ABSTRACT
Highly moral conduct and adherence to a code of ethics that specifies expected norms of behavior and articulates a covenant with society have been the goal and the mark of the profession of medicine since the School of Kos. This is based on the belief and social expectation that the possession of special knowledge and skills carries with it the mandate for its moral and ethical use. The daily practice of medicine, however, complicates the issue in several important ways. First, the closeness and intimacy of the physician-patient relationship depends on trust and on a fiduciary responsibility that goes far beyond generalized, external standards. Second, each clinical encounter is different, indeed unique, based on the unlimited diversity of human life experience. Finally, the environment of medicine is in constant change, generating new problems not specified or anticipated by general codes. This requires that the individual physician exercise constant moral judgment in decision making, a task further complicated by the changing values and expectations of the patient and of society. Thus, it is imperative that the physician learn to make responsible decisions while living with predictable and ever present doubt and uncertainty. Helping the physician to do this is the responsibility of medical education, which must teach students to clarify and understand the ethical standards of the profession and of society; to seek and develop insight into one’s personal values; to acquire a method of apprehending and appreciating the values and expectations of patients, families, and society; to maintain a constant attitude of vigilance toward this aspect of medicine; and to seek continued self-learning in personal and professional life.
