Need for professional ethics in medicine
Gonzalo Herranz, group of work of Bioethics, University of Navarra
lecture delivered at the Corso d'Aggiornamento Regionale Ticinese
Lugano, March 26, 1987
I. The Need for Medical Ethics, an Empirical Reality
II. Professional ethics, a necessary channel for the growing power of physicians.
III. Professional ethics and the need to moderate the power of the sick person
IV. The bioethical society and the ethical crisis of medicine
V. The need for ethics in medicine
I would like to begin by thanking the Order of Doctors of the Canton of Ticino for the kind invitation to participate in this short course on medical ethics. My thanks are most sincere.
First, because this invitation has given me the first opportunity to take contact with the cultivators of medical ethics in the Swiss Confederation. I am familiar with the work of the Swiss Academy of Medical Sciences, an institution of very high international prestige in the area of Medical Ethics. Its guidelines are listened to with attention and respect by all of us who are interested in Medical Ethics and we are also grateful to it for having sponsored and published programs of study with very interesting bioethical topics. This esteem for Swiss medical ethics is the reason why I come to this course with a certain perplexity. As a Spanish saying goes: it is like selling honey to the beekeeper.
Second, because he has offered me a very general, and I suspect very uncontroversial, topic to discuss with you. What can I say about the need for professional ethics in physicians that is not already known? To be able to address such a topic is a privilege rarely enjoyed.
I will present my subject in five successive steps. To begin with, I will briefly describe the empirical status . When we look at what happens in the medical business , we inevitably come to the conclusion that professional Ethics is not an ornamental and dispensable trace element, but an essential ingredient of the professional internship of Medicine. 2. I will analyze how, in order to harness the tremendous power of the contemporary physician, it is necessary for the physician to submit his or her conduct to ethical analysis. Only in Ethics can the physician find a humane control of his growing power. 3. Ethics has become necessary to the physician because the individual patient now appears to be invested with a very great power to intervene in medical decisions and can turn the physician into an obedient servant. 4. Medical ethics is essential to deal with a society obsessed with health. The State is the main entrepreneur of the medical industry. In order to respond to the abuses of politics and the demands of the public, the physician needs to learn to argue ethically. 5. Finally, medical ethics is necessary so that medicine, like business, faithfully maintains its commitment to the service of man, so that medical progress and its application to the sick is always made in accordance with the principle of respect. In my opinion, medical ethics needs to rediscover its religious roots.
I. The Need for Medical Ethics, an Empirical Reality
When one observes what good physicians do, what they read, what they talk about, one can see that ethical concern is omnipresent. In the last two decades, ethics has been at the heart of medicine internship. Let us consider a few examples, starting by looking at what is happening at the level of physicians' professional organizations.
We are gathered here to reflect on questions of medical ethics, in a meeting sponsored by the Order of Doctors of the Canton of Ticino. This means that here we are actively aware of the role that Ethics plays in the institutional life of Medicine. As time goes by, the conviction grows that the main function of the professional organizations of physicians is the protection of professional ethics. It is logical: in response to the concession granted to physicians by society to practice medicine exclusively, they join forces with their colleagues with the overriding aim of establishing rules of professional conduct to ensure the quality of the services provided and to monitor compliance with them. If physicians' organizations were not faithful to these standards, society would withdraw its confidence in them and replace professional ethics with legal regulation. This would be a terrible catastrophe, which would turn the medical vocation into a mercenary employment .
The national Medical Orders are aware that the vigilance and ethical inspiration of the medical internship is their primary function. The physicians of the countries of the European Community maintain two organizations: the lecture International of the Medical Orders, based in Paris, and the committee Permanent of the Physicians of the EC. (Representatives of physicians from other European countries, including Switzerland, attend the meetings of the latter as observers). ) In both bodies, medical ethics issues occupy a prominent place in the discussions. The lecture International has recently published the "Principles of European Medical Ethics" to serve as a term for reference letter and to inspire the ethical regulations of national Orders.
