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Published Airpower Journal - Summer 1996

*The idea for a paper on professional integrity was suggested to me by a very thoughtful article written by F. G. Miller and Howard Brady which appeared in Hasting Center Report, May-June 1995. The Miller-Brady article, "Professional Integrity and Physician-Assisted Death," pursued the thesis that under carefully delineated circumstances "voluntary physician-assisted death as a last resort . . . does not violate physicians’ professional integrity."


PROFESSIONAL INTEGRITY*

BRIG GEN MALHAM M. WAKIN, USAF, RETIRED


SOME YEARS AGO, one of the students in my medical ethics class approached me after the major research paper had been graded (it was worth 40 percent of the grade in the course). This student had worked hard during the course and had also worked hard on this 20-page paper, but it was clearly a solid B paper and there was tragic disappointment on the face of this student. "I need an A on this paper to keep my A in the course," he said. "Please, you must raise my paper grade or you'll jeopardize my chance to be admitted to medical school."

Now I was very much interested in helping this student achieve admission to medical school because I believed he had the potential to be an excellent physician and I had said as much in the strong letter of reference I had written for him and sent to several medical schools. But raise his grade on the basis of this request? My immediate response, provided almost automatically, was "I can't do that." In a very real sense, what I want to discuss with you is bound up with that answer--"I can't do that." When I gave that answer, I didn't mean that I wasn't able to do that or that I didn't have the authority to do that. Physically and from the perspective of being the only instructor in the course, I could have raised that grade. And I didn't mean that fear of external consequences prevented me from changing that grade--in other words, fear that I might get caught and possibly lose my job. No, what I meant was I can't change that grade because it would be wrong to do so for a number of good reasons. It would be unfair because the work really was not A work; it would be in appropriate to base student grades on the "need to get into medical school" rather than the "quality of work"; and it would be unfair to other students whose work was graded on the basis of qualitative merit. All of these are certainly good reasons why "I can't do that." But perhaps what I also meant was that changing that grade to one I did not believe was earned would be a violation of my own personal integrity, my self-respect, my ability to live with myself if I knowingly chose to do what I believed to be morally wrong. That was probably a good part of what I meant by the statement "I can't do that."

There is also such a thing as
professional integrity that is
related to--perhaps dependent upon,
certainly compatible with, but
different from--personal integrity.

But personal integrity is not the end of the story here. It seems to me that there is also such a thing as professional integrity that is related to--perhaps dependent upon, certainly compatible with, but different from--personal integrity. There are communal or corporate values associated with the teaching profession that place role-specific constraints on my behavior, and these are in addition to the normal moral values that I have as an ordinary moral agent. One thinks immediately of the special obligation to be competent in the subject matter and in teaching techniques. Proper preparation, special concern for each student's intellectual and, yes, character development, and fair and timely evaluation of student work--all of these and more constitute special obligations of teaching professionals. And the teacher, who is literally "in front" of these students constantly, must be totally conscious of the example that he or she sets for students. We teach by what we are and do, perhaps even more than by what we say. Maybe all of this was what was constraining me. Maybe this is what I meant when I said, "I can't do that." I have special responsibilities to the institution, to my professional colleagues, and to the community I serve in this profession who really do matter to the well-being of our community, and they trust me.

Consider a more complicated case, this time from the medical profession. As a general practitioner, I've just received the results of the blood tests on my 23-year-old male patient and he is HIV positive. He is also engaged to be married. I point out to him his responsibility to inform his fiancee because she has a right to know about the danger to her and to any future children they might have. He reacts very emotionally to my suggestion because he believes she will refuse to marry him if she learns he has the acquired immune deficiency syndrome (AIDS) virus. He says to me, "You must keep my condition a secret from her and from everyone. You're bound by the principle of patient confidentiality." Upon reflection, I reply, "I can't do that."

Now, what I mean when I say, "I can't do that," is that the moral principles that guide me as a medical professional require me to act, but in this case their guidance is not unambiguous. The principle of respect for my patient's autonomy by observing confidentiality is a very important one, and it does indeed constrain my conduct. But the competing obligation I have to prevent harm is also very relevant in this case, and if I cannot persuade my patient to tell his fiancee himself, then I may judge that my duty to prevent harm overrides my duty to observe confidentiality in this case. My professional integrity is bound up in these competing moral principles, and although it is extremely controversial here, I tell my patient, "I can't do that."

