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The SOCIAL REPORT

Published By

The Program in Social Economy & Social Justice:
Studies in Race, Class & Gender
Department of Sociology -- Boston College

Vol. XIII, No. 6 (Spring 1997)

In This Issue:


Contributors to this Issue of The Social Report

The Social Report is published twice a year, once in a print edition and once in a web page edition. This is the 1997 web page edition.

The larger theme for this issue involves the new problems arising in the world as a result of the increase in the number of transnational corporations and the spread of for-profit organizations into previously non-profit activities.

Sharon Brassey-Brierley's (M.Div/MSW; Princeton Theological Seminary, Rutgers University) article links the concept of corporate social responsibility to the history of the world's great religions and the concept of noblesse oblige. She is a Ph.D. candidate in the Sociology Department at Boston College. She has worked as a coordinator of voluteers with Mother Teresa in Calcutta, India (1987-88) and for eight years in rural poverty, domestic violence and community development. She also attended the Appalachian Ministries Educational Council at Berea College and worked with the homeless in rural Campbell County, Tennessee. Sharon studied industrial cooperatives and community development at the Coady International Institute, St. Francis Xavier University, Antigonish, N.S., Canada.

Severyn Bruyn's (Ph.D., University of Illinois) article details the global problems that have been created as a result of the rise of transnational corporations. He is Professor of Sociology at Boston College, and his interests include community development, social economy, and cultural evolution. He was among the first to write extensively on the philosophy and logic of participant observation, and he has been a pioneer in the sociology of business and the social economy. He has organized a number of conferences at Boston College around the topics of world peace, community development, and joint-degree projects with the School of Management. His current writing deals with the idea of the "sacred".

Ritchie Lowry's (Ph.D., University of California at Berkeley) article describes how codes of corporate conduct have changed in response to the rise of transnational corporations. He is Professor of Sociology at Boston College and Founder & President of Good Money, Inc., multimedia providers of information for socially and environmentally concerned investors, consumers and businesspeople. His most recent book, GOOD MONEY: A GUIDE to Profitable Social Investing in the '90s, was published by W. W. Norton in hardcover in 1991 and in paperback in 1993. A Japanese-language edition was published by Shobunsha Publishers in 1992. He has been involved with the socially responsible investing and consuming movements since the late 1970s and is currently working on a book about the history of corporate social responsibility since the early days of capitalism. He was editor for this web issue of The Social Report and would appreciate any comments and reactions.

Aimee Marlow's (B.A., Goucher College) article describes the problems created by the rise of for-profit Health Maintenance Organizations (HMOs) and the consequences for nearly all aspects of the profession of medicine. She is a Ph.D. candidate in the Sociology Department at Boston College. She is currently interested in investigating the role socially responsible investors can/will play in transforming unfair and unjust for-profit HMO policies. Some of her other interests include occupational health, organizational studies, gender and health, and critical media studies.

Severyn Bruyn's, Sharon Brassey-Brierley's, and Aimee Marlow's articles are edited versions of longer papers. If you would like a printed version of the longer papers, please send us your snail mail address.

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The Problems of Business in a Global Market
by Severyn T. Bruyn

Global corporations are increasing in large numbers around the world. Unchecked, the result could be economic and ecological disaster for the planet. Nations are losing control over corporations chartered on their own territory and there is no world government to regulate them. Global firms are closing down jobs at home and moving to places with lower wages, lower business taxes, and more freedom to pollute, without fear of sanctions from host governments. Nations compete with one another to get global corporate subsidiaries as well as to charter and headquarter global firms. Areas such as production, finance, banking, transportation, and telecommunication cross national boundaries.

Former Secretary of Labor, Robert Reich has said:

"We are living through a transformation that will rearrange the politics and economics of the coming century. There will be no national products or technologies, no national corporations, no national industries. There will no longer be national economies, at least as we have come to understand that concept. All that will remain rooted within national borders are the people who comprise a nation... Each nation's primary task will be to cope with the centrifugal forces of the global economy which tear at the ties binding citizens together..."

The globalization of capital is accelerated by national governments which compete to obtain the subsidiaries of multinational firms and in the process reduce labor, social, and environmental regulations. The result is what some writers call a "downward leveling" or a disastrous "race to the bottom" in which conditions for everyone, except the wealthiest, tend to fall toward the lowest/poorest standards. In a competitive environment, it is in a firm's own interest to seek the lowest wages and the least amount of government regulations. This "downward leveling" is due to the unintended consequence of millions of unconnected decisions made by individuals and business pursuing private self interests. It is due to a lack of civil standards and ethics for businesses operating in world markets. And, it is due to a deliberate policy of global corporations to reduce all barriers to downward leveling. This "downward" spiral is also advanced by trade agreements like the North American Free Trade Agreement (NAFTA) which foster free trade but pays little attention to maintaining global standards. NAFTA virtually eliminates all tariffs on products and services flowing in and out of Canada, the U.S. and Mexico. Much has been written on the rising of Mexican economic standards, but little is mentioned in the U.S. on the leveling down process experienced by Canadian firms.

The spiral is also advanced by the "shock therapy" and "structural adjustment" strategies of the IMF and the World Bank which lower standards for nations intending to become more competitive on the world scene. The dream of poor nations to produce more goods and services for the world market and thus raise their standard of living is sadly part of a doomsday scenario. The policies in these programs include reduction of social spending, devaluation of national currencies and privatization of state-owned segments of the national economy.

