Pharmacology, our word for the science of therapeutic drugs, derives from the ancient Greek. Yet the Hippocratic physicians were mistrustful of drugs. Their word, pharmakon, referred originally to magical potions, evil spells, and poisons. When Circe turns the men of Odysseus into pigs, she does so by giving them a pharmakon.
Herein lies the paradox: joined to the potential to do great good is the potential to do great harm.
Practicing physicians make dozens of decisions regarding pharmacological therapy each day. A decision becomes ethical insofar as it must select among conflicting values, especially if these reflect divergent interests of different stakeholders. That is, ethics is invoked not when the clear-cut choice is A, but when the choices are A or B, each with its pros and cons.
What kinds of ethical decisions must a physician make? What goes into the choice? What are the criteria, implicit or explicit, according to which one chooses? Reflection on the daily practice of medicine reveals a nuanced set of questions.
DO I TREAT THIS PATIENT WITH A MEDICATION?
Visitors to doctors' offices will frequently, perhaps usually, leave with a prescription for medication. This is a complex transaction that has become deeply imbedded in the expectations and behavior of both the patient and the physician. It must be understood as a phenomenon of contemporary Western biomedicine, our present healthcare construct, defined in large part by mechanistic concepts of health and disease.