ABSTRACT
This aphorism invokes a connection between membership of a specific occupation and the possession of special expertise and moral authority, which warrants doctors’ taking responsibility for making judgements on behalf of those who seek their services. A particular occupational identity is claimed as sufficient to guarantee ethical conduct and expertise. Historically, such claims have, as many sociologists have pointed out, been particularly associated with those occupations regarded as professions. For example, in the late eighteenth century, Adam Smith, generally associated with a ‘rigorous critique of occupational monopoly’ (Dingwall and Fenn 1987: 51), ‘defended the privileged position of professions on the grounds that the nature of their work requires trust’ (Freidson 2001: 214). Although when Smith wrote, doctors did not have a monopoly over matters of health, a century later they were well on course to achieve market control. By the time Talcott Parsons turned his attention to the professions in the middle of the twentieth century, medicine was in a very privileged position in most affluent countries (Parsons 1939, 1951). There was general acceptance of the medical profession’s claims that the nature of their work and the indeterminate knowledge required of its members warranted a high (but not unlimited) degree of public trust and autonomy to take decisions without extensive external monitoring. Trust in the medical profession was (and, arguably, is) accepted as especially important, because the vulnerability and uncertainty involved in illness, and its diagnosis and treatment, render lay people (be they patients, managers or politicians) unable to make appropriate judgements.
