Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care (...) policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine. (shrink)

A relatively small but intellectually robust strand in the Christian religion is the Reformed tradition. Especially, its Calvinist sensibilities inform this Protestant stance towards human culture in general and vocations in particular. Correspondingly, there are some small but robust contributions to academic discourse in nursing ethics. So far there has been no attempt to bring those together as a distinct approach. This article suggests such a Reformed Christian, especially Calvinist, account of nursing ethics. Central to the Reformed perspective is the (...) notion that God is sovereign over all of creation and culture and hence that there can be no religiously or morally neutral area in human life. Consequently, nursing is not seen as professional to the extent it is based on research evidence or theoretical models, but to the extent it serves the ultimate purpose of the practice of care. In the Reformed view, this purpose is fostering the well-being of human beings in need as intrinsically valuable. Nurses are professionals who accept this responsibility, that is, the whole of expectations holding for personal qualities, conduct and outcomes, required to serve the purpose of care. As this is a moral purpose, succeeding or failing to live up to these expectations is the source of moral issues in nursing. (shrink)

My view on what I see as the predicament of Christian philosophy in ethics has been shaped by a number of experiences. I will first share with you some of these experiences, to give you an impression of the background against which this article has been written.