Perspective: Redrawing the Ethics Map

Reflections on Clinical Ethics

“…Starting as a dogmatic, paternalistic physician, I have with experience and time become less arrogant; less certain I know what is "best", and more concerned about the effects of these treatment decisions on society. My concerns have been deepened by an article by Lamm [6] emphasizing the societal costs of the decisions we make. I believe that I have become more humble and less certain of the ingredients in the decision-making process.…”

Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent

“…In 1999, Richard Lamm,3 the former governor of Colorado, eloquently stated the ethical dilemmas and fiscal problems of our current healthcare system: “Individual-centered ethics,” he maintains, “are incompatible with maximisation of the social good,…[We]…cannot have unlimited healthcare with limited premiums and limited taxes… As a society we must begin to re-think our priorities in healthcare”. As the administration begins to expand healthcare for all, perhaps the time has come for that redrawing.…”

Caring for students: A teacher's view

“…The health care system of which they form a part often operates on the teleological (ends) framework, because it is concerned with all those who form part of the patient pool. In this analysis, consideration of economic issues is inescapable [4]. In some sense, similar problems emerge with respect to education.…”

“…Often, as is the case with public health measures, these obligations conflict. Lamm [4] notes that “the ‘moral unit’ of a physician is the patient, while the moral unit of public policy is all citizens.” He argued that one “cannot build an ethical code for a publicly funded system around assumptions ‘that cost is never a consideration.’” A similar dilemma faces those educators who operate under similar conditions.…”