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Wanted: a social contract for the practice of medicine

BMJ 2001; 323 doi: (Published 14 July 2001) Cite this as: BMJ 2001;323:64

We need to invest in promoting social consensus

  1. Raanan Gillon (, professor of medical ethics,
  2. Roger Higgs,
  3. Kenneth Boyd,
  4. Brendan Callaghan,
  5. Raymond Hoffenberg
  1. Imperial College, London
  2. Institute of Medical Ethics, Heythrop College, London W8 5HQ

    The scandal about stored organs1 is only one recent manifestation of fundamental disagreements about what people expect from medicine. Irreconcilable differences remain between those who think it's kinder not to go into detail when asking permission to remove organs after death and those who think that respect for individuals' autonomy requires that they should be given all information, no matter how distressing. Moreover, in society the balance of such beliefs changes over time. We propose that an independent high level standing commission should be created to determine socially acceptable norms in the NHS and medicine generally—in effect to draw up and maintain a “social contract” between healthcare workers and the community they serve.

    There are many areas in which expectations differ over the practice of medicine. Among these …

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