Medical ethics.

The topic of medical ethics is as old as our profession, and yet as new as tomorrow. We will look at three concerns, viz. our relation to our patients, our relation to our colleagues, and our relation to ourselves. Parts are referenced and others are not, the source having been lost to me. Little if any is original, although much, I trust, is applicable. This is not a scientific study, and it is not intended as a sermon. It contains no data, soft or hard, just concerns, human and difficult. This reflects solely the opinions of the author. It raises questions from outside us, and calls for answers from within us.     

Medical ethics and human rights

Allegations of physician involvement in torture of detainees in Chile are reported. In addition, Amnesty International's condemnation of medical participation in executions is cited in relation to the role of American physicians in capital punishment by lethal injection.     

Medical ethics in a multicultural context

Abstract. One contemporary challenge for medical ethics is to formulate an approach to ethics that will enable us to adapt to a multicultural or pluralistic setting. This challenge has had to be met in New Zealand where there is an explicit biculturalism at the heart of social policy. The two cultures involved are very different but, when examined closely, it can be seen that they have significant moral intuitions in common. Some common threads include the unique value of the parent–child bond, the principle of respect for the individual, and the idea of belonging. I note a number of specific examples where similar intuitions are expressed in different ways. I then suggest that it is in the common and shared experiences of development as a human being that we are more likely to find common ethical intuitions rather than in attempts to agree on abstract rules. This suggests an ethic based in narrative and imaginative sensitivity to the situation of another person. Such an approach to ethics needs to attend both to the meanings and symbols of another culture but also to their history when it has involved significant dealings between cultures.     

Medical ethics – new horizons

Abstract. The medical ethics of Hippocrates are no longer sufficient in a society with changing social attitudes and, especially, rapidly developing medical technologies. This Minisymposium is the third in a series of three, dealing with Medical Journals (J Intern Med 1992; 231 : 99–102) and their central role in the distribution of new medical knowledge, bringing them into close contact with Scientific misconduct in medical research (J Intern Med 1994; 235 : 103–35) and Medical ethics (this Minisymposium). The contents of the three Minisymposia are of importance not only to those dealing with medical journals but to all physicians – regardless of whether they are involved in research or in patient care – and to all others involved in health care. The Minisymposium gives a brief history of the development of research ethics, widens the scope of medical ethics and discusses its transcultural aspects. From a more practical standpoint the two last articles deal with the problem of who makes the decisions for whom, and when to stop treatment – both with relevance to one of the most important problems of medicine today: prioritization. The reader should note the difference between ‘medical ethics’, which is the wider concept, and ‘research ethics’, which deal specifically with the relation between the researcher and her/his patient or volunteer.     

Medical ethics in the 21st century

OBJECTIVES: To foresee how medical ethics may develop in the 21st century. DESIGN: We have looked into our crystal ball to see what factors are likely to drive medical ethics over the next few decades. We have given examples of how such factors might affect specific issues. RESULTS: Those factors that we identified as likely to shape the future of medical ethics are: Globalization: Medical ethics is likely to have to grapple increasingly with ethical issues arising from the huge discrepancies in the level of health care available in different countries. Increase in longevity: We predict that there will be, at least amongst the richer nations, a significant increase in life expectancy. This will result in issues of resource allocation becoming increasingly problematic within medicine. Child enhancement: Developments in genetics combined with control of reproduction will make it possible to select our children for a broad range of characteristics. There are optimistic and pessimistic predictions as to how such power will be used. In either case, this area will be an important focus of concern in medical ethics. The biological determination of behaviour: Genetic research will lead to an increasing sense that undesirable behaviour is genetically determined. This will lead to a re-examination of such concepts as criminal responsibility. Therapeutic research and clinical practice: We predict that an increasing amount of clinical practice will be within the setting of clinical trials. The ethics of therapeutic research and clinical practice will need to be brought within a coherent framework.     

Medical ethics: a rational approach to patient management

Physicians make their decisions based upon scientific evidence with their first consideration being the Hippocratic axiom 'not to do harm'. In practice, a number of non-medical issues influence this process and generate conflicting judgments. We analyze these issues that form the context of medical ethics which is perceived as a subject wider than morality. It is also a religious, social, political, economic, legal and cultural issue. Therefore, the patient, physician and other professionals play important roles in the decision-making. The final decision is not a decision based on medical textbooks, but is rational in that it is based on reason for the benefit of the individual.