• ethics

Two positions that Rosamund Rhodes puts forward are the proper starting point for this commentary:

1. Medical ethics based on the common morality that uses a body of abstract principles or rules are not ‘an adequate and appropriate guide for physicians’ actions’.

2. We need, but do not have, a true professional medical ethics for physicians, which must be ‘distinctly different’ from ethics based on common morality.

I will argue that both positions are mistaken.

Rhodes does not analyse what she means by a professional ‘medical ethics’ and does not supply content for what she calls ‘medical professionalism’. ‘Common morality‘ is also not given a precise meaning. However, I set aside these problems of conceptual clarity and concentrate on a paradigm case of professional ethics for physicians (and others) in interactions with patients. My example is The Belmont Report.

Belmont is almost certainly a document that, in the USA, has for four decades been highly influential on physicians, especially physicians engaged in clinical research. It is not merely research ethics. In full satisfaction of the American Board of Medical Specialties’ ‘definition of medical professionalism’, The Belmont Report puts forward a system of ethical principles showing that physicians and other health professionals must conduct research in the service of the public interest and the well-being of patient–subjects. The Belmont Report also satisfies the earlier delineated conditions of medical professionalism in the American Board of Internal Medicine’s ‘Physician Charter’, which are stated in terms of the ‘fundamental principles’ of the primacy of patient welfare, patient autonomy and social justice.¹ ,1–3

Belmont more than satisfies these conditions of medical professionalism. Indeed Belmont may well be the source of the principles …