When Gallup released the results of its annual survey of honesty and ethics in the professions earlier this winter, nurses once again earned the top spot.
This marks 17 straight years that nurses have ranked higher than any other profession. Eighty-four percent of respondents rated them “very high” or “high” in honesty and ethical standards. Medical doctors came in second with a 67 percent “very high” or “high” rating.
Bankers, real estate agents, lawyers, stockbrokers and members of Congress all had a positive rating under 30 percent. Members of Congress were once again at the very bottom of the list with only 8 percent of respondents rating them positively and 58 percent rating them negatively. Clergy, who once were the most trusted profession, had an all-time low 37 percent positive rating.
Why do some professions enjoy consistently high levels of trust while other professions rate low year after year?
Part of the answer may lie in the motivations of individuals within the professions. When I ask nursing students why they want to go into nursing, they invariably respond by saying they want to help others. Business students, by contrast, are more likely to be motivated by self-interest.
But motivation does not fully explain the reputational difference among professions. Most young people who go into ministry or politics also embark upon their careers with pro-social motivations. And my own experience of lawyers, bankers, real estate agents and car salespeople suggests that the individuals in those professions are just as trustworthy as anybody else.
If that is true, then what earns a profession a positive or negative reputation is not just the people in the profession but the way the profession is practiced. Especially important is the way different professions handle ethically problematic cases and circumstances.
Most professions in the United States today have codes of ethical conduct or professional standards. Many, like law and engineering, also require a certain number of hours of ethics training each year.
But only health-care professionals have gone beyond codes and standards to develop a culture of working together in teams to figure out how to handle ethically complex situations in real time.
That was not always the case.
After the parents of Karen Ann Quinlin filed a lawsuit to remove her from a respirator in 1975, health-care professionals around the country realized they were going to be faced with more and more cases in which new technologies presented them with choices they had not been trained to make.
They wisely came up with the idea of creating ethics committees to handle such cases, knowing there would be no way to craft comprehensive rules of conduct for every future situation.
A hospital ethics committee will typically receive referrals by someone in the system, gather information about the case, deliberate using an agreed upon decision-making model, and then deliver a recommendation about how to proceed. They will ask whether the case was an isolated instance or whether system changes should be made to prevent similar problems from arising in the future. If the case is particularly difficult to resolve or presents instructive features, they might publish the case for the benefit of ethics committees at other institutions.
No other profession relies upon the collective judgment of their own members to determine how to proceed in challenging circumstances, nor does any other profession devote so much time and money into improving the quality of their collective judgment.
In other words, in health care, teams of people work together in a transparent, methodical fashion to resolve their most difficult ethical problems.
In every other profession I can think of, the most difficult ethical problems are handled either individually or by small groups of people working in an ad hoc fashion behind closed doors.
Everything we know about ethical decision-making tells us that human beings tend to make bad choices in isolation or in secrecy.
Right now, most professions put their faith in an ever more complex set of rules, standards and regulations to try to rein in unethical behavior.
But there is no way we can possibly devise comprehensive ethical rules for every situation. The world is changing faster than new rules can be developed. Besides, the imagination of people designing the rules is never as robust as the imagination of those intent on evading the rules for their own advantage.
It does not have to be this way.
What if other professionals — like politicians, lawyers, bankers and clergy—conducted themselves more like health care professionals?
What if they organized local teams of people to look into ethically complex situations within their professions? What if those teams were tasked not with making judgments about past conduct but instead were asked for recommendations on how to proceed in current situations? What if members of each profession held one another accountable for following those recommendations?
I predict we would see a restoration of trust and confidence throughout our society.
When a majority of people report no confidence in the guardians of most of our core institutions, isn’t it time to try something new?