Today we know that industrial processes are ruining the environment. Factories are principal emitters of green house gases, ozone-depleting chemicals, and toxic pollutants. Polluting petrochemical plants, oil refineries, and steel smelters are being spread around the world to countries willing to exchange global oxygen for jobs. Some developing nations are facing ecological disasters. Dioxin is the common name for a family of chemicals with similar properties and toxicity. Seventy-five different forms of dioxin exist, the most toxic bring 2,3,7,8-tetrachlorodibenso-pdioxin, or TCDD. Dioxins are not deliberately manufactured. They are the unintended byproducts of industrial processes that involve chlorine, or processes that burn chlorine with organic matter. The dioxin story includes coverups, lies, deception, and data manipulation by corporations and governments as well as fraudulent claims and faked studies. For people, it is a story of pain, suffering, anger, betrayal and rage; of birth defects, cancer, and many other health problems. It is a story about what happens when business operates in a global market without regulation or pollution prevention practices.

There is no enforceable world law of the open seas. The Law of the Sea Convention entered into force only in 1965, and the United States has not yet ratified it. The effect of its environmental protections is still uncertain. There is free competition to do anything a corporation wants to do on the seas. As the global demand for seafood overruns the sustainable yield of fisheries or as pollution destroys their productivity, fisheries collapse, raising seafood prices, eliminating jobs, and shrinking the economy. The economic wreckage left in the wake of these collapses can be seen around the world. Fishing villages that once lined the Aral Sea are now ghost towns. In Newfoundland, the collapse of the cod and haddock fishery has left 33,000 fishers and fish-processing workers unemployed, crippling the province's economy.

Governments sign agreements, then exercize little or no control over corporate conduct on world markets. For example, the Basel Convention on hazardous waste was designed to restrict the shipment of hazaardous waste. But firms still ship waste. So the Basel Convention says governments will take measures to prevent firms from exporting hazardous waste. However, even the U.S. does not have an export review system, except for military related products. So the U.S. does not have the capacity to control waste exports directly.

According to the United Nations Development Program's Human Development Report 1992, the gap between the rich and the poor is increasing worldwide. In 1970, the richest fifth of the world's people received 30 times more income than the bottom fifth; by 1989 they received nearly 60 times more. The richest fifth now receive more than 80 percent of the world's income, while the poorest fifth receive 1.4 percent. There is no world government to encourage a fairer distribution of wealth among people through taxation.

The global issues are more complex than the problem of rich vs. poor and unregulated world industries producing planet problems in health, safety, and the environment. Global firms are also in the production of a worldwide culture in their own corporate self interest. The influence of global firms on cultural life is greater than nation states in selective ways. The advertisements of Coca-Cola reach billions of people globally at the same instant. A global culture is increasingly created and transmitted by big firms through movies, TV programs, videos, records, cassettes, books, and CDs around the world. Disneyland is a global empire, drawing 300,000 visitors a week in Tokyo. Global entertainment centers for the twenty-first century are under construction in many parts of the world. Theme parks are described as "educational experiences" by global firms and parents of young children. Parents consider Disney creations "wholesome entertainment." Japanese parents take their children into the magic world of learning inspired by Sesame Street. John Miclethwait, writing in the Economist, concludes that "entertainment has replaced its most potent rival for human emotion, religion, as the opium of the masses." There are no government agencies monitoring these advertisements and this traffic in culture.

In 1990, consumers in the world's industrial nations spent $232 billion on tourism. In the "developed world" traveling is the third-largest household expense after food and housing. Tourists from Europe and Japan are traveling in ever larger numbers. One result of this tourism is the degradation of the natural environment. Congestion has virtually decimated Yosemite National Park. Wildlife preserves in Amboseli National Park in Kenya have been torn up by safari vehicles and by elephants trying to get out of their way. Lake Como is polluted.

The combined assets of the top 300 firms make up a quarter of the productive assets of the world. In 1970, there were 7,000 global companies in the world, and more than half were based in the U.S. and Britain. By the l990s, there were 35,000 global companies. These big companies hold power to veto a range of crucial political decisions across the planet. Because these "intersecting webs" of economic activity go unmonitored, many scholars believe that this global market could produce subtle (virtually undetectable) forms of power through information networks.

The global problems in the production of goods, services, money, and culture are endless. In the past, national governments have monitored and regulated business competititon. Today there is no movement in the direction of establishing a federal government of nations. Between civil society and a world federation of nations lies a reformed United Nations. In this transition of an evolving global society, the issue is whether anything can be done about these mounting problems of business in a global economy.

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Transnationals & Corporate Codes
by Ritchie P. Lowry

Over the last several decades, the socially responsible investing and corporate social responsibility movements have undergone significant changes in both tactics and strategy. The earliest tactics involved confrontation with corporations over corporate practices that were seen as socially irresponsible. Investors used divestiture of a company's stock as a tactic, while socially concerned consumers used boycotts of a company's products or services.

Early examples included the 1985 Sullivan Principles for companies doing business in South Africa. If a company did not meet the standards set by the Principles, the stock would be divested from an individual's or institution's portfolio. Shortly thereafter, divestiture was expanded to include all U.S. companies doing business in apartheid South Africa. This tactic played a significant role in the collapse of that regime. An example of a world-wide consumer's boycott was INFACT's campaign against Nestle in the 1980s for selling infant formula in less developed nations. INFACT's current campaigns include the tobacco industry's marketing to young people and continuing efforts to promote breastfeeding rather than bottle feeding of infants.