If, leaving the institutional and corporate level of Medicine, we move on to examine the medical internship , we will also see that the concern for Ethics appears everywhere. I usually devote my Monday mornings, and not infrequently my afternoons as well, to searching for and examining the articles that deal, more or less directly, with medical ethical issues that appear in the journals that have just arrived at Library Services of my School. I pay preferential attention to the journals that, in my opinion, create public opinion in medicine. They are a few and well known: Lancet, New England Journal of Medicine, JAMA, British Medical Journal, Nature, Science, Annals of Internal Medicine, Archives of Internal Medicine, New Scientist. These in the first place. Then many others, including Schweizerisches medizinisches Wochenschrift and Naturwissenschaften. Of course, I also look at the indexes of the journals of Genetics human, gynecology, pediatrics, family medicine, and nursing. Every Monday I come back from Library Services with a pile of articles xerocopied for my documentation file and the impression that the bibliographic production on medical ethics is already unmanageable. And that is not counting the specialized journals, which are no longer few, and the massive production of monographs.
If anyone suspects that I am exaggerating, they only have to perform a simple experiment: go to the analytical indexes of the journals or to the Index Medicus and look for the entries corresponding to the concepts Medical Ethics and derivatives.
Is all this the exclusive province of the leadership of the Orders, who somehow have to prove that they are doing something, or of rats from Library Services, who devote their attention to marginal matters and take their joy in scrutinizing editorials, letters to publisher and other minor genres of the medical bibliography ? Not many field programs of study designed to measure the importance that Medical Ethics has in the ordinary lives of practical physicians. But I find the research conducted at the department of Gastroenterology at Herlev University Hospital in Denmark to be quite representative, and highly unsuspicious of manipulation. For three months, physicians in that unit made a grade whenever they encountered what was called a significant ethical problem, that is, a problem that involved a non-technical value judgment and either made the clinician doubtful about the decision he or she should make or believed that other physicians might have evaluated the problem differently. Of the 426 patients admitted to the hospital unit, significant ethical problems were found in 106 (25%). The problems arose in connection with diagnosis, treatment, information to be given to patients, conflicts of patient rights and health system restrictions, or conflicts between the patient and family members, participation in clinical research programs, etc. It is not, therefore, an occasional or exotic finding significant ethical problem in the medical internship .
I believe that this simple sampling of the presence of ethics in medicine today allows us to conclude that medical ethics is part of the fabric of medicine. It should also lead each of us to ask ourselves how we are doing in terms of ethical sensitivity: if, like our Danish colleagues, we discover in one out of every four patients we treat some significant ethical problem.
II. Professional ethics, a necessary channel for the growing power of physicians.
But we are well aware that the result of this examination would not be too bright in the profession as a whole. In a considerable sector of the medical profession there is a widespread attitude towards ethics that could be characterized as benign and optimistic ignorance. They think that it is enough to have a good conscience, good character or good intentions to be an honest person and to resolve the ethical dilemmas of the professional internship with intuitive success. Another sector, increasingly numerous, is formed by those who are skeptical about the practical value of Deontology. Some reach this pessimistic conclusion out of nostalgia for the good old days: medicine is not what it used to be. Others do not believe in Deontology when they see how little attention is paid to it: the Code of Ethics is a beautiful piece of literature written on wet paper. Finally, other physicians condemn ethics for political reasons, since it hinders the use of the medical profession as an instrument of social revolution.
And curiously, these attitudes of naïve ignorance, skepticism or political rejection occur at a time when the physician's technical capacity places a tremendous moral responsibility on his shoulders. Today, the physician, any physician, has fabulous power. The public has a very partial and anecdotal idea of the resources available to the physician to change the way of life of his patients and to intervene in the deepest layers of their personality. We know this well. The power of medicine does not consist primarily in the spectacular achievements of diagnostic technology, epidemiological surveys, or the therapeutic revolutions that we hear about in the media. The power of medicine has become capillarized, it is already everywhere. The office of any doctor, rural or urban, is already an agency of great transforming power for individuals and, ultimately, for society. A couple of examples will illustrate what I mean.
