The Professions Under Pressure

THE MIDDLE CLASSES

By ANGUS MAUDE, MP

IBOLD every man,' said Francis Bacon, 'a debtor to his profession, from the which as men do of course seek to receive countenance

and profit, so ought they of duty to endeavour themselves, by way of amends, to be a help and an ornament thereunto.'

This is perhaps a good moment, what with the financial troubles of the hospital doctors and the acceleration of the 'brain drain,' to consider the position of the professions and its implications for the country as a whole. When Roy Lewis and I

wrote Professional People thirteen years ago, we

were concerned to call attention to the problems beginning to arise from the increasing 'socialisa-

tion' of the professions and the rapidly rising proportion of their members employed by public authorities or by industrial and commercial firms. These problems loom larger than ever today; nor can it be said with any confidence that the professions themselves have done much to resolve them.

It is not only the increasing concern of the state with the details of social life that has affected the status, morale and motivation of the older profes- sions. It has been affected also by the efforts of other callings to gain the recognition of a profes- sional status to which little in their nature or organisation entitles them—a recognition that in an age of woolly goodwill is often far too readily conceded. Few people today, in short, have any clear idea of the nature of a profession and of the obligations it implies. Mr W. J. Reader's history of the establishment of the leading profes- sional organisations during the nineteenth century* is therefore timely, for it tells us what people who did think seriously about these things were trying to do.

One of the things that most of them were trying to do, as Mr Reader makes very clear, was to raise their social status—in other words to achieve 'countenance' as well as 'profit.' The early Vic- torian situation has never been better summarised than by the fictional Mrs Marrable:

She always addressed an attorney by letter as mister, . . . explaining that an attorney was not an esquire. She had an idea that the son of a gentleman, if he intended to maintain his rank as a gentleman, should earn his income as a clergyman, or as a barrister, or as a soldier, or as a sailor. Those were the professions intended for gentlemen. She would not absolutely say that a physician was not a gentleman or even a surgeon; but she would never allow to physic the same absolute privilege which, in her eyes, belong to the law and the Church. There might also pos- sibly be doubt about the Civil Service and Civil Engineering, but she had no doubt whatever that when a man touched trade or commerce in any way he was doing that which was not the work of a gentleman.

So the solicitors and the doctors and the rest set out to secure `countenance'—but not simply as an end in itself. They raised their social status primarily by improving the general standards of knowledge, skill and probity in their professions, which meant securing the power to insist on proper standards for qualification and to enforce proper codes of ethics and practice. Not only did they get rid of the crooks and the quacks, they

* PROFESSIONAL MEN: THE RISE OF THE PROFES- SIONAL CLASSES IN NINETEENTH-CENTURY ENGLAND.

By W. J. Reader. (Weidenfeld and Nicolson, 36s.) also set up the beginnings of a decent system of professional education and training. Moreover, as the status of the solicitors, surgeons and GPs improved, they were able to stir the disciplines of law and medicine out of the antique lethargy in which the Inns of Court and the College of Physicians had been preserving them.

These struggles Mr Reader chronicles and documents competently in his book. Surveying the protagonists and their motives with impar- tiality and urbanity, he recognises a certain amount of pompous hypocrisy and some tiresome rationalisation of self-interest. He also believes that the Victorian professions' preoccupation with social status, and their consequent aversion to anything savouring of the commercial, caused them to ignore the increasing need for improved technical education at the end of the century. But he is perfectly clear that, by taking a pride in their work and caring deeply about professional skills and ethics, professional men 'permanently en- riched and purified the life of the nation.' So did the reform of the upper reaches of the Civil Service, which Mr Reader also describes.

Indeed it is scarcely going too far to say that the upper-middle-class professional men provided this country with a genuine aristocracy just when it most needed one. This aristocracy, together with its ideals, is now in the process of being destroyed:

It was always an object of resentment, as aristocracies and elites of all kinds commonly are. Its ideals and motives have been misunder- stood and misrepresented. The restrictionism of the professions, which of course had an element of self-interest about it, has been attacked as if it were solely a trade-unionist concern with financial security, which it never was. Envy and perverted egalitarianism have tried, without much success, to force dilution on the professions.

But now the mass society, which is incapable of thinking of any activity except in its own crude terms of 'making a living,' is trying to force the professions to conform. But the whole ethos of the professional man is against this. Richard Hughes summed it up well enough when he said that 'whereas the economic man looks on work as the means to get money, the professional man looks on money as the means to do work.' But how can the doctors be expected to go on thinking in this way when their whole livelihood and their work- ing conditions are at the mercy of egalitarian politicians and penny-wise Treasury officials? Professional bodies which ought to be concerned with the proper advancement of their arts and sciences are being forced to behave and bargain exactly like trade unions. Thus does the mass society degrade the professions to its own level.

At the same time it has the impertinence to try to get the best of both worlds by appealing to the professional conscience and bleating about the professions' duty to society.' In other words they must behave better than trade unionists while being treated worse. There is no more nauseous cant than the current preoccupation with 'social duty.' A doctor has no responsibility to society at all. He is responsible to his patients directly as people, and he is responsible for the honour of his profession. Just as the purpose of medicine is not making a living, but health, so it is the health of patients as people that matters, and whether this health is good for society or not is only secondary. If it were otherwise, doc- tors would have to think a good deal harder about whether to keep 'useless' people alive.

.Many doctors who were deeply concerned for the honour of medicine and the interests of their patients welcomed the National Health Service because they wanted to give better treatment to people who could not afford to pay for it. And clearly they were right. But so were those who foresaw the dangers to professional freedom and to the doctor-patient relationship. Nor is medicine the only profession at risk from 'society' and the economic man. By squeezing the profes- sional man's profit, society may end by taking from him the kind of 'countenance' that matters most—his own self-respect. And when the profes- sional ideal is wholly discredited and destroyed, society will be an even more squalid business than it is now.