In terms of strategy, the early divestiture and boycott movements focused upon fairly specific issues such as apartheid, infant formula, and animal rights. Codes and principles by which to measure corporate conduct were constructed and implemented by individuals and special interest groups with particular concerns. The Sullivan Principles were first suggested by The Reverand Leon Sullivan, who at that time was a Board member at General Motors. The Sierra Club and the Environmental Defense Fund focused upon environmental issues. The Nuclear Information and Resource Service concentrated upon the handling of toxic wastes.

By the 1990s, both tactics and strategy began to change, as reflected in the more recent principles and codes for corporate conduct. This was in response to the rapid appearance of transnational corporations -- companies with no identifiable national base and, therefore, no apparent responsibility to a specific constituency. The concerns of investors and consumers were becoming global in terms of social, political, and environmental issues. Therefore, the newer codes began to specifically identify a corporation's many constituencies (consumers, employees, community residents, the environment, suppliers, competitors, governments, shareholders) and drafted principles by which a corporation could respond to each of these constituencies in a just way on a global basis.

There was also a less confrontational character to the newer codes. Most were based upon the strategy of increasing the public's and the corporation's awareness about existing injustices and working with corporations to seek new and more just ways of conducting a global business. Some of the newer codes, like the Principles for Global Corporate Responsibility, sought the widest and most diverse representation possible in the drafting of the codes and active citizen participation in the refining and implementing of them. The following is a list of some of the more important principles and codes (with web site links where appropriate) that have been drafted and implemented in the last several decades and that illustrate these important changes:

  • 1977 - The Community Reinvestment Act (CRA); Federal Reserve (investment by financial institutions in local community development)

  • 1984 - A Code of Ethics on International Business for Christians, Muslims and Jews; interfaith consultations

  • 1984 &1986 - The McBride Principles; Irish National Caucus & Sean McBride (for companies doing business in North Ireland

  • 1985 - The Sullivan Principles; The Rev. Leon Sullivan (for companies doing business in apartheid South Africa)

  • 1986 - The Caux Principles; The Caux Round Table (international ethics code for businesses dealing with working for the common good and human dignity --- there is also a sight at Temple University.

  • 1989 - The Maquiladoras Standards of Conduct; Coalition for Justice in the Maquiladoras (for companies doing business in the Maquiladoras of Mexico)

  • 1989 - The Valdez/CERES Principles; Coalition for Environmentally Responsible Economies (corporate environmental practices)

  • 1993 - Code of Conduct for Businesses Operating in South Africa; South African Council of Churches (after apartheid code)

  • 1993 - Declaration Toward a Global Ethics; Parliament of World Religious (a code for global ecology and global politics)

  • 1995 - ISO 14000; International Organization of Standardization (an international standards for environmental management system)

  • 1995 - Kyosei: The Guide for a New World Order in Business; Ryuzburo Kaku, CEO, Canon Inc.

  • 1995 - Principles for Global Corporate Responsibility; Interfaith Center on Corporate Responsibility-ICCR (US), Ecumenical Committee for Corporate Responsibility-ECCR (UK), and Taskforce on the Churches and Corporate Responsibility-TCCR (Canada) (global codes of conduct)

  • 1995 - Sourcing Guidelines; Council on Economic Priorities (for companies to use for their contractors and suppliers dealing with issues such as child labor and safe working conditions)

  • 1996 - Corporate America's Role in Human Rights; Reputation Management (codes for companies doing business in countries like China)

  • 1996 - Viable Ethical Standards for Business: Building on the Common Ground; (Wharton-business-church-community meetings on business ethics)
  • There are also a number of companies that have their own codes, credos or social performance reports. For example, see: Ben & Jerry's Homemade, Canon, Ciba-Geigy, Johnson & Johnson, and The Home Depot.

    Most of these codes can also be found in the GOOD MONEY Home Page's 1997 Directory for Social Investors & Consumers.

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    Setting the Standards:
    An Apology for Corporate Responsibility

    by Sharon Brassey-Brierley

    The fast-paced technological revolution at the turn of the twenty-first century, gives humankind a unique opportunity to re-exam past codes of conduct to attain higher levels of human as well as technological consciousness. In the search for principles of corporate social responsibility, it is beneficial, to look back and remember why and where codes of conduct arose. A comparative look at where our values have come from will help us evaluate where we wish to go in our effort to enhance societal co-creation.

    William May in Dominating Spires of Business and Social Responsibility writes about the social role of business institutions in our society. May frames the societal dilemma by referring to Thornton Bradshaw, former president of Atlantic Richfield Company and Walter Wriston, Chairman of Citibank. May asks: "Is business a social entity -- a successful organization that must possess a moral sense -- as Bradshaw suggests, or is Wriston closer to the mark when he says there are no institutional values?" Tracing the development of two ideals noblesse oblige and "the righteous man," we expand May's framework by asking: Do corporations have obligations of social responsibility to citizens and the state/national/world societies and, if they do, why do they?

