Medical ethics could be better understood if some basic theoretical aspects of practices in health care are analysed. By discussing the underlying ethical principles that govern medical practice, the student should also become familiar with the notion that medical ethics is much more than the external application of socially accepted moral standards. Professions in general and medicine in particular have internal values that command their moral virtuosity at the same time as their technical excellence. Three examples where clinical practice can (...) be clearly shown to require an ethical analysis are given: medical praxiology illustrates the motives, means and aims of physicians and patients; clinical decision-making as a practical syllogism that reaches prescriptive conclusions based on medical knowledge and the patient's wishes/intentions. Finally, diagnostics as an ethical bayesian approach is discussed, where the patient informedly decides the benefits and risks of further testing. (shrink)

The relation between biomedical knowledge and clinicalknowledge is discussed by comparing their respectivestructures. The knowledge of a disease as a biologicalphenomenon is constructed by the interaction of factsand theories from the main biomedical disciplines:epidemiology, diagnostics, clinical trial, therapydevelopment and pathogenesis. Although these facts andtheories are based on probabilities andextrapolations, the interaction provides a reliableand coherent structure, comparable to a Kuhnianparadigma. In the structure of clinical knowledge,i.e. knowledge of the patient with the disease, notonly biomedical knowledge contributes to the structurebut also (...) economic and social relations, ethics andpersonal experience. However, the interaction betweeneach of the participating ``knowledges'' in clinicalknowledge is not based on mutual dependency andaccumulation of different arguments from each, as inbiomedical knowledge, but on competition and partialexclusion. Therefore, the structure of biomedicalknowledge is different from that of clinicalknowledge. This difference is used as the basis for adiscussion in which the place of technology,evidence-based medicine and the gap between scientificand clinical knowledge are evaluated. (shrink)