The Morals of Medicine

The ethical problems of the medical profession stem from the extraordinarily high value placed on life, well- being, and freedom from pain in our culture; from the neces sarily intimate relation of doctor and patient; from the strains of private practice, a small entrepreneur role, in a society of big government, big business, big labor, and big cities; from contradictory social values in matters of religion, sex, and right of privacy in the individual's own body; from failures of com munication between the profession and the public as to the na ture of medicine and the limits of science; and from the con flict over change in the organization of medical service. The profession has fought its battles with notable success on most fronts, but without a fully satisfactory answer to the tough problem of maintaining quality. Medical society discipline and malpractice suits have not provided effective enforcement. Isolated individual practice is diminishing. Group practice, certification of advanced training, widened hospital-staff mem bership, and improved hospital certification provide new disci plines to enforce quality. The language of medicine's codes and of the politico-economic debate have contributed to a pub lic image of guild restrictionism and self-protection. Though impossible to measure, change appears to have been, in fact, to marked improvement in quality and protection of the patient against negligent, incompetent, or exploitative medical service. The introduction of compulsory sickness insurance and social ized medicine raises the new ethical issue of the doctor's strike.