Doctors' ideas about when psychotropic drugs are indicated are as different as the quantities they prescribe. I do not want to refer now to the criminal behavior of prescribing narcotics to drug addicts in exchange for money: we all agree at agreement that this is not medicine, but a dirty business. But, I add in parenthesis, we cannot ignore that in the United States, for example, the consumption of psychotropic drugs (narcotics, amphetamine stimulants and barbiturates) fraudulently prescribed by physicians exceeds that of those introduced by illegal trafficking; and that, recently, the introduction of a simple system of partnership between police and medical organizations in some States has managed to reduce to one third the amount of psychotropic drugs dispensed with medical prescriptions. I go back. Doctors are very different about the role of psychotropic drugs in people's lives. Some believe that people have the right to rely on Chemistry to overcome the conflicts and inconveniences of life and to give themselves a little artificial happiness through psychopharmacological hedonism. Others believe that psychopharmaceuticals should be dispensed very sparingly, because some anxiety is a normal ingredient of human life. Man, they think, is a restless being; to extinguish his anxiety by means of pharmacology is not only a way of squandering money, but of withering the vitality of individuals and of society. We are told that, if Dostoevsky, Wagner or Tchaikovsky had been treated by a certain subject of physicians, they would not have left us their art. But, in fact, the psychopharmacological manipulation that is within the reach of any physician can extinguish anxieties and emotions, and also the courage to live, the capacity for repentance of ordinary citizens. In fact, psychopharmaceuticals are taking the place of virtues in the lives of an increasing issue number of people. The Chemistry is replacing asceticism.
Another example. In an emergency room, a subject is presented who masterfully plays his role: he is a simulator. The on-call shift is attended by several physicians. The patient's fate will be very different depending on the ethical convictions of the attending physician. Doctor A is of the opinion that his patient is a social parasite, much more in need of a strong reprimand or criminal punishment than of any medical treatment. Doctor B will look for a way to socially reintegrate the pseudo-sick person and will see to it that his personal problems are duly attended to. Doctor C, finally, thinks that opposing the deception will lead nowhere, since the patient will reoffend in his behavior: he decides, therefore, to agree to give him the job leave and to condescend to the patient's wish to spend a few days in the hospital.
These examples, and others much more dramatic that we could add, show us how great is today the discretionary power of the physician. When he employs himself in the service of his patients, he is in reality serving an idea of man. He can choose between being protective of his threatened humanity or becoming deaf to the noblest values in man. The professional freedom of the physician obliges him to assume ethical responsibilities of enormous magnitude. For this reason, medical ethics is as consubstantial to his work with the sick as is the scientific knowledge .
III. Professional ethics and the need to moderate the power of the sick person
While the power of the physician may seem exorbitant, the power of the patient is no less exorbitant and no less decisive. Indeed, today, as a result of technical progress, it is possible to have access to solutions that did not exist before or to choose between different treatment offers because each problem is susceptible to different optional solutions.
But, above all, the power of the patient has become very great by virtue of his or her rise to decision-making positions. Since the 1960s, the movement claiming the so-called patient's rights has been spreading everywhere. There are among these rights, as we all know, some just claims derived from the human dignity of the patient, which were not duly recognized before. But there are also some crazy and haughty demands introduced by the libertarian wing of the consumerist movement.
It is not surprising, therefore, that the movement in favor of patients' rights has produced, in addition to certain beneficial effects, some bitter fruits. It has, on the one hand, enlivened the ethical conscience of the patient because, by vigorously affirming his autonomy and his right to be informed in order to decide in conscience, it places the patient in a freer position and manager and, therefore, richer in moral values. But when the patient, too jealous of his rights, assumes an aggressively vindictive attitude, he runs the risk of giving the doctor-patient relationship a ruinous bias. He then tends to abuse his rights and become arrogant. It tries to impose its decisions and demands that the physician submit to its demands. Thus arise the inhumane and immoral practices of abortion on demand, cooperation in suicide, and voluntary sterilization.
Moreover, we cannot forget that, as a consequence of the socialization of medicine, the patient is not alone. Behind him is the very powerful bureaucracy, through which the Ministries of Health control the gigantic complex of the health industry. The figure of the physician is dwarfed while the patient, in his double condition of consumer of services and citizen with the right to vote, becomes the referee of the status. The doctor-patient relationship is thus losing the benign, friendly and paternalistic character of yesteryear, and becomes contractual, cold and potentially contentious.
It is a pity that what began as a welcome movement to strengthen the ethical immunity of the sick has become partly corrupted, so that in some quarters it is taking on the character of a conspiracy against the moral integrity of the physician or a safe-conduct for permissive concessions to the libertarian autonomy of certain patients.
IV. The bioethical society and the ethical crisis of medicine
We cannot end this brief inventory of the problems of medical ethics today, because it is necessary to pay attention to an unprecedented phenomenon: people are dissatisfied with medicine, they are increasingly interested in bioethics and, faced with the inability of physicians to put their house in order, they wish to intervene in matters of medical ethics. Dissatisfaction and interventionism: this is the response to the progress of medicine.
