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Abstract

Research in professional ethics is a fairly new ﬁeld of ethics, which is concerned with the values which govern the professions and provides us with the theoretical framework for dealing with issues which arise in the context of the professions.

Introduction

Though apparently a new ﬁeld of philosophical research, professional ethics, as a domain of research, can be traced back to antiquity, to the treatises of the philosophers–physicians, and even before them to the work of philosophers such as Plato, Aristotle, and Xenophon. Even though they did not actually have a notion of professional ethics, nevertheless the way they conceived professions was heavily value-laden. Unlike with what happens in our era, in antiquity professions could hardly be divested of the rich evaluative meaning they possessed.

The Origins And The Historical Development Of Professions: From Technai To Professions

Plato On Technai

The notion of profession is not a modern one. Its origins can be traced back to classical antiquity and, in particular, to writers such as Plato, Aristotle, Xenophon, Hippocrates, and Galen. Plato in his dialogues mentions a great number of technai (te wnai), as he calls them, which range from shoemaking, pottery, weaving, carpentry, building, shipbuilding to medicine, music, calculating, and political craft. However, things are not as simple as they may appear to be. It may be true that Plato has not written a dialogue on technai; however, he has a rather sophisticated conception of technê (te wn ) and he comes back to it again and again in his dialogues. He is careful to point out that whereas in some cases the result or the product of technê is different from and independent of the activity, in other cases the result is the activity itself. Thus, in the case of medicine, the result is health, and in the case of building, the result is a house; on the other hand, in the case of calculation, there is no result or product which is independent of the activity of calculating.

Technê is initially associated with a practical component, with knowing how to do certain things or certain activities. But even in this early stage of development, technê also involves a theoretical element, a kind of knowledge or episteme (ἐpistήm ). Throughout his dialogues, the two notions are used in an interchangeable manner, and it seems that Plato’s foremost concern is not so much to distinguish technê from episteme as to make the concept of technê clearer.

In his conversation with Polus in the dialogue Gorgias, Socrates argues that rhetoric is not a technê but instead an experience (ἐmpeirίa) (Gorgias 462 B-C). He draws a distinction between the industries which are assigned to each of our two parts (Gorgias 464 B-C). We have, on the one hand, the tendance of the body, which is divided into two branches, medicine (ἰatrikή) and gymnastic (gumnastikή), while, on the other hand, we have the care of the soul, politics (politikή), which in an analogous manner is distinguished into two parts, justice (dikaiosύn ) and legislation (nomoyetikή). As he points out, between each of these pairs there is some kind of intercommunication (ἐpikoinonoῦsi mὲn dὴ a᾿llήlaiB), and medicine is related to gymnastic in connection with the body in the same way that justice is related to legislation in connection with the soul.

Along with these four technai which look after what is best and advantageous for the body and the soul, respectively, there is the art of ﬂattery (kolakeίa) which divides itself into four parts, i.e., personal adornment (kommotikή) and cookery (ὀcopoi tikὴ) on the one hand and sophistry (so’istikή) and rhetoric (ῥ torikή) on the other. Even though each of these parts of ﬂattery does not possess any knowledge or episteme, it insinuates itself in the position of one of the four branches of technai. Cookery, for instance, pretends to take the role of medicine, assuming that it knows what is good and healthy for the body. But in so doing, it does not beneﬁt the body at all, it simply presents itself as something which is not, seeking what is delightful and pleasant and ignoring what is best (Gorgias 464 D–E). According to Plato, ﬂattery is something disgraceful and shameful because it is concerned with what is pleasant and not with what is beneﬁcial. It is not a technê but a habit or an experience, “since it has no account to give of the real nature of the things it applies, and so cannot tell the cause of any of them” (Gorgias 465 A). Plato claims that we cannot call something an art if it is irrational (Gorgias 465 A). A technê, on the other hand, can give an account of the nature of its object, can explain in a scientiﬁc manner the causes of the things it does, and can justify rationally its existence (Gorgias 501 A).

It becomes obvious that technê, according to Plato, has two characteristics: (a) it involves knowledge and (b) it is beneﬁcial to its object. The physician and the physical trainer look for the welfare of the body in the same way that the judge and the legislator care for the welfare of the soul (Gorgias 464 C).

But Plato also says something further. He claims that engaging with knowledge, acquiring an episteme or technê has a reﬁning inﬂuence upon the technites himself. True, in the lower stages of knowledge, the knowledge of the things of the senses, a technites can come to experience certain virtues, the ones required for his expertise. So he may become brave but he has not been virtuous yet. However, as he goes up the ladder of knowledge and he acquires knowledge of the Forms, he eventually beholds (yeᾶtai) the Idea of Good; he becomes one with it. This man participates in the Idea of Good by virtue of which all other virtues are uniﬁed.

