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Rapid response to:

Editor's Choice

Learning for life

BMJ 2006; 332 doi: (Published 02 February 2006) Cite this as: BMJ 2006;332:0-f

Rapid Response:

Limitations for clinical decisions.

Dear Sir,

Godlee (1) asks an interesting question for the medical
profession about the influence of our moral values on clinical decisions.
Definitively, our response is positive since the physician’s formation and
performance has always been and will always be ruled for moral values.

The bioethical principles of beneficence, non maleficence (primum non
nocere), justice and autonomy (2) should always be present in our medical
practice, although, sometimes they become controversial and limiting , in
fact, the doctor’s performance.

In the case of the footballer, who had an expensive liver transplant
for alcoholic liver disease, this patient made fun of doctors when he
continued drinking, contradicting the bioethical principles. First,
physicians work in good faith when trying to cure this patient and comply
with the principle of autonomy when respecting the patient’s decision to
continue drinking after the transplant although he was explained about the
danger of the drinking habit in the prognosis of his medical problem, but
the principle of justice is violated when giving him resources he didn’t
deserve, which could be assimilated successfully by another member of

Modern Medicine limits the medical work and sometimes it doesn’t
allow freedom enough to vary our practice with our moral values.
Medicalization of life, the primacy of diagnosis, evidence based medicine
(3), the guides for a good clinical practice lead our steps making rigid
our practice which is sometimes lacking of an affective doctor – patient
relationship that can provide moral values and positive ways of action.

It is necessary to rescue the art of Medicine that has been lost and
substituted for technology. The physician’s classical proceedings by
means of a good doctor – patient relationship in which communication and
confidence have a major role is the kind of behaviour.

We thing doctors should developed in medicine students in such a way
that the moral values of our human profession could be transmitted
through generations.


1. Godlee F. Learning for life. BMJ 2006; 332(7536): 0-1.

2. Ribera Casado JM. Ethics aspects in geriatric assistance. In: Farreras
Rozman: Internal Medicine. Masson Edit. Barcelona 2000: 1300-7.

3. Goodwin JS. Geriatrics and the limits of Modern Medicine. N Engl J Med
1999; 340: 1283-85.

Competing interests:
None declared

Competing interests: No competing interests

25 February 2006
Ángel J. Romero Cabrera
Physician (Internal Medicine)
Orestes Fresneda, Francisco Olascoaga
Gustavo Aldereguía University Hospital, Cienfuegos, Cuba