Beyond ProfessionalEthics:Issuesand Agendas

ABSTRACT. Many professional bodies now include activist committees devoted to better serving the broad public interest. Some of the different ways that these groups operate are explored and analyzed. In particular, professional activist groups are divided into two general categories:those dealing mainly with standards of professional practice, and those dealing with political and social issues relevant to the larger social milieu. By participating in such groups, professionals can give the public an alternative view of their profession, and set the stage for public demand for more responsive, socially controlled, professionalpractices.

Introduction In George Bernard Shaw's play The Doctor's Dilemma, Sir Patrick Cullen, an elderly doctor, declares that: "All professions are conspiracies against the laity." l This is, of course, an outrageous statement, now just as much as in 1906 when Shaw wrote his play. Indeed most professions have as their mottoes some maxim that urges their members to serve, protect, or defend their clients; and no doubt most professions do try to serve their clients as well as they can, according to their own particular lights. But what Shaw's doctor points out is that the interests of the clients, or laity, and the vested interests of the professionals who set out to serve them may not be entirely consistent: in fact, Sir Patrick is suggesting that they are quite contrary. It's

Beth &van teaches Environmental Studies at Innis College, University of Toronto. She has a Ph.D. in ecologyfrom Imperial College of Science and Technology, University of London. Her analysis of the influence of vested interests on scientific research, Science Under Siege: The Myth of Objectivity in Scientific Research, was published by CBC Enterprises in 1988. Her other areas of research interest are environmental assessment and environmental education.

Journal of Business Ethics 8:179-- 185, 1989. © 1989 KtuwerAcademic Publishers. Printed in the Netherlands.

Beth Savan

clearly flippant and misleading to go as far as Shaw does, but it is certainly worthwhile to examine what the interests of the public or various publics are, and what exactly the interests of professionals and their organizations might be. In this paper I briefly examine these interests, and then describe and discuss the efforts of various professional "ginger groups" to better serve the broad public interest. (For this purpose I define "the professions" as groups which apply special knowledge in the service of a client - Professor Stevenson's "Group B" - which I take to include academic "experts" working in fields relevant to public policy as well as doctors, lawyers, engineers, nurses, dentists, et al. I will concentrate primarily on activist groups in science, since this is where my background and interest lie.) 2 As several speakers indicated during the Waterloo conference, most professional bodies now include committees or sub-groups devoted to encouraging the honest, decent, ethical delivery of professional services; they expect their clients' interests and more general concerns of social welfare to guide how their members work. 3 In some cases, though, these groups or others are also attempting to match what they do with the broader public interest. This is a much more profound and difficult demand, and can affect almost every aspect of professional practice. I will discuss some of the groups and individuals that have embarked on this path, and explain how it changes their careers and their working lives. Finally, I will conclude with a plea for better integration of the personal, political, and technical aspects of professional work.

Background The professions are among the most respected

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groups in society. People with professional careers generally enjoy the unusual status and credibility reserved for those with specialized knowledge and mastery of a particular area essential to our wellbeing. Public credibility can lead to many advantages. Partly because they are seen (and like to be perceived) as indispensable, professional groups have often established special positions for themselves in society - they have more independence in terms of practice, self-regulation, fees charged and range of services provided. Professional training is gruelling, underpaid, stressful, and often exploitive, engendering alienation from clients and outsiders and encouraging a sense of group identity and common experience. Trainees form a sort of underclass, essential for the smooth operation of the profession. They perform many routine, arduous, but necessary tasks, such as carrying out most of the repetitive lab work in many fields of experimental science. This is justified as an essential learning experience. It forms part of the strict hierarchy existing in most professions, in which the senior members profit by the efforts of their more junior partners who are, in turn (provided they dutifully toe the line) rewarded with good references and the support of their supervisor for their future career advancement. I have described elsewhere the relationship between scientific research supervisors and their postdoctoral assistants as a kind of unwritten contract between the junior and senior scientist: the senior scientist secures the research funds, using his or her reputation to ensure generous grants to cover the cost of equipment, chemicals, and even the junior researcher's salary. In exchange, the junior investigator churns out data and drafts the papers, which he or she and the senior scientist co-author, to provide the senior scientist with proof that research funds are well spent. The senior researcher's reputation eases publication and also greatly enhances the job prospects of the junior researchers working in the lab. 4 In a system where promotion and success depend on an established group of prestigious individuals in the profession, challenging the priorities and/or practices of the group is strongly discouraged. This kind of isolated, stressful training does not encourage,