It is now understood why the carpenter, the smith, and the farmer, who have a limited knowledge of the objects of the senses and, therefore, possess only certain virtues, will concentrate only on some partial good of the city; whereas the philosophers who have acquired the supreme form of knowledge, i.e., the dialectic, by virtue of which they can behold and thus participate in the Idea of Good, can work for the welfare of the city as a whole (Republic 428 b–d). This is how Plato reaches his twofold conclusion: (1) that the persons most appropriately equipped to become rulers of the city are the philosophers and (2) that the craft of ruling is the supreme of all arts.

Aristotle On Technê, Art, And Craft

The notion of technê is taken over and further elaborated by Plato’s pupil, Aristotle. According to Aristotle, technê is not distinguished from knowledge, since it is a form of knowledge itself. In the Nicomachean Ethics, he offers an account of the different forms of knowledge or science, as he calls them, and of the way these are interrelated (Nicomachean Ethics, VI, I, 1138 b 34 – 1139 a 15). All forms of science are processes which take place in the rational part of the soul, unlike the instincts, drives, and desires which are included under the irrational part of it. Thus far, Aristotle emphasizes the common origin of both science and technê. However, as he hurries up to add, if knowledge proceeds by virtue of a kind of likeness or afﬁnity between subject and object, it follows that if there are different kinds of object, then there must be different kinds of knowledge (Nicomachean Ethics, VI, I, 1139 a 9–12). As a consequence, if we examine and contemplate things whose principles are necessary or invariable, then we employ the kind of knowledge which stems from the Scientiﬁc Faculty of the rational part of the soul. If, on the other hand, we contemplate things which admit of change and variation, we proceed by means of the kind of science which ﬂows from the Calculative Faculty of the rational soul. Even though in both faculties the aim is the attainment of truth, however, the virtues or dispositions which best qualify them to achieve the truth differ in each case (Nicomachean Ethics, VI, II, 1139 b 12–14). Aristotle distinguishes ﬁve qualities by virtue of which man attains truth: science, wisdom, intelligence, technê or art, and prudence (Nicomachean Ethics, VI, II, 1139 b 15–18).

Science, wisdom, and intelligence are the three (intellectual) virtues by means of which operates the Scientiﬁc Faculty of the soul. The objects of the Scientiﬁc Faculty are the theoretical sciences which, in Aristotle’s days, included ﬁrst philosophy (metaphysics or theology), physics (natural science), and mathematics (Metaphysics, VI, I, 1026 a 18–19). In the case of theoretical sciences, the principles are in the things to be known and not in the knower. Of course, things may be either necessary and invariable (as in the case of philosophy and mathematics) or changeable and variable (as it is the case with natural science). Science or episteme implies knowing things which are necessary and invariable. It also implies knowing things which are variable by virtue of the unchanging principles which are instantiated in these changeable things (Polansky 2000). Moreover, science proceeds by means of demonstration from ﬁrst principles, and it aims at truth or knowledge. In this sense, it is entirely speculative and not practical, despite the fact that Plato and Aristotle quite often connect the theoretical activity of man with eudaimonia (eὐdaimonίa) (Nicomachean Ethics, X, VII). Furthermore, precisely because it proceeds by a kind of apodeictic syllogism, science can be taught. Of course, ﬁrst principles cannot be so taught, because they cannot be conceived through demonstrative syllogisms. If known at all, these ﬁrst principles can only be known through a particular activity of the Theoretical Faculty initiated by intelligence, the dialectic.

Art or technical skill and prudence (phronesis, ’rón siB) are the particular dispositions of the Calculative Faculty of the soul by virtue of which we attain knowledge of things which could have been different from what they are (ἐndewómena). The builder has to think about the size of the house he is about to build in the same way that the physician has to contemplate in advance the kind of treatment he is going to prescribe to the patient. Aristotle draws a distinction between the productive and the practical sciences. The productive sciences include crafts like carpentry, shoemaking, building, and shipbuilding; arts like painting, dancing, and poetry; and technai like medicine (ἰatrikή), husbandry (georgίa), and warfare (polemikή te wn ). In the case of productive sciences, the artist has the form of the thing to be made in his soul, and he then realizes it gradually in some external matter. The principles of the art, therefore, reside in the artist (Metaphysics, VII, VII, 1032 b 1–1033 a 1). Even though the power which originates the art is in the artist, the arts have to conform to the standards of good practice which are appropriate in each ﬁeld. The ultimate justiﬁcation of these standards is nature, since according to Aristotle all that technê does is to imitate and compliment nature (Polansky 2000; Physics, II, 194 a 21–27). Productive sciences therefore are potencies, principles by virtue of which we produce things, whose origin lies in the rational soul of the producer. These rational potencies admit of contrary results, because science is a rational account which involves both the thing and its privation. The physician has knowledge of the principles of health but equally of what destroys it, of disease (Metaphysics, IX, II, 1046 a 36–1046 b 29). What he eventually decides to bring about, health or its privation, does not fall in the realm of productive sciences; it is a matter of choice and as such it is a concern of practical sciences.

