Physicians are marginalized, and individual autonomy in patient decision-making has been effectively negated

Today, your doctor is likely to be a “stranger at the bedside,” making decisions according to a “new morality” of bioethics, rather than the traditional Oath of Hippocrates, writes Dr Jeffrey Hall Dobken in the Journal of American Physicians and Surgeons. Dr Dobken writes from the perspective of a doctor who is also a patient with a terminal disease. It is a stinging – and rare – attack on conventional bioethical principles.

Framing ethical questions has passed from the physician to the bioethicist, who may have no medical training, Dobken writes. Bioethicists may be moral philosophers, theologians, clergy, attorneys, hospital administrators, nurses, therapists, or others, with academic degrees in law, business, economics, health policy and management, public health, social science, political science, or allied health sciences such as pharmacology or nursing.

The foundational questions are: Whose needs are being served, or whose interests are being protected? In traditional Hippocratic ethics, the goal is to serve the patient. Bioethics places society or the “system” first, Dobken contends.

The four core principles of bioethics—replacing the supposedly outmoded Oath of Hippocrates—are patient autonomy, provider beneficence (doing “good”), provider non-maleficence (doing no harm), and justice (treating equal cases equally). Bioethicists consider themselves the guardians of social justice, Dobken states. The code they are expected to follow leads to predictable and stereotypical results. Physicians are marginalized, and individual autonomy in patient decision-making has been effectively negated.

Bioethicists, Dobken writes, “have, in large measure, enabled the transition from Hippocratic ethics to post-modern bioethics,” which enables “healthcare reform.” Bioethics emphasizes “a gatekeeper duty…focused on community resources and distribution of sparse resources in an economic view based on a social justice ideology.”

“These goals appeal to the healthy well, and thus are readily saleable to society, including the 'new class of medical professionals,'” Dobken observes. But what about the sick patient?

“Bioethics represents a radical shift in focus away from the individual to the collective,” he concludes. “The implications for patient care deserve sharp scrutiny, not blind acceptance of bioethical premises based on prestige and proclaimed lofty intentions.”

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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