It's the spring of 1968 and I'm a young sergeant in a combat infantry company in South Vietnam. My platoon has captured an entire village of suspected Vietcong sympathizers: 400 people, including women, old people, children, and babies. We find no weapons in the village. My lieutenant orders us to herd them all over to the roadside ditch and shoot them. I say to him, "I can't do that." What I mean is, we can't do that--no one can do that. I know that I have a duty to obey the orders of my superiors, but I know that this order is in direct conflict with both my country's laws and with the fundamental moral law against harming the innocent. Several years earlier, in confirming the death sentence of Japanese general Tomoyuki Yamashita, Gen Douglas MacArthur said, "The soldier, be he friend or foe, is charged with the protection of the weak and unarmed. It is the very essence and reason of his being. When he violates this sacred trust, he not only profanes his entire cult but threatens the fabric of international society."1 In this case of conflicting duties, my professional integrity tells me that my higher duty is to avoid harming the innocent, and when I'm ordered to kill babies--I can't do that.

These examples from education, medicine, and the military may help us to focus on this fuzzy notion of professional integrity. Integrity itself is a much-used term but very much in need of analysis. When we use the word integrity in a moral context, we refer to the whole moral character of a person, and we most frequently allude to one's personal integrity. When we say to someone, "don't compromise your integrity," we usually mean, "Act in accordance with your moral principles within your value system. Be consistent." There is a real sense in which integrity encompasses our personal identity. As Polonius has it, "To thine ownself be true." But we must be very careful here. Consistency is not all there is to personal integrity. There is little merit in being consistent with your principles if "thine ownself" is egoistic, treacherous, criminal, and abusive. This is why integrity has to do with "wholeness," with one's entire character and what that moral character is like is what counts. And subscribing to decent moral principles is not enough. We must act on decent principles--consistently. Others have noted accurately that integrity is the bridge between character and conduct.

No member of the professions can
escape these ties to the community
since they constitute the very
reason for the existence of the
professions. Thus, professional
integrity begins with this necessary
responsibility to serve the
fundamental need of the community.

Several centuries ago, Aristotle pointed out that moral credit is not automatic when right actions are done, nor is it enough to know what is right or to say what is right. He suggested that we are morally praiseworthy when we perform a right action if we first of all, know that the action is right; second, that we choose the act for it's own sake because we know it is right; and third, that we perform the action from a firm and unchangeable character--from the habit of performing that kind of action consistently. For Aristotle, it was very important that we develop the moral virtues through habit and practice, performing right actions so that they become part of our identity--our character. Integrity is the modern name we use to describe the actions of those persons who consistently act from a firmly established character pattern of doing the right thing. We especially stress the concepts of integrity when there is temptation to diverge from what good character demands. Persons of integrity do not stray from acting in accordance with strong moral principle even when it is expedient or personally advantageous to do so. Persons of integrity act like the ideal persons they are trying to be. This is perhaps what the ancient Taoist had in mind when he said, "The way to do, is to be." Thus, the wholeness of the good person, the total identity, is what we mean when we refer to his or her integrity. When we say, "Don't sacrifice your integrity," we really mean, "Don't stop being who you are."

If I'm a member of one of the professions, then "who I am" must also involve my social role as a practicing professional. My professional integrity will include the role-specific obligations and responsibilities of my particular profession. I stress here the social character of professional integrity because the community is involved at every stage of professional development.

"The soldier, be he friend or foe, is
charged with the protection of the
weak and unarmed. It is the very
essence and reason of his being.
When he violates this sacred trust,
he not only profanes his entire
cult but threatens the fabric of
international society."

--Gen Douglas MacArthur

First of all, the very existence of the professions results from some fundamental need that society has, and it is likely to be an eternal need. The need that we have for health care, for example, is unlikely to go away, and it is that need that over time has generated what we know today as the medical profession. It may come as a surprise to some to learn that the health-care professions do not exist for the sole purpose of providing employment to health-care professionals or profits for health-care organizations. It is because of societal need that our communities develop and maintain medical schools and nursing schools. Similarly, every organized society will express its interest in justice by providing some variation of a court system and a legal profession. We need an ordered society, we want to be treated fairly, and we seek justice. We train our judges and our lawyers in law schools supported by the community because of the important value that we place on justice. Similarly, we know how crucial education is to our society, so we provide for the training of teachers. We know how important security is to our nation-state, so we provide military academies and military training for the members of the military profession.

No member of the professions can escape these ties to the community since they constitute the very reason for the existence of the professions. Thus, professional integrity begins with this necessary responsibility to serve the fundamental need of the community. Notice that the community makes possible the opportunity for one to become qualified in a given profession and usually allows the professionals the authority themselves to set the standards of competence and conduct of its members. Doctors control the licensing and certifying of doctors; lawyers do the same for members of the legal professions; and military officers certify and control the commissioning process for leaders of the military profession.