    The English Oxford Dictionary (1989) defines the feudal term noblesse oblige as the notion that the privilege of noble ancestry requires one to honorable behavior e.g., privilege entails social responsibility. Webster (1964) tells us noblesse oblige means people of high birth or status are constrained to behave nobly to others especially in providing charity for the poor. Webster defines righteous as acting in a just or upright manner and doing what is right or virtuous. A righteous person does what is morally right or justifiable by a righteous act. Employing Max Weber's sociology of ideas (who developed it? who believes it? and why?) we ask: Where does this concept "privilege entails social responsibility" originate and why? This paper examines the historical obligations of "righteous acts" (noblesse oblige) and the social duties of "the righteous man" from a moral religious and philosophical perspective.

    [NOTE: The following sections on ancient moral history were taken from The Encyclopedia of Religion and Ethics, edited by James Hastings (1981)]

    Each society has formed an ideal type of "the righteous man" through its religious or philosophical principles. In Assyro-Babylonian (c. 2,600 B.C.E.) the words for "righteousness" (kittu) and "justice" (mesaru) are interchangeable terms and imply "uprightness" or "to be straight, right." Both of these terms are common attributes of gods and men. In Babylonia an ancient inscription called Warnings to Kings against Injustice indicates that rulers were expected to be righteous and well-disposed towards their people. A ruler was not to "favor roguery" and if the ruler was just Ea, the god of wisdom, would give the ruler knowledge and understanding. If the ruler rejected justice, Samas, god/judge of heaven and earth, would set up a foreign law in the land with those who obeyed the law. Having a reputation for justice was important when an angry populace could overthrow a ruler any time. The ideals of righteousness, justice and law were bound up with the sacred worship of gods which also encouraged people to make the person of the king/queen sacred. Thus, the virtues of uprightness, integrity, love of the people and fair and benign conduct were important values of kingship.

    In Buddhist thought originating in India around 570 B.C.E. with Siddhartha Gautama, there is no connection to God in the sense of ontology or morals, nor is there a concept of salvation by good works. There is, however, a concept of righteousness as a law of the universe. In Buddhist teaching karma is the divine standard to which all should conform. The higher ideals of righteousness is practiced by the converted who seeks a better life in Truth which leads to a renouncement of earthy desires. The attainment of positive qualities such as friendliness, compassion, sympathy, and equanimity are valued. Buddhists believe detachment, the goal of aesthetic purity, invites wisdom and knowledge. The virtuous king (laity) who ruled "in righteousness" (dhammena) ruled according to the moral principles of right conduct. The blessings of a virtuous man included wealth, fame, self-confidence in any group, and death without bewilderment. The virtuous ruler was reborn in heaven.

    Confucianism in China is based on the secular teachings of master (K'ung Fu-tze ) philosopher, K'ung Ch'iu (c. 590 B.C.E.). Confucius had faith in man made for society. He did not write about man outside society. On the subject of Heaven (Confucius impersonal name for the Divine), remarked: "When you do not know about life, what can you know about death?" Confucius believed good and evil would be recompensed over time. If the actor was not affected by his conduct his descendants would be. Although he performed services to the spirits, Confucius believed in man as he is and the duties belonging to him in society. When asked what constituted wisdom he replied: "To give one's self earnestly to the duties due to men, while respecting spiritual beings keeping aloof from them, is wisdom." Confucius had faith in the goodness of human nature. His conservative philosophy included the 'golden rule' deduced from the study of man's mental constitution. This rule stated in the negative is: "What you do not like when done to yourself, do not do to others." A second valuable contribution to ethical and social science was Confucius' emphasis on the power of example, and its necessity for benevolence and righteousness for those in authority. He taught primarily that a bad man was not fit to rule.

    The Hindu expression of righteousness is the term rta found in the Rigveda from the Vedic tradition (c. 1400 B.C.E.). Rta refers to cosmic order and the order of moral law along with the concept of sacrifice. The gods are not only born out of rta, but they follow rta and are knowers and practitioners of rta. Varuna, the great guardian of morality, moves about discerning the truth and the unrighteousness of humankind. When the goddess, Yami, tried to persuade her brother Yama to commit incest to propagate the human race, he replied that incest would lead them into unrighteous action because the current view was held incest was evil. Therefore, righteousness was associated with general opinion in harmony with its companion truth (satya). General opinion demands the virtues of consideration in domestic relations, political loyalty, truth in friendship, abstention from crimes such as theft and murder, and from women faithfulness in wedded life. In the ancient Hindu hymns more stress is laid on the merits of liberality than on manly virtues such as courage in war. In the Grhya- and Dharma-sutras, manuals of civil and religious life, the complex rights and duties of the priest, ruler, warriors, peasants and serfs are given. These rules stress the normal laws of morality---truth, abstention from injury (personal or property), charity, hospitality, courage, and devotion to duty. Those who disregard them are threatened with pain and penalties in future lives. In the Upanishads, Prajapati, the voice of thunder, demands self-restraint, charity, and mercy from the faithful.

    In the Hebraic tradition, righteousness is connected with the Arabic sidk "truth", "sincerity", "firmness" and signifies what is true, right, and fit for end needs. The righteous man in society is one who adheres loyally to the moral and religious customs of his people. Abraham's righteousness consists of his unswerving regard for Hashem (god) and God's commands. Lavish generosity toward one's relatives and hospitality to passing strangers are the most sacred obligations of the righteous tribesman. Judges were appointed when social life became complex. These judges were able men who feared god, loved truth, and despised unjust gain. These judges determined the rightful customs for changing times. The righteous man was the successful litigant or one who enjoyed a right standing before God.

