69 Unbundling goodness and expertise

Three of the main tenets of post-professional critique have been:

1. The professions’ own claims to goodness and expertise
2. The way group morality and highly abstract forms of knowledge have been bundled together and converted into status and reward ^[1],
3. How these have largely survived attempts at organisational reform ^[2][3].

The link between goodness and expertise was perhaps first established in the gentlemanly secular health sciences of the 18th century ^[4][5][6]. Through the Industrial Revolution, medicine’s role as a disciplinary technology directed at improving public health, and its ‘warm friendship’ with the state ^[7], became increasingly significant ^[8]. Medicine’s success in ‘conquering’ illnesses that had decimated earlier societies (smallpox, diphtheria, typhoid, etc.), also indexed closely to the 20th century’s cultural desire to find technical solutions to human problems ^[9], and led to the ‘morally satisfying’ alliance between the health professions and the welfare state ^[10][11]. Along the way, ethical, service, and care values, were laminated onto the health professions, giving them the tools to turn abstract knowledge into social and economic capital.

We know that goodness and expertise are vital to the professions because there have been many occasions when one or other has been threatened. Numerous cases of medical malpractice and reports of ethical misconduct, for instance, have seen the public’s trust in doctors decline ^{[12][13][14][15]}. Deborah Lupton has commented on what she called the ‘cultural crisis of modern medicine’, in which healthcare under capitalism is perceived as largely ineffective, overly expensive, under-regulated and vastly inequitable’ ^[16].

In recent years, health professionals have been accused of being ‘agents of the capitalist state’ ^[17], for being patriarchal, racist, discriminatory, ableist, ageist, homophobic, and heteronormative’ (ibid). ‘What is common to all these challenges’, Pamela Abbott and Liz Meerabeau argue, ‘is their dissent from the view that professionals can define problems and solutions to them, that professional practice is disinterested and client-centred, and that the caring professionals have a scientific knowledge base that enables them to be objective and value-free’ (ibid). Repeated critiques like this, reflect the fact that the professions’ claims to goodness and expertise are being treated with increasing scepticism. As a result, ‘The generic ideal traits of service, altruism and goodness have been increasingly unbundled from the role of guarantor of expertise in contemporary society’ ^[18].

Post-professionalism reminds us that there is nothing inherent in goodness or expertise that demands the person be a professional, and there is nothing innate in professionalism that makes the person a good person or knowledgable practitioner. After all, civic society functioned for thousands of years before the invention of the health professional, and there are many things we trust in life that are not controlled by professional elites. Perhaps this vulnerability explains why the professions indulge in ‘normative strategies of defence, boundary keeping, entitlement to substantial earning and maintaining public plausibility as central to professional performance’ (ibid)? Perhaps, as Edgar Burns argues, goodness and expertise speak more to professionals’ attempts to ’lean the market in their favour’ (ibid), than to be true public servants? After all, if the success of a health profession was judged by how well it increases the ability of people to look after themselves, then we would have lost most professions by now, either because they had succeeded, or because they had demonstrably failed. And yet, the professions persist, and so do the health problems they claim to be the response for.

So, perhaps we have arrived at a point where the goodness and expertise of the health professions are no longer accepted uncritically? Andy Grossman has asked whether professions like medicine would still even be thought of as a profession if it lost its social prestige and authority ^[19]? And Jonathan Gabe has asked whether healthcare in the hands of consumers would even need professionals ^[20]. These questions suggest that some, at least, believe that the professions are now much more reliant on their cultural legacy than any innate qualities of goodness and expertise. Post-professional scholars like Grossman and Gabe are, therefore, much more likely to ask whether the health professions have become a convenient accompaniment to poor health, rather than an effective response to it.

But it is also perhaps worth reiterating here, that post-professional critiques are not suggesting that the professions are neither good nor expert, only that claims to goodness and expertise should not be seen as ‘fact’, but as claims made by the professions in service of their social goals and, therefore, open to challenge in a manner that the professions themselves have been historically reluctant to perform.