Issues in medical ethics include abortion, physician assisted suicide, the cost and distribution of scarce medical resources (including organs for transplants), the funding of health care, life extending technologies, genetic engineering, cloning, the use of animals in medical research, professional codes of conduct for health care officials, the definition of mental illness, and conditions when it should be permissible for someone to be forcefully committed to a mental institution.
The following is the official American Medical Association code of conduct. Do you think it is
reasonable? Should it be amended or extended?
Principles of Medical Ethics
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.
Principles of medical ethics
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people.
While the topics of study in medical ethics are extremely wide-ranging, offering an inexhaustible variety of moral questions, one current area of interest in biomedical ethics is the topic of abortion. To give an idea of how ethics pervades the field of medicine, here is a sampling of arguments used in the case for restricting or prohibiting abortions:
- The fetus (fertilized egg), once intact as an organism, has sufficient unity to constitute a
being that will (if nature takes its course) become a human person. There is no non-arbitrary point from fertilization to birth at which we can with certainty claim that the fetus is a person. Therefore we should accept the position that the fetus is a human being at conception, and is thus worthy of ethical treatment.
- Even if there is insufficient reason to think that the fetus is a person at conception, it is reasonable to believe that it is a potential person, and thus should be treated with the respect due to an actual person.
- In the Christian tradition, Biblical testimony seems divided: in the Psalms it is affirmed that God knows the person in the womb, but other verses suggest that God knows persons before they exist. Also, in the Old Testament, if one unjustly causes a woman to miscarry, the penalty is less than the punishment for homicide.
Here is a sample of arguments for the permissibility of abortions (at least some) along the lines of Roe v. Wade:
- There is a non-arbitrary line to draw when it is reasonable to believe the fetus is a person. It is the reverse of the criterion for death. Humans are (often) believed to die when they have irreversible loss of consciousness due to the decline of brain activity. Conversely, it may be reasonable to believe that the point at which brain activity begins (8-12 weeks) is when the fetus becomes a person.
- We do not legally require men to give their bone marrow or spare organs to those in need, so isn’t it unfair to require a woman to carry an unwanted pregnancy to term, sharing their bodies with the fetus?
When is appealing to one’s emotions through images of the fetus ethically revealing? When might it be manipulative and misleading? There is a new law that has been passed in Wisconsin requiring all women seeking abortions to view an ultrasound of the fetus before making their final decision.
Also, a great book to check out regarding medical ethics is Paul Ramsey’s, The Patient as Person:
If you are interested in physician codes of ethics, see these two excellent chapters from Atul Gawande’s book Complications on medical mistakes/negligence. The first chapter looks at the types of mistakes that “good doctors” make. It explores the need for safe space (and maybe safe culture) for doctors to openly discuss mistakes and ways that innovation can help with the problem. The second chapter (“When Good Doctors Go Bad”) tells of the story of a doctor whose depression causes him to be consistently negligent in a way that harmed many patients over time, and how the system does not have good ways of confronting this kind of doctor. It explores some very hopeful and just ways of handling the problem.
For those interested in the intersection between medicine and social justice, turn to Gene Outka’s paper, “Social Justice and Equal Access to Healthcare.”
The following is from St. Olaf’s Karen Gervais:
Distribution of Scarce Medical Resources
In 2005, the Minnesota Center for Health Care Ethics (the nonprofit organization I direct in St. Paul) undertook a community-wide project on rationing vaccine in a severe influenza pandemic. Our work was eventually published in the journal, Vaccine:
Vawter DE, Gervais KG, Garrett JE, Pandemic Influenza Ethics Work Group. Allocating pandemic influenza vaccines in Minnesota: Recommendations of the pandemic influenza ethics work group. Vaccine. 2007;25(35):6522-6536.
The Minnesota Department of Health, taking the cue from our project, supported us, along with members of the Center for Bioethics at the UM, in a much more extensive project to develop and apply an ethical framework for allocation (i.e., rationing) of numerous health resources in a severe pandemic. This project eventually involved public engagement to educate and attempt to resolve some of the least-agreed upon prioritizations among the work group that developed the ethical framework for rationing. Age-based rationing was one of the issues we took to the public. The document listed below is the record of this entire project, including the ethical framework, detailed prioritization strategies for the resources we studied (vaccines, antivirals, surgical masks and N95 respirators, mechanical ventilators), and our public engagement results (which led to meaningful revisions to the final statement of our ethical framework and the prioritizations/deprioritizations of groups to get resources). The interesting memory I have of public engagement (I led sessions in Moorhead and the Range) was that the public did not trust the inclusion of the word “fairness” but did trust and agree with the ways in which the framework specifically required fairness). The elderly were deprioritzed for resources where evidence supported reduced benefit for them as a group, e.g., in the case of vaccines. Here is a link to the Minnesota report. I recommend the Executive Summary.
-Karen Gervais, St. Olaf College