    The prophet Amos called for a living embodiment of social ethics. His imperative for justice incorporated values of business honesty e.g. standard wages and prices and impartial justice in the law-courts. The prophet Hosea reminded the people of Israel that God had betrothed Israel in "righteousness, justice, love and compassion" and the same spirit was expected in return towards each other. Isaiah's call to holiness blended justice with mercy. Isaiah declared the city of righteousness as where kings and princes praise justice as the ideal of government, and people live in mutual confidence and security. Micah sums up the prophets imperative with the three-pronged principle 1) do justice; 2) delight in love, and 3) walk humbly with God. For Jeremiah and the other prophets the practical aspects of the just man was one who did just acts and sought truth. These acts include: using good judgement with one's neighbor, not oppressing strangers, the fatherless, and the widow, and not shedding innocent blood. The just man speaks the truth, walks with God in honesty and integrity and turns away from iniquity. Ezekiel's pragmatic view saw the righteous person as one who restored to the debtor his pledge, harmed none by violence, shared his bread with the hungry, clothed the naked, did not condone usury or profit by increase, took his hand from iniquity, executed true judgment between persons, and kept God's judgements.

    Egyptian righteousness, truth and justice is found in only one word me'ek, for the goddess of that name and her females priestesses. From an ancient Hieroglyphic Text on an Egyptian Stelae comes the claim of righteousness made by Egyptians of all classes:

    "I came forth from my city, I came down into my home and I spake the truth therein. I did righteousness therein...I am one who loves good and hates evil...There is no iniquity that has issued from my mouth, there is no evil that my hands have wrought. I was a righteous man upon earth. Never did I any evil thing unto any people. I am a noble pleased with righteousness, conforming to the laws of the Hall of the Two Rights." (Hastings)

    The Egyptians had powerful incentives to live righteous lives motived by the fear of judgement after death since happiness was reserved for those who had pleased the gods. Other motives included rewards or punishments during life. Re, the sun god, issued proclamations of righteous living such as right speaking and doing right, because of their greatness, might, and endurance. In Egyptian thought, the reward finds the doer and brings him/her honor. The hierarchial rewards of this system included: (1) the desire to stand well with the Pharaoh; (2) the desire to stand well with the community; and (3) the desire to abide by one's conscience.

    In Greek thought, Aristotle (384-322 B.C.E.) separated the term justice from the more encompassing term righteousness (a synonym for all virtue). A cardinal virtue of definable equality or proportion justice (concerning respect of rights) is ascertainable. According to Aristotle, justice is not limited by "equity", or renounced by generosity, nor is it equalized in the interests of a social ideal. Plato (427-347 B.C.E.), on the other hand, sees justice in a "social" sense. Anticipating the Aristotelian legal formulas of his pupil, Plato tested his broader concept of social justice in terms of "Be this" rather than "Do this." Plato also emphasizes equality of service in the voluntary acceptance of natural inequalities, not the equalization of rights and rewards. In Plato's Laws and Republic, one finds subjective justice of righteousness as the harmony, unity, and right functioning of the division of labor in all 'parts' of the soul. Plato, the writers of the Bible and Cicero held in common the problem of the ultimate 'sanction' of righteousness or justice.

    The Roman concept of righteousness taken from the Greeks, especially the Stoics, taught justice is a cardinal and "social" virtue of due distribution. It is not the accuser nor the defendant, but the judge to whom justice is germane. Among subordinate attributes of distributive justice are kindliness (equity), democratic sociability, and square dealing. Later, Roman literature combined the Stoics wisdom with the Platonic and Roman justice forming an "ideal of righteousness." The perfectly just man served humanity, was not terrified by the tyrant or mob, and had an incorruptible soul.

    Righteousness taught by Christ included the legalistic 'right conduct' of the Pharisees, but added a deeper component. 'Right conduct' was preceded by a 'right condition of the heart' brought about by a 'right understanding' of the spiritual tenor of the Law. This right conduct included obedience to the law (Judaic), almsgiving, prayer, repentance and fasting which were all obligatory, but they were to be practiced in a different spirit than the Pharisaic version. Jesus admonished his followers not to do their righteousness before men. This command stressed the importance of humility and avoiding publicity for doing one's moral obligation to each other and God. Even through Christ purges the concept of righteousness, he does not vanquish the Hebraic concept of reward for right living.

    The Apostle Paul adds a dimension to righteousness called "faith" in which his whole being was permanently absorbed in Christ who died. Paul's faith includes entering into the mind of Christ with relation to sin and accepting the divine sentence on sin as it relates to conscience. In Christian theology righteousness stands for a virtue that implies conformity to the requirements of 'divine or moral law.' One aspect in English deals with 'justice' which belongs to the realm of law. In its wider sense, justice is a synonym for 'righteousness' as it appears in the English Bible. Aristotle clarifies the distinction. In the narrower concept of the law, Aristotle regards the highest virtue as the 'virtue towards another' (justica civilas). This principle, which regulates the relationships between men, the community, the State, is 'distributive' and 'corrective.' In jurisprudence it is translated 'to give to each his own' (suum cuique tribuere). A similar sense is found in Christian theology when man's relationship to God and the moral order comes into question. After the glow of Christian spirituality faded, the popular versions of Cicero and the Stoics formed the basis of Christian moral development.