Moreover, each productive science aims at some particular good. The art of shipbuilding aims at making a vessel, whereas the art of engineering aims at building a bridge. The particular good of each art is often wished for its own sake; however, it is also wished for some further good. This implies that there must be some ultimate Good, the supreme Good. The Good however is not the object of a particular art but of a mastercraft, as is obviously called the science of Politics (Nicomachean Ethics, I, I, 1094 a 27–29). Politics determines which sciences should exist in the state, which kinds of knowledge should be sought, and which forms of good should be promoted. It would seem that in so far as it includes the particular goods of the other sciences, the end of Politics is the Good of man. But since the Good of man is the same for the individual and the state, and the Good of the state is greater and more difﬁcult to attain, it follows that the Good of the Political science is the Good of the state (Nicomachean Ethics, I, I, 1094 b 5–12).

Aristotle does not hesitate to restore experience to the place it deserves. He claims that art came from experience. It is through repeated experience that a universal judgment or principle is formed with regard to similar objects. Experience is the knowledge of particulars, whereas art is the knowledge of universals. This is why art remains superior to experience and the master-craftsmen (a᾿rwite ktoneB) are wiser than the artisans (weirote wnai) (Metaphysics, I, I, 981 a 26–981 b 5). For the artisans know how to do things, but they do not know the reason why they do them; the mastercraftsmen, on the other hand, are wiser because they know the causes of the things which have to be done (Metaphysics, I, I, 981 b 5–7). This explains why art can be imparted by teaching, whereas experience cannot. The artist who wishes to teach his art can do so by knowing and explaining the reasons for which everything is done in his art. The artisan, however, does not have this option. The conclusion, therefore, is not only that art can be taught. But precisely because the sign of knowledge is that it can be taught, art turns out to be a kind of knowledge, a kind of science, something which obviously experience is not (Metaphysics, I, I, 981b 7–12).

However, if the productive sciences are concerned with making a product which goes beyond the process of making, the practical sciences are concerned with choice and action. As already hinted at, the practical sciences are indirectly involved in the way the artist chooses to perform his art, since he can have knowledge of the contraries. It is practical wisdom, the capacity of the practical sciences, which will enable him to make the right choice regarding his art. Practical wisdom or prudence is the capacity the agent has to think about the human things and know what is good for him, for his house, and his community (Nicomachean Ethics, VI, VII, 1141 b 8–11). This is why, according to Aristotle, there is the main prudence (ethics, ἦyoB), the prudence which concerns the house (house management, economy, oἰkonomía), and the prudence which concerns the city or the community (politics, politikή). The faculty by virtue of which we realize the things our prudence tells us that we ought to do, if we wish to attain our end, is cleverness. If the end is noble, then this competence is praiseworthy; if the aim is evil, then it is knavery. Now prudence is precisely related to this kind of cleverness which enables us to attain the right end. This is why, according to Aristotle, we cannot be prudent without being virtuous at the same time (Nicomachean Ethics, VI, XII, 1144 a 35–37).

The physician therefore who chooses to restore health rather than its opposite shows that he is a prudent man, since he consciously chooses to bring about the right end and to avoid the evil. He is the person who distinguishes what things ought to be done with regard to himself, to his house, and to his city, in the light of the right end. The aim of practical science is human happiness.

This is why the practically wise man, (prudent, spoudaῖoB), in choosing which things ought to be done and which particular arts ought to be practiced, actually promotes the supreme Good, which is eudaimonia (eὐdaimonίa). Unlike the particular sciences or technai, each of which promotes a particular good, the practical science aims at the attainment of the whole Good. As a consequence, while they need to be ordered by practical science, and in particular by the superior of all practical sciences which is Politics, practical science need not be so ordered (Polansky 2000).

Practical wisdom, like virtue, is exercised rather than taught. Virtue is a state of character which lies between two extremes, the excess and the deﬁciency. No amount of teaching can show anyone how to achieve this medium. Only by habitually making the right acts, man gradually succeeds in developing his character to this intermediate state and become practically wise and virtuous. This is a process which takes quite a while and in which teaching plays only a secondary role (Polansky 2000).

