Medical ethics was once concerned with the professional obligations of physicians, spelled out in codes of conduct such as the ancient Hippocratic oath and elaborated by contemporary professional societies. Today this subject is a broad, loosely defined collection of issues of morality and justice in health, health care and related fields. The term ‘bioethics’ is often used interchangeably, though it is also used with its original broad meaning, which included issues in ecology.
The range of concerns grouped under ‘medical ethics’ begins with the relationship of doctor to patient, including such issues as consent to treatment, truth-telling, paternalism, confidentiality and the duty to treat. Particular moral uncertainty is engendered by contexts which demand divided allegiances of physicians, such as medical experimentation on human subjects, public health emergencies and for-profit medicine. Issues in medical ethics arise in every stage of life, from the fate of defective newborns to the withholding of life-sustaining therapies from the very old. Medical practices with patients who may not be competent to make their own medical decisions, including paediatrics and psychiatry, raise a distinctive set of ethical issues, as does medical genetics, which involves choices affecting family members, future individuals and offspring in utero. In recent years, medical ethics has broadened its focus beyond the individual physician or nurse to include the organization, operation and financing of the health care system as a whole, including difficult theoretical and practical uncertainties regarding the fair allocation of health care resources.
Medical ethics is at once a field of scholarship and a reform movement. The latter has campaigned in many countries on behalf of patients’ rights, better care of the dying and freedom for women in reproductive decisions. As a field of scholarship, medical ethics addresses these and many other issues, but is not defined by positions taken on any of them. Though ethicists often favour an emphasis on informed consent, oppose paternalism, urge permission to end life-sustaining therapy (or choose suicide) and seek protection of human subjects of experimentation, a diversity of viewpoints finds expression in the medical ethics literature.