and may even discourage, a sense of responsibility to the wider community. Powerful professional bodies are largely autonomous - lawyers, doctors, dentists, and engineering groups operate with little outside scrutiny and negotiate (like powerful unions) directly with government to guarantee continued perks. Professionals contribute enormously to society but only on their own terms, as free agents, answerable directly to their internal governing bodies and with little contact, as individuals or as associations, with their client communities. As a result of these favourable arrangements professional groups are usually bulwarks of the status quo. As the recent brouhaha preceding the Province of Ontario's ban on extra-billing by doctors demonstrated, professionals will strenuously resist attempts to wrest control from their own internal hierarchies, and will insist on their nominal "selfemployed" status. Professional bodies appear to feel responsible primarily to their peers rather than to the wider lay community that they serve. Doctors, lawyers, nurses, and engineers, and various expert policy advisors, can have a strong influence and sometimes indirect power over the lives of their clients and the political and social choices affecting us all. An example is the medical profession's vigorous protection of its own turf in lobbying against giving more responsibility to nurses and midwives, and the recently established task force to investigate spiralling health-care costs set up by the Ontario government, with a membership composed mainly of doctors! 5 Of course, it is inevitable that professional bodies will use their knowledge and influence to promote certain perspectives; but, because their self-interest usually coincides with the social and political status quo, and because the professionals themselves usually deny any bias at all, these subtle lobbying efforts can go unnoticed. Not all professionals subscribe to the values and attitudes fostered by the official professional organizations. Many individual professionals lead double lives: in mainstream jobs, serving their bureaucratic masters; and surreptitiously blowing the whistle by smuggling out heavy brown paper envelopes containing confidential information on matters of public import, or gently discouraging the worst excesses of their colleagues.

Beyond ProfessionalEthics More relevant to the theme of the conference at Waterloo are the various special-interest groups or splinter groups that have been formed with their own social, political, and moral perspectives. I will devote the rest of this paper to an exploration of these groups and their members, the mavericks in these professions: those who are willing to make their professional work in some way an extension of their personal convictions, and who may thereby sacrifice many of the benefits usually accruing to professionals. It is always more difficult to be in the minority, and groups which break ranks with the prevailing professional dogma - political, technical, or social - do so at considerable risk. In the largely conservative professions, which pretend to maintain a certain reserve on social issues or a veneer of "objectivity", such activist groups stand out; their members can be isolated, labelled as "unprofessional" or "subjective", or seen as inappropriately using their status to promote personal interests. Movements to explore and act on the wider social responsibilities of professionals can be seen as attempts to act separately from the larger, established professional hierarchy, to set up different rules governing professional practices, and to establish new links with the communities of clients. Ultimately this can lead to an effort to take some of the power and knowledge of the profession and pass it on to a larger lay group - to demystify the profession and undermine its status as the exclusive guardian of certain knowledge, judgements, and authority.

Issues and agendas: What is the goal of the activist group? Obviously, activist groups can have various goals, and each kind of coalition or committee of professionals can be useful. I will try to oudine below some of the different ways I see such groups operating, and I will focus on those which encourage an integrated view of their values, their politics, and their professional endeavours. I have divided professional activist groups into two general categories: those dealing mainly with standards of professional practice, matters relevant primarily to persons within particular professions, and those which take professionals beyond their own practices to deal with political and social issues relevant to the larger milieu.

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Professionalstandardsgroups This kind of group, which deals with activities within the discipline, is by far the most common and accepted form of professional ginger group. It would include the sub-committees of the American Association for the Advancement of Science (AAAS), the medical, engineering, and dental associations that deal with ethical professional practice. For example, the AAAS has an Office of Scientific Freedom and Responsibility, and it has sponsored workshops on whistle-blowing and a special project on professional ethics in scientific and engineering societies? Many scientific or academic associations have developed conflict-of-interest and publishing guidelines that deal with such issues as plagiarism, republication of work, criteria for co-authorship, and measures for fairer and more effective peer review of publications by the professional association's journals. 7

