Institute of Ethics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Department of Psychiatry and Human Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA.
Med Health Care Philos. 2022 Mar;25(1):153-159. doi: 10.1007/s11019-021-10061-0. Epub 2021 Nov 20.
Over the last 50 years, the term professionalism has undergone a widespread expansion in its use and a semantic shift in its meaning. As a result, it is at risk of losing its descriptive and analytical value and becoming instead simply an empty evaluative label, a fate described by C. S. Lewis as 'verbicide' (Lewis 1967). This article attempts to rescue professionalism from this fate by down-sizing its extension and reassigning some of its work to two other ethical domains, introduced as the neologisms organizationalism and sur-moralism. Professionalism is defined as a morality based in system of obligations that are assumed by physicians over the course of their professional training and which primarily refer to two groups: patients and colleagues, including trainees. Organizationalism is also a morality, but the obligations are owed to the employing organization and on different grounds. A third ethical domain, here called sur-moralism, comprises actions that are not based in obligations. They are discretionary and potentially meritorious; they cannot be required by the profession or organization. This article presents a conceptual model of the three ethical domains and the shifting borders between them. One practical benefit of this typology is that physicians can more accurately understand the nature and sources of obligations that they are asked to accept, and when necessary prioritize them. Another is that physicians will be able to describe the potential tension between the three domains and understand how and why the borders between them can move. Both should help physicians to be more ethically oriented to their work settings.
在过去的 50 年里，“专业性”一词在使用上得到了广泛扩展，其含义也发生了语义变化。结果，它有可能失去描述和分析的价值，而仅仅成为一个空洞的评价标签，用 C.S.刘易斯的话来说，这就是“动词谋杀”（刘易斯 1967）。本文试图通过缩小其延伸范围，并将其部分工作重新分配给另外两个伦理领域，即“组织主义”和“超道德主义”，从而使专业性避免这种命运。专业性被定义为一种基于义务的道德，这些义务是医生在专业培训过程中承担的，主要涉及两个群体：患者和同事，包括受训者。组织主义也是一种道德，但义务是对雇佣组织承担的，其依据不同。第三个伦理领域，在这里称为“超道德主义”，包含的行为不是基于义务。它们是自由裁量的，可能值得称赞；不能由专业或组织要求。本文提出了三个伦理领域及其边界变化的概念模型。这种分类法的一个实际好处是，医生可以更准确地了解他们被要求接受的义务的性质和来源，并在必要时对其进行优先排序。另一个好处是，医生将能够描述三个领域之间的潜在紧张关系，并了解它们之间的边界是如何以及为何可以移动的。这两者都应该帮助医生更注重自己的工作环境中的伦理问题。
