In this paper we are revisiting the concept of a profession. Definitions of the concept are readily encountered in the literature on professions and we have collected a sample of such definitions. From these samples we distil frequently occurring elements and ask whether a synthesis of these elements adequately explains the concept. We find that bringing the most frequently occurring elements together does not adequately address the reason (or purpose) that society differentiates professions from other occupations or activities – why there is a concept of ‘profession’ at all. We suggest an alternative approach that attempts to make sense of the concept at a more general level. This, more philosophical, approach employs analytical tools from Julius Kovesi, Patricia Hanna and Bernard Harrison to address the question of what is the point of the concept.
This chapter argues for appreciating the distinctiveness of medical ethics. If the ethics of medicine is different from the ethics of everyday life, it follows that the character of physicians is and should be different from the character of others. Molding the character of future physicians therefore becomes an important matter for the attention of medical educators. In that light, this chapter explains the appropriate goals for such an educational program and discusses the means for teaching and inculcating the principles, attitudes, and behaviors that physicians need to embrace in order to fulfill their special social role and professional obligations.
Much ink has been spilled in recent years over the controversial topic of conscientious objection in health care. In particular, commentators have proposed various ways…
Much ink has been spilled in recent years over the controversial topic of conscientious objection in health care. In particular, commentators have proposed various ways with which we might distinguish legitimate conscience claims from those that are poorly reasoned or based on prejudice. The aim of this chapter is to argue in favor of the “reasonableness” approach to conscientious objection, viz., the view that we should develop an account of “reasonableness” and “reasonable disagreement” and use this as a way of distinguishing licit and illicit conscience claims. The author discusses Rawls’ account of “reasonableness” and “reasonable disagreement,” and consider how this might guide us in regulating conscientious objection in health care. The author analyzes the “public reason” account offered in Card (2007, 2014), and argue that we should modify Card’s account to include a consensus among regulators about what counts as “basic medical care.” The author suggests that Medical Conscientious Objection Review boards should consider whether conscience-based refusals are based on defensible ethical foundations.
No topic in medical education has received more attention and generated more discussion in recent years than that of “professionalism”. In many ways, this should come as…
No topic in medical education has received more attention and generated more discussion in recent years than that of “professionalism”. In many ways, this should come as no surprise in light of the dramatic technical and scientific advances in medicine, the changing, and often confounding, roles of physicians in complex health care systems, and the growing expectation throughout society that physicians should provide more effective, patient-centered care. Any of these factors alone is sufficient to create anxiety and confusion about basic duties and responsibilities of physicians to patients, the medical profession and to society. In this complex, demanding, commercialized and yet, values-laden, world of health care it is an understatement to say that there are fundamental challenges to what it means to be a medical professional in today's society.
This contribution argues that there is a fundamental problem for the multi-level governance (MLG) approach in that what the approach is trying to explain has never been…
This contribution argues that there is a fundamental problem for the multi-level governance (MLG) approach in that what the approach is trying to explain has never been fully agreed by the vast group of scholarship that references it. The chapter then examines and proposes that ideas and concepts from network governance, principal–agent (PA) and learning can provide the necessary micro foundations for the MLG approach.
The chapter examines and critiques the original MLG formulations and the later efforts at elaboration. It then reviews the literature and concepts for three public policy approaches that have been associated with European governance to see how core explanations can be elaborated upon in a multi-level context: network governance, principal–agent (PA) and learning.
This contribution suggests that co-ordination, and the resources that help maintain this co-ordination, is the key dependent variable that underpins the MLG approach. With multiple principals and multiple agents, operating at a number of levels of analysis, direct authority and control is harder to evoke. The key explanatory variable underpinning this MLG co-ordination is learning by the participants.
Researchers need to concentrate both their theoretical and empirical efforts in understanding the conditions that support multi-level governance and that sustain its effort.
The contribution outlines some of the key practical questions that policy-makers must face. Can they manage resources and induce learning from all the relevant public and private stakeholders to engage in the MLG effort?
Not only does an effective MLG process involve engaging a wide range of societal stakeholders, these stakeholders have to be persuaded to invest effort in learning about the nature of the governance system, the challenges of the policy problem and the implications of the efforts to resolve these problems.
This chapter isolates the fundamental lacuna at the heart of the MLG project and offers academics and practitioners a conceptual lens for building a clearer analytical structure for studying MLG.
