Ethics and Medicine

Nuala Kenny

Chair, Department of Bioethics, Dalhousie Medical School, Halifax, Canada

There is a longstanding tradition of ethical commitment to patients in the traditions of medicine. The early focus in East and West was on the character of the physician; oaths were the usual expression of personal physician commitment. With scientific advances there arose a need for the addition of professional standards of conduct and care most frequently expressed as codes of professional ethics. Both oaths of commitment and professional codes of ethics focused exclusively on the physician; they were expressions of medical ethics.

  In the late 20^th century, especially in Western liberal societies, the focus of ethical concerns expanded beyond physicians to bioethics. This expansion of ethical concerns in modern health care was a result of at least two major movements. First, was the Nuremberg Code, a response to the research atrocities committed by physicians in the Nazi concentration camps. The second was a more complex set of scientific advances (dialysis, cardio-pulmonary resuscitation etc) which present special concerns regarding the judgment of patient best interest, resource allocation issues and the social responsibility of physicians. Both developments heralded profound changes in medical decision-making and challenged the understanding that the doctor’s judgment of ‘patient best interest’ or ‘acceptable risk’ was the privileged one.

In this paper we’ll explore the history of these developments, the challenges they present to physician education, the place of ethics in professionalism, and the central role of faculty as role models in the formation of new physicians and surgeons.