Ethical Changes: Duty to Man versus Duty to Mankind

Abstract

For 2,000 years, western medicine has sought the ideal of the medical relationship as a cooperative interchange between two parties only, the patient and the physician. Under this patient-centered covenant, reciprocal duties and benefits obtain. In the past two centuries, military, industrial, governmental, and academic medicine interposed their interests with impact on the patient ranging from benevolent to the horrific, from the improved public health to physician participation in involuntary human experimentation and torture. These changes have been eclipsed by the interposition of the interest of third-party payers into the physician-patient relationship, the subject of this work. It appears that individual physician-patient teams can no longer be permitted unfettered access to unfortunately limited resources, lest exhaustion of means to care for other patients and to meet other needs of society be the inevitable result. The profound ethical changes underway have been obscured by the economic complexities. Clear thinking is needed here, since medicine is being altered to its roots.