For starters, let's look at what people say about doctors. When people leave the doctor's enquiry or come back from the hospital after visiting a relative or a friend, they sometimes don't seem too happy. I remember that a few years ago some top executives of the American Medical Association visited the University Clinic of Navarra. I was then the Dean of the School of Medicine and I invited them to make a visit to the Departments of the Clinic. One of the Vice Presidents of the AMA graciously declined the invitation, telling me that, in their internal structure and technical facilities, all hospitals were boringly similar. That, if I allowed him, he wanted to move freely around the entrance hall of entrance of the University Clinic. When, after three hours we met again, he made this comment to me: This is an exceptionally good hospital: people are more cheerful when they leave than when they come. You don't see this phenomenon in many other places.
Indeed. In the opinion of many, experts and people in the street without distinction, medicine has recently become impoverished in human values. Despite spectacular advances in knowledge and technology, there have never been so many patients dissatisfied with the care they receive in hospitals and doctors' offices. It is paradoxical that, despite the enviable level of health achieved by advanced societies, doctors are now being sued for errors and negligence more than at any other time. There has never been so much malpractice litigation internship. Some journalists seem to be possessed by a morbid tendency to denounce lurid situations. Driven by the J'accuse complex, they publish terrifying reports showing hospitals as pain factories, turned into chaos by strikes or by the indifference of doctors and nurses. Everywhere, the trust that cemented the old relationships between doctors and patients appears to have been eroded.
How is it possible that medicine, being more effective than ever, is receiving more criticism than at any time in the past? People's dissatisfaction has different origins. It is due in part to the fact that too much is expected of medicine. Every day more and more value is placed on health, which for many is the most precious value. This is logical, especially in societies dominated by hedonism. In these societies, survival is no longer a problem, thanks to the protection of the welfare state. The public aspires to be healthy and fit. Many modern constitutions include the right to health among the fundamental rights of the citizen. It follows that we all have the right to be healthy and not in any way, because, according to the official doctrine of the World Health Organization, we should aspire to a state of perfect physical, mental and social well-being and not simply to be free of disease. It is therefore not surprising that some people go to the doctor with an almost legal demand for well-being and expect the doctor to remedy not only their ailments, but also all their problems. But, evidently, the doctor cannot satisfy such far-fetched aspirations and this leads to disenchantment.
I think, however, that most of the dissatisfaction does not stem from the physician's thaumaturgic incapacity. It stems from the fact that patients do not feel that they are treated as persons. That is why it has become a cliché to say that medicine has become dehumanized. When patients are asked why they are dissatisfied, they usually say that the doctor devotes little time to them, that he is not interested in the problems that really concern them, in their fears or apprehensions. They add that the doctor tends more to prescribe than to listen, to see the results of their tests or X-rays, that they look them less and less in the face. They feel depersonalized.
That there is so much talk about the dehumanization of medicine does not mean that physicians have become negligent and lazy. There has never been more efficiency or more feverish activity. And yet people do not find what they expected. They complain that there is an eclipse of humanity in the doctor-patient relationship. And in the darkness of this eclipse, Medicine, the most humane of the sciences, goes astray.
But that's not all. People's concern is fueled daily by the Health, Society and Medicine columns in the newspapers. Not a day goes by without a few individuals getting together and writing a statement or a manifesto. One day it is the local group pro-Right to Die with Dignity or a commission of reforming jurists demanding the decriminalization of euthanasia and financial aid voluntary suicide; another day it is the Animal Liberation activists calling for the abolition of bullfighting; the next day it is the turn of the squalid group plant liberation lobby demanding a ban on the engineering Genetics of bacteria, because bacteria have the right not to have their genetic constitution violated by the transfection of foreign genes.
These movements, with many others of the irrational cut subject Science for the people, create a diffuse status of distrust towards Science and Medicine, of rebellion against the Expertocracy and create a background noise that prevents hearing clearly the voices, much less strident, of physicians who sincerely seek to rehabilitate medical Ethics.
The society of our time is a society dazzled by Bioethics. It sees in Biomedicine a fairy godmother who can bring it longevity, an unlimited capacity for pleasure and power and does not want to miss the opportunity. He wants to make doctors the servants of his aspirations for happiness. Governments have begun to take action on the matter, because they know that in the general and local elections, the offer of health and well-being is one of the decisive points of the electoral offer. Recently, one of the autonomous regions of my country remained without a government for a hundred days due to a dispute over the control of the Health Department. Logically, Parliaments want to legislate. There is a proliferation of parliamentary commissions of deputies and multidisciplinary experts to prepare bills. International organizations, the committee of Europe, the European Parliament, for example, are preparing recommendations on human reproductive technology, the fight against AIDS, the legislative development of the right to health.
