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Medical Ethics: Common or Uncommon Morality?

Published online by Cambridge University Press:  02 June 2020

ROSAMOND RHODES
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Abstract

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the medical profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach.

Keywords

common moralitymedical ethicsmedical professionalismuncommon morality
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 3 , July 2020 , pp. 404 - 420
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

“Dissecting Bioethics,” welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss a suitable topic, contact Matti Häyry at matti.hayry@aalto.fi and Tuija Takala at tuija.takala@helsinki.fi.

Acknowledgments: The arguments presented in this paper for medical ethics being distinct and different from common morality, and the tables that are included, were developed and explained in greater detail in my forthcoming book, The Trusted Doctor: Medical Ethics and Professionalism, Oxford University Press, 2020. Some of this material was also incorporated in an article with a somewhat different focus, “Why not common morality?” Journal of Medical Ethics, December 2019. I am grateful to those who pressed me with their questions when I presented some of this material at the Cambridge Consortium on Bioethics, Paris France, on June 28 2019. Sections of this paper reflect my thoughts in response to their challenges.

References

Notes

1. Moore, GE. Ethics. New York, NY: H. Holt; 1912Google Scholar.

2. Baumrin, BH. The Autonomy of Medical Ethics: Medical Science vs. Medical Practice. Metaphilosophy 1985;16,2&3: 93–102CrossRefGoogle Scholar.

3. Here I am using the terms ‘rational,’ ‘reasonable,’ and ‘overlapping consensus’ in the technical sense that John Rawls ascribes. Rawls, J.Political Liberalism. New York, NY: Columbia University Press; 1993Google Scholar.

4. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 7th ed. New York, NY: Oxford University Press; 2013Google Scholar.

5. Gert, B, Clouser, KD, Culver, CM. Bioethics: A Return to Fundamentals. New York, NY: Oxford University Press; 1997Google Scholar.

6. Gert, B, Culver, CM, Clouser, KD. Bioethics: A Systematic Approach. New York, NY: Oxford University Press; 2006CrossRefGoogle Scholar.

7. Jonsen, AR, Siegler, M, Winslade, WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 8th ed. New York, NY: McGraw-Hill Education; 2015Google Scholar.

8. Clouser, KD, Bioethics. In: Reich, W., ed. Encyclopedia of Bioethics, 1st ed. New York, NY: The Free Press; 1978:532–42Google Scholar.

9. See note 4, Beauchamp, Childress 2013:407–8.

10. Beauchamp, TL. The compatibility of universal morality, particular moralities, and multiculturalism. In: Teas, W, Gordon, J, Renteln, AD, eds. Global Bioethics and Human Rights. Plymouth, UK: Rowan & Littlefield; 2014: 34Google Scholar.

11. See note 6, Gert et al. 2006, at 34.

12. See note 6, Gert et al. 2006, at 36.

13. See note 6, Gert et al. 2006, at 208.

14. See note 6, Gert et al. 2006, at 89.

15. I take the ethics of medicine to extend broadly and inclusively across the several medical professions and apply to all medical professionals, such as, for example, nurses, physicians, pharmacists, genetics counselors, physical therapists, social workers, chaplains, bioethicist, and so on.

16. See note 4, Beauchamp, Childress 2013, at 7.

17. See note 4, Beauchamp, Childress 2013, at 46.

18. See note 4, Beauchamp, Childress 2013, at 6.

19. See note 4, Beauchamp, Childress 2013, at 8.

20. See note 4, Beauchamp, Childress 2013, at 155.

21. See note 6, Gert et al. 2006, at 92.

22. See note 6, Gert et al. 2006, at 43.

23. See note 6, Gert et al. 2006, at 36.

24. See note 6, Gert et al. 2006, at 36, and 12.

25. See note 6, Gert et al. 2006, at 222.

26. In the ethics literature, roles and professions are often lumped together (e.g., Gibson, K. Contrasting role morality and professional morality: implications for practice. Journal of Applied Ethics 2003;20(1):s17–29Google ScholarPubMed.

27. Role morality and ‘voluntarism’ are discussed by numerous authors, e.g., Hardimon, MO. Role obligations. The Journal of Philosophy 1974;91(7):333–63CrossRefGoogle Scholar; Simmons, AJ. External justifications and institutional roles. The Journal of Philosophy 1996;93(1):28–36CrossRefGoogle Scholar; Cane, P. Role responsibility. The Journal of Ethics 2016;20(1–3):279–98CrossRefGoogle Scholar; Baril, A. The ethical importance of roles. The Journal of Value Inquiry 2016;50(4):721–34CrossRefGoogle Scholar; MacKay, D. Standard of care, institutional obligations, and distributive justice. Bioethics 2015;29(4):262–73CrossRefGoogle ScholarPubMed; Stern, RA. “My station and its duties”: Social role accounts of obligation in green and bradley. In: Ameriks, K, ed. The Impact of Idealism: Volume 1, Philosophy and Natural Sciences. New York, NY: Cambridge University Press; 2013;299–322CrossRefGoogle Scholar.

28. Sociologists like Talcott Parson define ‘profession’ by cataloging what they observe about professions. Parsons, T. Essays in Sociological Theory, Revised ed. Glencoe, IL: The Free Press; 1993:372Google Scholar. The literature on professions largely follows the lead of those sociologists. (e.g., Latham, SR. Medical professionalism: a parsonian view. Mount Sinai Journal of Medicine 2002; 69(6):363–9Google ScholarPubMed.

29. Alan Tapper and Stephan Millet and also W. P. Metzger take positions that are, in some respects, similar to mine on this issue. Tapper, A, Millett, S. Revisiting the concept of a profession. Research in Ethical Issues in Organisations 2015; 13:1–18CrossRefGoogle Scholar. Metzger, W P.What is a profession. College & University 1976; 52(1):42–55Google Scholar.