Not only in Aristotle’s treatises but also in his successors’ works there is the widely held view that certain arts are superior to others and that the highest of all is medicine. After describing how various arts developed out of experience, Aristotle draws a distinction between the arts which are related to necessities and the arts which are related to our leisure time, esteeming those who practice the latter wiser, because they do not aim at some kind of utility (Metaphysics, 981 b 18–22). Despite this distinction, however, Aristotle does not fail to remind us repeatedly of the various respects in which medicine excels all other arts. In his ethical treatises, in particular, the science of medicine is the standard paradigm by reference to which he compares and contrasts ethical thinking.

Xenophon On The Noble And Illiberal Arts

In a similar spirit, the famous historian Xenophon (430–354 BC), somewhat older than Aristotle, distinguishes between the illiberal (banaustikaί) and the noble arts (Oeconomicus, IV, 2–6). He speaks disapprovingly of the former because they force the craftsmen to sit and work all day indoors, softening in this way both their minds and bodies. Moreover, as they so work in complete isolation, they have no spare time for their friends, nor do they have the interest or the ability to defend their country. The opposite is the case with the noble arts, and the king of Persia is a good example in this respect, because he engages equally in husbandry and the art of war (Oeconomicus, IV, 2–6).

The Philosophers-Physicians On Technai

Along Aristotle runs a long tradition of philosophers–physicians who compose treatises on medical art praising medicine as the superior of all arts. The most popular of them was, of course, Hippocrates (460–370 BC). Among Hippocrates’ medical and deontological works are included his two treatises: On Medical Art and The Art respectively. His aim in the former is to show that, even though medicine came out of philosophy, it has nevertheless developed into a new and independent art with its own principles and methods (On Ancient Medicine, XX 1–27; Kalokairinou 2014). In the latter, he defends medicine against its detractors’ objections who claim that there is no such thing as a medical art and that all cures are due to luck, and he goes on to deﬁne the end of medicine (The Art, IV–VI).

The reason however Hippocrates has been renowned is because he was the ﬁrst philosopher–physician to introduce a systematic kind of medical code in the form of his Oath. Unlike the famous Code of Hammurabi (eighteenth century BC), which is an example of a legal code issued by the supreme Assyrian leader Hammurabi, Hippocrates’ Oath deﬁnes the standards of practice which all good physicians should follow. According to Hippocrates, the good physician should not only have knowledge of his art, but he should also practice it as a virtuous physician would (Oath). This implies that he should be careful about his relationship with his patients and their family members due to their vulnerable situation (The Physician, I, 23–27). But in order to be kind and respectful toward his patients, the physician has to be modest, reserved, of sound opinion and judgment, free from prejudice, and to be opposed to vulgarity, greed, and shamelessness. But then, if he is all that, the physician is a philosopher, i.e., equal to god (Decorum, V, 1–13).

By Roman times, the medical profession is further developed and formed. Aulus Cornelius (c. 25 BC c. 50 AD) is famous for his treatise, De Medicina. This is a kind of encyclopedia, a lengthy work which included volumes on agriculture, law, rhetoric, military, and other arts. However, in extant parts of this, Celsus presents us with an excellent history of medical art up to his own days.

Galen of Pergamon (129–199 AD) devotes a whole treatise on exalting all arts, and particularly medicine (Exhortation to study the Arts, especially Medicine, 2004). He divides all technai or professions into two categories. The ﬁrst, which consists of all the arts of intelligence, Galen calls honorable and liberal arts. These are medicine, rhetoric, music, mathematics and calculation, astronomy, grammar and jurisprudence, and, of course, sculpture and painting. The second category includes all those crafts which require manual labor or the illiberal arts. Galen concludes that the young, if they are not to be vulgar, should learn how to exercise one of the arts, and especially the best of all which is medicine (Galen 2004).

The Professions In The Roman Era And The Middle Ages

Unlike the medical profession which was formed and developed in ancient Greece, the legal profession was rather exclusively a Roman achievement. Although the Ars Oratoria was practiced in ancient Athens, it was the Roman Republic that ﬁrst introduced the expert consultants and later the advocates, when the forensic and the trial system became more complex (Siggins 1996). At the same time, in the Christian era, the Church developed its canonical laws and ecclesiastical courts. As a consequence, even though the paid legal representation was not accepted, the Church legal ofﬁcials quite often undertook issues of property and family law. The result was that this mixed legal and ecclesiastical system survived through the centuries of feudalism that prevailed in Europe and reappeared in the twelfth century as University disciplines in the civil and canonical law. However, whatever the inﬂuence was between law and canon, to the standard ethical dilemma which the legal professional was facing, i.e., whether to do his duty and support the person represented or whether to do his duty to society, the Church bequeathed the injunction that he should practice his profession in accordance with law and truth (Siggins 1996).