Members of the public professions are thus educated and supported by the society because of the critical services the professions provide. In the case of teachers in public institutions and in the case of the military profession, practitioners are supported from the public coffers during their entire careers. Clearly, some of the role-specific obligations are based on this relationship and on the authority to act on behalf of the entire society, which is literally bestowed on these professionals. With the authority to act goes the public trust, and violations of that trust are serious breaches of professional integrity. For example, there were instances recently in the local public school system where two male high school teachers engaged in sexual intimacies with teenage female students. These teachers violated the trust they had been given; they violated their professional integrity. But let us direct our attention to the elements of professional integrity in the military profession to see if that will illuminate both our responsibilities as military practitioners and the relationships between professional and personal integrity.

Professional integrity derives its substance from the fundamental goals or mission of the profession. For the military profession, we might broadly describe that mission as the preservation and protection of a way of life deemed worth preserving. Just as one violates professional integrity in the field of medicine by performing surgical procedures that are not medically indicated in order to increase the surgeon's income, engaging in operations that are not militarily necessary in order to reflect glory on the commander would also be a breach of professional integrity. Killing unarmed prisoners, the elderly, and babies who are not engaged in the attempt to destroy you is surely inconsistent with the goals of the military and hence a breach of professional integrity.

In the military, as in all of the professions, the issue of competence is directly relevant to professional integrity. Because human life, national security, and expenditures form the national treasury and are so frequently at issue when the military acts, the obligation to be competent is not merely prudential. That obligation is a moral one, and culpable incompetence here is clearly a violation of professional integrity. When a B-52 pilot is known to engage in unsafe practices, when he frequently endangers the lives of other aircrew members and people on the ground by performing forbidden flying maneuvers, then not only does he violate professional integrity but so do those colleagues and superiors who tolerate this conduct and take no action to prevent it. This aspect of professional integrity is worth noting.

Part of the social aspect of professional integrity involves the joint responsibility for conduct and competence shared by all members of the profession. When fellow surgeons bury the mistakes of their incompetent colleagues rather than expose these colleagues and remove their license to practice, they fall short of their responsibilities to the goals of the profession--they sin against professional integrity. Only fellow professionals are capable of evaluating competence in some instances, and hence fellow professionals must accept the responsibility of upholding the standards of the profession. Fellow officers can spot derelictions of duty, failures of leadership, failures of competence, and the venalities of conduct that interfere with the goals of the military mission. The wing commanders of that B-52 pilot who knew of his repeated safety violations and failed to ground him before he killed himself and others failed in their responsibilities--they violated their professional integrity. Often the obligations of professional integrity may be pitted against personal loyalties or friendships, and where the stakes for society are so high, professional integrity should win out.

These lessons seem obvious in theory but are most difficult to put into practice, especially in the preprofessional training which takes place in military academies, medical schools, and law schools. Nontoleration of failures of professional integrity does not seem so crucial in training situations where the stakes are not too high. Perhaps this is why the penalties for tolerating lapses of integrity are ameliorated in training situations but they often seem sensationally tragic when enforced in the professional context. But preprofessionals must learn the importance of the social elements of professional integrity and the responsibility they inherit to maintain standards of competence and conduct in the entire profession and not just for themselves. Society provides the training opportunities, the resources necessary for carrying out the professional function, and the authority to act on its behalf. With this authority to act and the autonomy which usually accompanies it, breaches of professional integrity must be viewed as serious failures of social trust. When a cadet at the Air Force Academy knows that a fellow cadet has plagiarized a paper to meet a deadline and takes no action to correct this behavior, he or she has violated societal trust in a fashion analogous to the colleagues who took no action to correct the unsafe B-52 pilot. If our preprofessional preparation does not inculcate the habits of professional integrity, can we have confidence that those habits will be practiced by these same individuals when they become licensed professionals?

When a B-52 pilot is known to
engage in unsafe practices, when he
frequently endangers the lives of other
aircrew members and people on the
ground by performing forbidden
flying maneuvers, then not only does
he violate professional integrity
but so do those colleagues and
superiors who tolerate this conduct
and take no action to prevent it.

We derive other aspects of professional integrity as we examine the basic functions of each profession. If in preserving our way of life we must use the military instrument, then members of the military profession must sometimes go to war. If combat occurs, then professional soldiers must fight. To refuse a combat assignment is to break faith with all other members of the profession and is a first-order violation of professional integrity. It would be the equivalent of a teacher refusing to teach, a doctor abandoning patients, a judge refusing to hear crucial cases. Because the stakes are so high in the military case, this breach of professional integrity could be devastating to society.

