The ancient Jewish law took a strict approach to medical relationships between Jews and non-Jews. The current study deals with the attitude of Amatus Lusitanus (1511–1568), a notable Portuguese Jewish physician towards treating gentiles. The Physician’s Oath of Lusitanus emphasises that as a doctor he treated people from varied faiths and socio-economic status. Lusitanus treated many non-Jews. For instance, he received an invitation from the municipality of Ragusa to serve as the town physician and he accepted (...) this mission. In Anconare, he was called upon to treat Jacoba del Monte, sister of Pope Julius III, and he also prescribed for Julius himself. Amatus Lusitanus was forced to leave his country because of the Portuguese inquisition and wandered in many countries. Despite the hostile religious attitude of his close surroundings, he did not retaliate against his patients and provided medical treatment indiscriminately. (shrink)

A discussion of Christian ethics focuses on the physician's image as a parent, warrior against death, expert, and teacher, and the oath that guides his or her practice.

"Consists basically of medical prayers, oaths, pledges, ethical aphorisms and codes, and covenants of physicians throughout the ages, in various civilizations."--Intro. Published 1973.

I shared Raanan Gillon’s1 surprise at Robert Veatch’s criticism of the white coat ceremonies,2 and I think that the points raised by Veatch were quite adequately countered by Gillon’s response. The provocative points raised by Veatch do stimulate some valuable critical thinking about the process, although I think Veatch was carried away a bit by hyperbole. To label the drama of the ceremony as “ominous” goes a bit far by any criterion.I should like to describe an oath taking initiation (...) ceremony in use at the Ben Gurion University Faculty of Health Sciences for almost three decades, its history, features, current practice, and conclusions. I believe that Veatch’s specific objections are addressed by our process and merit consideration by other institutions as well.When the medical school was founded in 1974 the then dean , Professor Moshe Prywes, met with the just entering class several weeks before the onset of the academic year during a summer preliminary orientation period . Professor Prywes, an imaginative, charismatic innovator with a flair for public relations and the dramatic, suggested to the entering class that they take the physician’s oath during the first weeks of the academic year, coinciding with their first exposure to patients . He explained that he wanted the students to regard themselves as already bearing responsibilities and duties, and not just rights. He saw them as “change agents” working to upgrade the medical care and the health of the patients and community, right from the first days of their schooling.I had just arrived in Israel as a new immigrant to assume the foundation professorship of medicine, coming from …. (shrink)

T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician (...) -- and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

In this paper, I supplement T. A. Cavanaugh’s arguments against physician-assisted suicide in his book, Hippocrates’ Oath and Asclepius’ Snake, by focusing more specifically on the dangers of the misuse of physician power and on the virtues essential to restrain such power. Since Cavanaugh’s starting point is similar to Edmund Pellegrino’s views on the fundamental ends of medicine, I start with the question of the proper ends of medicine. Cavanaugh’s interpretation of the Hippocratic Oath as the (...) limitation of physician power to heal and to kill raises the issue of the proper use of physician power over the patient. In order to support and strengthen Cavanaugh’s case, I use Richard Zaner’s discussion of physician power over the patient and the attendant duty to use such power in a responsible way. Finally, I supplement Cavanaugh’s discussion with a fuller account of physician virtues as they relate to physician-assisted suicide. I first discuss the ends of medicine, medical power, and physician-assisted suicide. Second, I discuss the relationship between virtue and physician-assisted suicide. Third, I draw some final conclusions. (shrink)

The white coat ceremony is a common practice at many American and European medical schools. Current justification for the ceremony is mainly based on the good will felt by participants and an assumed connection between the ceremony and encouraging humanistic values in medicine. Recent critiques of the ceremony faults its use of oaths, premature alignment of students and faculty, and the selective appropriation of meaning to the white coat itself. This paper responds to recent critiques by addressing their misconceptions and (...) arguing that the white coat ceremony is a contemporary medical ritual with a key role for students and faculty in developing a professional identity.Since its inception in 1993, the white coat ceremony has become a national and international phenomenon. It is now practised at the beginning of the year at more than 100 American medical schools and is supported by foundation grants dedicated to endorsing and encouraging professional development and humanism in medicine.1 While some literature addresses the symbolism and history of the white coat itself, few sources consider the meaning of the ceremony.2–4 A common appeal is to the emotion and good will felt at the event.1,5 Although feelings are important, a deeper justification is called for.Criticism of the WCC is more explicit, charging that the ceremony: uses the Hippocratic Oath inappropriately or, at best, prematurely; fosters improper student faculty relationships, and; interprets the meaning of the white coat selectively.6,7 Critics suggest either that students not be asked to swear an oath together because it might conflict with personally held beliefs, or that students not be allowed to take the oath until they have demonstrated competence as physicians.6 Some also say that the WCC aligns students with faculty and against patients.6 The third …. (shrink)

In Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession, Thomas Cavanaugh focuses on performative aspects of the taking of the oath which bear upon the formation of that community we identify as the medical profession. In this paper, I suggest that we can go further than Cavanaugh does in identifying what the Hippocratic oath makes possible. Given its particular content and what it communicates, the oath makes possible, to a degree few other oaths (...) could, and in a way which might be significantly impaired by the absence of an oath, the form of community we have come to call the physician-patient relationship. In Section I, I will discuss Cavanaugh’s treatment of the oath’s relationship to the community of medical professionals. In Section II, I discuss at a relatively abstract level the relationship between communication and community. In Section III I show how the oath can additionally constitute the primordial moment in the existence of the physician-patient relationship. (shrink)

Medicine was until recently a greatly respected profession supported by trust and faith on one side and compassion and care on the other. However, over the years, the relationship between doctors and patients has suffered. Doctors now find themselves in the news for all the wrong reasons. Labelled as 'murderers', 'knife happy', 'organ stealing thieves' or touts of pharmaceutical giants, they have now lost respect in the eyes of society. When and how did this happen? When did doctors go from (...) being 'Next to God' to maut ke saudagar, as the media is so fond of labelling them? Hippocratic Oath or Hypocrisy?: Doctors at Crossroads is the author's journey as a doctor over three decades, from a young medical student to an experienced paediatrician. She has used her experience to highlight serious issues--demanding patients, prescribing of unnecessary investigations, hospitals run like business houses, the role of big pharmaceutical industries and so on from the point of view of both doctors and patients. (shrink)

This review examines issues relating to biomedical ethics and literature in the African drama The President’s Physician by Emmanuel Babatunde Omobowale. The play investigates the psychological dilemma of Doctor Bituki Warunga, a personal physician to General Kalunga Ntibantunganyah who brutally and inhumanely rules Wavaria, a fictional African country. The doctor is faced with deciding to uphold the ethics of his profession versus terminating the tyrant’s life to set the nation free. The play aims to help budding medical doctors (...) rightly inculcate the principles of medical ethics—autonomy, beneficence, competence, and power—by providing a fictional platform to investigate difficult issues that can arise in clinical practice. The play highlights Warunga’s complex dilemma as he struggles to uphold the Hippocratic Oath and at the same time satisfy his conscience towards his contribution to his country’s freedom. This review explores the difficulties in decision-making when professional duties not only clash with personal preferences but also with the well-being of an entire nation. This discussion is done alongside the ethical concept of utilitarianism and also highlights significant literary concepts such as satire, symbolism, intertextuality, utopian aesthetics, and authorial vision as conveyed in the text. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy (...) with respect to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I (...) argue that the author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

ABSTRACT:Robert Veatch argues that physician oaths should not be valued as substantive moral commitments, transformational rituals, or symbolic acts. Further, he insists that oath recitation in medical schools is immoral. I respond to Veatch's criticisms and argue that, with alterations to their content and practice, oaths can have value for articulating moral commitments and building a sense of moral community within the profession. I break down Veatch's multitude of objections to oaths over his career, and I suggest how (...) medical schools can avoid the pitfalls identified by Veatch. A promising and innovative path forward is to integrate a commitment to diversity, equity, and inclusion—though with an understanding that a few lines in an oath are far from sufficient for institutional culture, faculty accountability, or students' education. (shrink)

