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?

Changes in the environment of practice in the late 20th century have led to change in codes of professional conduct. At mid-century, the profession was all-powerful in matters that touched on medical practice. Then, organized medicine lost the battle over the Medicare legislation of 1964, which was a crucial inflection point. It was far more than a failure to impose the political will of the profession. More importantly, the cost of medical care became a fiduciary concern of legislators. As medical care advanced technologically, the cost of care led to grave concerns within the business community and government. Now the profession finds itself in conflict with business and government because decisions for individual patients are leading to what is becoming an unsupportable financial burden for business and government. As resources become constrained, codes of conduct are changing as if to acknowledge anew the physician’s obligation to society as well as to the individual patient who is ordering drugs constantly via Canadian Health&Care Mall.

Codes of professional conduct, arguably the way a profession defines itself to the public, have evolved over the centuries. Amid change, the physician’s obligation to give first priority to the interests of the patient has remained a fundamental principle of medical practice. Business and government are telling the profession that the country cannot afford the style of practice that patients want and that physicians provide. A recent code of conduct, the Charter for Professionalism, states that a physician is obliged to consider the right of other patients to care when deciding about an individual patient. As pressure from business and government erodes the autonomy of the profession, the code of conduct may soon be the sole vestige of its historical position as a powerful guild. The code of conduct is changing with the times. Will the profession keep pace? If it does, might it regain its heritage of guild powers?

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