Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no (...) evidence of their effectiveness. (shrink)

One of the career options Ede Christian University for higher professional education offers is nursing. As a Christian professional school, the ECU provides learning environments for nursing students to become professionals who are to exhibit a Christian life style, values and professional ethics. Nursing graduates of our school in general may have a Christian disposition regarding major issues in health care like displaying respect for patients, having a correct attitude, practising informed consent, displaying confidentiality, and avoiding euthanasia etc. A worrying (...) development for educators, though, is that often within a year after their graduation these young nursing professionals may adopt the secularized behaviour predominant in their workplace, even when that behaviour in some respects contrasts with the values they internalized during their nursing education. . Apparently, the shaping force of the social context of a professional practice can be stronger than the personal beliefs young professionals adopt before their graduation. (shrink)

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)

This essay describes how longstanding conceptions of professionalism in American medical care came under attack in the decades since the enactment of Medicare in 1965 and how the reform strategy and core provisions of the 2010 Affordable Care Act illustrate the weakening of those ideas and the institutional practices embodying them.The opening identifies the dominant role of physicians in American medical care in the two decades after World War II. By the time Medicare was enacted in 1965, associations of American (...) physicians were almost completely in charge of medical education, specialist certification, and the enforcement of professional norms on their members. Who could be a doctor, what education and training would be required, and what collegial oversight was operative was first a professional matter and only secondly implicated the state through malpractice or major corporations via the employment of physicians. (shrink)

Proletarian journalists are ?professionals?; in America's news factories. Their ?conversion downward?; took place over several ?long waves?; of capitalist development that linked commerce to ideology and legitimated marketplace practices. ?Independence,?; ?objectivity,?; and ?social responsibility?; emerged as ideological corollaries of commercial strategies deployed to stabilize marketplace crises and class conflicts within journalism.