Ethics and Professionalism

9. Reconstitution of Institutions

09 RECONSTITUTION OF INSTITUTIONS The social ideal of maximum welfare fairly distributed will not be brought into being by preachments. What are needed are not voices in the wilderness but ways to make them heeded in the workshop and marketplace. It is not enough, therefore, to articulate the professional ideal. People must be induced to pursue it, and this requires moral engineering as well as moral theory. The term 'moral engineering' raises the specter of pallid puritans drafting detailed blueprints for the lives of others. What we have in mind is rather an intelligent effort to design institutions that will foster moral practices, perhaps moral horticulture as we suggested in Chapter 3, though this term also is misleadingin its way. In any event, since genuine morality presupposes autonomy, manipulation has no place. Rational persuasion is the tool. Nor can moral reformers be drawn from a separate professional class, such as ministers of the gospel or professors of philosophy; they must be persons in a position to affect the shape of institutions, such as leaders of professions and politicians. The purpose of a study such as this is to counsel those with the power to act, those who can determine the conditions under which rank-and-file professionals make their decisions and act morally or immorally. Piecemeal engineering must work with the materials at hand. Moral reformers can only criticize and improve existing institutions , codes of conduct, educational programs, and other instrumentalities of the moral life; they cannot create them de novo. We will analyze the principles that they would need to follow in the circumstances described in the first part of this study. 182 STRUCTURALCHANGE Professional Corporations The major and, it appears, unavoidable step toward involving all practitioners in the corporate business of a profession so as to orient their activities collectively to human welfare is to organize them under a state charter. This step must be taken with diffidence in view of the concentration of power and organizational problems it would entail. The obvious way to establish a corporation for a profession would be to charter one of its existing associations. In some professions it would be obvious what association this should be; for example, the American Bar Association, the National Association of Social Workers. In others, there are several small associations with overlapping territories: for example, the American Psychological Association, American Personnel and Guidance Association, and American Psychiatric Association; the National Education Association, American Federation of Teachers, and American Association of University Professors. The National Society of Professional Engineers' might seem the logical candidate for engineering, but the profession is so sprawling that it might be necessary to charter associations for different disciplines : for example, the American Institute of Chemical Engineers , American Society of Civil Engineers, Institute of Electrical and Electronic Engineers, American Society of Mechanical Engineers . We might be tempted to designate the American Medical Association as the corporation for health care professions, but the American Nurses Association and the organizations of medical technicians would object, since it would fortify the place of physicians on the top of the medical hierarchy. In some professions, existing associations with elitist structures and inveterate biases might have to be bypassed altogether and corporations created from scratch. This would encounter bitter resistance because present practitioners think they have proprietary rights over their professions and they would necessarily be the initial members of newly constituted bodies. It would be easier to persuade them to accept new responsibilities and restrictions by the promise of new powers for favored old organizations than to shift their loyalty to new organizations. Nevertheless , new organizations would be necessary were the old ones too unreceptive to the proper kind of charter or were organizational problems among them too tangled. 183 RECONSTITUTION OF INSTITUTIONS Once a corporation was established, ways would be designed to engage all practitioners in its activities. Membership could be made a condition of licensure to practice. Financial contributions would be mandatory. This, supplemented by public support (tax revenues, service surcharges, etc.), could provide resources for important responsibilities. These responsibilities would involve the corporation in the work of ordinary practitioners and give them a stake in its behavior. The corporate powers would be extensions and consolidations of powers now exercised weakly by some associations in some professions. The powers would be assigned to the corporation and to other institutions such as schools and state agencies coordinated with the corporation. The profession would be charged...