The Professions In Modern Times

In the ﬁrst millennium of the Christian era, the profession of divinity also makes its appearance. Initially this profession is used to imply the conversion to monastic life and its vows; later on it means the kind of vocation which takes care of the man’s soul. More than any other, the profession of religion matches with the deﬁnition of a profession as a serious commitment or calling. To profess (the Latin verb “proﬁteri”) means to state openly that one has a belief, to avow that one has a faith or conviction, and to declare publicly that one has a particular kind of knowledge and that he is a physician, an advocate, a teacher, or a priest and therefore one who fulﬁls all the conditions in order to realize his calling (Siggins 1996).

Moreover, while all these professions were preserved in the monastic order during the middle ages, with the establishment of the European University, the teachers of religion were the ﬁrst that were called “professors.” The title was further extended to the readers of other disciplines in the sixteenth century, when the king of England Henry VIII established ﬁve regius professorships at Oxford, contributing in this way to the process of secularization that all learned professions were going through (Siggins 1996). The distance from the modern professions was not far.

Definition: What Is A Profession?

The “profession” is often used as an umbrella term in order to include all sorts of occupations ranging from vocations, arts, to trades, jobs, etc. This is why it is difﬁcult not only to deﬁne professions but also to distinguish them from various kinds of occupations. The distinction between illiberal and liberal arts, already present in antiquity, continues and is further enhanced in modern times: liberal are the professions that beﬁt the “free men”; they are also “learned” in the sense that they are related to a certain body of knowledge or expertise. Moreover, the professionals “practice” their art, and they do not simply “work,” something which denotes not only their autonomy but also their authority in the particular ﬁeld they exercise (Chadwick 1997). As a consequence, an occupation usually means the particular activity one is engaged in for living, whereas by “profession” we imply the “white collar” activity one practices which is usually related to a certain status, e.g., physician, lawyer, clergyman, teacher.

Attempts to deﬁne a “profession” in terms of necessary and sufﬁcient conditions have not been successful, because there will always be borderline cases which these deﬁnitions cannot account for. Deﬁnitions by means of family resemblances, on the other hand, seem to be more to the point, since they assume that the concept of a profession is a developing one and that they are not formulated on the basis of the standard characteristics that professions such as medicine, law, or teaching have (Downie 1990). However, both of these types of deﬁnitions are wrong in that they attempt to capture the features which as a matter of sociological fact professions have, and they fail completely to conceive what is good and important about them. Unlike the sociologist, the philosopher is concerned with bringing about what is good about the professions and the professionals and with providing a partly evaluative account of them (Downie 1990).

Along these lines, it has been suggested that the ideal features the professional includes are mainly that she provides a service to the clients who are in need of it, by means of a relationship which is conceived in a twofold manner: either as a bond which joins two or more persons, for instance, physician–patient, teacher–pupil, marriage, etc., or as an attitude, a desire to help those in a vulnerable position, a feeling of beneficence. This kind of inequality which characterizes the professional relationship requires that the bond takes the form of an institutional body, all the more so especially if we take into account the degree of intimacy to which professionals come with their clients and intervene in their lives. Moreover, the professional has the social function to go beyond her duties to her clients and to express her opinion boldly on issues of public policy which relate to her expertise. Of course, she can only retain her outspokenness and integrity, if she can remain free from any inﬂuences that come either from the state or from commerce (Downie 1990).

One does not fail to notice a gradual shift from deﬁning a profession by virtue of certain characteristics to deﬁning a professional or a professional attitude. The professional must always be in a position to justify with reasons the work she does, reasons that are independent of what the consumer likes. If she chooses to sacriﬁce “the value of reasons” in order to save “the trade value,” then she is not a professional anymore but turns into a tradeswoman. If she, on the other hand, sticks to her reasons and decides to act in accordance with them, even at the risk of losing her customer to another worker, she is a professional. Professionalism, therefore, and working in a professional way is what characterizes the professions (Davis 1991).

Because of the difﬁculties with which are replete the deﬁnitions of a profession, a further suggestion has been made that we should conceive of professions not in terms of traits but in terms of a process, that is, a process by virtue of which certain occupational groups get gradually recognized and acquire status. This conception of a profession however is heavily laden with the Anglo-American values which tie up occupation with status, unlike the European value system which associates it with education (Chadwick 1997).

According to a different kind of approach originating in sociology, a profession is not so much an orientation that offers guidance and support to vulnerable people but, instead, an ideology. Its ultimate goal is, through determining human needs, to make people dependent upon them and so exercise authority and control upon the whole population (Chadwick 1997).

