normative ethics: a type of ethics that formulates ethical theories;
and specifies behaviors that support ethical standards.
1-6.
ROLE OF THE MEDICAL ETHICIST
a. Before 1970, medical ethics as a formal field did not exist. The medical
profession was considered ethical by its very nature, with ethical dilemmas handled in
the privacy of the doctor-patient relationship. But the advances in medicine that gave
physicians dramatically increased power over life and death brought new challenges to
the profession. Issues once handled in the privacy of the doctor's office, such as the
extent of treatment of seriously deformed infants, became a matter of general public
interest and comment. With the difficult choices presented by modern medicine and
public exposure, the need arose for a way of sorting out underlying ethical principles in
order to make morally based decisions. A committee in Seattle, for example, choosing
candidates for kidney dialysis realized they needed help when they found themselves
choosing candidates based on supposed worth to society (men over women,
upstanding citizens over prostitutes, married people over singles). Another example
involves the advances in medical neonatology that result in premature and badly
handicapped infants surviving to face painful, difficult lives.
b. Medical ethicists are employed by hospitals to oversee conferences, conduct
teaching rounds and committee meetings. They help the health care team deal with
such ethical issues as: the right to choose treatment, the right to know who is treating
you, informed consent, confidentiality, treatment of severely handicapped infants, when
to withdraw or withhold treatment for an adult, and the right to die. The medical ethicist
meets with medical team members (working in highly sensitive areas) and senior faculty
members (some specializing in ethics, others in medicine) to work out some of the
difficult ethical dilemmas facing doctors today.
c. Sometimes the choices have been made, and the case is reviewed for
educational purposes. Other times a decision has yet to be made, with a life hanging in
the balance. The ethicist doesn't tell doctors what to do. Rather, he or she helps clarify
the problem, sorting out the underlying moral principles so that a consistent moral basis
for a decision can be developed. According to Ruth Macklin, Medical Ethicist In
Residence at Albert Einstein College of Medicine, "Sixty percent of medium and large
hospitals in the country have an ethics committee.... [They] make policy, [and] hear
cases.... Some 300 people identify themselves as clinical bioethics consultants--people
who are actively involved in ethics consultation in a medical setting. They may be
philosophers, doctors, nurses, lawyers, or clergy.
MD0066
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