Beyondprofessionalstandardsgroups There are several sorts of activities relating a profession and its functions to the broader social or political context. These can be intended to benefit society as a whole, on matters of universal relevance, like nuclear war. Alternatively, an activist group may have goals which are geared to a segment of the population which is particularly needy or deprived of professional services. The range of projects undertaken by such a group can be divided into three categories: collective advocacy and action on single, focussed issues; support and assistance to individual professionals determined to make their careers socially constructive; and public education and empowerment, to enable lay clients to assume more power and responsibility in their dealings with professionals. These categories are somewhat artificial, and several professional groups engage in two or all of them; nonetheless it is useful to distinguish between these various endeavours in order to observe the evolution of particular groups and their members. 1. Many professional organizations take part in focussed, issue-oriented collective activities, like anti-nuclear lobbying (Science for Peace), lobbying against extra-billing (the Medical Reform Group),

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and medical and legal assistance to prisoners of conscience and torture victims (the Medical and Legal Networks of the Canadian branch of Amnesty International). 2. Several of these groups also provide important support for individuals devoting themselves to lines of professional work chosen on the basis of personal convictions. These include:

(a) Not doing work that is harmful (e.g., not accepting or applyingfor &fence researchcontracts, and blowing the whistle on sociallyirresponsibleactivities in the profession);and Doing work which has as its goal some social or political goal grander than effective and ethical delivery of professional services (e.g., lawyers working with the poor and the disenfranchised,academics carrying out peace research as Anatol Rapoport advocates,8 doctors working to return medical decisions to the patient in community health settings where the doctors are staff and not free agents). In one of the rare commentaries on these ginger groups in science Dot Griffiths, John Irvine, and Ian Miles describe the evolution of the British groups advocating socially responsible science, from the view that scientists must merely avoid harmful work to a much stronger commitment to positive, socially constructive professional activity. 9 A rather broad range of concerned scientists established the British Society for Social Responsibility in Science (BSSRS) in 1969. Initially many members of this group articulated a use/abuse model of professional activity, arguing that science had the potential to be enormously beneficial but that it was often abused; and this abuse was the focus of their early efforts. Science and technology themselves were perceived as being either value-free or inherently good, and it was only those using (or abusing) the science who were to blame for the nasty outcomes of scientific work. Proponents of this view argued that individual professionals should produce honest "objective" work and should merely inform themselves on the uses to which it could be put. They actively avoided doing work which could be harmful. More radical scientists, however, questioned this model, arguing that their work inevitably served social and political purposes and that the scientific bureaucracy itself reflected undesirable social and

political assumptions. They supported the active pursuit of work which would directly benefit socially or politically deprived communities. This radical group gained control of the BSSRS, and the other, "liberal", group left to form the Council for Science and Society. Yet another group of British scientists and historians forms the Radical Science Collective, which argues that the very act of scientific inquiry must be political. They dispute the view that science can ever be "objective" or that it is only the products and applications of science that are political, and they suggest instead that the process of science inevitably incorporates the scientist's values, assumptions, and ideology. 3. Taken to its logical conclusion, professional activity which is devoted to social and political goals rather than merely the delivery of good-quality, non-harmful professional services can lead to public education and empowerment. Professional groups may share their knowledge and skills, making their expertise accessible to the public which needs it. This then places decisions in the hands of the public rather than in those Of the professionals, and it allows the client groups to direct their professional employees and to participate in interpreting the results of professional intervention. Professional determination to share authority also leads to public education and to work with the media in order to correct the public view of the profession as a monolith with a uniform view of the world and itself. Professional groups with these goals operate, by necessity, outside the official professional bodies, trying to forge independent links with clients and client groups. An excellent example of a professional body devoted to work which is explicitly useful to socially disadvantaged groups is the International Institute of Concern for Public Health (IICPH), based in Toronto. The IICPH is directed by Dr. Rosalie Bertell, a biometrician. She is assisted by a small administrative and support staff, and by various medical consultants who provide their services to the institute for a pittance. Collectively, they work with groups of radiation victims and residents of polluted communities on their agendas and concerns. The IICPH has a strong commitment to respecting the priorities of its clients, as was reflected in Dr. Bertell's speech accepting the Right Livelihood

Beyond ProfessionalEthics Award (termed the "Alternative Nobel Prize"), in December 1986. The quotations she used in that speech were not from respected experts, statesmen, or religious leaders, but from the words of a woman who was a non-fatal casualty of the 1979 reactor accident at Three Mile Island. Current IICPH projects include an International Conference on Radiation Victims and assistance to people in Malaysia who are suing the Asian Rare Earth Company for careless dumping of radioactive and chemical toxic waste? ° IICPH has also contributed to the Ontario Nuclear Safety Review and has assisted the Serpent River Indian Band in carrying out a local health survey. I discuss this last project at length below, as an e:~ample of the kind of interactive professional work which allows the client, rather than the professional, to retain authority over the expert work which is carried out.