    Cicero says of justice:

    "Although justice embraces all the virtues together, yet there are two, the chief of all, which cannot be torn asunder and separated from it -- piety and equity... But piety and equity are, as it were, its veins: for in these two fountains the whole of justice is contained; but its source and origin is in the first, as its force and method in the second. To injure no one, to oppress no one, not to close his door against a stranger, nor his ear against a suppliant, but to be bountiful, beneficent, and liberal. This truly is justice..." (Hastings)

    Aquinas adds to Aristotle's moral and intellectual virtues the three theological virtues of faith, hope and love. The dividing line between Catholic and Protestant righteousness was the theological dilemma posed by St. Paul: When righteousness is reduced to its essential elements how is man accepted and justified before God? The Catholic answer said that man is justified in virtue of a righteous disposition produced in his heart through prevenient grace. The Protestants claimed that justification is grounded only in the righteousness of Christ imputed to faith which is not gained by merit. After the harsher Reformation concept of imputation, Christian theory, modeled after Scheiermacher in the 19th century, has come to follow the lines of living faith and experience. Christianity seeks not only forgiveness and reconciliation, but a righteous character and life.

    In Muslim thought, the concept of righteousness (i.e., faithfulness to one's pledge, loftiness of character, and sincerity towards oneself and others) although widespread in Oriental traditions, is merged with the concept of justice. Justice, in this tradition has a two paths. One path upholds the idea of the tempering of feelings and passions and the other path relates to a political philosophy found in social justice.

    Rosenthal and Richmond in People, Politics and Community in the Later Middle Ages point out that religious activities increased in European households, especially among the aristocracy in the 14th and 15th centuries. This rise in the personalization of Christianity is attributed to the fear of death during the plague years. Pietistic practice (i.e., private family chapels with compulsory daily attendance) was synonymous with good lordship. Acts of charity were considered a social duty (noblesse oblige) of the aristocracy with almsgiving benefitting certain groups (friars). In Noblesse Oblige, Kathleen McCarthy argues that in a country devoid of aristocracy, noblesse oblige is transformed into richesse oblige, the duty of the rich to give back something to the society which has enriched them. She suggests a second urban interpretation involves the notion of "civic stewardship" where it is the duty of successful citizens to give both time and money back to their respective communities. McCarthy notes that by the 1929 in the U.S. most wealthy citizens were happy to "buy out of civil responsibility, signing checks while lavishing the fruits of their leisure upon themselves."

    As this article has shown. the ideals of moral and ethical responsibility have traditionally been maintained by leading institutions -- the polis, kingship, and state -- and have been fueled by religious convictions. Berle and Means might suggest that the apathy encountered by McCarthy stems from "the divorce of ownership from the control of the modern corporation." First published in 1932, The Modern Corporation and Private Property by Berle and Means correctly predicted that "the corporation as an institution may become not only an equal to the state, but even supersede it as the dominant social organization."

    Several conclusions emerge from this examination. Manifestation of past codes of conduct have been derived from: (1) mythic representation [gods to humans]; (2) tradition [customs passed on by elders]; (3) wisdom; (4) covenantal agreements with God; (5) jurisprudence [e.g., distribution, correction, equity and equality]; (6) conscience; (7) edicts from political hierarchies; and (8) general opinion. Historically each of the systems is cybernetically looped and most contain tautological reasoning (e.g., a covenantal agreement with God involves codes being set up to satisfy the covenant, with acts of conscience conforming to the religious codes and political hierarchies enforcing the codes and developing new codes based on the covenant). These systems exhibit an a priori assumption that there is a universal force to which one is answerable. Controls for these systems include: (1) belief in an afterlife [either eternal or reincarnational]; (2) belief in consanguineous condemnation [saving face]; or (3) compliance with the system [e.g., feudal, polis, democratic].

    One of the problems confronting ethicists today is who to hold responsible and how. The princes of corporations, the executives and managers, are not directly obligated to passive property holders. They are free to use profits, labor, and the community's natural resources to maximize economic returns, regardless of the human and social costs that are entailed. Who, then, is the "righteous person" today and what controls, if any, does society have to prick the conscience of the "lords of industry"?

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    Health Maintenance Organizations
    And The Deprofessionalization of Medicine

    by Aimee Marlow

    Physicians are losing power and authority as a result of the new corporate structure of medicine, particularly with the spread of for-profit Health Maintenance Organizations (HMOs). We are witnessing a process of deprofessionalization. In some cases physicians are no longer in charge of the most basic of things, such as what they say to patients and what tests they can or cannot administer. Those who downplay the importance of this process fail to recognize that "the fate of patients is tied to the fate of doctors," as Eliot Freidson has put it. In other words, the deprofessionalization trend in medicine is not just an issue for physicians, but for anyone who uses physicians.

    Sociologists have identified the major changes in characteristics an occupation goes through as it becomes professionalized. Of particular importance to this paper are three:

    The link between integrity, service and appreciation for knowledge is quite evident. This places a great amount of responsibility on the people within the occupation to uphold its professional status. The reward for doing this successfully is great as the profession gains the right "[of] freedom, not only to do his work according to his own best judgment...but also to choose his own style of work and economy of effort," as Everett C. Hughes has observed. This model reflects what medicine should be and what most Americans expect it to be: an altruistic profession, dedicated to integrity, and autonomous but with a strong sense of ethical responsibility. Commitment to serving society can be seen in organizations like Physicians for Social Responsibility.