Moral injury occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses their deeply held moral beliefs. The deeply held moral belief that physicians share is the oath they take when completing their lengthy training and embarking on their career: Put the needs of patients first. In today's American healthcare system, doctors, nurses, and other healthcare providers are increasingly forced to consider the demands of other stakeholders -- insurers, hospitals, even their own financial (...) security -- before the needs of their patients. Whenever they are forced to make a decision that contravenes their patient's best interest, they feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. Moral injury and its causes help explain why healthcare workers started leaving the field in droves long before the COVID-19 pandemic exposed weaknesses in the US system, why a rich country has such poor outcomes in certain categories, why there is a shortage of young doctors training for critical areas, and why patients feel so frustrated. In If I Betray These Words, Wendy Dean explores and exposes the impacts of moral injury through vividly told stories that are at once bewildering and eye-opening. Her book serves as a roadmap through a healthcare landscape that can be confounding, and at times even hellish, for those who must navigate it, and it suggest alternative routes for healers and their patients. (shrink)

Since the fourth century, B.C.E., the Oath of Hippocrates has been the starting point in analyzing the obligations of physicians to protect the privacy and confidentiality interests of their patients. The pertinent provision of the Oath reads as follows: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account must be spread abroad, I will keep to myself, holding such (...) things shameful to be spoken about.”This part of the Oath is subject to more than one interpretation, but its commonly accepted meaning provides the ethical foundation for the physician’s duty of confidentiality. The Oath expressly declares that a physician’s obligation of confidentiality applies beyond matters of medical care. At a time when there were no hospitals or physician offices, patients received medical care in their homes or in public places. Physicians treating patients in their homes could be expected to see and hear a wide range of activities that might be considered embarrassing, immoral, or even illegal. (shrink)

Many enhancement technologies are distributed by healthcare professionals—by physicians—who are held to the Hippocratic Oath and the goals of medicine. While the ethics of enhancement has been widely discussed with regard to the social justice, humanism, morals and normative values of these interventions, their place in medicine has not attracted a great deal of attention. This paper investigates the potential for enhancement technologies to fulfil the goals of medicine, arguing that they play a role in promoting the health of (...) individuals, and thus, an unavoidable place in medicine. It also warns of potential dangers, suggesting a set of guidelines to initiate conversations regarding the role and responsibilities of physicians practising in an era of enhancement. (shrink)

Physicians in Islamic countries might be requested to participate in the Islamic legal code of qiṣāṣ, in which the victim or family has the right to an eye-for-an-eye retaliation. Qiṣāṣ is only used as a punishment in the case of murder or intentional physical injury. In situations such as throwing acid, the national legal system of some Islamic countries asks for assistance from physicians, because the punishment should be identical to the crime. The perpetrator could not be punished without a (...) physician’s participation, because there is no way to guarantee that the sentence would be carried out without inflicting more injury than the initial victim had suffered. By examining two cases of acid throwing, this paper discusses issues related to physicians’ participation in qiṣāṣ from the perspective of medical ethics and Islamic Shari’a law. From the standpoint of medical ethics, physicians’ participation in qiṣāṣ is not appropriate. First, qiṣāṣ is in sharp contrast to the Hippocratic Oath and other codes of medical ethics. Second, by physicians’ participation in qiṣāṣ, medical practices are being used improperly to carry out government mandates. Third, physician participation in activities that cause intentional harm to people destroys the trust between patients and physicians and may adversely affect the patient–physician relationship more generally. From the standpoint of Shari’a, there is no consensus among Muslim scholars whether qiṣāṣ should be performed on every occasion. We argue that disallowing physician involvement in qiṣāṣ is necessary from the perspectives of both medical ethics and Shari’a law. (shrink)

Burns, C. R. Introduction.--Antiquity: Margalith, D. The ideal doctor as depicted in ancient Hebrew writings. Edelstein, L. The Hippocratic oath. Edelstein, L. The professional ethics of the Greek physician. Michler, M. Medical ethics in Hippocratic bone surgery. Maas, P. L., Oliver, J. H. An ancient poem on the duties of a physician.--The medieval era: Levey, M. Medical deontology in ninth century Islam. Bar-Sela, A., Hoff, H. E. Isaac Israeli's fifty admonitions of the physicians. Rosner, F. The (...) class='Hi'>physician's prayer attributed to Moses Maimonides. MacKinney, L. C. Medical ethics and etiquette in the early middle ages, the persistence of Hippocratic ideals. Welborn, M. C. The long tradition, a study in fourteenth-century medical deontology.--The modern period: Larkey, S. V. The Hippocratic oath in Elizabethan England. Pleadwell, F. L. Samuel Sorbiere and his Advice to a young physician. Clark, G. Bernard Mandeville, M.D., and eighteenth-century ethics. Burns, C. R. Thomas Percival, medical ethics or medical jurisprudence? Burns, C. R. Reciprocity in the development of Anglo-American medical ethics, 1765-1865. Williams, T. F. Cabot, Peabody, and the care of the patient. (shrink)