An example of client-professionalinteraction In 1981 the IICPH was approached by the Serpent River Bandl which has had more than the usual share of the hard times experienced by native people. Over the past decade members of this band have been particularly concerned about an abandoned. acid plant on their reserve. Initially the IICPH developed a health questionnaire for them to administer to members of three bands on the north shore of Lake Huron: the Serpent River, Mississagi, and Spanish River bands. This survey established a very rough indication of the background level of health in these communities and provided a basis for more detailed medical examination of individual band members. Follow-up activities included screening clinics for high blood pressure and diabetes, and educational programs focussed on alcoholism and other public health problems. The project was very unusual in that only the band office had the lists which identified participating households: the band, and not the experts it had hired, retained control over the survey. The band then wanted to find out whether the abandoned acid plant site presented a health hazard or could safely be used for residential or commercial purposes. Dr. Bertell and her team carried out further investigations and concluded that the old acid plant indeed posed a health threat to band members, and that no homes or workplaces

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should be built on the site until the plant residue had been removed; they also recommended that further investigations were required to determine how best to protect public health now and during the cleanup. This work helped the Band to press for cleanup of the plant site and compensation for past suffering and damage. Inevitably, however, given the sparse resources and records to which the IICPH team had access, its reports were not without weaknesses. Their summary of the report concluded that: "The limitation of this report is obviously its lack of clinical medical studies and its inability to quantify the extent of the medical problems identified as of concern to the Band. These aspects await further authorization and financial assistance from Health and Welfare Canada." 1~ Clearly surveys like this one, carried out by non-experts and without external validation, are subject to serious reporting errors; nevertheless such preliminary indications of the nature and prevalence of local health problems can be the basis for subsequent more rigorous and expensive work. Other cases, such as the work of Beverly Paigen on the health effects of Love Canal chemicals on local residents, 12 and that of Michael Racb_lis (another participant in the "Activist Groups" session of the Waterloo conference) with the Environmental Health Committee of the South Riverdale Community Health Centre on local lead pollution, t3 offer further examples of sympathetic professionals putting their expertise at the service of community groups with the specific purpose of helping them improve their local situations. In these cases the professionals invest their time in the pursuit of agendas which have largely been set outside the profession; and goals for particular pieces of work are developed interactively, with full participation of the lay clients. A common pattern is revealed here: citizens raise an issue that intimately concerns them and their families and neighbours, and sympathetic experts and professionals respond to this concern, helping the citizens to study the problem, suggest remedies, and lobby to remove the cause. Sometimes the experts involved are criticized for employing "unscientific" or "unprofessional" methods, because the work is often carried out by volunteer citizens rather than by well-paid experts. TM The fact remains that in many cases the citizen-instigated preliminary studies have indicated problems or alarming trends which

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have later been substantiated by government agencies with more time and resources. O f course, the government or agency officials rarely acknowledge their debt to the earlier studies; rather, they claim the hypotheses of those studies as their own. Official recognition and measurement of the problem may nonetheless then pave the way for action to remedy the situation or to compensate those who have suffered from it. But there is another, more important, consequence of expert involvement in citizen advocacy. Ultimately, this kind of work encourages a critical public view of the role of the profession. It sows the seeds of a change in the popular perception of how professionals should behave. Experts dedicated to serving the broad public interest may be ignored or even ridiculed by their colleagues; but the public will take notice. Eventually other public groups will demand similar treatment from members of the profession and, whether they like it or not, the more traditional professionals will have to alter their practices and their relationships with their clients. It is no coincidence that the scientists or professional experts involved with citizen groups are often women. W o m e n are likely to feel a greater responsibility to the lay communities to which they belong because they are usually more integrated into them: children ensure contacts with other parents in libraries, pools, community centres, schools, and daycares. This integration of the professional and the personal is important;, it may be valued most by women, who often have to struggle to balance the demands of their careers and those of their families. Projects which combine these interests hold a natural appeal for many women.