But as a result of legislation, which always has to grant bonuses and supplements to ensure re-election, health and welfare costs grow to the point of becoming unsustainable. Politicians then force physicians to ration limited resources. Since it is virtually impossible for a physician to find medical reasons not to treat certain groups of patients, it is necessary to introduce non-physicians into the decision-making systems in order to meet the urgent demands of officials at budget. It begins with the creation of Service Optimization Committees and audits to evaluate technology performance. It soon becomes clear that in order to overcome ethical resistance, Bioethics Committees must be created.
The comitological fever in Bioethics surpasses all the forecasts made by Parkinson. There are Committees that bring together researchers at Basic Sciences, clinicians, pharmacologists working in industry, retired physicians, moralists, philosophers, lawyers, representatives of medical corporations, social psychologists and representatives of associations of consumers or patients with such a disease. This world of the Committees is fascinating. Many of them have a tragic destiny. Their work is thankless. The desired majority is not achieved or abstentions predominate. Philosophers do not fully understand the complex situations faced by the physician. Laymen sometimes have invincible prejudices. Clergymen are listened to with increasing reluctance in our pluralistic and secularized society. When, after endless negotiations about the meanings of words and the placement of commas and after miracles of persuasion and patience, the President of committee gets provisional recommendations approved and makes them known, practically always the same phenomenon occurs: after a fleeting passage through the pages of the newspapers, amidst criticism from some and praise from others, the recommendations are quickly forgotten and replaced by new ones. The process starts all over again. This has been the fate of the most famous Bioethics committee of our days. The report of committee Warnock, hailed as a masterpiece of prudence and wisdom, is now history. It is useless: the British Parliament has not used it to prepare its laws. It has ordered another committee to be set up.
Discouragement then spreads among the members of the Committees and also among physicians who expect a lot from consensus ethics. Contemplating the status of helplessness in which physicians sometimes find themselves when faced with certain ethical dilemmas, a JAMA editorialist commented a few years ago: "The ethical dilemmas of medicine often elude a rational solution. Some of the ethical conflicts that confront the physician are made of the same stuff as a classical Greek tragedy, more in need of the intuitive insights of an Aeschylus than the logical and moral analysis of an Aristotle. For the time being, without the financial aid of either, the physician, faced with such dilemmas, will have to be the playwright and philosopher of himself."
Can I conclude from this schematic description of the crisis of Bioethics in our society that the Physician needs to be an expert in Medical Ethics if he/she wants to survive as an autonomous moral agent?
V. The need for ethics in medicine
This is the degree scroll that was offered to me for this lecture. I was not asked to speak about the general need for Ethics in Medicine, but about ONE specific Ethics.
The first point, the need for Ethics in the medical internship hardly needs any demonstration, after what has been said so far. Medical ethics permeates the whole of medicine, it is its nerve. We know that Medicine is in itself a moral activity. Nothing that the physician does lacks moral significance, since all his efforts are directed, in the last analysis, to making decisions, to perform acts that seek to do good to another person who is in need of financial aid and healing. In medicine, everything is ethically significant. This has been pointed out in all the Codes and Declarations of Deontology that have inspired the conduct of physicians of all times.
The problem lies in deciding whether it is enough for each of us to be our own playwright and our own philosopher or whether, on the contrary, we must sit at the feet of a master and learn from him. To answer questions like this, it seems to me that it is essential to go back to the beginning.
With Hippocrates, medicine was freed from its magical primitivism and became a natural-scientific activity, in which observation, experimentation and statistics are the basis of medical theory and internship . But it was also with Hippocrates that the physician, aware of his power over man, submitted to a code of high moral demands. The Hippocratic physician realizes that when he treats a patient, when he makes decisions on which the life or death of his fellow man depends, he is invested with a formidable power, which he cannot abuse. That is why he swears before the gods of Olympus that he will maintain his life in purity and sanctity, as if to imply that all his activity will be carried out under the gaze of the divinity. This is the fundamental reason why the Hippocratic Oath could be incorporated into the Judeo-Christian and Muslim tradition of medicine.
