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Internal morality of medicine and physician autonomy
  1. Stephen McAndrew
  1. Department of Philosophy, University at Buffalo, The State University of New York, Buffalo, New York, USA
  1. Correspondence to Stephen McAndrew, Department of Philosophy, University at Buffalo - The State University of New York, Buffalo NY 14260, USA; sm76{at}


Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls’s distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. In opposition to Christopher Boorse, it is argued that medicine is pathocentric and that physicians exercise skills in treating pathologies. The autonomous treatment of pathologies is justified because non-interference with physicians will lead to greater treatment of pathologies and so benefit society. Finally, the analysis of medicine as the autonomous exercise of skills in treating pathologies yields the rule that physicians not be forced to cause pathologies.

  • autonomy
  • philosophy of the health professions
  • moral and religious aspects
  • conscientious objection

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  • Contributors SMA is the sole author and contributed all ideas and performed all research for this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.