Identifying The Problems

The ﬁrst problem of professional ethics refers to the professional relationship, the way the professional is related to his client. How do we analyze the professional relationship? Is it contractual, covenantal, or a commodity transaction (Pellegrino et al. 1991)? As philosophical arguments have shown, the professional relationship is none of these. It has been viewed in different terms. Especially in the medical profession, the client has to lay herself open, both literally and metaphorically, to the prudence of the professional and ask his counsel or advice. This has come to be known as “the phenomenon of nakedness” according to which the client has to lift the cover of privacy that protects her in order to facilitate the professional’s acquisition of knowledge about her state (Sokolowski 1991). It is the nakedness, openness, or vulnerability of the client which grounds the professional’s obligation to exercise his professional judgment and skills for the good of the client. This obligation does not spring out of the beneﬁcent or virtuous character of the former. Rather it is based on the relationship which is formed between the professional and the client (Sokolowski 1991).

The professional relationship is mostly seen as a ﬁduciary one. The client entrusts the professional not merely her possessions but herself: the health of her body, the salvation of her soul, the education of her mind. The professional, on the other hand, is trustworthy not in the way that a friend or a relative is but in virtue of the certiﬁcation he has received as an expert in a ﬁeld (Sokolowski 1991). The professional relationship is mostly reciprocal: not only the client trusts the professional and entrusts her problems to his judgment but also the professional expects that the recommendation or counsel he has given will be followed and respected (Sokolowski 1991).

Viewing, however, the professional relationship as a ﬁduciary relationship presents certain problems. Some philosophers tend to understand the ﬁduciary relationship as a form of paternalism in which beneﬁcence is the prevailing principle (Zaner 1991). The professional decides the most appropriate therapeutic method which will mostly beneﬁt the patient. In this spirit, certain philosophers talk about the “ﬁduciary paternalism” (Zaner 1991).

The ﬁduciary paternalism, however, tends to highlight the inequality of the two parties. The patient is condemned to enter a relationship of asymmetry because she is vulnerable, while the professional possesses the knowledge and the skills to heal her (Zaner 1991). This asymmetry, which is inherent in the professional relationship, imposes certain responsibilities and obligations on the professional. In actual fact, the root of the professional’s obligations lies in this very asymmetry (Zaner 1991).

While the asymmetry of the professional–client relationship constitutes a permanent temptation for the professional to employ his power in such a way as to take advantage of the client, at the same time it founds the moral imperative which is implied by the trustworthiness attached to the professional in virtue of his social certiﬁcation. This is the most important issue about the ﬁduciary relationship. Moreover, it is true independently of whether we conceive it as paternalistic or view it in terms of informed consent, entitlement, and rights (Zaner 1991). It is argued that for the last 30–40 years, things have changed not only in medical but also in the other professional relationships. Even though at its very core the professional relationship remains ﬁduciary, we have gradually replaced the beneﬁcence model with the autonomy model (Zaner 1991). However, trust and trustworthiness still remain the core concepts of the relationship. It is simply that all the issues discussed so far in the language of beneﬁcent paternalism have by now been shifted to the language of rights, entitlements, and autonomy. This is even more obvious in the case of informed consent, the most central notion of autonomy. If a patient or a client is to be informed in an unbiased manner, in order to give his uncoerced consent to a treatment or a course of action in a relationship which is asymmetrical, trust will have to be the presupposition of the professional relationship. And this is so not only with regard to the relevant information the professional discloses to the client but also in connection with the actions he undertakes to perform regarding her vulnerable situation (Zaner 1991).

The inequality of the professional relationship implies precisely the vulnerability which the patient or the client experiences. She is in a sensitive position, and so she calls for support and help from someone she trusts that can understand her situation. In a way, she asks the professional to be in her shoes and, while remaining himself, see her situation as she herself experiences and understands it. In feeling the situation as the patient feels it, the professional is actually orientated towards her, and he feels compassion for her. In fact, he enters in a caring, sympathetic dialogue with her (Zaner 1991). It is this care and compassion which the professional feels for the patient which lifts the inequality of the relationship and transforms it into a relationship between equals. To be sure, like all dialogues, the professional–patient one has to be mutual, between two equal parts. This is why, for some philosophers, care for the vulnerable patient is the root axiom of an ethics of trust (Zaner 1991).

The notion of trust, as a key notion in professional ethics, has been disputed by philosophers for both social and theoretical reasons. The empirical reasons may relate to a number of events and policies that have been taking place in society for the last 20–30 years such as the commercialization of medical care, the phenomenon of malpractice, the excessive income of certain professionals, the payment-in-advance-of treatment policy which many hospitals and physicians apply, etc. Or they may have to do with the incompetent, self-interested, greedy, and insensitive character of the professional or, even, with the patient or client herself (Pellegrino 1991). The patients or clients have been recently better educated and informed and have all the means to check not only the knowledge they acquire from the professional about their situation. As the patient or the client is getting gradually more independent and he moves from a beneﬁcent paternalistic to a patient or client autonomy trend, she can also seek to examine the professional’s failure and success records and even ask his peers’ opinion (Pellegrino 1991).

