Ethicist Ed Pellegrino foresees a divided road ahead for medicine
CHICAGO--"As I look into the future, I think we will undoubtedly be a much more divided profession than we are now. We will not have again an ethic which will bind all of us," medical ethicist Edmund D. Pellegrino, MD, predicted recently. There will be "those who choose to follow the moral imperative--the high ground--and those who become purely businessmen and entrepreneurs," he said.
Dr. Pellegrino, the John Carroll Professor of Medicine and Medical Ethics at Georgetown University in Washington, spoke to doctors of many specialties at the April 13-15 conference "Contemporary Health Care and the Ethic of Medicine: What is a Physician to Do?" The meeting was sponsored by the Council of Medical Specialty Societies (CMSS) and the American Academy of Otolaryngology-Head and Neck Surgery.
Dr. Pellegrino's presentation was one of several about ethical challenges facing medicine in the era of managed care. In addition, physician workgroups met several times to draft a new framework for ethical medical practice. The draft will be shared with CMSS member societies, including the AAFP, for input. CMSS will consider ratifying the resulting document this fall.
Two AAFP members participated in workgroups: Director Lanny Copeland, MD, of Albany, GA, and Leonard Fromer, MD, of Santa Monica, CA.
Of all the plenary presentations, Dr. Pellegrino's was the most sobering assessment of medical ethics today.
"Medical ethics at the present moment is in disarray," Dr. Pellegrino said. Medicine is in the midst of a serious moral malaise, one in which doctors aren't certain who and what they are, he said. Some have even asked him why they should have to respond to a higher standard of dedication and self-effacement than others in society.
To answer the question, Dr. Pellegrino reflected back on the "healing relationship" between the physician and patient, which he considers to be medicine's moral foundation. Physicians become physicians when they "raise their hands and take an oath of some kind--whatever it happens to be--which is a promise, a public declaration of commitment to a way of life characterized by certain ethical obligations," he said.
Physicians make that same kind of promise every time they engage a patient, he said. It's not a contract as some ethicists suggest, he said, because "how can there be a contract between individuals who are unequal one to the other, one dependent and vulnerable" because of illness? The physician makes a promise to help and invites the patient's trust--and must have the courage to say no when it's necessary, he said. "I think our profession is coming to that point in its history when we must say about certain things, 'we will not'--and we will have to do it collectively. Not because it violates our prerogatives. No, it goes back to the fact that we are in a relationship that requires of us that there are times we must say no," he said.
"Courage, I think, was what was lacking too many times in the past 30-40-50 years in Europe and this country, when our profession became corrupted by acceding to political and economic forces," he added.
Despite his sobering assessment, Dr. Pellegrino said there was much physicians could do today. For example, those gathered for the conference could affirm the doctor-patient relationship as the foundation of medical ethics.
"We have enormous moral power, if we but use it," he said.
- FP Report is published by the AAFP News Department.