Thoughts from a senior surgeon with an interest in ethics

Abstract

The article by Chu et al 1 itself, I believe, is not helpful because it does what we in clinical ethics have attempted to avoid, and that is the conundrum of battling philosophies that are interesting to discuss, but of little help in a clinical situation. Remember, this was the impetus for Mark Siegler and Edmund Pellegrino 2 to create the specialty of clinical medical ethics in 1975, and then to use this approach in 1997 to address the Nazi doctors and Nuremberg. 3 Until that time, when clinicians confronted such challenges, they had to rely on clergy or philosophers from their adjacent universities, folks who had never confronted a patient in distress.I am especially troubled by the concept of doing good for society rather than for an individual patient. In Leo Alexander's pivotal article, "Medicine under a dictatorship" in the New England Journal of Medicine, 4 he explained that this was the plea to physicians from the Nazis. As he explains, only the Dutch physicians saw through this ruse and made the stand for their individual patients.