    The role and use of professional knowledge and theory is particularly important. Traditionally physicians relied on their interpretive knowledge as the one thing that separated them from other professions, securing them a distinctive, coveted place in society as healers. Medical knowledge in a very basic sense serves to separate patient from physician. It acts as a touchstone, giving all a sense of the role the patient and the physician should play. We trust physicians with our health, one of the most valued things in American society, and this role has strong moral and social functions. Everett Hughes notes that in general professions "also claim a broad legal, moral and intellectual mandate." He adds:

    "Not only do the practitioners, by virtue of gaining admission to the charmed circle of the profession, individually exercise a license to do things that others do, but collectively they presume to tell society what is good and right for it in a broad and crucial aspect of life."

    Physicians started to gain authority in the late 19th and early 20th centuries, but prior to this, they encountered a myriad of obstacles. They lacked a scientifically grounded body of knowledge and a sense of unity. Aggravating the issue even more was the traditional view of illness that dominated the society. Paul Starr explains:

    "Many Americans who already had a rationalist, activist orientation to disease refused to accept physicians as authoritative. They believed that common sense and native intelligence could deal as effectively with most problems of health and illness."

    Over time advances were made in diagnostic technology. By the 1880's, the organisms responsible for tuberculosis, cholera, typhoid and diphtheria had been isolated, and, by the 1890's, laboratory tests couldo detect them. however, other obstacles remained. Physicians lacked a strong collective organization to represent them. Even more troublesome was the profession's lack of a defined track for education. Such ambiguities left plenty of room for other alternative forms of medicine like homeopathy and eclectic medicine to enter the market. The birth of the American Medical Association (AMA) in 1847 attempted to give physicians organizational foundation, but more importantly, the AMA sought to standardize medical education thereby eliminating alternative medicine. The AMA set up a Council on Medical Education in 1904, which set standards for medical education including lengthening the amount of college needed to be a physician and requiring that all physicians pass state licensing examinations before being free to practice.

    Standardization of medical education had other benefits as well, for it brought physicians to a point where they could truly define what it meant to be a physician. Lines of distinction were drawn between physicians and other health care professionals. The profession simply deligated certain duties, such as taking blood pressure or filing forms, to other workers. If anything this acted to separate physicians even more, and menial, time-consuming tasks were no longer in their repertoire of responsibilities. Physicians ascended into the professional ranks, but maintaining this position at first was not easy. For decades, the public still doubted the motives that propelled physicians, particularly in the post World War II era. The profession climbed to an unimagined level of prosperity, resources and wealth. The boom in the medical profession presented physicians with previously unforeseen opportunities to make money, and many did, thus adding the role of businessman to the physician's job characteristics. Investment opportunities presented themselves in many forms, particularly the ones offered by the pharmaceutical industry. By the mid-1950's this industry was worth $4.5 billion, and physicians investing in it argued that this was reasonable since doctors knew something about the drugs they prescribed.

    But the public was not satisfied with this explanation. Many people voiced complete disdain over the issue of physicians turning into businesspeople, uncomfortable and threatened by the idea that physicians could be influenced by money, especially from drug companies that wanted physicians to use their products instead of other, possibly more appropriate treatments that existed. Recognizing the problem of losing the public's trust, the AMA denounced any physician involvement with pharmaceutical companies that offered the potential for profit, and in an effort to further clean up a tarnished image, AMA delegate Dr. Edwin B. Dunphy stated in June of 1952:

    "The medical profession is not a luxury business but a profession dedicated to rendering service to humanity. Reward or financial gain is a subordinate consideration. Physicians should never lose sight of this principle. If they do, the medical profession will certainly be government regulated eventually and with public approval."

    One would think that such bad publicity and the poor public approval over this episode would have deterred physicians from involving themselves in business ventures, yet as history tells us, it didn't. Corporate medicine found for the most part willing participants in physicians. Little did Dunphy known what the future would hold for medicine and its business alliances. The managed healthcare concept first became popular in the early 1980's. Most HMO's maintained a non-profit status until 1987. Their main purpose was based upon ideas of utilitarianism and rationalization: give as many people as possible quality healthcare with the least amount of expense. By 1987, there were 650 HMO's with about 29 million members. Early non-profit HMO's and encouraged efficient coordinate care, including preventive services, in long-term personal relationships between patients and primary care providers.

    What is happening today was predicted by physicians and sociologists over 10 years ago. The coming of the corporation into medicine was a fear in some minds, and the most compelling predictions came from Paul Starr and Eliot Freidson (both considered experts in the medical sociology field) and the Journal of the American Medical Association's (JAMA) editor in 1985. In the final chapter of The Social Transformation of American Medicine, Starr painted a dreary picture for the future of American medicine. He spoke of a time when the corporation, or "private sector" would step in and "rationalize" medical services, taking over where public institutions and regulations fail. As corporations take over medicine, new challenges to physician autonomy and prestige would be inevitable, and in an extreme case, "doctors will no longer have as much power over such basic issues as when they retire." One of the backlashes of this corporate takeover also brings to light another key issue for Starr in the shape of boundaries"

    "Another key issue will be the boundary between medical and business decisions; when both medical and economic considerations are relevant, which will prevail and who will decide? ...A regime of medical austerity will test the limits of professional autonomy in the corporate world."

    Also related to this issue according to Starr was the "different techniques for modifying the behavior of physicians, getting them to accept the management's outlook." Physicians will be "socialized" not just as physicians, but also corporate spokesmen, "[learning] to do things the way the plan or the company has them done." But the most chilling words of Starr's vision of the future seemed to be the most prophetic. He believed that the medical profession's and the public's complete inability to control the situation was a perfect invitation for corporations to turn medicine into a for-profit industry. "Instead of public financing for prepaid plans," he wrote, "there will be corporate financing for private plans...whose interests will be determined by the rate of return on investments."

