The Roman god Janus, entombed in the name of January, the month that, beginning the new year, also marks the end of the old, was always de picted with two faces, one looking forward, the other back. Someone to watch a doorway, Janus was the god of change—and, I suppose, as "jani tor", also the god of maintenance, the war against change. His temple was closed only in those rare moments of universal peace when history and prophesy, like tired dogs, sleep in a corner.

The Anniversary and the Topic
Janus must also have been the god of anniversa ries, those moments when, celebrating an old beginning, we consciously begin anew, measuring the settled past against the wilds of a future we can only guess—which is why I mention him here. This issue of Perspectives marks the twenti eth anniversary of IIT's Center for the Study of Ethics in the Professions.

Twenty years is a long time for an ethics center. Only one, the Hastings Center, has survived longer; and only two others, the Center for Busi ness Ethics at Bentley College and the Institute for Philosophy and Public Policy at the University of Maryland, have survived as long.

But twenty years is a good time to look both anniversary when looking backward and forward have a sort of equality. Soon, by the twenty-fifth anniversary or the thirtieth, the time between the old beginning and the new is so great that humans cannot look as far ahead as back; anniversaries then become occa sions at which the past is the honored guest and the future stands near the door forgotten.

When I arrived at the Center ten years ago, just in time for its tenth anniversary, the editor of Perspectives asked me to describe what the Center might be in ten years. Of the three predictions I made, only one, that the Center would still exist in 1996, turned out just as I said.

Having shown no gift for prophesy, and having myself become editor of Perspectives, I decided to let others do the predicting this time. I also decided to focus not on the Center but on (some of) the professions it tries to serve. I asked three relatively young practitioners each to take stock of his own profession: How have the profes sion's ethical concerns changed over the last twenty years? What has not changed? What may be different twenty years from now? What the same? The three --- lawyer, engineer, and doctor--- —differ a good deal in how they answer.

Lawyers, Markets, and Technology
Barry Maram, a graduate of IIT's Chicago-Kent, reports important changes in what lawyers do and how they do it. Over the last two decades, the line between the practice of law and certain other occupations has blurred. Law-school training has become an alternative to an MBA in administrative fields where law, rather than money, sets the fundamental boundaries.

The practice of law has also changed. Computers have, by giving lawyers the power to do better research, raised substantially the standard of legal research. They have also dissolved the line between preparing legal documents or letters and typing them up. Computers are making it easier for law firms to track costs and to supervise lawyers more closely. Computers may also have had something to do with the enormous growth in the size of law firms. Law firms are beginning to look like factories; lawyers, like skilled workers.

Expecting these trends to continue, Maram nonetheless predicts that the fundamentals of lawyering will remain. Lawyers will still owe their clients competent, independent judgment concerning what the law is, how to accomplish their ends within its bounds, and how to change those bounds.

New Opportunities for Engineers?
John Katrakis, a graduate of IIT's Armour College, begins with a problem Maram did not identify as a problem. Technology, Katrakis notes both grants power and taxes for it. Not all power is worth the tax. Those who make technology, especially engineers, should try to make it so that its tax, not just in dollars but in environmental harm, work satisfaction, family life, and other "side effects" are worth the price. Katrakis might, for example, have wondered whether, on the whole, anyone has benefited from the computerization of law. Lawyers work harder; clients must pay for more research in order to stay even with "the other side" in law's ultimately futile "arms race"; and firms must let go many employees in a struggle to survive in an increasingly competitive market.

Katrakis argues that engineers are now in a better position than twenty years ago to shape technology as they wish. The same competition that seems to be driving lawyers into larger and larger organizations seems to be breaking up or at least shrinking the large employers of engineers. More engineers are, according to Katrakis, able to work in small firms or alone.

Increasingly, too, competition makes it harder for companies hiring engineers to provide lifetime employ ment; engineers will change employ ers more often than they used to. Even within a company, competition means that the old lock-step advance up the career ladder is no longer pos sible. Engineers are therefore freer, both within a company and when choosing where to work, to choose what they do.

With this freedom comes more re sponsibility for what they do. How should engineers exercise that free dom? Katrakis offers nine principles. Might other professions benefit from trying to follow the same principles?

Corporate Medicine
Michael Frampton, a psychiatrist, describes a major change in the prac tice of medicine in the United States, one paralleling the change in the prac tice of law Maram describes. Until the last decade, physicians worked alone or in small groups, associating themselves with one or more hospitals as the convenience of their patients required. Now a good part of medi cine is under the control of large profit-making corporations, "managed care" companies; soon most of medicine will be.

The result, according to Frampton, is a system of health care with most of the disadvantages of a national health service and few of the advantages. In theory, the managed-care company is merely an insurer, paying Frampton for service provided under its policy. In practice, however, it is a "meta- doctor", intrusive, domineering, and bureaucratic. The company will not pay for services it has not authorized in advance, will not authorize a ser vice without examining Frampton's interview notes, and will make its determination according to elaborate protocols which, being secret, Frampton cannot challenge.

For Frampton, the great ethical problem, the one likely to dominate medicine during the next twenty years, is how to provide competent medical care under such conditions. The solutions Frampton canvasses—unionization, government regulation, and socialization of medicine—suggest how desperate he thinks the problem is.

A Trend?
Before deciding the subject of this issue, I consulted my advisory board. When two members of the board began arguing about how to look at what has happened in professional ethics over the last twenty years, I invited one, David Beam, the director of IIT's Master of Public Administration Program, to put his position in writing, and the other, Robert Ladenson, a philosopher much involved in the Center, to respond.

Beam's thesis is that the relative economic stagnation of the last two decades has created conditions in which ethics has become ever more marginal. "The market", "competition", and "survival" have become the key terms in most discussions of how to act. Beam hopes the next twenty years will be better, in part, it seems, because they could not be worse.

Ladenson's response accepts much of Beam's description of the last twenty years, but suggests a more hopeful interpretation. Efficiency and profit are, he notes, morally relevant considerations. The problem is not that efficiency and profit are taken into account but that sometimes they are taken into account to the exclusion of everything else. That problem, the problem of ignoring relevant considerations, has nothing in particular to do with business. The physician who considers curing the patient all that matters, excluding from consideration even the patient's own wishes or the welfare of other patients, would behave as immorally as would a physician who considered only the profit of her managed-care company.

Ladenson concludes by reminding us of what we have to celebrate. What an ethics center can do, what ours has done for twenty years, is try to ensure that "we", both academics and members of the various professions, do not ignore relevant considerations when making morally significant decisions.

Vivian Weil, the Center's director, concludes this issue with a report of recent events at the Center: this has not been a year to close the Temple of Janus.

-MD