The threateningconflict
is eliminatedand one courseof actionis chosen.Of
course,we can then criticizethe decisionon ethical
grounds.
However,sucha rankorderingof professionaland
businessvaluesmustbe justifiedto the public,who
maythink thata givenrankingis suspiciousor even
wrong.Also, the serviceprovidingprofessionalsmay
thinkthattheirownvaluesaremoralvaluesandthere
foreshouldbe rankedon top.If a conflictthreatensto
occuramongcare,education,justiceor humanauton
omy,andmoneyor administrativeefficiency,it is easy
to agreewith the ideaof the primacyof professional
valuesin question.The publicwoulddemandit, and
theprofessionalswouldseemto be justifiedin insisting
on it.
The conclusionis that becauseprofessionalvalues
are moral values,they are alwaysrankedon top.
Administrators,businesspeople,and engineersmay
restrictthe scopeof the realizationof the professional
valuesby pointingout the limitedresourcesthatthe
professionalshavein thiscase,butthisis all.Professions
dominatein thoseconflictsituationsthatdependonethics
andvaluejudgments.
A third alternativeis also possible.A multiprofes
sionalteamor networkmaysufferfrom real conflicts
thatarenearlyimpossibleto solve.This happenswhen
the teamhasmembersfromdifferentprofessions.The
problemis thatmanyagentshavetheirownmoralvalues
to promote,andbecauseall of themaremoralvalues,it
is difficultto rankorderthem.Whichoneis the most
importantvalue– health,education,justice,or personal
autonomy?Here,we needto go backto thefirst case,
namelyto theclaimthatall professionalvaluesandgoals
ultimatelyagree.All conflictswouldbemerelyapparent.
However,theconflictsituationsmaybe especiallypro
blematicwhen environmentsare multiculturaland
religiouslydivided.

622 Professional Ethics
Heterodox Professional Intrapersonal
Roles
The thirdalternativediscussedpreviouslyis reflectedin
theproblemthatconcernsthemultiplepersonalrolesof a
modernprofessional.A doctorprovidescare,teaches,does
research,andhassomemoreor lessvestedbusinessinter
ests.A doctormayalsohaveadministrativeduties.All these
personalrolesareheterodoxin thesensethat,forexample,
medicineandeducationhavetheirowncodesof ethics.
Businessethicsis notpartof professionalethics,andthe
samecanbesaidof theethicsof administration.
For example,whena doctoris alsoa teacher,the
relevantloyaltiesare necessarilydivided.As a doctor,
oneis unconditionallyresponsiblefor thepatients’good
health.A doctoris committedto givingthemthe best
possiblecare.As a teacher,however,oneis committedto
theeducationof thestudents,whodeservetheirteacher’s
totalcommitment.Froma businessstandpoint,thedoctor
is servingthestockholders’financialinterests,whichmay
wellconflictwithone’sprofessionalvalues.
Again,the professionalin questionmustrankorder
therelevantvaluesso thatthemostimportantis served
first and any necessarycompromisesare allowedto
infringeaslittleaspossible.A client’sinformedconsent
mustbesecuredin anycase.It is oftenthoughtthatthe
notionof informedconsentis a kind of talismanthat
solvesall problems.However,informedconsentmust
be securedfrom clients;otherwise,the educationof
new professionalsand the relevantresearchbecomes
impossible.
The cooperationof the clientswith professionalsis
necessary.The clientsmustbe instructedso thatthey
are willingto givetheirconsent.Egotisticalclientsdo
not givetheirpermissionto performscientificexperi
mentsor be availablefor teachingpurposes.This is a
hardrequirement:A patientis askedto sacrificesomeof
his or her own bestinterestsbecausethe professional
interestsare now focusedelsewhere– for example,in
thefieldof careresearchandteaching.Why anyrational
clientwouldassentis a cruciallyimportantquestion.The
professionalssupposethattheclientsaresocialaltruists,
whichmayor maynotbetrue.The keypoint,however,is
thattheymustnotbemanipulatedor forcedto sacrifice
theirownbestinterests.Any modernprofessionalmust
finda wayto combineseveralintrapersonalrolessothat
no moralconflictsensue.
Professions, the Law, and Business
Professionalsworkin differentenvironmentsdepending
on whethertheyarestateemployeesor workfor private
businesses.In both cases,the constrainton their
autonomousdecisionmakingis different.In the first
case,professionalwork is dependenton the work of
administrativeprofessionals,butin thesecondcaseit is
dependenton businessmanagers.We maythinkof the
extrememodels,in termsof politicalphilosophy,asthe
maximalwelfarestatemodelandtheminimallibertarian
model.Assuch,it is easytoseehowtheprofessionalwork
in bothcasesdiffers.Whenweconsiderethics,weshould
be ableto saysomethingof therelativemeritsof each
model.
In thefirstmodel,theprofessionalsareaccountableto
stateadministrators,whoaimto maximizehumanwelfare
byusingwhatcanbecalledtheone-payerscheme;thatis,
theyusethetaxpayers’moneyasagreedonin aparliament.