This chapter attempts to answer some of the questions raised in this volume, in particular: (1) provide a concise but precise definition of multi-level governance; (2…
This chapter attempts to answer some of the questions raised in this volume, in particular: (1) provide a concise but precise definition of multi-level governance; (2) prove that it is a theoretical and not just a descriptive concept and (3) dispel some of the misconceptions associated with it, for example, that (a) multi-level governance underplays and conceals the exercise of power or (b) it is incompatible with democracy.
The chapter is correspondingly organized in four sections, preceded and followed by short introductory and concluding sections. The four sections address, respectively: (1) the definition of multi-level governance (MLG) (‘Solving the dependent variable problem’); (2) the causes that explain the emergence and diffusion of MLG arrangements (‘The contextual causes of MLG’); (3) the changes that it triggers in the manner in which power is deployed (‘The institutional consequences of MLG’); (4) the democratic implications of the diffusion of MLG arrangements (‘Are MLG arrangements democratic?’).
The methodology employed is mainly that of ‘conceptual analysis’ (Sartori, 1984), which implies that the connotational features (those features which minimally allow us to identify cases of MLG) of the concept are identified so that we can delimit the denotational extension of the concept (the universe of phenomena which can be identified as cases of MLG). This chapter contains a highly abridged version of this conceptual analysis, which is fully developed in Piattoni (2010a).
MLG denotes a growing class of policymaking arrangements characterized by the simultaneous activation of governmental and non-governmental actors at various jurisdictional levels. These arrangements have identifiable contextual causes, even if the precise contours of MLG arrangements depend on the capacity of the actors to mobilize arguments and people on behalf of their specific ideas, values and interest. The precise shape that these arrangements will take, therefore, depends on the mobilization capacity of the actors (and on the capacity of other actors to contain or delimit such mobilization). The causes of mobilization are mainly contextual, having to do with the increased complexity and overload of state activities and with the growing request for direct involvement on the part of civil society organizations. Both these trends induce states to seek joint solutions to common problems, hence MLG dynamics occur on three axes: a centre-periphery axis, a state-society axis, and a national-international axis which challenge, respectively, the centrality, the distinctiveness and the sovereignty of the state.
This conceptualization of MLG allows us to analyse the extent to which different policymaking arrangements respond to MLG logics and to understand which actors and which levels are mostly responsible for the particular configuration that obtains. This conceptualization of MLG, although here deployed in a purely discursive manner, could enable us to ‘measure’ the degree of institutional and political empowerment of subjects, other than central state actors, in various policy realms.
The most important social implication is the impact that MLG arrangements have on how democratic decision-making occurs, on what we mean by democracy, and on the societal perception of how contemporary democracies work. The chapter argues that trying to apply to MLG arrangements democratic criteria and standards that were developed for the unitary, distinctive and sovereign state is misleading and that we must rather develop an updated notion of democracy appropriate for the interconnected, multi-level context in which we live. The concept of ‘transnational democracy’ is cursorily offered as a promising direction for further reflection.
The chapter is wholly based on the long-term work and reflection of the author on MLG and on the scholarly contributions of the other authors of the volume.
Today, the global education market is one of the faster growing sectors, and it has attracted several new actors or what we call educational brokers who are now…
Today, the global education market is one of the faster growing sectors, and it has attracted several new actors or what we call educational brokers who are now responsible for shaping national agendas. The newer actors in education are vastly different for the former players in that whereas previous actors engrossed national educational systems through the provision of technical assistance to meet international standards, best practices, and benchmarks, these newer players are for-profit entities that emphasize austerity, leanness, human resource maximization, performance targets, and competition. Therefore, in this new educational landscape, national governments are seen as “clients” who receive “expert” advice from “external consultants” that have an assortment of experiences across different sectors. Education governance is no longer a statist endowed but one that incubates in laborites of best practices resonates with existing case studies and results driven based on Big Date collected. We argue that educational brokers are responsible for the emergence of a hybrid form of education governance that use business and market techniques to reform strategies within the education sector. We conclude by suggesting that collectively educational brokers are using what we call “educational sub-prime mechanisms” – higher interest rates, reduced quality collateral, and less advantageous terms to counterweight higher credit risk – to manage educational portfolios and newer forms of educational risk.