To even begin to answer this question, we need to establish a few principles: key things to remember when we debate whether the professions even have a future.
Firstly, what we are talking about here when we talk about ‘the professions’ is the future for a particular social class: an ‘enabling’ class of people, and a relatively recent historical invention. They are neither the only nor necessarily the best solution for social problems like illness and disability. They are simply one — albeit unprecedented — contingent response among many.
Secondly, the vast majority of the literature now makes it clear that the only people now really advocating for the professions are the professions themselves. What this means, though, is that as long as professions like medicine and nursing continue to hold enormous power and prestige, it will appear that the professions have an important part to play in the future of social organisation. But what we now know from late capitalism, the unbundling of goodness and expertise, and the automation and rapid digital transformation of human affairs, is that the Doomsday clock for healthcare and education is already sitting at 11:55 pm and ticking, ticking, ticking.
And so, even though it seems hard to conceive of a time when we won’t have professionals like physiotherapists, podiatrists, audiologists, and even doctors and nurses running our healthcare system, there is an increasing argument to be made that if those of us within the profession genuinely care about the future of health, it is our ethical duty to think about a future in which healthcare is a) not delivered by the current cadre of elite professionals, and b) does not return to a pre-modern world in which healthcare is a luxury for those who can afford it or mere charity for those who cannot.
Thinking about a post-professional future in this way will not be easy though, and it’s likely that the greatest resistance to change will come from the professions themselves. So, is there a process that can be generative for the public and the professions? I think there is.
To begin with, the established professions will need to put in place ‘transition arrangements’ that transfer power and knowledge to communities of need. These arrangements uncouple each profession from its established allies — including The State — and actively work to redesign legislation; nurture trust and capability; share a century or more of wisdom, knowledge and resources; and relentlessly build capacity.
In many ways, this is a post-colonial project, because the establishment of the professions bears many similarities to other historic acts of enclosure. So, the transition arrangements mentioned above are effectively designed to “give the land back to the people.” But those people who have been through the traumas of post-colonial succession will know all too well that the actions of the colonial powers in leaving their occupied territories can make all the difference to the way resources are returned to their rightful owners. And the transfer of health back to the community will depend very much on how begrudgingly, or otherwise, the orthodox professions give up their power.
Is this not, then, an entirely counter-intuitive step for the professions to take? After all, why would turkeys vote for Christmas?
The answer to this may lie in a parallel process that needs to be followed within the professions themselves.
Alongside these ‘outward facing’ transition arrangements, there will need to be internal arrangements made which might make all the difference to the success of the project. These internal arrangements have to do with the way that professionals are coached to entirely rethink their professional purpose. Instead of valorising the preservation of their distinctive professional identity, autonomy and sovereign authority, health professionals will need to understand that their knowledge and skills will continue to play an important role in future health care despite the demise of their professional class. People’s predisposition to care, to want to heal, and to act therapeutically, is as ancient as their urge to domination, conflict, and destruction. And so, just as the negative traits of humankind are unlikely to dissipate in post-modern life, so is its caring. What this means is that those things that endure and remain after the instrumental and reductive aspects of healthcare practice our hollowed out, will play a key role in future healthcare.
There are ‘intensities’ at the heart of healthcare that have been captured and exploited by the orthodox health professions over the last century. But these have been somewhat obscured by layers of standardisation, technique, reason, formalisation, and instrumental objectivity. And so the ‘essences’ of these various practices are now very hard to see. But they are there nonetheless.
This is why there is now a close tie in between post-professionalism and some of the recent work on posthumanism, because a lot of this work has been directed to the study of the essential vitality of ‘things’ – be they non-human objects, metaphysical processes, social constructs, or human feelings. If there is something lying ‘beneath’ professionalised healthcare that can be mobilised in a future in which the controlling, elite professions no longer carry the same weight — whilst, at the same time, resisting the nihilistic logic of neoliberalism and the totalising spirit of the Welfare State — then, perhaps it’s possible to see why posthumanism is becoming increasingly interesting to those people working in healthcare, and why a post-professional future might be the best thing to happen to healthcare since the first Being went back to the primordial swamp for a hot bath.
Five years ago I went to an audiologist an d got a bargain, a $9,000 set of hearing aids for $6,000. I thought. But I am a musician of sorts, and I discovered that the device is useless with live music, excruciating sitting beside a violin and awful playing a harp, where the strings are close to the ear. Every year I had a follow-up appointment, I complained, the software was adjusted, to no avail. eventually I did my own research and discovered: a) the issue for musicians is well known; b) cheaper hearing aids work better for musicians; c) there is a cheaper brand than is well known to suit musicians. I concluded that the audiology profession was not interested in my health, they has another porpose, and: a) audiology companies will not tell you you need a cheaper hearing aid, and; b) they will sell you what is in vogue, or what they have a franchise for. I am now in a post-professional relationship to audiology, and I love having a name for that.