Is case management a true profession?
By Mark E. Meaney, PhD
Health Care Ethicist
Center for Ethics in Health Care
St. Joseph’s Health System, Atlanta
Many case managers think of themselves as members of an evolving profession. You probably refer to yourself as a professional. And a brief consideration of several characteristics seems to support that claim. For example, case managers have established their own standards and accreditation process and regulate entry to the field. In addition, in exchange for this level of professional autonomy, case managers perform a service.
However, another characteristic requires careful examination. It is a widely accepted view that the professions and professionals have special moral obligations. Those in the professions have a special relation to ethics because of the roles they occupy as members of a profession. More is appropriately expected of professionals because of their roles. When a group becomes a profession, that group acquires certain obligations. Furthermore, when a individual becomes a member of that profession, he or she likewise agrees to accept those special moral obligations.
Are case managers professionals? Is case management a profession? These simple questions illicit different responses depending on who you ask. Some argue that "profession" is an incorrect description of case managers and case management. Complete and proper answers to these questions require us to ask whether it is true that case management as a whole, as well as individual case managers, have special professional obligations.
Let’s begin with the supposition that case management is not a profession and case managers are not professionals. In this view, case management is no different from any other activity in the marketplace in which "customers" interact with "merchants." Case managers "sell a product," and their customers "purchase" it from them. We can call this the commercial view of case management.
No matter how you view the marketplace, there are still moral obligations that bind buyers and sellers. For instance, all participants in the marketplace have the moral obligation not to cheat, coerce, or defraud other participants. These rules of ethical conduct follow from the more general, morally binding marketplace principle of "do no harm." The principles and rules of the marketplace oblige participants to refrain from acting in ways that bring harm; they do not oblige participants to actually do anything.
The commercial view of case management would have it that a case manager’s expertise and skills are commodities. These commodities are then sold in the marketplace to the patient acting as a consumer. Since producer and consumer bargain and compete with one another over price, the case manager provides a service based not on the patient’s needs, but on whatever services the patient is willing to purchase. In addition, the case manager should provide only those services that give the greatest return for the least cost in terms of time and money. In short, the patient’s needs only play a secondary role. The contract and return are of prime importance. In this view, case managers owe their patients only to "do no harm."
The professional view of case management argues that it is a profession like other health care professions, and case managers are professionals. Accordingly, a case manager joins a group of people who have made a commitment to society, as in every other health profession. This commitment overrides the marketplace morality and entails certain special moral obligations. Consequently, case managers are obligated to go beyond the moral minimum of "do no harm." They have the positive obligation to pursue the patient’s well-being. Case management is not a commodity in this view, and patients are not consumers. Marketplace morality is simply insufficient.
Is case management a profession, and are case managers professionals? It depends on which view is the correct one, the commercial view or the professional one. With the formation of national professional associations and development of accreditation processes, it seems that case management is establishing itself as a profession.
Professionals are held to a higher degree of accountability for their actions than other players in the marketplace. Moreover, professional ethical development is a moral obligation of professional associations. Case managers must strive to accept the responsibilities that come with the title of "professional."
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