Oration

Responsibility to self

The attainment of knowledge brings responsibilities. Graduation is an important milestone towards becoming financially independent and striking out on your own. Many of today’s graduates will go out into the work market offering their services for financial gain; others will continue to further their academic careers, only to enter the work market later.

Yes – the professional intellectual does deserve fair remuneration for his or her services. After all, in the words of the eighteenth century Scottish moral philosopher Adam Smith [b.1723; d.1790], "It is not from the benevolence of the butcher, the brewer or the baker, that we expect our dinner, but from their regard to their own self interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages.” ¹

Today our society subscribes to the principle of a Free Market Economy – an economy where all markets are unregulated by any party other than the players within the market. In such an economic philosophy, the price for a service is set through a process of free competition between the vendors of products and services. In theory with this economic philosophy in action, prices should tend to decrease, while quality should tend to increase. However, this price balancing will only fairly take place if no price-setting cartel or monopoly influences the market.

This economic system is only fair if the principle of Perfect Competition is really in play. This assumes that the service buyer has truly been given the complete information about his options and full freedom of choice. The service buyer must not be coerced in any way through being presented with asymmetric information. The individual in need is very susceptible to emotional blackmail that can act as an external influence affecting his perception of options available.

The balance between fair remuneration for services rendered has long been a contentious issue, especially in the field of community health care services. In the past, the issue was resolved by having a government-controlled market economy in this field. In 1724, the consultation fee for doctors attending patients in the community was fixed at one taro during the day and four tari for a night consultation.^2,3 A hundred years later in 1821, a revised list of tariffs for physicians and surgeons established the consultation fees at 30 tari during the day and 60 tari during the night. Other fees were set for other specific instances and procedures.⁴ Further revisions in tariffs for consultations were made throughout the subsequent decades, the last being made in 1960.⁵ Today the fee-controlling mechanism is controlled in part by the private medical insurance providers.

Such regulatory control is unthinkable in the sphere of a free market economy. To temper out a free-for-all mentality, one can only promulgate the wisdom of the Old Testament that states “He that makes haste to be rich shall not be innocent” [Proverbs 28:20] for in the words of the third century AD Saint Cyprian of Carthage [b.208; d.258], the individual who falls into “The deep and profound darkness of avarice has blinded [his] carnal heart. [He is a] captive and slave of [his] money; [he is] tied by the chains and bonds of avarice….”. ⁶

Many of the graduates today belong to the health care fraternity. They are familiar with the traditional Hippocratic Oath historically taken by doctors swearing to practice medicine ethically. Believed to have been written by the Hippocratic School in the fourth century B.C.E., the Hippocratic Oath outlines facets of the responsibilities of the individual practitioner that can be extended to the intellectual graduate. The University of Malta Medical School has formulated a modern version of the Hippocratic Oath that will be read by the medical graduates during their graduation ceremony. This includes the statement “I will take care of all patients equally, irrespective of social, racial, political or ideological differences. I will not put profit or advancement above my duty and service to patients.” It may be high time for other Faculties to emulate the Faculty of Medicine and Surgery and ask their graduates to take a corresponding ethical practice oath at graduation.

Responsibility to clients

However, responsibility of balancing self-interest with the needs of the clients is only a small facet to the responsibilities brought on by the attainment of knowledge. The classical Hippocratic Oath particularly emphasizes the responsibility towards the client served by the physician. “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction …. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; …. But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.”

In other words, the graduate intellectual is morally obliged to be a true competent professional. Professionalism is not a straightforward concept to define. The word “profession” is, today, almost synonymous with occupation. Robin Downie, Professor emeritus of Moral Philosophy at the University of Glasgow, in 1990 defined the professional as an educated individual having a wide cognitive perspective who provides a service based on a special relationship with his or her clients. This relationship involves a special attitude of beneficence tempered with integrity that includes fairness, honesty, and clear understanding of the limits of his or her capabilities.⁷ I can only encourage you to strive for excellence in all of your professional activities and that “Patients [or clients] will be [your] first concern. [You] will be honest, respectful and compassionate towards patients [or clients] and [you] will ensure that their rights are fully respected, …..”.⁸

