The foundational ideas of the limits of science and medical ethics goes back a very long way and as it has evolved over the centuries, certain laws, rules, regulations and taboos have been put in place to protect the human race from that sometimes blurred line between scientific discovery and human existence. Medical ethics created a system, bound by the ideals of many that came before them to control this blurring and attempt to stand between sciences desire to discover and the public and individual's desire to remain safe and in control of one's own body. A long time medical ethicist discusses the history of medical ethics as one that was founded on the principles of the ancients, but that has now become one where medical ethicists are demanding concrete answers, even laws to guide and demand decisions regarding medical ethics be enforced. "My new colleagues were polite enough, to be sure, and tolerant. But they were telling me of their urgencies and they were asking me to demonstrate how moral principle and moral theory connected realistically to the examining room and the hospital bed."
Radest 4) According to some physicians and ethicists this can equate to a faltering of tradition, where the study of ethics has become a concrete desire for concrete answers and of coarse the answers given are not always in agreement, of all parties.
As the twenty-first century dawns, the Hippocratic tradition is ailing. According to the physician and ethicist Edmund D. Pellegrino of Georgetown University, it remains "the moral backdrop against which most American and British physicians made, and still make, their ethical choices." 56 However, the tradition has been under sustained attack for more than twenty years and is in acute danger of collapse.
Though this would seem a dire warning of the failing of medical ethics, most individuals would say this is not the case, in fact many would say that the concrete nature of the new science of ethics and bioethical practice. The change in the manner in which researchers see ethics, not as a reflection of what the public/gods will tolerate, in conjunction with the old mantra' "do no harm" has become a systematic exercise attempting to concretely answer questions such as, when does a person really die? The debate surrounding the different definitions of death has become of profound importance in the medical community as technology has reached such a stage that it can now take from one and give to another, to save a life, through the loss of another.
Is brain dead the same as really dead? Of course not!... Brain-death, in my opinion, is simply a futility judgment that has gained widespread acceptance in the medical community.... After all, this brain-dead patient is not a cold stiff corpse but rather a young, warm body with a chest that rises and falls with every artificial breath. 9
The value of answering these questions in a concrete manner is seen by many as important work, as the world attempts to detail moral guidelines and demands for action, that protect the interests of the individual and the greater society. The inherent concern is that like the new definitions of life and death and the critical questions of who to protect, the stakeholder of the hospital, the physicians legal interest and/or the patients wishes is also a question as old as ethics, that even the philosophers could not answer. The legalistic environment in which the development of medical ethics committees began is awash with far more questions than answers, as even law is a living evolving thing.
The increase of rights "talk" parallels the ability of modern scientific medicine genuinely to effect cures. In other words, when real benefits are available, then a right to those benefits becomes a relevant expectation. The fear of harm is similarly enlarged to include greater concern about risks and violations. Claims for, as with access to health care or to new technologies, and claims against, as with negligence or wrongful life, lead to the assertion of a generalized right to "best available" care. However, in articulating rights, moral discourse tends toward legalistic discourse, that is, to a language of duties, violations, and punishments. So it is not surprising that the courts become a point of last resort for the moral dilemma.
The evolving nature of medical ethics is seen by some as a progressive movement to protect rights, in a legal and ethical manner and others as a way to take those same rights away from the individual to make life determining decisions about care and in a sense even the value of human life.
The debates will likely rage on for centuries, just as they always have but the debates now take on a different meaning. Codification of rights and responsibilities as well as economically minded assessments of the greater good will continue to be the basis of arguments for and against medical intervention, as well as dominate the ethical practice of research. It is clearly no longer a time when a family physician can educate a well-known patient about their prognosis, medical options and collectively make a decision about the rout of treatment. While some view a more legal minded approach to ethical practice as progress that is overdue, it is likely that demanding more concrete answers, mirroring a much more technical medical practice than has even been seen before, will alter even some of the most basic processes of medical decision making. This trend comes in the wake of demands for authoritative protection of the right to be informed, as well as the right to demand or decline treatment but it also complicates ethical practice as ethics like so many other philosophical issues is intangible, and context is often essential to the determination of right and wrong, by anyone's standard.
Adler, Robert E. Medical Firsts: From Hippocrates to the Human Genome. Hoboken, NJ: Wiley, 2004.
Harvey, William. Lectures on the Whole of Anatomy: An Annotated Translation of Prelectiones Anatomiae Universalis. Trans C.D. O'Malley, F.N.L. Poynter, and K.F. Russell. Berkeley, CA: University of California Press, 1961.
Jecker, Nancy S. "Knowing When to Stop: The Limits of Medicine." The Hastings Center Report 21.3 (1991): 5.
Marble, Annie Russell. The Nobel Prize Winners in Literature. New York: D. Appleton, 1925.
Radest, Howard B. From Clinic to Classroom Medical Ethics and Moral Education. Westport, CT: Praeger Publishers, 2000.
Serafini, Anthony. The Epic History of Biology. New York: Plenum Press, 1993.
Shelley, Mary Wollstonecraft. Frankenstein or, the Modern Prometheus. New York: Collier Books, 1961.
Singer, Jane. "The Fiend in Gray: Washingtonians hit with biological weapons* Mass fear and civilian casualties in New York * Plots for launching toxic chemicals in the air * the strange saga of Civil War terrorism." The Washington Post Sunday, June 1, 2003; Page W18 at http://www.washingtonpost.com/ac2/wp-dyn/A50445-2003May28?language=printer
Smith, Wesley J. The Assault on Medical Ethics in America. San Francisco,…