Pols logo

Professional Ethics

Today, enormous value is attached to the partly dysfunctional physicochemical aspects of illness and being ill, so of illness as an ontological concept. At the same time, a different, integral aspect of medicine is retreating from focus these last decades. This aspect is medical ethics. Medical ethics deals with matters such as confidentiality, privacy, loyalty to the patient, and respecting that which the patient considers to be in his own interest. In other words, ethics are losing attention because physicians are interested in studying physical, “objective” phenomena.

The state has expressly reserved a place for itself in the field of medical ethics by means of legislation. I will say more about this in the next section.
Many outside parties have become interested in and want to know more about what is discussed confidentially in the doctor’s office or during a medical consultation. The state is interested due to its constant preoccupation with keeping down the costs of health care, and making it controllable. Employers, too, want to know what is going on, and where they stand with their ill employee. Large firms employ in-house physicians and controlling medical services through which employers seek medical information about their employees. Of course medical insurance companies have a financial interest in this information. In the United States this development has been experienced extensively through managed care.

The physician is bound to professional confidentiality since antiquity. This prohibits him from passing information about the nature of his patient’s disorders to third parties. However, the physician’s adherence to this confidentiality is becoming increasingly unacceptable to outside parties. The growing tendency to water down patient confidentiality seems nowhere near culmination.

Decades ago a book containing medical-ethical rules, published and regularly revised by the Dutch Alliance for the Art of Medicine (Nederlandse Maatschappij ter Bevordering der Geneeskunst), turned into a loose-leaf publication. By now it has been out of print for years. There is relatively little about medical ethics on the Internet.

The relative disinterest of physicians in medical-ethical matters is also expressed in the increasingly more prominent actions of professional ethicists in the field of health care. In itself there is no objection to this. Medical advancement engenders a number of serious and difficult to solve dilemmas. The scrutiny of professional ethicists in these matters is commendable. Yet closer contact between physicians and ethicists is desirable, to keep the ethicist abreast of the practical circumstances and catch-22s that physicians face. Such close contact, however, hardly seems to materialize.

Fulford attempted to bring medical ethics back into focus by proposing Value Based Medicine (VBM) in addition to EBM. VBM is a system of values and ethical foundations that determines the relationship between physician and patient in addition to diagnostics. In this way he attempts to place ethics alongside positivistic science and draw attention to it. The need to do this illustrates how undervalued ethics have become in daily practice. The same holds true for the ethical dilemmas concerning involuntary commitment, which will be discussed below.

Note that interest in medical ethical matters has not waned evenly across the different branches of medicine. Obvious exceptions are the ethics involved in more recent, controversial developments, e.g. abortion, euthanasia, and highly technologized fertility treatments.

Szasz has repeatedly addressed ethical problems such as patient confidentiality and voluntariness. He continues to do so, recently in particular in Liberation by Oppression. His position on these medical ethical matters is conservative, meaning that he advocates preserving old, received values. He condemns new developments quite critically. Inasmuch as medical ethics are rapidly becoming marginalized, his views deserve every support.Today, enormous value is attached to the partly dysfunctional physicochemical aspects of illness and being ill, so of illness as an ontological concept. At the same time, a different, integral aspect of medicine is retreating from focus these last decades. This aspect is medical ethics. Medical ethics deals with matters such as confidentiality, privacy, loyalty to the patient, and respecting that which the patient considers to be in his own interest. In other words, ethics are losing attention because physicians are interested in studying physical, “objective” phenomena.

The state has expressly reserved a place for itself in the field of medical ethics by means of legislation. I will say more about this in the next section.
Many outside parties have become interested in and want to know more about what is discussed confidentially in the doctor’s office or during a medical consultation. The state is interested due to its constant preoccupation with keeping down the costs of health care, and making it controllable. Employers, too, want to know what is going on, and where they stand with their ill employee. Large firms employ in-house physicians and controlling medical services through which employers seek medical information about their employees. Of course medical insurance companies have a financial interest in this information. In the United States this development has been experienced extensively through managed care.

The physician is bound to professional confidentiality since antiquity. This prohibits him from passing information about the nature of his patient’s disorders to third parties. However, the physician’s adherence to this confidentiality is becoming increasingly unacceptable to outside parties. The growing tendency to water down patient confidentiality seems nowhere near culmination.

Decades ago a book containing medical-ethical rules, published and regularly revised by the Dutch Alliance for the Art of Medicine (Nederlandse Maatschappij ter Bevordering der Geneeskunst), turned into a loose-leaf publication. By now it has been out of print for years. There is relatively little about medical ethics on the Internet.

The relative disinterest of physicians in medical-ethical matters is also expressed in the increasingly more prominent actions of professional ethicists in the field of health care. In itself there is no objection to this. Medical advancement engenders a number of serious and difficult to solve dilemmas. The scrutiny of professional ethicists in these matters is commendable. Yet closer contact between physicians and ethicists is desirable, to keep the ethicist abreast of the practical circumstances and catch-22s that physicians face. Such close contact, however, hardly seems to materialize.
Fulford attempted to bring medical ethics back into focus by proposing Value Based Medicine (VBM) in addition to EBM. VBM is a system of values and ethical foundations that determines the relationship between physician and patient in addition to diagnostics. In this way he attempts to place ethics alongside positivistic science and draw attention to it. The need to do this illustrates how undervalued ethics have become in daily practice. The same holds true for the ethical dilemmas concerning involuntary commitment, which will be discussed below.

Note that interest in medical ethical matters has not waned evenly across the different branches of medicine. Obvious exceptions are the ethics involved in more recent, controversial developments, e.g. abortion, euthanasia, and highly technologized fertility treatments.

Szasz has repeatedly addressed ethical problems such as patient confidentiality and voluntariness. He continues to do so, recently in particular in Liberation by Oppression. His position on these medical ethical matters is conservative, meaning that he advocates preserving old, received values. He condemns new developments quite critically. Inasmuch as medical ethics are rapidly becoming marginalized, his views deserve every support.
Previous
Next
Table of Contents