Professionalworkis thenconstrainedby a fixedbudget
thattheycannotinfluencein anyway.Also,salariesand
benefitsareregulatedbythelawandlargelyoperateinde
pendentlyof performancelevel.Professionalscandotheir
workundisturbedby anyexternaldemands,makingtheir
positionsimpleandnoncontroversial.They are freeto
obeytheirownmoralcodeastheyandtheprofessional
elitewish.This meansa highdegreeof autonomywithin
the boundsof law.In one sense,this maybe the best
possiblesocialenvironmentfor theprofessionalworkand
flourishing.
Accordingto thelibertarianmodel,theprofessionsare
relativelylooselycontrolledby thelawandstateadmin
istrators.The professionalswork in a free market
environmentwhoseenterprisesarecharacterizedbybusi
nesslogic andregulatedultimatelyby businessethics.
Businessethicsis notpartof thetraditionalprofessional
ethicssimplybecausebusinessis neithersciencenor
service.Also,theideaof thegatekeeperof thebusiness
world doesnot makesense.Anyonecan starta new
business.Sciencedoesnothelpmuch.The goalof busi
nessis to makea profit,althoughtheideaof maximizing
profitsis invalid.The goalsof businessarequitedifferent
fromthoseof theprofessions.Therefore,if theprofession
mustwork underthe constraintsof businesslogic,it
restrictsthescopeandautonomyof professionalwork.
The Future
The professionstodaymustmeetmanychallenges,and
theymaynotbe ableto maintaintheirformerstatusof
autonomyand power.One threatis the free flow of
informationto the membersof the public on the
Internet.The publicis increasinglymoreknowledgeable,
whichmeansthatrelevantknowledgeis no longerthe
professionalmonopoly.Peopleknowmoreabouttheir
illnessesindependentlyof doctors.Medicalcompanies
aim theirmarketingeffortsdirectlyto the public,who
are supposedto askfor a medicinefrom theirdoctor
withoutaskingthedoctor’sopinionfirst.

Professional Ethics 623
Suchchangesmakeprofessionsa serviceprofessionin a
newsense.Traditionally,theprofessionshaveprovideda
valuableserviceto theirclients,buttheyhavealsohada
highdegreeof autonomyandauthority.Now,theirauton
omy is reducedbecauseof the businesslogic and its
associatedethics.Authorityis in dangerbecauseof the
clients’independentaccessto all therelevantknowledge.
Ever-increasinglegalpressuresmustalsobementioned.If
professionsaresupposedto providea servicetothepublic,
althoughtheynowdo nothavemonopolyof knowledge
and they sufferfrom reducedautonomyand minimal
authority,professionsmustchangefast.This meansthat
theirethicsof conductwill alsobein thelimelight.High
standardsof professionalworkandethicsaremoreimpor
tantnowthaneverbefore.
See also:Abortion;Altruismand Economics;Benefit
Sharing;BusinessEthics,Overview;ClinicalEthics;
Conflictof Interest;CosmeticSurgery;Disability,
DefinitionWithinLaw and Society; GeneTherapy;Health
andDisease,Conceptsof; Loyalty;Nursing;Paternalism;
Patients’Rights;PopulationHealthData;Social Welfare,
Provisionand Finance;Technology,Ethicsof: Overview;
Trust;VirtueEthics.
Further Reading
AbbottA (1988)The Systemof Professions.Chicago:Universityof
ChicagoPress.
CoreyG, SchneiderM, and CallananP (2007)Issuesand Ethicsin the
HelpingProfessions.Belmont,CA: ThomsonBrooks/Cole.
ForesterT and MorrisonP (1995)ComputerEthics.Cambridge:MIT
Press.
Ha¨yryM andTakalaT (eds.)(2003)ScratchingtheSurfaceof Bioethics.
Amsterdam:Rodopi.
LantosJD (1997)Do We StillNeedDoctors?New York:Routledge.
OakleyJ and CockingD (2001)VirtueEthicsand ProfessionalRoles.
Cambridge,UK: CambridgeUniversityPress.
PritchardMS (2007)ProfessionalIntegrity.Lawrence:UniversityPress
of Kansas.
WhitbeckC (1998)Ethicsand EngineeringPracticeand Research.
Cambridge,UK: CambridgeUniversityPress.
Biographical Sketch
Timo Airaksinen(Ph.D.,Turku)is Professorof Philosophyat
the Universityof Helsinki.He haspublishedwidelyon the
philosophicalproblemsof trust,socialpower,socialcapital,
andprofessionalethics.He is an experton thephilosophyof
ThomasHobbes.His interestsincludethephilosophyandethics
of technologyandengineering,especiallyitsrisksandtheques
tionsof safety,security,andcare.He haslecturedto many
professionalassociationsandhastrainednumerousprofessions.
He is a life memberof ClareHall, Cambridge.He is thevice
presidentof InternationalBerkeley Society and the
PhilosophicalSocietyof Finland,andheis anhonorarymember
of the LearnedSocietyof Praxiology(Warsaw).He hasalso
writtenontheMarquisdeSadeandH. P. Lovecraft.