I do not believe that it is possible to restore to the fragmented Ethics of today's pluralistic society the unity it has lost without some recourse to its religious roots. Respect for man is the core of medical ethics. The reason for the triumph and massive acceptance of the Declaration of Geneva of the World Medical Association association , as well as of many of its subsequent Declarations, is precisely that by consecrating the utmost respect for the sick person as the source of the physician's ethics, it transferred to the new lay formula of the Declaration all the religious values contained in the old Oath.
It is not possible to have a valid medical ethics for medicine that is not based precisely on the idea that the sick person is endowed with a particular dignity. The dignity of the sick person, paradoxically and fortunately, demands from the physician, over and above the demands of the general dignity of man, a supplement of appreciation that is directly proportional to the weakness, the handicap or the danger that the illness represents for him.
But some ethical currents circulating in the world of contemporary medicine have become blind to the human values of the sick person. The penetration of hedonism in the contemporary mentality, its rejection of weakness and pain; the temptation of man to become master of his own destiny and programmer of society; the almost irresistible attraction of penetrating into the most intimate areas of the person to instrumentalize them and make man's sexuality and mind an instrument docile to manipulation, all these things that frightened us a few years ago and that are now making their way into permissive laws, all this is result of the loss of respect for man. Medicine, which deals with man in his weakest situations, is the ideal field for establishing the dominion of the strong over the weak.
Medicine cannot be ethically neutral. Neither in the application of the knowledge acquired by the research, nor in the fascinating business of the biomedical research . The extent to which this is forgotten is demonstrated by the rejection by broad sectors of the profession of the vigorous incitement to respect that is the Instruction on respect for nascent human life published a few days ago by the Congregation for the Doctrine of the Faith. It is painful for those involved in the world of medical ethics to see the deterioration that the idea of respect for human life and the integrity of the person has undergone in recent times, once social tolerance of abortion has anesthetized the moral conscience of society.
Medical ethics must be restored to its commitment to respect the life and integrity staff of the patient. It is in the interest of each one of us to make from time to time a cure of humility and, leaving aside the scientistic triumphalism, to put ourselves once again at the service of man with all our resources and all our respect. And according to the specific way of the physician, which is to serve the weak. The weak are supremely important in Medicine. Medical ethics is not an ethics of power, but of service.
I do not hide in any of my interventions before colleagues that it is necessary to cultivate the study of medical ethics, not to become very skilled in the management of ethical reasoning, but to grow in sensitivity and responsiveness to the demands of respect. Einstein said that concern for man and his destiny should always be the main interest of all technical and scientific efforts. Sometimes, meeting colleagues who reproach me for this insistence on the concern to respect man, which leads me to make reference letter to transcendent values, consider it an intolerable intrusion to bring up any reference letter to religious values in the discussion of the ethical problems of Medicine. I reply that it is illusory to claim the moral neutrality of scientific research and its applications and I tell them that any controversy about the existence of a value-free science is futile. Science, even if I concede that astronomy can be excluded, is all strongly loaded with moral values of more or less close implications for the moral way of living of man. I remind you of what happened at Harvard when a large part of academic staff reacted with scandalized surprise to the public and solemn affirmation of a professor to the effect that in every university teaching there should be a religious dimension. It was feared that obscurantism and dogma might once again take the place of free inquiry and free discussion in that temple of scientific knowledge. The professor in question was forced to explain that by religious dimension in the university teaching he did not mean anything other than this: that he thought that all professors, whatever the subject they might be teaching, were obliged to devote sufficient attention to ultimate values.
Not long ago, here in Switzerland, more precisely in Basel, some personalities of Judaism met at lecture to discuss Ethical Values in Medicine. My friend, Prof. Shymon Glick, Dean of the School of Medicine of Ber-Sheva, ended his intervention thus: "There is a decisive problem: that of knowing if it is possible that, without restoring among us the category of the sacred, that category that has been thoroughly destroyed by scientistic enlightenment, it is possible to have an ethics capable of facing the formidable power that we have today and that continues to grow unceasingly and that we feel compelled to use. Personally, concluded Glick, I believe that the answer to this question is an unequivocal NO".
This is also my thought. It is not only that Ethics, in general, is necessary for Medicine. I think that Medicine needs ONE Ethics: that of respect for man.
Thank you very much for your attention and infinite patience.