Letters

An ethical code for everybody in health care

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7142.1458a (Published 09 May 1998) Cite this as: BMJ 1998;316:1458

The role and limitations of such a code need to be recognised

  1. Alexander E Limentani, Director of health policy and public health
  1. East Kent Health Authority, Protea House, Dover, Kent CT17 9BW
  2. Belford Medical Practice, Belford, Northumberland NE70 7ER
  3. Chief executive, King's Fund, London W1M OAN
  4. Global Lawyers and Physicians, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
  5. Wigtown, Wigtownshire DG8 9DZ
  6. Diabetes Centre, St Helier Hospital, Carshalton, Surrey SM5 1AA
  7. Rustington, West Sussex BN16 3NX
  8. Bristol Royal Infirmary, Bristol BS2 8HW
  9. Birmingham B14 7LL

    EDITOR—Ethics are not optional in medicine: they are an essential and integral part of health care. A common ethical code for everybody involved in health care, as proposed by Berwick et al,1 is potentially valuable and is to be welcomed, but the role and limitations of such a code need to be recognised.

    An ethical code cannot provide the answer to specific ethical problems. Rather than dictating particular actions a code should describe the ethical environment for the delivery of health care and reflect its character and general approach. An ethical code should not try to make subjective aspects of care more objective or separate value from practical situations: it is in the nature of the work of professions that there remains individual responsibility for ethical practice. If challenged, ethical codes cannot explain why moral judgments should be made or give a firm justification for making those judgments; considered, individual moral judgments themselves are more basic and require no more profound reference.

    Ethical codes can give shape and structure to our moral environment and summarise our ethical position while leaving ethical responsibility with the individual practitioner. Looked at in this way, individual variation and personal issues can be taken into account. An ethical code can facilitate the discussion of ethical issues in difficult cases, and distinctive ethical positions can be established and argued, leading to broader and more secure moral conclusions. An ethical code can describe the ethical attitudes that are shared by healthcare workers, and in this it can be immensely valuable and influential. But what it cannot do is provide the certain answers for the many ethical problems encountered in the course of medical practice.

    References

    1. 1.

    Three crucial limitations need to be considered

    1. Saul Miller, Scottish higher training fellow in general practice
    1. East Kent Health Authority, Protea House, Dover, Kent CT17 9BW
    2. Belford Medical Practice, Belford, Northumberland NE70 7ER
    3. Chief executive, King's Fund, London W1M OAN
    4. Global Lawyers and Physicians, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
    5. Wigtown, Wigtownshire DG8 9DZ
    6. Diabetes Centre, St Helier Hospital, Carshalton, Surrey SM5 1AA
    7. Rustington, West Sussex BN16 3NX
    8. Bristol Royal Infirmary, Bristol BS2 8HW
    9. Birmingham B14 7LL

      EDITOR—The call by Berwick et al for the development of a new ethical code for everybody in health care raises a few …

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