Views & Reviews Review of the Week

Lost in medicine’s moral maze?

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d3617 (Published 13 July 2011) Cite this as: BMJ 2011;343:d3617
  1. Julian Sheather, senior ethics adviser, BMA
  1. jsheather{at}bma.org.uk

Julian Sheather considers two books that exemplify two approaches to bioethics—one abstract and philosophical, and the other practical and evidence based

During the 1970s some of those who thought more deeply about medicine and its role in society began to register a gathering sense of unease. Doubts about the capacity of the moral tradition of medicine—loosely, the Hippocratic tradition—to respond adequately to the ethical challenges confronting it started to emerge.

The sources of this unease were diverse. Rapid developments in medical technology gave rise to novel ethical dilemmas that soon exhausted the explicatory reserves of that ancient injunction primum non nocere—first, do no harm. Social and political changes in Western societies also led some to doubt the authority of medicine. The increasing egalitarianism of post-war Western societies meant that people began to question the automatic deference paid to professionals. Medicine’s largely unquestioned social contract—the belief that it should be at liberty to act in the best interests of patients—began to look more like condescension. Beneficence began to be recast as unwarranted paternalism. And in the United States there was the Tuskegee syphilis study.

Between 1932 and 1972, in Tuskegee, Alabama, the US Public Health Authority conducted a clinical study into the …

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