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Iconoclastic ethics.

Abstract：

:Arguments are advanced, on a pragmatic basis, for preferring a 'situational' approach to medical ethical problems, rather than an approach based on any one of the dogmatic formulations on offer. The consequences of such a preference are exemplified in relation to confidentiality; and in relation to the ethical dilemmas which surround the beginning and the end of terrestrial human life. :Black gives three reasons for his skepticism about the usefulness of codes of medical ethics: the lack of consensus on an absolute basis for ethics; his positive sympathy with "situation ethics"; and his doubts as to whether strict adherence to an ethical code benefits patients. In this context, he considers ethical problems related to confidentiality, abortion, contraception, and euthanasia. In each example given, he regards medical ethics as relative and requiring modification according to the patients involved and their situations. The author concludes that good medical practice is based upon sympathy, kindness, knowledge, competence, and prudence. :The author argues for a situational approach to medical ethics rather than an approach based on blind adherence to a preset ethical code. Medical ethics is conceptualized as a system of relationships that may require modification in light of the people involved and the particular situation. This approach is then applied to 3 areas: confidentiality, pregnancy prevention and promotion, and issues of life and death. Although it is in the interests of patients that information they have divulged remain confidential, rigid application of this principle can impair the clinical usefulness of patient records. The issue of confidentiality also comes up in the case of young girls who want a prescription for oral contraceptives but are unwilling to tell their parents. In some cases, it might be appropriate to inform the parents against the patient's wishes. Advances in techniques for preserving the life of prematurely born infants further suggest grounds for revising the designation of 28 weeks of pregnancy as the upper limit for pregnancy termination. Finally, the duty of preserving life at all costs should be viewed as less than absolute in the cases of victims of brain stem death or even painful terminal illnesses. Both anti-abortion groups and voluntary euthanasia societies share a tendency to reject consideration of the relevant particulars in individual cases. It is concluded that formal ethics are not central to good medical practice. Rather, medical practice is derviced from human sympathy and kindness, wide knowledge and technical competence, and an element of prudence.

journal_name

J Med Ethics

journal_title

Journal of medical ethics

authors

Black D

doi

10.1136/jme.10.4.179

subject

Has Abstract

pub_date

1984-12-01 00:00:00

pages

179-82

issue

eissn

0306-6800

issn

1473-4257

journal_volume

pub_type

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Iconoclastic ethics.