My Homophobic Physician
Sometimes the links are clear enough. We do not want a heroin user working as a pharmacist, a peclophile supervising a child-care center, a rapist working as an anesthesiologist, a rabid bigot serving as a judge. In these instances, general character bears directly on the work. More often the link is not so clear. Do we, for example, want to bar from practice a homophobic physician who is admirably skilled and caring except when the patient is gay?

For me, this is not an abstract question. On June 21, 1999, 1 picked up the Los Angeles Times to read--to my horror--that the American Civil Liberties Union was suing my own physician (and HMO) for sex discrimination. While conducting a routine physical, which included a pelvic examina- tion, the physician asked the patient about birth control. She replied that she used none because she was a lesbian in a monogamous relationship. Following the exam the doctor asked the patient to make her next medical visit with another physician in the office because he did not approve of her "lifestyle."

Homophobia and many other bigotries are all too common in the professions, as are drug abuse, kleptomania, an assortment of sexual perversions, and so on. A hard line on character would not merely create a shortage of qualified professionals; it might leave us with none at all!

Nevertheless, there is a problem here. On the one hand, knowing the physician in question, I would not have wanted him blocked from entering medicine because of his homophobia. On the other hand, his homophobia might well surface many times during a career in medicine. Bigotry is at least one important character trait I would want taken seriously in preparing individuals for medical careers--and to be addressed in programs of continuing education.

Character and Conscience
So far I have focused on preparing for a profession, including what education can do about character flaws likely to surface in practice. Let me conclude by distinguishing several additional issues regarding the interplay of character in private and professional roles.

One issue concerns disciplining people for specific failings once they have become professionals. My physician should (and undoubtedly will) be disciplined, by the courts and by his HMO, for how he dealt with his patient. (He should at least have found a less insulting way to transfer his patient to another physician.) But the penalty will be for the act, not for his flawed character. This is true even if, as seems unlikely, he were to be required to undergo counselling for homophobia. In general, we should respond only when abuses occur. We should leave room for the exercise of both personal freedom and professional conscience.

Issues about private conscience in professional life are notoriously complex. How far should we allow private conscience to guide professional conduct when it departs from the moral consensus expressed in the relevant code of ethics. When does conduct guided by personal conscience become unprofessional? These issues are the primary topic of most debates about professional ethics in the courts, classrooms, and professional societies. We all agree, for example, that college professors should have great freedom to express their views. Academic freedom is central to what college professors are supposed to be. But what about an atheist philosopher who grades down a student for defending religion in an essay? The professor is wrong, of course. The question is what should we, his colleagues, do about it? Here, I think, a code of ethics is essential in setting and enforcing standards-even though codes are always vague and incomplete.

Issues of conscience are also connected with the meaning and requirements of professional distance. Just what does appropriate distance amount to? What does it require by way of setting aside personal values in order to meet professional responsibilities, to avoid greed, sexual dominance, paternalism, or conflicts of interest, and otherwise to meet minimum standards for practice of the profession?

Room for Aspirations?
I turn now to the more positive side of character, the aspiration to do more than meet the profession's minimum standard. We want practitioners who have been drawn into their profession by a deeply-felt commitment to its ideals. This commitment must cohere with codified duties, but it transcends the minimal competence required of members of the profession. Professional ethics is more than shared duties and episodic dilemmas. It includes the personal commitments that motivate, guide, and give meaning to the lives of professionals. These commitments, though personal, deserve greater emphasis in thinking about professional ethics--as I argue in my latest book, Meaningful Work: Rethinking Professional Ethics (forthcoming, Oxford University Press).