30. This point was noted by Dr. Daniel Moros in conversation.

31. Here I am distinguishing professional ethics from both common morality and what has been called ‘role morality.’ It is because a profession is permitted special powers, privileges, and immunities that it requires distinctive rules for the regulation of those distinctive powers, privileges, and immunities.

32. Pellegrino, ED. Professionalism, profession and the virtues of the good physician. The Mount Sinai Journal of Medicine 2002;69(6):378–84Google ScholarPubMed.

33. On this point, I regard my position to be in line with similar stands taken by a handful of others including Hippocrates, Thomas Percival, John Gregory, and more contemporary authors such as David Thomasma, Edmund Pellegrino, Bernard Baumrin, Robert Baker, Lance Stell, and Lawrence McCullough.

34. American Board of Medical Specialties. Ethics and Professionalism Committee–ABMS Professionalism Work Group. ABMS Professionalism definition.

35. Wear, D, Kuczewski, MG. The professionalism movement: can we pause? American Journal of Bioethics 2004;4:1–10CrossRefGoogle ScholarPubMed.

36. Hafferty, F, Papadakis, M, Sullivan, W, Wynia, MK. The American Board of Medical Specialties Ethics and Professionalism Committee Definition of Professionalism. Chicago, IL: American Board of Medical Specialties; 2012Google Scholar.

37. Birden, H, Glass, N, Wilson, I, et al.Defining professionalism in medical education: a systematic review. Medical Teacher 2014;36(1):47–61CrossRefGoogle ScholarPubMed.

38. Parsi, K, Sheehan, MN. Two faces of professionalism. Healing as vocation: A medical professionalism primer. Langham, MD: Rowman & Littlefield; 2006Google Scholar.

39. Pavlica, P, Barozzi, L. Medical professionalism in the new millennium: A physicians’ charter. Lancet 2002; 359:520–2Google Scholar.

40. Swick, HM. Towards a normative definition of medical professionalism. Academic Medicine 2000;75:612–6CrossRefGoogle Scholar.

41. Doukas, DJ, McCullough, LB, Wear, S, Lehmann, LS, Nixon, LL, Carrese, JA, et al.The challenge of promoting professionalism through medical ethics and humanities education. Academic Medicine 2004; 88: 1624–9CrossRefGoogle Scholar.

42. Cohen, JJ. Professionalism in medical education, an American perspective: From evidence to accountability. Medical Education 2004;40:607–17CrossRefGoogle Scholar.

43. Inui, TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges; 2003Google Scholar.

44. Stern, DT, Papadakis, M. The developing physician—becoming a professional. New England Journal of Medicine 2006; 355, 17:1794–9CrossRefGoogle ScholarPubMed.

45. Irvine, D. The Doctors’ Tale: Professionalism and Public Trust. Oxon, UK: Radcliffe Publishing Ltd; 2003Google Scholar.

46. Kao, A, ed. Professing Medicine: Strengthening the Ethics and Professionalism of Tomorrow’s Physicians. Chicago, IL: American Medical Association; 2001Google Scholar.

47. Cruess, SR, Johnston, S, Cruess, RL. Professionalism for medicine: Opportunities and obligations. Medical Journal of Australia 2002;177(4):208–11CrossRefGoogle ScholarPubMed.

48. Cruess, RL, Cruess, SR. Expectations and obligations: Professionalism and medicine's social contract with society. Perspectives in Biology and Medicine 2008;51(4):579–98CrossRefGoogle ScholarPubMed.

49. Brody, H, Doukas, D.Professionalism: A framework to guide medical education. Medical Education 2014;48:980–7CrossRefGoogle ScholarPubMed.

50. Karches, KE, Sulmasy, DP. Justice, courage, and truthfulness: virtues that medical trainees can and must learn. Family Medicine 2016;48(7):511–6Google ScholarPubMed.

51. Pelligrino, ED, Thomasma, DC. The virtues in medical practice. New York, NY: Oxford University Press; 1993Google Scholar.

52. Wynia, MK, Papadakis, MA, Sullivan, WM, Hafferty, FW. More than a list of values and desired behaviors: A foundational understanding of medical professionalism. Academic Medicine 2014;89 (5):712–4CrossRefGoogle ScholarPubMed.

53. National Board of Medical Examiners. Embedding professionalism in medical education: Assessment as a tool for implementation. 2002.

54. Wilkinson, TJ, Wade, WB, Knock, LD. A blueprint to assess professionalism: Results of a systematic review. Academic Medicine 2009;84:551–8CrossRefGoogle ScholarPubMed.

55. Irby, DM. Constructs of Professionalism. In: Byyny, RL, Paauw, DS, Papadakis, M, Pfeil, S, eds. Medical Professionalism Best Practices: Professionalism in the Modern Era. Aurora, CO: Alpha Omega Alpha Honor Medical Society; 2017:9–14Google Scholar.

56. Arnold, L. Assessing professional behavior: Yesterday, today, and tomorrow. Academic Medicine 2002; 77:502–15CrossRefGoogle ScholarPubMed.

57. This example was provided by Dr. Ronald Grelsamer.

58. Here I am drawing on Scanlon, TM. What we Owe to Each Other. Cambridge, MA: Belknap Press of Harvard University Press; 1998Google Scholar.

59. See note 6, Gert et al. 2006, at 11.

60. See note 4, Beauchamp, Childress 2013, at 396.

61. See note 4, Beauchamp, Childress 2013, at 374.

62. See note 4, Beauchamp, Childress 2013, at 374.