How are personal integrity and professional integrity related? There are varying opinions about this. Some people believe that one can live up to high standards of competence and conduct in one's professional role--at the hospital, in the school, at the military base--but live an entirely different kind of moral life outside the professional context in one's private life. Some think they may be required to do things in their roles as professionals that they would never do as private laypersons. Some instances of this dichotomy are obvious. As a private person I would normally not even contemplate harming other persons, yet as a military professional I am licensed to kill (under specified conditions) for reasons of state. A variation of this concern surfaced during an annual meeting of the Colorado Bar Association in the fall of 1995. One of the topics offered for small-group discussion was the following one: "I would never do many of the things in my personal life that I have to do as a lawyer." At the heart of this matter is the issue of client advocacy. Lawyers are enjoined to act in their clients' interests and to do so zealously. In defending my rapist client whom I know to be guilty, I may cross-examine the innocent rape victim in such a fashion as to totally discredit her even though I know she is telling the truth. If it is legal and will help my client, it would seem that the standards of the profession require me to do it, even though in ordinary morality I would judge it to be wrong to harm an innocent person.2 This sort of example really is problematic, for it appears to reveal a direct conflict between personal integrity and professional integrity.

There are similar examples in medicine. Abortion for convenience is legally permitted in most US hospitals, but some obstetricians believe that convenience abortions are immoral. Thus, in these hospitals they find a conflict between professional integrity and personal integrity. Now in most such situations, doctors and nurses are permitted to refuse to participate on moral grounds even though the action itself is legally permitted. Perhaps this is one key to resolving integrity dilemmas--what is legally permitted is not always or even usually morally obligatory. But I mention these possible clashes between professional integrity and personal integrity because I wish to minimize them. I wish to support the view that the two types of integrity are generally compatible and to foster the position that they are interdependent. What I wish to argue is that since professions exist to serve society's need for important values (education, health, justice, security, etc.), the means used to provide those values and services should be morally decent means, and the persons in the professions who provide them should be morally decent persons.

Put in more direct terms, good teachers ought to be good persons, good doctors ought to be good persons, good lawyers ought to be good persons, and good military professionals ought to be good persons. We want to live in a world where the duties of a competent professional can be carried out by a good person with a clear and confident conscience. That means that professional practices must always be constrained by basic moral principles. That this is not always the case now is obvious. Several of the attorneys at the previously mentioned convention pointed out that they had left certain large law firms because they perceived that they were being asked to do things that violated their personal integrity. Now in the best of all possible worlds, the moral restraints on professional functions would have made those same actions inimical to professional integrity as well. And this is the proper order of things. When professions go beyond their essential service function to society and distort their purpose toward profits, power, or greed, then they lose the trust and respect of their communities and they stop being professions. Militarism is the pejorative term we use to describe a society or a military gone bad in the sense that it distorts the essential goals and functions of the military profession. The twin sources of guidance we use to hold militarism in check are the just- war theories and the law of war. These twin guides are related in an essential way to professional integrity, representing in the broadest terms when and how the military instrument ought to be used.

Well-established professions often spell out the role-specific principles which support that profession's conception of professional integrity. The codes of conduct promulgated by the American Medical Association and the American Bar Association and state and local chapters of these groups are well known. The military profession has many codes, regulations, mottoes, and traditions that combine to form a military ethic on which professional integrity is based. At the Air Force Academy, we have our honor code and our honor oath, and our specific list of core values is now identical with the official list of core values of the Air Force. When we say that we value integrity first, service before self, and excellence in all that we do, we acknowledge that the essential nature of the military profession is to serve our parent society. We make specific our commitment to the concept that good soldiers are good persons. What we should mean when we commit ourselves to "integrity first" is that we understand the importance of both personal integrity and professional integrity, and through our efforts to keep them compatible, we will best provide the crucial military function to our society.

Notes

1. Quoted in William Manchester, American Caesar: Douglas MacArthur, 1880-1964 (Boston: Little, Brown and Company, 1978), 488.

2. For this example I am indebted to Michael Davis and Frederick A. Ellison, eds., Ethics and the Legal Profession (Buffalo, N.Y.: Prometheus Books, 1983), as quoted in T. L. Shaffer's American Legal Ethics: Readings and Discussion Topics (New York: Matthew Bender, 1985), 335.


Contributor

Brig Gen Malham M. Wakin,, USAF, Retired (BA, MA, University of Notre Dame; PhD, University of Southern California), is professor of professional ethics at the US Air Force Academy, where he has taught since 1959. He began his military service in 1953 as an aviation cadet in the navigator training program, and he retired as a brigadier general in 1995. He has authored numerous articles and has authored or edited four books on ethics, leadership, and the military profession. General Wakin was featured as one of 12 "great professors" in a 1975 issue of People Magazine and was the subject of a feature article in the 19 November 1984 issue of Newsweek. He was national chairman of the Joint Services Conference on Professional Ethics from 1979 to 1992 and is a member of the Ethics Oversight Committee for the US Olympic Committee.


Disclaimer

The conclusions and opinions expressed in this document are those of the author cultivated in the freedom of expression, academic environment of Air University. They do not reflect the official position of the U.S. Government, Department of Defense, the United States Air Force or the Air University.


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