In a perfect world, physicians and drug producers would have only one goal: to advance the health of their patients. Unfortunately, ours is not a perfect world. While every physician’s prime responsibility—by oath and by law—is to the patient, every pharmaceutical producer’s first and foremost obligation, by design, is to shareholders and employees. Their ultimate objectives are diagonally diverse. This situation calls for a code of ethics to govern the marketing and prescription of pharmaceuticals. This paper attempts to (...) identifythe business practices prevailing in the Indian pharmaceutical industry, in order to provide a basis for constructing an appropriate code of ethics. The research is based on surveys or in-depth interviews of physicians, patients, retail pharmacists, and drug manufacturers. (shrink)

This essay offers an exegesis and critique of the moment of community formation in Agamben’s Homo Sacer Project. In The Sacrament of Language, Agamben searches for the site of a non-sovereign community founded upon the oath [horkos, sacramentum]: an ancient institution of language that produces and guarantees the connection between speech and the order of things by calling the god as a witness to the speaker’s fidelity. I argue that Agamben’s account ultimately falls short of subverting sovereignty, however, because (...) the sacramentum derives its power, at a fundamental level, from the ‘monothetic’ structure of truth—what Agamben calls ‘the name of God’ [il nome di Dio]. I propose we may yet salvage the oath as a means of subverting sovereignty, however, if we reconsider it in the context of polytheism, where the names of the gods [i nomi degli dei] can be many, while remaining powerful. First, through a reading of Aeschylus’ Eumenides, I argue that the Greeks understood the oath to function even where truth and falsity were inherently undecidable. Second, I argue that if we separate the truth and power functions interwoven in the sacramentum, we find a second formula, the decisory oath, which can be taken in order to produce a community even in the absence of one sovereign truth. As a kind of magical speech, the decisory oath provides the limit conditions for the possibility of distinguishing true from false in the sacramentum, and thus founds it. (shrink)

: Dr. Smith is an internist in private practice who works at an inner city clinic affiliated with a university hospital. He is also a member of the university faculty. Many of Dr. Smith’s patients have type 2 diabetes mellitus and struggle with health care and other costs. Thinking about opportunities to better serve his patients and advance his career, Dr. Smith considers conducting clinical research in his office. ACME is a respected pharmaceutical company that for decades has engaged in (...) research, development, and production of widely used drugs. Several of ACME’s oral agents for type 2 diabetes will soon go off patent. In an effort to retain its market share in this class of drugs, ACME wants to complete clinical trials expeditiously and obtain approval for its new oral hypoglycemic medicine. The company approaches Dr. Smith to be a coinvestigator in its multicenter clinical trial. (shrink)

"I do solemnly swear" -- Economics in practice : what do economists do? -- Ethical challenges confronting the applied economist -- Historical perspective : "don't predict the interest rate!" -- Interpreting the silence : the economic case against professional economic ethics -- The economic case against professional economic ethics : a rebuttal -- The positive case for professional economic ethics -- Learning from others : ethical thought across the professions -- Economists as social engineers : an ethical evaluation of market (...) liberalization in the south and transition economies -- Global economic crisis and the crisis in economics -- On sleeping too well : in search of professional economic ethics -- Training the "ethical economist" -- The economist's oath. (shrink)

This paper examines several areas that health care providers may find difficult in the care of patients near the end of their lives. It looks at society's denial of death and at ways physicians and their patients use ongoing active treatments to maintain that denial. It suggests that as active treatment fails to be effective and hope fades, physicians must find ways to care for those they cannot cure. It explores the function of hope to help physicians, their patients, and (...) their patients' families redirect their thinking. Finally, it describes how the physician may support a patient's spirituality by becoming more comfortable with his own. (shrink)

