In theory, physicians subscribe to and in their actions personify a set of virtues whose performance demands personal engagement. At the same time, they are instructed in their professional roles to remain emotionally and personally distant from those they are called to treat. The result, the authors argue, is an ethical conflict whose nature is described through an analysis of two narratives drawn from an online blog for young physicians. Confusion over professional responsibilities and personal roles were found to affect (...) physicians' perceptions of their clinical duties and their social roles. In addition, it sets in sharp relief contemporary debates on physician training and the ethical nature of medical professionalism. Practically, the authors suggest, the confusion may contribute to early physician burnout. Methodologically, this paper promotes the use of online discussion sites as rich repositories providing an insight into real dilemmas and the actual perception of physicians' attempts to address them. It thus promotes use of such sites as a resource in which assumptions about physicians' own perceptions about the nature of their role in contemporary society can be tested. (shrink)

Bioethics coverage of the recent Ebola outbreak neglected the ethical issues associated with aspects of the outbreak having environmental significance. The neglect of environmental dimensions is symptomatic of the way that the current institutionalization of bioethics as a field of inquiry separates medical and environmental expertise. As visionaries who are recognizing the need for better integration of human and veterinary medicine with environmental health are starting to call for “One Health”, it is now time to recognize the need for “One (...) Bioethics.”. (shrink)

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so (...) much suffering. (shrink)

The heart-rending story of Mrs. J raises many complex ethical issues. Key elements include suffering, disagreement, culture, religion, perspective, and facts. Overarching concerns include whose voices and stories should count, the connection of pain with suffering, and how healthcare ethics committees should respond.

Bioethicists have typically disdained where they did not simply ignore the Hippocratic tradition in medicine. Its exclusivity—an oath of and for physicians—seemed contrary to the perspective that bioethicists have attempted to invoke. Robert M. Veatch recently articulated this rejection of the Hippocratic tradition, and of a professional ethic of medicine in general, in a volume based on his Gifford lectures. Here that argument is critiqued. The strengths of the Hippocratic tradition as a flexible and ethical social doctrine are offered in (...) its stead. (shrink)

This article defends ‘relational theorizing’ in bioethics and public health ethics and describes its importance. It then offers an interpretation of solidarity and care understood as normatively patterned and psychologically and socially structured modes of relationality; in a word, solidarity and care understood as ‘practices.’ Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. Care is characterized as paying attention to the moral being of others and their needs, (...) suffering, and vulnerability. The wager of relational theorizing in health care and public health is that substantive ethical visions of solidarity and care will provide support for more just and egalitarian health care and public health policies. (shrink)

This article explores the association between medical professionalism, revenue enhancement, and self-interest. Utilizing the sociological literature, I begin by characterizing professionalism generally and medical professionalism particularly. I then consider “pay for performance” mechanisms as an example of one way physicians might be incentivized to improve their professionalism and, at the same time, enhance their revenue. I suggest that the concern discussed in much of the medical professionalism literature that physicians might act on the basis of self-interest is over-generalized, and that (...) instead we ought to argue about ways to distinguish permissible and impermissible self-interested actions. Also, I argue that financial incentives for medical professionals ought to be permissible but considered as “by-products” of doing what physicians are expected to do as professionals in any case. Nevertheless, I conclude that, even if a positive association between increasing professionalism and revenue enhancement can be established, in the long term it may not be an unambiguous good for physicians as professionals in that this association may tend to reduce their professional discretion. (shrink)

Clinical ethics consultation is beset by a triumvirate of limited opportunities, modest aims, and conservative impulses. Contrary to what their “God committee” nickname would imply, clinical ethics...