    Freidson also feared what the future of medicine would be. He, too recognized the coming of the corporation as the biggest threat to the profession and even more specifically turned attention to the detrimental role of incentives that cut costs in health care. Freidson asserted that "considerably less emphasis on economic incentives would greatly improve the spirit in which practitioners approach their work." More idealistic than Starr, he believed that a "greater emphasis on professional values" would be the only thing that repairs the ailing reputation of physicians in America. Freidson predicted the medical community would face a "critical choice" that would determine the future:

    "We can passively accept a health care system that, in the interest of cost containment, slowly moves toward mechanizing and bureaucratizing services. Or we can actively choose to struggle for a system that...[is] designed to do everything it can to improve the unique lots of all those who need help.

    The first choice will see "physicians and health care workers [following] elaborate rules of procedure" and "patients [as] standardized objects" while the second focuses on "truly human health services." Freidson concludes that within a mechanized health care system physicians "will have lost the opportunity to do autonomous, challenging and creative work" and patients will "lose the opportunity to regain...their fullБВГДЕИю€€€ю€€€ЙКЛМНОПРСТУФю€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€ potential." Industrializing medicine will bankrupt the profession of any morality. Physicians and patients in this scenario both pay.

    In an editorial in 1985, the editor of JAMA lashed out at his own profession, focusing on how "we, the aggregate medical profession, are in big trouble with the public at large." The problems surround the issue of trust, but not technical or personal trust. Rather, he argued that the real issue was that patients do not trust physicians economically or morally:

    "Never in modern history has the medical profession been weaker... To a great extent, physicians are becoming seen as highly successful businessmen, who are functioning with the business ethic rather than the professional ethic...We are viewed by many as a restrictive cartel."

    Lundberg substantiated his argument by citing longitudinal data that reflected a severe decline in patient trust in physicians, specifically in the area of money. "In 1982, 42% of the public queried expressed the opinion that physician fees were reasonable. This declined 15 points to 27% in 1984, a shocking change." Lundberg implored all physicians to be aware of each person's "financial circumstances" and adjust payments to needs when necessary. He emphasized the need for physicians to take a "leadership position" in cost management and containment, and to be "intolerant of devious cost shifting and of questionable creative accounting."

    Lundberg's conclusions provided room for hope, positive change and the possibility of a brighter future, but all of it is contingent on physicians "[getting back to] caring for the public", choosing altruism over greed, and taking a stand against unethical practices. Physicians thus far have failed to rise to the occasion. Why is it so important for physicians to rise to the occasion? From a professional point of view, rising to the occasion means no more than successfully adhering to the Hippocratic Oath, which asserts:

    "...that physicians have duties to (1) be loyal to patients; (2) act in their patients' interests; and (3) make their patients their first consideration, even when their own financial well-being is opposed...."

    The present-day changes taking place in American medicine are clearly leading to a loss of authority by physicians and a resulting deprofessionalization. Relative to the three characteristics of professions mentioned above, for-profit HMO's rob physicians of their ability (1) to be "altruistic servants" to their clients and society, (2) have their work and competence judged only by other physicians, and (3) direct their practice based upon their own body of specialized knowledge free of any other considerations.

    For-profit HMO's take away the altruistic characteristic by introducing financial incentives for physicians to reduce services. Financial incentives come in various forms. In their most blatant form, these incentives lure physicians away from using certain expensive diagnostic tests. In another form, HMO's significantly reduce hospitalization, often forcing patients out the door after major surgery. A large proportion of a physician's salary may be contingent on these incentive.

    Physicians have long enjoyed the ability to oversee their profession's educational standards, ethical codes, and also the opportunity to rate each other's performance. Physicians working within the for-profit HMO structure find themselves in a position where the quality of their work is not based upon their ability to be a good physician, providing excellent care and developing trust with patients, but rather their ability to cut costs, and add to corporate returns. The for-profit HMO denies physicians the chance foster relationships with not only patients, but also other physicians. The new wave of corporate medicine includes a kind of stringing together of physicians, all working in different practice locations, but for the same corporation. Thus, some for-profit HMO's are not made of a core of dedicated staff but rather networks and private practitioners linked by part-time contracts".

    The manipulation of medical knowledge is the most solid, telling indicator of the deprofessionalization of medicine, exemplified by the use of "gag-clauses" by managed care corporations. These clauses censor what physicians can and cannot say to patients, and anyone who does defy these "gag-clauses" generally faces dismissal. An example is a clause from a contract US Healthcare has with one HMO:

    "Physicians shall agree not to take any action or make any communication which undermines or could undermine the confidence of enrollees, potential enrollees, their employers, their unions or the public in US Healthcare or the quality of US Healthcare coverage... Physicians shall keep the Proprietary Information [payment rates, utilization-review procedures, etc.] and this Agreement strictly confidential." (quoted from Woolhandler and Himmelstein, "The New Corporate Proposition for Physicians," New England Journal of Medicine)

    The AMA could play a key role in the healthcare crisis that has developed as a result of the rise of HMOs and the deprofessionalization of medicine. Actions could include the following:

    It is only through such long-term physician-patient-public partnerships that the problems will be resolved.


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