Medicine, Ethics, and Philosophy
Relationship Between Bioethics and Medicine
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Medicine and ethics are by no means strangers - on the contrary, medicine started out as an aspect of early philosophy. What this meant was that was a close integration of medical expertise and medical ethics existed. Those who engaged in research and experiments to determine what could be done in the fight against ill health were also the ones who led the debate over what should be done in that struggle - a very different situation from what we have today where the two tasks tend most often to be separated.
This is, in fact, the central source of tension and disagreement in pretty much all debates in the field of medical ethics. On the one hand we have a system of medical technology and medical research which constantly pushes the boundaries of what doctors are capable of doing. Indeed, our medical capabilities today are so advanced that many would have been inconceivable even half a century ago.
On the other side is the question of what should be done. Just because we can transplant organs from one person to another, keep a person alive solely through the use of machines, and use genetic engineering to determine what type of child a couple will have, does that mean we actually should take such actions?
Of course, it shouldn't be assumed that such questions exhaust all of the questions which need to be addressed in medical ethics (although they are the questions we hear most about). There are many other issues which are essentially independent of technical issues, mostly involving the various responsibilities that a doctor has towards his or her patients. May a doctor pursue sexual relations with a patient? Must a doctor render medical assistance in any and all situations?
Most of the very early medical oaths and ethical treatises are focused exclusively upon exactly those issues of medical responsibilities and doctor/patient relationships. These are in many ways most fundamental to medical practice. and are often necessary for addressing other issues which deal with advancing medical technology and research. When asking whether a particular treatment should be done, we should first ask whether and how it benefits the patient.
This suggests that it is the doctor's responsibility towards the patient which comes first, the technical skills which come second. It also suggests that answering questions about whether and how certain treatments should be used must depend a great deal on the answers to questions about our general responsibilities to other human beings and about doctors' specialized responsibilities to people who are ill. If we try to separate the two, our answers to technological questions will not be adequate to the problems before us.
Unfortunately, these sorts of questions are made more difficult by the current separation in medicine of technical skills and philosophical education. Doctors today are, by training, more technicians than philosophers - and that's not inherently a bad thing, considering how much technical skill is required for modern medicine. At the same time, all of that skill must be tempered by wisdom and a strong understanding of both the general philosophical and specific ethical issues involved in the various aspects of their work.
Whether working directly with patients or doing basic research, doctors are capable of doing both great good and great evil. The further medicine develops, the more extreme the possible good and evil can become. We all have a stake in what they do, and this means that we should all participate in the debate - not only over the advancing medical technology, but also over the proper responsibilities that doctors have towards us as patients.
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