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Doctors and Ethics, Morals and Manuals
- Edmund D. Pellegrino, MD;
- Arthur Caplan, PhD; and
- Susan Dorr Goold, MD
- Center for Biomedical Ethics; Washington, DC 20007 University of Pennsylvania; Philadelphia, PA 19104 University of Michigan Medical School; Ann Arbor, MI 48109 Grant Support: In part by the Department of Veterans Affairs and the Picker-Commonwealth Scholars Program (Dr. Goold). Current Author Addresses: Dr. Pellegrino: Center for Clinical Bioethics, 4000 Reservoir Road, NW, #D-238, GUMC, Washington, DC 20007.
We invited an ethicist from each of three generations to review the fourth edition of the American College of Physicians Ethics Manual. Each was asked to consider the role of the professional society in promulgating an ethics code as the medical profession approaches the next century. Each was also asked to focus on a specific issue: the formal field of bioethics in historical context-that is, where we have come from; how ethics codes are regarded by those outside the profession-where we are now; and ethics in a changing practice environment-where we are going. The result is a thought-provoking set of commentaries from various perspectives. We think that they enrich our understanding of the new edition of the Manual and will usefully inform subsequent editions.
Lois Snyder, JD
ACP Counsel for Ethics and Legal Affairs
Lloyd W. Kitchens Jr., MD
Chair, ACP Ethics and Human Rights Committee
Frank Davidoff, MD
Editor
The Past as Prologue
Dr. Edmund D. Pellegrino: Thirty-five years ago, medical ethics entered an era of unprecedented change [1]. The rapidity of this change is reflected in the fact that the American College of Physicians has issued a fourth edition of its Ethics Manual in slightly more than a decade. How many more editions there will be, or what shape they will take, we do not know-we only know that there will be many.
Such rapid change is worrisome both to traditionalists and modernists. With each change, the former are concerned about losing the best from the past, and the latter, about not enough change from the past. Both need to be reminded that changes will continue to occur. What must not change is the moral heart of medicine, that which gives the profession its ethical identity-the primacy of the welfare of the patient.
The new manual must be examined keeping in …
