BMJ 2000;320:499-503 ( 19 February )

Education and debate

Internal and external morality of medicine: lessons from New Zealand

Charlotte Paul, associate professor of epidemiology. 

Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin, New Zealand

charlotte.paul@stonebow.otago.ac.nz

The first 150 words of the full text of this article appear below.

    Introduction

It has been claimed that the Bristol case will kill internal self regulation.1 The New Zealand experience should serve as a warning against believing that internal self regulation by the medical profession is useless and should be discarded. After the report of the New Zealand cervical cancer inquiry 11 years ago,2 which has similarities with the Bristol case, many new rules were made, some of which have the status of legal regulations, governing both research and medical practice. Yet these apparent improvements in ethical standards represent an unbalanced concentration on an external morality for medicine. Over the same time internal morality, though it had a key role in limiting the harm done to patients in the cervical cancer study, has been thoroughly neglected.

Henk ten Have has described internal morality as those values, norms, and rules that are intrinsic to the practice of medicine.3 Internal morality arises from within a community . . . [Full text of this article]
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