The responsibility towards clients must include also the need to maintain full confidentiality, bearing in mind that the relationship between the professional and his client is based on mutual trust and respect. The buzz-word today is Data Protection. The medical profession has long identified the need for confidentiality with the classical Hippocratic Oath stating: “All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.” The concept of professional secrecy relating to the health care professions was so strongly felt that it was long before the promulgation of the Data Protection Act incorporated within the Criminal Code of Malta [Ch.9:257]. The law reads as follows: “If any physician, surgeon, obstetrician or apothecary or, in general, any other person who, by reason of his calling or profession, becomes the depository of any secret confided to him, shall, except when compelled by law to give information to the public authority, disclose such secret, he shall, on conviction be liable to a fine.” Furthermore, any conviction under this heading may also involve disciplinary action on the part of the Medical Council.

Responsibility to society

The attainment of knowledge thus puts increased responsibility for the individual to maintain an ethical professional behaviour in all his or her relationships with clients; carefully balancing self-interest and the interests of the client. The Nobel Prize winner Albert Camus [b.1913; d.1960] wrote that “An intellectual is someone whose mind watches itself.” We are therefore bound to maintain the highest of ethical standards in our practice. The leadership that you provide must be exemplary. However, the intellectual must do more than watch him or herself; he or she must also serve as a watchdog for society. By virtue of the learning attained, the graduate professional attains a standing within the community he or she lives in. The knowledge you have attained grants you certain privileges and power in society. Knowledge frees the mind and in the words of the songwriter Bob Dylan [b.1941] “a hero [is] someone who understands the degree of responsibility that comes with his freedom.” ⁹

The graduate intellectual has the moral obligation to go beyond the duties to specific clients and speak out on broad matters affecting public policy and justice. The physicist Albert Einstein [b.1879; d.1955] believed that “The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing.” Remember the words of the 16^th century protestant reformer Martin Luther [b.1483; d.1546] – “You are not only responsible for what you say, but also for what you do not say.” If you have the knowledge to foresee the possibility of an outcome that can be harmful to society, then you have the ethical and moral responsibility to share that knowledge with the people at risk and with those in power who could take steps to prevent the outcome. Treat your privileged status in society with humility and respect, and so continue to live within the deepest traditions of this university. Speak out whenever you have a well-informed concern about any aspect relating to the welfare of society – but importantly do so intelligently without any bias, political or otherwise.

The Hippocratic Oath taken by the medical graduates promises that the graduate “will try to influence positively authorities whose policies harm public health and oppose policies which breach internationally accepted standards of human rights, [and] will strive to change laws which are contrary to patients’ interests or to professional ethics.” In order to discharge the responsibility towards society, graduate professionals should appear to really be acting independently from any influence placed upon him or her by politicians, industrials or any other policy-making body. The Whistle-blower Act promulgated in 2013 makes provision for procedures in terms of which employees in both the private sector and the public administration may disclose information regarding improper practices by their employers or other employees in the employ of their employers and to protect employees who make said disclosures from detrimental action. It thus recognises the obligation of coming forward to reveal truthful information and grants protection to whoever comes forward – a concept that is diametrically opposite to the past Estacode Regulations concerning the employment of public sector employees enforced by the Public Services Commission. These regulations required permission from the administration before publicly making comments about any matters relating to one’s work in the public sector.

Responsibility to knowledge

To be a leader in society, you must be comfortable with initiating and responding to change. Your education does not end today; your learning must be lifelong; after all, “Real knowledge is to know the extent of one’s ignorance” [Confucius – philosopher: b.551; d.479 BCE]. Do not become passive or complacent, or you will slide into mediocrity. Many professions have joined the bandwagon of Continuing Professional Education and the respective professional associations encourage their members to keep up to date with advances in their fields. They have realised that to succeed in this changing world, one must constantly strive for higher performance, higher standards, higher competencies and higher ethics. In the words of the 20^th century American philosopher, psychologist and educator John Dewey [b.1859; d.1952] “the aim of education is to enable individuals to continue their education…. [and] the object and reward of learning is continued capacity for growth.” The true lover of knowledge must adopt Socrates’ outlook that “one thing only I know, and that is that I know nothing”. Do not be overtly close-minded to believe that your knowledge is absolute and infallible. Be open to criticism and adopt the mentality promulgated by the Italian cardinal Cesare Baronius [b.1538; d.1607] who wrote that “I shall love with a special love the man who most rigidly and severely corrects my errors.” That same cardinal in conversation with Galileo was to show intellectual open-mindedness in the Inquisitional Age when he remarked that “The Bible teaches us how to go to heaven, not how the heavens go.”