In their article, van Gils Schmidt and Salloch defend the claim that physicians have a duty to protect the climate. The logic of the argument in broad terms is that (i) there is a relationship between climate change and the burden of disease, (ii) the healthcare sector is a significant emitter of global greenhouse gasses, thereby enhancing the burden of disease and (iii) since doctors are advocates of health and stakeholders in the healthcare sector, they have a duty to respond (...) to climate change. The authors recognise the ‘ethical basis for the claim of healthcare professionals having a special responsibility in climate change is far from being obvious’. The theoretical framework they choose for making this tentative link more apparent is Korsgaard’s theory of practical identities. The main argument of the authors seems to be that practical identities are pluralistic—a person can identify as a physician and environmentalist simultaneously—and the normative positions attributable to these identities may come into conflict. More than that, they claim that being an environmentalist is increasingly becoming …. (shrink)

The debate over futility is driven, in part, by physicians' desire to recover some measure of decision-making authority from their patients. The standard approach begins by noting that certain interventions are futile for certain patients and then asserts that doctors have no obligation to provide futile treatment. The concept of futility is a complex one, and many commentators find it useful to distinguish ‘physiological futility’ from ‘qualitative futility’. The assertion that physicians can decide to withhold physiologically futile treatment generates little (...) controversy. The claim that they can withhold qualitatively futile treatment runs afoul of standard objections to medical paternalism. There is reason to believe that the conceptual distinction will not be maintained in clinical practice. This paper contends that the scientific data which would support a physician's unilateral decision to withhold physiologically futile treatment also provide support for an institutional policy restricting access to the treatment. The data the doctor uses to take decision-making power out of the hands of the patient can be used by the administrator to take power out of the hands of the doctor. While this loss of power is unproblematic, there is reason to believe that the ambiguity in the term ‘futility’ will allow a much greater loss of physicians' power. Keywords: futility, physician authority CiteULike Connotea Del.icio.us What's this? (shrink)

Economics is today among the most influential of all professions. Economists alter the course of economic affairs and deeply affect the lives of current and future generations. Yet, virtually alone among the major professions, economics lacks a body of professional ethics to guide its practitioners. Over the past century the profession consistently has refused to adopt or even explore professional economic ethics. As a consequence, economists are largely unprepared for the ethical challenges they face in their work.The Economist's Oath (...) challenges the economic orthodoxy. It builds the case for professional economic ethics step by step-first by rebutting economists' arguments against and then by building an escalating positive case for professional economic ethics. The book surveys what economists do and demonstrates that their work is ethically fraught. It explores the principles, questions, and debates that inform professional ethics in other fields, and identifies the lessons that economics can take from the best established bodies of professional ethics. George DeMartino demonstrates that in the absence of professional ethics, well-meaning economists have committed basic, preventable ethical errors that have caused severe harm for societies across the globe. The book investigates the reforms in economic education that would be necessary to recognize professional ethical obligations, and concludes with the Economist's Oath, drawing on the book's central insights and highlighting the virtues that are required of the "ethical economist."The Economist's Oath seeks to initiate a serious conversation among economists about the ethical content of their work. It examines the ethical entailments of the immense influence over the lives of others that the economics profession now enjoys, and proposes a framework for the new field of professional economic ethics. (shrink)

A physician’s long-established right to refuse to provide a requested service based on his or her moral beliefs is being challenged. Some authors suggest that physicians should not be licensed if they are unwilling to provide all legal services. Others would grant them the right to refuse, but require them to refer to a willing professional. What are the limits of a physician’s right to refuse? When such a right is claimed on moral grounds, what residual obligations does (...) the physician have to the patient? How should the profession (or society) decide when a moral claim to a right to refuse is justified? (shrink)

