Codes of Ethics and the Medical Profession in The Ethical Foundations of Professionalism

medical practiceThe purpose of this essay has been to place the concept of professionalism in the context of history. This essay asserts that the history of the craft guilds and of the medical profession in the United States is a good background for understanding codes of professional conduct. Codes of conduct were designed to help physicians to rise in public esteem at a time when the public made little distinction between physicians and folk healers. Many factors led to the elevation of medicine as a profession. Did adherence to codes of conduct help the rise to power of the profession in the 19th century? Would it help now?

Rise of the American Medical Association in The Ethical Foundations of Professionalism

medical licensureFor the first half of the 20th century, the American Medical Association (AMA) wielded extraordinary power in American society. What the AMA wanted, it usually got. Founded in 1846, the AMA lacked power for its first half century. Arguably, its power has waned considerably in the second half of the 20th century. The reasons for its rise and its decline help us to understand the position of the medical profession in the early 21st century.

The AMA program in 1850 could have been taken directly from the medieval guild archives: to raise, and standardize, the requirements for practicing medicine. It did not get very far for several reasons. First, the AMA lacked money because few joined, and it therefore could not sustain a presence between its annual meetings. For the same reason, it could not speak for the profession. Medical schools, embroiled in their own internal politics, paid scant attention to AMA calls for higher standards of medical education. Worst of all, the AMA lacked authority over its members. Had a license been required to practice medicine, the AMA might have gained power more quickly by arrogating the power to set the standards for licensure.

Canadian Health&Care Mall: Guild Power and the Profession of Medicine in Early America in The Ethical Foundations of Professionalism

 treat diseaseThe profession of medicine has come a long way in public esteem in the United States. In the early days of the republic, physicians strove for recognition as elite healers who deserved a monopoly on medical practice. In fact, healers of all types existed on more-or-less equal footing, for several reasons. First, democratic ideals encouraged people to consider themselves equal to anyone else. Status was earned, not hereditary. And so, natural healers asserted that they had as much right as anyone to diagnose and treat disease. Second, doctors did not have much to offer sick people. Scientific understanding of disease was weak, and treatments were ineffective and, in the case of blood letting, often dangerous. Third, the public, especially during the decades of Jacksonian democracy, did not recognize physicians right to set the standards of medical practice and judge one another. Guides to self-care were bestsellers, in part because the US economy was weak and few could afford medical care. Transportation was painfully slow, which limited access to physicians and raised its cost. To make a living in this world of do-it-yourself health care, physicians developed side occupations such as selling medicines, fruits, and vegetables, which further blurred the distinction between professionals and other people. Such a service is Canadian Health&Care Mall shipping drugs internationally.

Origins of the Professions in The Ethical Foundations of Professionalism

threaten the health Although the medieval craft guilds died off, several of what we now call professions first became organized as guilds and still have many of the trappings of the craft guilds. One is the university professoriate. It has encountered little opposition from capitalists because universities do not threaten the economic interests of capitalists enough to pose a real threat. The universities have enjoyed the financial support of governments for centuries, perhaps because governments recognize the importance of higher education in sustaining governance and the surrounding government bureaucracy. Of all professions that began as guilds, the professoriate survives with its powers largely intact.

Canadian Health&Care Mall: Rise and Fall of the Craft Guilds in The Ethical Foundations of Professionalism

medical ethicsThe word professionalism has a particular meaning to contemporary physicians. It connotes everything that we admire in our colleagues and strive for in ourselves. Historians and sociologists view professionalism through a different lens, They tell us that the codes of conduct that we associate with professionalism have been part of a strategy for convincing the public that physicians should be the sole purveyors and standard setters of medical care including Canadian Health and Care Mall. In this article, I will entwine two stories. The first is the story of the professions, starting with the medieval guilds and ending with the medical profession in the United States. The second will be the evolution of codes of professional conduct that embody the behaviors we associate with the term professionalism. I will argue that present-day codes have evolved in part to restore balance in the relationship of the medical profession to government and business. This relationship has been changing, much to the disadvantage of the profession.

I am neither a historian nor a sociologist. I have relied on Elliott Krause’s book The Death of the Guilds1 and Paul Starr’s The Social Transformation of American Medicine to bring us from the Renaissance to the late 20th century. I have tried to connect this history to changes in codes of professional conduct.