Guiding the moral vision of medicine
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2012)

In a profession governed by ethics, be they clinical, research or publication, how often do we hear an urgent call for a bioethicist? Indeed, in our work as clinicians, researchers, and editors we usually convince ourselves that we understand enough about ethical issues to get by without assistance. Calling for an urgent ethical opinion in the middle of an emergency procedure will probably never happen. Yet, it's a pity we don't seek the advice of specialists in bioethics more often, for when we do need a bioethicist we usually can't find one.

Part of the problem, of course, is trying to understand what the remit of a bioethicist should be? Is it purely advisory or should bioethicists become more central to our work routines, taking a lead? For example, when a doctor whose ethical standards have been questioned is nominated as president-elect of the World Medical Association, a farce described by Chattapodhyay and colleagues1, should the ranks of bioethicists raise hell at such an outrageous triumph for corruption? Should they be held responsible if the nominee progresses unchallenged?

Perhaps not, but the crux of the issue is whether or not the healthcare professions are complacent in their response to ethical concerns. It seems less troublesome to ignore corrupt practices in their various guises than embark upon a moral crusade, with professional and personal consequences, to expose wickedness.

Financial, academic, political, and religious competing interests influence us to lower our ethical standards and judge that an enterprise is ethically sound. According to Chattapodhyay and colleagues, bioethicists are as ensnared by competing interests as the rest of us; a reality that allows bioethicists to ignore the important battle against corruption in healthcare, including in medical politics. Corruption, the authors argue, is an important but overlooked medical issue.

Interpretation of ethical issues is also culturally bound. One doctor's corruption is another doctor's cultural norm. A GMC-funded study on the experiences of overseas trained doctors in the UK neatly demonstrates the ethical and legal difficulties that these doctors face.2 ‘Back home there is an entirely different situation,’ explains one overseas trained doctor. ‘In my country if the patient is diagnosed with ovarian cancer, we will never go and tell the patient that you have ovarian cancer. We would tell the relative. Here the practice is entirely different.’

To date, the ethical acclimatization of this important group of doctors has been ignored, which is more a failing of our regulatory process than another sin to be laid at the door of bioethicists. Indeed, wherever we look our ethics fail us. It might be in our dismal efforts to construct meaningful clinical trials of surgical procedures3 or our disregard for the mental health of our ageing population.4 Bioethics is intended to be pro-active but it rarely is. We can probably agree that it should be more involved in daily practice, but the insurmountable challenge appears to be ensuring that bioethicists play a role in what Chattapodyay and colleagues describe as ‘guiding the moral vision of medicine.’ History will not forgive, they say, any failure in moral duty.