For all these reasons, an ethos of distrust has appeared in society. Fewer and fewer people consider the professionals trustworthy, preferring to secure the patient–professional or the client–professional relationship by employing various mechanisms: by means of contracts or by appointing an ombudsman or a healthcare manager or a patient advocate who will operate as an intermediary (Pellegrino 1991).

However, these people do not understand that by turning a professional relationship into a contractual one or by interjecting a third objective party to the relationship with the professional, they actually reduce a natural relationship into a legalistic one (Pellegrino 1991). Each party is simply concerned with protecting her own interest to the extent that this is safeguarded by a contract or a legal representative, and nobody wishes to transcend herself and act in ways that go beyond the conditions of the contract. This is a policy, however, which will automatically lead to the eradication of trust in the patient–professional relationship and to its replacement by a more complex contractual or legal system of agreement (Pellegrino 1991).

Contracts and legal agreements, however, are more difﬁcult for a patient or a client to handle. Even though she had so far to attempt to communicate with the professional in a direct manner, now she has to get to him, be it a physician, a lawyer, or a minister, through a healthcare manager or a contractual agreement. Such a procedure not only complicates things, but it mainly brings out the ineradicability of trust in professional relationships. The patient or the client now has to trust not only the professional but also the ombudsman or the third party that intervenes between her and the professional. Contracts and third parties’ interventions cannot operate and be efﬁcient, unless they are rooted in the trustworthiness of the parties involved.

There are also conceptual reasons for which professional trust has been questioned. Robert M. Veatch provides us with three basic arguments in support of his contention that trust for the professionals is not a coherent concept (Veatch 1991). The ﬁrst argument is that quite often it is impossible for the professionals to know what the best interests of the clients are. And if they cannot know them, obviously they cannot be trusted to be in a position to advise their patients accordingly (Veatch 1991). According to the second argument, trust is affected not so much because the professional cannot know the patient’s or client’s wellbeing but because he cannot provide the client with a value-free description of the facts that concern her. If the physician, the lawyer, the minister, or the teacher cannot offer the required information with regard to the client’s situation in a way which is independent of his own evaluations, then he cannot be trusted as a reliable, impartial expert in the ﬁeld, and the ﬁduciary character of the professional relationship breaks down (Veatch 1991). The last argument refers to the importance virtues have for professional trust. Even though we cannot trust the professional because he cannot know the patient’s or the client’s best interests, or because he cannot give a value-free account of the facts which are relevant to the patient’s situation, we could perhaps still consider him trustworthy because he was a virtuous man and because of the speciﬁc virtues which are inherent in that profession. However, it is claimed, it would be a mistake to argue in this simplistic manner. There are no virtues which are speciﬁc to each role or to each profession. This is because it would be wrong to conceptualize a certain profession in a particular manner. The conception we have of the profession of the physician, the lawyer, the minister, or the teacher is not univocal in the different cultures. The physician is certainly conceived quite differently in the Hippocratic, Christian, Talmudic, or liberal tradition. As a consequence, there cannot be speciﬁc virtues in the generic role of the physician. On the contrary, the virtues of the generic profession of the physician are different, depending on the particular conception of the physician we have in mind each time, which, in turn, is determined by the different underlying social and ethical systems (Veatch 1991).

These attempts, however, to deconstruct professional trust and to establish ethics of distrust are doomed to fail. As has been pointed out, the physician is responsible for deﬁning the patient’s good and for attempting through his advice to make her achieve it. This is the physician’s expertise. He cannot however be worthy of his role, unless he is able to place it in the patient’s or the client’s scheme of evaluation of his total good or well-being. The latter is the patient’s or the client’s business. However, he would have violated his patient’s autonomy, if he assumed that deﬁning a patient’s well-being was the physician’s job (Pellegrino 1991). In a similar manner, the professional trust is not affected because the physician cannot give an account of the medical facts which are relevant to the patient’s situation in a way which is not laden by his evaluations. In fact, even though this happens fairly often, it is not always the case. In most cases, the physician can present the medical situation and the required treatment in a way which is logically independent of any evaluations he may hold, even though admittedly at some more progressed stage the values he embraces as a physician and as a person may come into the picture and shape the way he conceives the medical facts. Such a thing however need not imply that professional trust is eradicable; the least it can mean is that trust in the professional relationships is not perfect (Pellegrino 1991). This is why philosophers like Edmund D. Pellegrino wish to prescribe a new ethics of trust in which ﬁdelity to trust will be the logically necessary concept upon which the basic obligation in all professional relationships will be founded (Pellegrino 1991). Moreover, it would seem that in conceiving the speciﬁc virtues of a profession not only in virtue of the particular conception of the profession but also in terms of the underlying ethical and social systems, one may be criticized for holding a relativistic view of virtue. Such a view, however, need not worry us very much. As Julia Annas has pointed out, virtue is a “thick” concept; it conveys information about the situation to which it is applied and at the same time evaluates our disposition towards it (Annas 2015). The speciﬁc virtues inherent in the Talmudic conception of the medical profession may be different from the speciﬁc virtues which are inherent in the liberal conception of the same profession. However, even though they are as speciﬁc as to apply to each conception of the medical role, nothing stops them at the same time from being equally universalizable. On the contrary, the speciﬁc professional virtues are not so much a threat to the universalizability of virtues as they are a danger to what we call “the unity of virtues” (Meilaender 1991). In the very end, are the virtues of the good physician, of the good minister, or of the good teacher different from the virtues of a good citizen or a good person? Would the physician, who is committed to the healer’s role and who would never kill either for compassion or for money, ever harm someone in his civic and/or private life? Do the virtues of the professions ever clash with the requirements of ordinary morality? (Meilaender 1991).

