Public and institutional aspects of professional responsibility in medicine and psychiatry

The article develops fresh perspectives on the normative practice model (npm) by extending its application to meso- and macrocontexts. Health care-related interactions, negotiations, and activities in these contexts have their own internal structure. One of the origins of the crisis in medical professionalism is the disregard for norms that shape health care conditions: efficiency standards, rules for policy making, quality measures, and principles of distributive justice. Disconnecting the professional from the moral purposes of health care was another source of the crisis. Doctors are not engineers; technocratic and scientistic views on professionalism detract from the vocation of the physician, which is to heal, to diminish suffering, and to console. The npm does not offer a blueprint - rather, it serves as a heuristic device that helps professionals and administrators to orient themselves both conceptually and normatively. Differences between contexts lead to different constellations of normative principles and to different descriptions of core responsibilities of stakeholders.