Context: A growing number of Japanese people have completed advance directives, especially living wills, even though there is no legislation recognising such documents and little empirical research on their impact on clinical care at the end of life in Japan.Objectives: To investigate physicians’ attitudes about living wills and their experiences with patients who had completed a living will and later died.Design: Self administered survey and qualitative study using open question and content analysis.Setting: Japan.Participants: Physicians known to have cared for a (...) patient who had presented a living will prior to death.Measurements: The physician’s response to receiving a living will, communication about the living will, the impact of the living will on clinical care, demographics, and their opinion on advance directives, especially living wills.Main results: Fifty five per cent of respondents approved of advance directives in general, and 34% had more opportunities to communicate with a patient and his/her family after receiving the living will. Sixty nine per cent of the physicians who received a living will did not, however, change their course of therapy as a consequence of receiving the living wills. Based on the analysis, we identified three areas of concern in the comments on living wills: concerns relative to patients, physicians, and families; social context, and clinical and administrative concerns. The physicians raised various topics for discussion; they tended to describe the issues from a clinical perspective.Conclusions: Our identified areas of concern should prove helpful in better understanding the clinical and ethical implications of living wills in Japan. (shrink)

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.

The influence of physician judgment on the disclosure, competency, understanding, voluntariness, and decision aspects of informed consent for bone marrow transplantation are described. Ethical conflicts which arise from the amount and complexity of the information to be disclosed and from the barriers of limited time, patient anxiety and lack of prior relationship between patient and physician are discussed. The role of the referring physician in the decision-making is considered. Special ethical issues which arise with use of healthy (...) related bone marrow donors are discussed, as is the physician's discretion in raising questions of competency. It is concluded that in this setting, regardless of the theoretical goals of the physician, patients appear to utilize informed consent discussions to assess their capacity to trust the physician rather than as a time to weigh the large amount of relevant data. The conscientious physician best serves the patient with recommendation of the best medical alternative rather than with attempts to remain neutral. (shrink)

Next SectionBackground: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such (...) situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other. Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process. (shrink)

In this paper I briefly summarize Pellegrino’s phenomenological analysis of the ethics of the physician–patient relationship. In delineating the essential elements of the healing relationship, Pellegrino demonstrates the necessity for health care professionals to understand the patient’s lived experience of illness. In considering the phenomenon of illness, I identify certain essential characteristics of illness-as-lived that provide a basis for developing a rigorous understanding of the patient’s experience. I note recent developments in the systematic delivery of health care that make (...) it difficult for health care professionals to realize Pellegrino’s ethical model of the role of healer. Such developments limit both the physician’s freedom to act on behalf of the patient without the constraint of third parties and the physician’s freedom to act in light of his or her own ethical or religious convictions. Given these difficulties, I note MacIntyre’s call for the development of moral communities, as an alternative to the prevailing culture, and share a first-hand example illustrating how intentional Christian community provides an alternative nurturing context that permits the full development of the healing relationship. (shrink)

Book reviewed in this article: The Physician's Covenant: Images of the Healer in Medical Ethics. By William F. May.

Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s ethical guidelines on gifts from the pharmaceutical industry.Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms , facilitating conditions , profession-specific precedents , individual-specific precedents and intent. Multivariate regression (...) modelling was conducted.Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% of respondents were aware of the guidelines; 50% had read them. 48% thought that following the guidelines would increase physicians’ credibility and professional image; 68% agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent were attitude, subjective norms, the interaction term , sponsorship of CME events and individual-specific precedents.Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance. (shrink)

Responsibility for the protection of human research subjects is shared by investigators, research ethics committees, sponsors/funders, research institutions, governments and, the focus of this article, physicians who enrol patients in clinical trials. The article describes the general principles of the patient-physician relationship that should regulate the participation of physicians in clinical trials and proposes guidelines for determining when and how such participation should proceed. The guidelines deal with the following stages of the trial: when first considering participation, when deciding (...) whether to enrol patients, when asking patients to participate, when the trial is underway and when it is completed. (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Responsibility for the protection of human research subjects is shared by investigators, research ethics committees, sponsors/funders, research institutions, governments and, the focus of this article, physicians who enrol patients in clinical trials. The article describes the general principles of the patient-physician relationship that should regulate the participation of physicians in clinical trials and proposes guidelines for determining when and how such participation should proceed. The guidelines deal with the following stages of the trial: when first considering participation, when deciding (...) whether to enrol patients, when asking patients to participate, when the trial is underway and when it is completed. (shrink)