Has the ethical climate of American society undergone a significant decline over the past twenty years, a decline affecting every important area of life, including the professions? David Beam argues that it has, linking the decline principally to the widespread economic anxiety and insecurity that began in the 1970s, as the post-World War II boom ended, and still continues. Throughout American society, economic anxiety and insecurity are expressed, according to Beam, in an excessive preoccupation with economics that crowds out serious attention to any other considerations, even ethics.

A Different Interpretation
Major changes in the American and world economies over the past two decades certainly have had a significant impact upon ethical issues related to many important areas of life. But I would describe that impact differently than Beam does. Since the end of the affluent 1960s, individuals and institutions have had to make many difficult choices concerning the allocation of scarce resources. Many people strongly disapprove of some of these choices. Yet even they need not conclude that the choices themselves are part of an overall decline in ethics. The choices might instead, in the main, express an ethical response to the economic side of important, but extremely complex and difficult, issues, a response allowing much room for intense but reasonable dis- agreement in good faith.

Beam points to developments over the past two decades affecting professions such as medicine, law, journalism, and public administration to illustrate the excessive subordination of ethics to economics that he regards as endemic in American society. While such subordination has sometimes occurred, at least as often what occurred was, I believe, something ethically more complex, a difficult balancing of ethically appropriate considerations.

Psychotherapists
Here is an example of what I have in mind: Recently, the New York Times reported that managed-care companies now routinely require psychotherapists to submit treatment plans, diagnoses, descriptions of symptoms, and even therapists' notes for review. One company, the Times reported, even told an affiliate, a small psychotherapy group, to include a company representative in sessions where the group's members discuss cases.

Such developments diverge sharply from the strict norms of confidentiality traditional in psychotherapy. (The Times quoted one psychotherapist's bitter protest: "Managed care is like having a third person in the room.") There is another side to this story, however. Before managed care, psychother- apists rarely had to account to anyone for treatment recommendations. Therapy could continue many years without any effort to compare its effectiveness with less expensive alternatives.

To say that this Times story poses the dispiriting question of which is worse, managed care or psychotherapy as traditionally practiced, would be both cynical and misguided. What the story does is bring out the need for an accommo dation between two concerns of great ethical importance, confidentiality and accountability. In this case, the two concerns appear to pull in opposed directions. The advent of managed care did not, by itself, force this choice between confidentiality and accountability. What did that was a change in economic circumstances, the need for increased cost effective ness in the expenditure of social re sources for health care. Deciding, after full deliberation in good faith, that cost and effectiveness are impor tant enough to outweigh some con cerns about confidentiality cannot be equated with blatant, callous, or heed less pursuit of economic profit what ever the ethical loss.

CSEP's Role
Widespread economic anxiety and insecurity can adversely affect the ethical climate, leading people to make disastrously wrong ethical choices with full awareness of doing so, for example, stealing or embezzling. But Beam's concern is another kind of adverse effect, a preoccupation with economics so intense and narrow that individuals fail to keep important ethical considerations in focus. This adverse effect, though real and significant, must be kept in perspective. Other factors besides economic pressure can make ethical considerations go out of focus. One of these, familiar to CSEP, is the process of value formation connected with education, work, and collegial interaction through which individuals acquire a professional identity. "Thinking like" a lawyer, doctor, engineer, or college professor tends to keep certain aspects of situations in sharp focus--—those amenable to analysis in terms of one's professional expertise—while allowing others to go out of focus, ethical considerations among them.

Over the past two decades, the principal purpose of most CSEP activities has been to help keep important ethical issues in focus for students, educators, and practitioners in engineering, the sciences, and other professions. Those activities have proceeded on two key assumptions. First, insufficient attention to ethical issues in the professions more often stems from loss of focus on such issues than from any deeper lack of ethical concern. That is to say, most people are fundamentally decent. Second, helping to keep a reasonable focus on ethics in the professions is not a matter of "pointing the way," that is, of telling people the ethically correct solution. It is, instead, a matter of getting the profession to think about the problems seriously and with an open mind. Issues of ethics in a profession tend to be complex, multifaceted, and subject to more than one reasonable interpretation.

Despite the economic stringency, there is, I believe, as much basic good will as ever in American society, and more openness about ethical issues than twenty years ago.