SYMPOSIUM: HEROES—OR JUST DOING THEIR JOB?

Are doctors altruistic?

W Glannon¹, L F Ross²

¹ Biomedical Ethics Unit, McGill University, Montreal, Canada
² Department of Pediatrics and MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA

Correspondence to:
Correspondence to:
Dr Lainie Friedman Ross, Department of Pediatrics and MacLean Center for Clinical Medical Ethics, University of Chicago, 5841 S Maryland Ave, MC 6098, Chicago, IL 60637, USA;
lross@uchicago.edu

Revised version received 6 July 2001

Accepted 11 July 2001

There is a growing belief in the US that medicine is an altruistic profession, and that physicians display altruism in their daily work. We argue that one of the most fundamental features of medical professionalism is a fiduciary responsibility to patients, which implies a duty or obligation to act in patients' best medical interests. The term that best captures this sense of obligation is "beneficence", which contrasts with "altruism" because the latter act is supererogatory and is beyond obligation. On the other hand, we offer several examples in which patients act altruistically. If it is patients and not the doctors who are altruistic, then the patients are the gift-bearers and to that extent doctors owe them gratitude and respect for their many contributions to medicine. Recognising this might help us better understand the moral significance of the doctor-patient relationship in modern medicine.

Keywords: Altruism; beneficence; duty; doctor-patient relationship; professionalism

The first 150 words of the full text of this article appear below.

In a recent review of the advances in medicine in the twentieth century, the editors of the New England Journal of Medicine asserted that "medicine is one of the few spheres of human activity in which the purposes are unambiguously altruistic".¹ This assertion affirmed the conviction of the American Board of Internal Medicine, which, in its Project Professionalism, stated that "altruism is the essence of professionalism. The best interest of patients, not self-interest, is the rule".² But the pervasive belief among medical professionals that they are essentially altruistic is misguided because it depends on a misunderstanding of the meaning of "altruism".

Perhaps the most fundamental feature of medical professionalism is fiduciary responsibility to patients, which implies a duty or obligation to act in patients' best medical interests. The term that best captures this sense of obligation is "beneficence", which refers to the moral obligation to act for the benefit of . . . [Full text of this article]

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