By Rosamond Rhodes

When I first began my work at Mount Sinai, I was the sole philosopher at the institution, and I certainly felt like a stranger among the hundreds of medical professionals.  As the only bioethicist on campus, I was called upon by any department that wanted ethics education for their trainees and any team that wanted ethics consultation.  I was asked to join the hospital Ethics Committee, then I became Ethics Committee Secretary, and I was recently named Co-Chair of the Committee.

Over the years, my position at Mount Sinai exposed me to a broad range of medical environments that were associated with the full complement of the institution’s departments and services, nurses, social workers, patient representatives, genetic counselors, and clergy.  Most of my Mount Sinai activities count as education in one way or another, but I have also been involved in research projects, policy development, crafting responses to challenging issues as they arise, and planning to address possible future problems.  I was involved in these activities because the organizers wanted my philosophic input.  At the same time, my exposure over the past 31 years allowed me to learn about the conundrums that arise in today’s medical practice, how medical professionals understand their roles, and how the professions are practiced in a tertiary care facility in the middle of New York City.

As I developed my comprehension of the landscape little by little, and one bit at a time, my engagement led me to develop a deep appreciation of the work of medical professionals, their commitments, and the complicated and difficult ethical matters they confront.  My interactions also provided me with experience in thinking through the extraordinarily thorny dilemmas that require resolution every day.  I note these experiences in order to display the source of my understanding of medical professions and my insight into their ethics.

When I began my work in the field I felt secure that my knowledge of traditional moral philosophy provided me with the theoretical background for addressing ethical issues in medicine.  But over the years, I started to notice that the well accepted views from traditional philosophy and common morality did not cohere with what physicians and non-physicians consider good clinical practice.  For example, after 9/11 I realized that many allocations of medical resources were not compatible with my then favorite view of what justice required.  Similarly, through my work as Living Donor Advocate for the liver transplant program, I noticed serious problems in views on autonomy espoused by leading philosophers.

One by one counter-examples began to accumulate until I reached the conclusion that everyday ethics and medical ethics were inconsistent with each other.  I also developed an appreciation of the fact that even though numerous elements of well accepted medical practice were radically different from common morality, for the most part those practices were appropriate.  That recognition left me with the realization that a new and different account was needed to explain the ethics of medicine.  It would have to cohere with laudable elements of clinical practice and be able to explain why they were right.  A new theory of medical ethics would also have to explain why some accepted behaviors and policies were wrong.

In ethics, philosophers start their explorations with observations of actions and character and formulate hypotheses about what makes actions right or wrong and what makes character virtuous.   Thus, my years of exploring the ethics of medicine, positing standards for ethical action, identifying why some doctors should be regarded as virtuous, and examining my assumptions in light of actual experience led me to amalgamate my insights, reject the widely accepted common morality view of medical ethics, and ultimately propose a different theory of medical ethics.

My aim in this paper is to demonstrate that the ethics of being a medical professional is very different from the morality of everyday life.  In other words, I argue for stripping doctors from their mooring in common morality’s four principles account of medical ethics that has been the mainstay of medical ethics teaching for more than 40 years. The paper’s arguments set the stage for me to develop an account of the moral foundation of medical ethics, delineate the core duties of medical professionals, explain why each one is a necessary element of medical professionalism, and show how the various pieces of required behavior and character fit together and conform to what is largely recognized as exemplary action and professionalism.  In sum, the overview of medical ethics that I propose in the article and develop in my forthcoming book, The Trusted Doctor, clarifies the moral dimension of clinical practice and serves as a guide to what medical professionals have to do and be in order to meet the standards of professionalism.

Paper title: Why not common morality? [OPEN ACCESS]

Author: Rosamond Rhodes

Affiliation: Icahn School of Medicine at Mount Sinai

Competing interests: None, unless you want to count my forthcoming book