Contemporary Ethical and Social Issues in Medicine

Abstract

October 2005

Section Clinical Essentials

II Contemporary Ethical and Social Issues in Medicine

Christine K. Cassel, M.D., M.A.C.P.
President, American Board of Internal Medicine, Philadelphia

Ruth T. Purtilo, Ph.D.
Director and Dr. C. C. and Mabel Criss Professor of Clinical Ethics, Creighton University Center for Health Policy and Ethics

The rapid advance of medical technology has raised a host of new moral issues around such fundamental questions as when does life begin, when and how does life end, which services can patients require of physicians, and which requests can physicians legitimately refuse. Physicians who encounter such questions in their medical practice are often faced with ethical dilemmas. This chapter presents a framework for ethical decision making and discusses several areas of current ethical debate (e.g., issues related to life span, quality of life, and medical futility). The traditional ethical standard of doing what is in the patient's best interest is being challenged by changes in the economics and delivery systems of health care. This chapter discusses those changes and describes a population-based health care approach, in which some treatments that are potentially beneficial to the individual patient are forgone to benefit larger numbers of patients with the resources thus recovered. An example of this principle is used in foregoing brand-name medications for generic medications. The savings resulting from the adjustment in prescription allows the health care plans to cover the health care costs of larger numbers of people. This chapter contains 47 references, as well as a listing of 11 practice guidelines and consensus statements.

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