Abstract
At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ba-Sela, Ariel, and Hoff, Habbel E. “Isaac Israeli's Fifty Admonitions to the Physician.” InLegacies in Ethics and Medicine. New York: Science History Publications, 1977.
Benarde, M., and Mayerson, E.W. “Patient-Physician Negotiation.”Journal of the American Medical Association 239 (April 1978): 14–15.
Burns, Chester. “American Medical Ethics: Some Historical Roots.” InPhilosophical Medical Ethics: Its Nature and Significance, edited by Stuart Spicker and H. Tristram Engelhardt, Jr. Dordrecht: D. Reidel, 1977.
Cabot, Richard. “The Use of Truth and Falsehood in Medicine, an Experimental Study.” InEthics in Medicine, edited by S. Reiser et al. Cambridge, Mass.: M.I.T. Press. 1977.
Cassell, Eric. “Autonomy and Ethics in Action.”New England Journal of Medicine 6 (August 1977): 333–34.
Cicero on Moral Obligation: A New Translation of Cicero's “DeOficiis.” Bks. 1 and 2. Introduction and notes by John Higinbotham. Berkeley: University of California Press. 1967.
Deichgraber, Karl.Professio medici zum Vorwort des Scribonius Largus. Wiesbaden: Franz Steiner Verlag, 1950.
Edelstein, L.The Hippocratic Oath: Test, Translation and Interpretation. Baltimore: Johns Hopkins Press, 1943.
Edelstein, L. “The Professional Ethics of the Greek Physician.” InAncient Medicine, edited by Owsei Temkin and C. Lillian Temkin. Baltimore: Johns Hopkins Press, 1967.
Gert, Bernard.The Moral Rules. New York: Harper Torchbooks, 1973.
Hippocrates. Translated by W.H.S. Jones. Loeb Classical Library. Cambridge, Mass.: Harvard University Press, 1923.
Hooker, Worthington.Physician and Patient, a Practical View of Medical Ethics. New York: Arno Press, 1849.
Jones, W.H.S.Philosophy and Medicine in Ancient Greece. Baltimore: Johns Hopkins Press, 1946.
Jonsen, A.E., and Hellegers, A.E. InConceptual Foundations for an Ethics of Medical Care, edited by L. Tancredi. Washington, D.C., 1974
Levey, Martin. “Medical Ontology in Ninth Century Islam.” InLegacies in Ethics and Medicine, edited by Chester Burns. New York: Science History Publications, 1977.
Marcus Aurelius.Meditations. Translated by George Long. Garden City, N.Y.: Doubleday & Co., 1960.
Nortell, Bruce. “AMA Judicial Activities.”Journal of the American Medical Association 239 (April 1978): 1396–97.
Owens, Joseph “Aristotelian Ethics, Medicine and the Changing Nature of Man.” InPhilosophical Medical Ethics: Its Nature and Significance, edited by Stuart Spicker and H. Tristram Engelhardt, Jr. Vol. 3. Dordrecht: D. Reidel, 1977.
Pellegrino, E.D. “Toward an Expanded Medical Ethics: The Hippocratic Ethic Revisited.” InHippocrates Revisited, edited by Roger J. Bulger. New York: MEDCOM Press. 1973.
Pellegrino, E.D. “The Anatomy of Clinical Judgments: Some Notes on Right Reason and Right Action.” Paper presented at the Fifth Trans-Disciplinary Symposium on Philosophy and Medicine: Clinical Judgment, University of California School of Medicine, Los Angeles, April 14–16, 1977.
Pellegrino, E.D.Humanism and the Physician. Knoxville, Tenn.: University of Tennessee Press, 1979.
Pellegrino, E.D., and Thomasma, D.C.A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York and Oxford: Oxford University Press, 1981.
Pellegrino, E.D. “Toward a Reconstruction of Medical Morality: The Primacy of the Act of Profession and the Fact of Illness.”Journal of Medicine and Philosophy, Vol. 4:1, March 1979, pp. 32–56 (University of Chicago Press).
Percival, Thomas,Medical Ethics. Huntington, N.Y.: Robert Krieger, 1975.
Scribonius Largus.Compositions, edited by Georgius Helmreich. Stuttgart: B.G. Teubner, 1887.
Spicker, Stuart. “Medicine's Influence on Ethics: Reflections on the Putative Moral Role of Medicine.” InPhilosophical Medical Ethics: Its Nature and Significance, edited by Stuart Spicker and H. Tristam Englehardt, Jr. Vol. 3. Dordrecht: D. Reidel, 1977.
Additional information
Dr. Pellegrino is Director of the Joseph and Rose Kennedy Institute of Ethics and John Carroll, Professor of Medicine and Medical Humanities at Georgetown University. This essay, a distillation of his many writings on the human side of medicine, was prepared for oral presentation to a predominantly lay audience at the Cedar Lane Forum on Medicine and Society, Bethesda, Maryland, February 11, 1982. For those interested in pursuing the subject in greater historical and philosophical depth, he now provides the list of references that follows the essay. He is also the author of a work in process of publication, “a third volume which will deal with the vexing question of the good of the patient.”
Rights and permissions
About this article
Cite this article
Pellegrino, E.D. Toward a reconstruction of medical morality. J Med Hum 8, 7–18 (1987). https://doi.org/10.1007/BF01119343
Issue Date:
DOI: https://doi.org/10.1007/BF01119343