Discussion and conclusion Women may deliberately seek a consonance between their professional and personal priorities, but there is a sense in which the values an individual holds most dear will unavoidably direct his or her career, whether this is welcome or not. I believe that professional behaviour is inescapably political, not in any partisan sense but because the choices that professionals make - in the work they pursue, the clients they cultivate, and the relationships they develop with their clients - inevitably reflect their

values and the larger social goals they consider desirable. Indeed, professionals should recognize the responsibility they bear for the outcomes of their personal work, not merely in terms of traditional professional ethics but in terms of the goals and impacts of their particular professional practice on society. As individuals, or by participating in activist groups, they can give the public an alternative view of their profession and set the stage for public demand for more responsive, socially controlled professional practices. This is an ambitious and demanding view of the social responsibilities of professionals and the groups to which they belong, but it is one which should, ultimately, be satisfying for those professionals adopting it. If professional work becomes more of an extension of the individual lives of the professionals, the professionals themselves become, in a sense, members of the communities that they also serve. And then they will never, in Shaw's words, "conspire against the laity".

Notes 1 George Bernard Shaw: 1911 (rev. 1932), The Doctor's Dilemma, London: Constable and Co., Act I, p. 106. 2 Jack Stevenson, 'Reasonableness in Morals', in these proceedings. 3 Note, for example, other papers in these proceedings by Mark Frankel and Leonard J. Brooks. 4 Some of the above passage was taken from Chapter 5 of my book, 1988, Science Under Siege, Toronto: CBC Enterprises. s "OMA - Ministry of Health Task Force to analyze use of medical services", 12 February 1988 press release from the Ontario Ministry of Health. 0 See, for example, 1981: Agenda Book of the Workshop on Whistle Blowing in Biomedical Research sponsored by the President's Commission for the Study of Ethical Problems in Medicine and Research, the American Association for the Advancement of Science Committee on Scientific Freedom and Responsibility, and Medicine in the Public Interest, all in Washington, D.C.; and R. Chalk, M. Frankel and S. Chafer: 1980, The AAS ProfessionalEthics Project,Washington: AAAS. 7 See, for example, Mark Frankel's 'Professional codes: Why, how and with what impact', also in these proceedings. s Anatol Rapoport, 'The redemption of science', in these proceedings. 9 D. Griffiths, J. Irvine, and L Miles: 1979, 'Social statistics:

Beyond Professional Ethics Toward a radical science', in Demystifying Social Statistics, J. Irvine, I. Miles, andJ. Evans, eds., London: Pluto Press. ~0 For more information contact International Institute of Concern for Public Health, 830 Bathurst Street, Toronto, Ontario MSR 3G1. 11 R. Bertell, D. McLoughlin and M. Stogre: 1986, Serpent River Report (unpublished), Toronto, International Institute of Concern for Public Health, p. 1. 12 B. Paigen: 1982, 'Controversy at Love Canal', The Hastings Centre Report 12:3 (June), pp. 29-37. ~3 South Riverdale Community Health Centre, Submission

from the Environmental Health Committee of the South Riverdale Community Health Centre to the Royal Society of Canada Commission on Lead in the Environment, 13 June 1985 and i8 March 1986. 14 The inadequacies in the resources and time available to lay groups attempting or assisting with professional work often lays them and their professional allies open to accusations of bias and lack of rigour; but these criticisms can also

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be seen as a difference in outlook, a difference in the values and priorities of the professionals involved. Advocates of "complete evidence" or "clear statistical significance" are sometimes more willing to risk being wrong in saying that a problem does not exist than the responsible professional may be to risk being wrong in saying that a problem does exist. In one case, the error involves mis-spent public funds; in the other, damaged human health. See, for example. B. Paigen: 1982, op. tit., and N. Ashford: 1986, 'Ethical problems in using science in the regulatory process', Natural Reserves and the Environment 2:2 (Fall), a publication of the American Bar Association.

Innis

College,

University of Toronto, Toronto, Ontario, MSS IAI Canada.