The answers to these questions are divided. On the one hand, there are those who tend to argue for the unity of virtues. Their view is logically implied by their conception of moral life as a harmonious whole in which clashes of virtues cannot even be conceived. In such a conception of morality, the professional does not simply seek a speciﬁc virtue, be it justice or spiritual care, but also seeks to promote the whole virtuous way of life. Considered in this light, professional trust not only is not threatened by the unity of virtues but is also extended beyond the sphere of each individual profession and establishes itself at the center of moral life itself.

There are those, on the other hand, who claim that conﬂicts and tragic dilemmas are the essence of moral life (Meilaender 1991). They conceive moral life as fragmented, consisting of different compartments, public, professional, private, in which we are called to participate and decide. Decisions now taken in the professional sphere cannot merely depend on the virtues inherent in the particular profession or on the trustworthiness of the professional. In order to avoid the arbitrariness intruding in the professions in the contemporary liberal society, philosophers suggest that there should be at least an ethic speciﬁc to each professional group, instead of relying on every individual professional’s judgment. In this way, even though the professional’s autonomy will be preserved, he will always be required to give an account of his decisions and his actions not only to his clients but also and more importantly to his peers (Chadwick 1997).

Along with the internal approaches to professional ethics, consequently, there are also the external approaches. An external approach would imply that a moral theory like Kantianism, Utilitarianism, or Feminism can be applied to the issues that arise in the professional context and in connection with the professional–client relationship (Chadwick 1997). The principles of the professional codes have often been considered as a ﬁrst attempt to apply Kantian ethics in the professions, even though one could also work out an interpretation according to which the codes of conduct may ﬁt into a virtue ethics account of morality. A Kantian analysis of the codes of conduct would mean that we tend to view the contents of the codes not so much as Kantian moral principles but as a number of guidelines which prescribe the particular courses of action which the professionals ought to follow (Harris 1994). This kind of approach, however, has been disputed on the grounds that it does not constitute a genuine interpretation of the Kantian thought. Kant would object to specifying maxims and putting them down in print. This would go against the grain of morality which is primarily concerned with authenticity. According to a Kantian account, professionals would be expected to work out their principles themselves and not to take them ready from the codes of a conduct book (Harris 1994).

Moreover, the Utilitarian approach seems to ﬁt quite well to the legal profession. This is so because in the contemporary liberal society, the lawyer is expected to know how to promote the client’s best legal interests through the adversarial system, something which by deﬁnition has been set to promote the greatest interests of the whole society (Chadwick 1997). In the end, the Feminist theories of care can be construed either as an internal account, when care is conceived as a virtue which is inherent in the professions, or as an external account, when care provides the logical framework through which we can address the issues rising in the professions (Chadwick 1997).

Conclusion

In this paper, we attempted to bring out the development of the professions both historically and systematically. In so doing, we noticed that this was not easy, as these two kinds of accounts could not always be kept apart. The origins of professions can be traced back to classical antiquity, at a time when the artist was equally concerned both to achieve the truth and to beneﬁt the others. The picture changes gradually in the renaissance and the modern era. The professional now is concerned to support, counsel, and offer spiritual care to the vulnerable client that approaches him through and by virtue of a caring and trustworthy relationship. In the liberal contemporary society, however, as life has been essentially compartmentalized and every sense of unity has been lost, external ethical accounts have been applied to professions in an effort the philosophers make to safeguard the interests of both parties in the professional process.

Our conceptions of the profession, however, and of the way we conceive the professional context are going to change further in light and under the pressure of the new technological developments in the related ﬁelds. Telemedicine or e-medicine, for instance, is going to inﬂuence the way in which we understand the professional relationship and to redeﬁne the professional process anew.

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