The clients we serve are also better informed. The proliferation of knowledge-at-the-fingertip brought on by the advent of the World Wide Web presents new challenges to the practicing professions. These new technologies and the globalisation of information has created a meritocratic culture where status and success can no longer be inherited or bought, but must be earned and held on to through merit. The advent of the internet has opened new vistas to knowledge sources. The libraries of great universities are no longer the domain of the few privileged scholars. In the past, it was access to information that helped determine success of the individual or of a community. Now access is often not the limiting constraint – the constraints are accessing that knowledge and sieving the good from the bad and the ugly. This brings up the issue of differentiating between gathering information, amassing knowledge and acquiring wisdom, for “knowledge is a process of piling up facts [or gathering information]; wisdom lies in their simplification.” [Martin H. Fisher - physician and author: b.1879; d.1962]. In the words of the poet laureate Lord Alfred Tennyson – “Knowledge comes, but wisdom lingers” [b.1809; d.1892].

However, the responsibility towards knowledge itself does not simply refer to continuing one’s professional education. The university graduate does have a responsibility towards the propagation and advancement of knowledge itself. The graduate is obliged to aggressively, passionately and untiringly seek new wisdom and extend the boundaries of human knowledge. The extent of human knowledge today has only been achieved through the constant contributions by questioning individuals who allowed their imaginations to roam the limits of their perceptions and go beyond the confines of contemporary beliefs. We are after all "like dwarves perched on the shoulders of giants, and thus we are able to see more and farther than the latter. And this is not at all because of the acuteness of our sight or the stature of our body, but because we are carried aloft and elevated by the magnitude of the giants” [Bernard of Chartres - French Neo-Platonist philosopher: d.1124]. We therefore must appreciate the knowledge gathered by our predecessors and work to extend the boundaries to new horizons without fear. In the words of the theologian Tyron Edwards – “He that never changes his opinion, never corrects his mistakes, will never be wiser on the morrow than he is today” [b.1809; d.1894]. Remember that “in questions of science, the authority of a thousand is not worth that humble reasoning of a single individual”[Galileo Galilei - physicist and astronomer: b.1564; d.1642].

The intellectual is also responsible to pass on the knowledge down to future generations for “education is the transmission of civilization” [William James Durant - writer and philosopher: b.1885; d.1981]. The philosopher and orator Marcus Tullius Cicero showed his appreciation of the value of knowledge to the development of the community when he wrote: “What greater or better gift can we offer the republic than to teach and instruct our youth?” [b.106; d.43 BCE)]. However, remember that educators “cannot teach anybody anything, [they should] only make them think.”[Socrates – philosopher: b.469; d.399 BCE].

Graduates – today, you embark on a road filled with the promise of high adventure. Be agents of change first within yourselves, but also within the institutions and societies in which you live. However, while keeping an open mind, remember that not everything is meant to change. Hold fast to your ethics, be aware of your responsibilities, and strive for excellence within the framework of these values in all your professional activities. I am well aware that today I have placed a significant responsibility on your shoulders. I challenge you to not merely accept these expectations, but to exceed them.

References

1. Smith A. An Inquiry into the Nature and Causes of the Wealth of Nations. London: W. Strahan and T. Cadell; 1776.
2. National Malta Library. Archives of the Order of Malta Ms. 464, f.386t.
3. Anon. Del Dritto Municipale di Malta. Nuova compilazione con diverse altre costituzioni. Malta: G. Mallia 1784, 108, 296.
4. Government of Malta. Malta Government Gazette, 1821 March 28; 387:2567-2568.
5. Government of Malta. Legal Notice 1 of 1960. Malta Government Gazette, 1960.
6. Phan PC. Social Thought: Message of the Fathers of the Church. Delaware: M. Glazier Inc.; 1984.
7. Downie, R.S. Professions and Professionalism. Journal of Philosophy of Education. 1990, 24, 2.
8. Hippocratic Oath - Version adopted by the University of Malta Medical School. Faculty of Medicine and Surgery, University of Malta, 2018.
9. Dylan B. Biograph album set [Interview]. New York: Columbia Records, 1985 November 7.

Figure

Test image