Medical practitioners have traditionally seen themselves as part of an international community with shared and unifying scientific and ethical goals in the treatment of disease, the promotion of health, and the protection of life. This shared mission is underpinned by explicit acceptance of traditional concepts of medical morality, and by an implied link between individual human rights and the ethics of medical practice long enshrined in a range of World Medical Association (WMA) and other medical codes. These have been powerful instruments exhorting individual practitioners to promote health and to defend universal principles in order to protect their patients and the physician-patient relationship even in the face of authoritarian state coercion and imposed national ideologies and policies. There has been widespread support for this approach and this should be intensified.
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22. I hope that my concerns will be viewed in the context of an ongoing attempt by a physician to “stand outside his discipline and world view” and see perplexing social problems as symptorr arising in an unjust world that is undergoing profound changes–changes that are reflected i the much admired transition taking place in South Africa which, with all its turbulence, has positive message for the world. The concerns and criticisms I shall express regarding bioethic and medicine in the U.S. relate to the system within which these operate and not to the man fine colleagues in both fields whom I hold in high regard and affection, and from whom I hav received so much intellectual stimulation and friendship over the years. Having experienced th impact of being included by some in the stereotypic picture of “Apartheid medicine” in Sout Africa–perhaps an inevitable consequence of living in this society–I am aware that in taking broad view I risk offending colleagues by portraying a somewhat monolithic image of America medicine and bioethics. This is certainly not my intention and I regret any offense I may cause i my attempt to provoke greater interest in the pervasiveness of exploitation and in the symbolic and material influence of the U.S. medical and bioethics enterprises on a global scale.
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