So far this essay has contended that morality demands proportional diversity in the professions (based upon the puzzle-maker model of merit). This section will also argue for the ethical foundations of proportional diversity within the professions via an argument that goes to the nature of professional ethics itself: the contract with the host society. On a general level, professions can be said to operate because of a contract with the society. One version of this contract can be seen in Figure 2.
Obviously, the most controversial premise in this argument is premise #7. It is incumbent upon those making this sort of case to show that the when the social contract is breeched it results in a failure to fulfill premise #6, e.g., in a reduced access to care in the affected population and in less cultural competence within the profession. In order to address these and other issues surrounding premise #7, it is necessary to provide further information on the social contract itself. erectalis 20 mg
The profession has specialized knowledge that can be delivered in a reliable fashion, and this knowledge can benefit society. From the professional’s point of view, this relation entails certain rights and responsibilities. The rights are that the profession may govern itself (so long as it is responsible). This means that the profession has crucial input in terms of selection, education, and practice. The responsibilities involve being responsive to the society at large that enfranchises the profession. In turn, society has certain rights and responsibilities. The rights include expectations of professional excel lence in education and practice. They also include fulfilling the social contract to meet particular social needs for the entire society—not merely some advantaged subgroups of the society.
The responsibilities of society include treating professionals as people. This means that they must be given respect, support, and compassion in the exercise of their professional duties.
Figure 2. The Professional Social Contract
1. All professions entail the existence of an implied social contract—Assertion
2. All professional social contracts are between the host society and the individual profession—Fact
3. Society (in this context) is understood as a set containing various subsets of sociologically distinct populations—Assertion
4. What is true of the whole is also true of each subset (re: the social contract)—Assertion
5. Each distinct sociological population has a contract with each profession—1-4
6. Part of any social contract is the expectation that the profession (or any other institution) will be responsive to its needs—A
7. The best way to insure responsiveness and need inclusion is via proportional professional representation—A
8. Each distinct sociological group should have proportional professional representation—5-7
9. Lack of proportional professional representation constitutes a breech of the professional contract by the profession—2, 5, 8
However, as the argument in Figure 2 points out (premise #7), the social contract requires proportional representation in order for the profession to fulfill its responsibilities to society. It would seem that those sociological groups who are under-represented among orthopedic surgeons are not having their contractual rights upheld. This is because when the profession is proportionally skewed away from particular groups, the social contract has been abrogated (conclusion of the argument in Figure 2). The profession that is not proportionally diverse is in material breech of the social contract. Such a breech must be rectified on the basis of the professional contract between the profession and society. So long as the professional contract is an ethical one, the weight of ethical duty attends to rectifying this imbalance.
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Thus, the very fact that some groups are severely under-represented in a profession (for example African Americans are 12% of the general population in the United States and yet they are only 6% of the population in medical school; 5% of medical school graduates are African-American; and 3% of medical doctors in practice are African-American while 2% of the medical school faculty are African-American). These statistics are significant. While 6% of the admitted medical school students are African-American, this figure shrinks to 2% of the faculty being African-American. There is no getting around the fact that African Americans are not proportionately represented in medicine. Through exclusionary practices (intended or not), there is no proportional representation and the social contract between medicine and the African-American population (a subset of the American society) has been breeched.
One can only conclude two things from the statistics showing proportional disparities: (a) either African Americans are not suited for such “high-powered intellectual activity” or (b) the medical school community worldview is constructed in such a way that it disadvantages African Americans. Two pieces of evidence for the latter view are: 1) The representation of African Americans in medical school is around 50% of their societal numbers. This compares with South Africa (long a society ravaged by cruel apartheid). In South Africa, blacks in medical school are around 30% of their societal numbers. 2) AQA membership (already established as an important factor in being accepted for a prestigious residency) has only 1.3% African-American members and 26% female members. If the medical profession in general and orthopedic surgery in particular were really open to diversity, these numbers would be different. For this reason alone, the profession of orthopedic surgery in the United States is in material breech of its professional contract with the American people. It must therefore take immediate steps to rectify this situation. (See Section Three.)
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In Section One of this essay, it has been argued that there is a general ethical duty to promote diversity in the professions based upon a view of merit depicted in the puzzle-maker model. In addition to the moral duty, a professional duty for diversity was put forth based upon a notion of a professional social contract.