Has Medicine Lost the Ethics Battle?
Modem medicine began with the Greeks and has developed over the past 2,500 years. Medical ethics, which was also initiated by the Greeks, and summarized in the Hippocratic Oath, has guided the moral actions of the physician in his medical practice for the past two and one half millennia. Recently, however, there have been profound changes in bioethics, not only in how the basic Hippocratic cannon is understood but also in who interprets that code. The purpose of this essay is to explain why the clinical decisionmaking role of the physician has been overshadowed by ethical theories and ethical specialists. To this end we shall briefly review the history of medical ethics (Table 1) with an emphasis on the recent past (1960 present). The Hippocratic tradition of the art of medicine refers not just to diagnosis and treatment modalities, but to the moral dimension of life and death decisions affecting the patient. It is this latter dimension of the medical profession which has been usurped by non-physicians in the ethics debate, as we shall explain. It is the thesis of this review that the operative relationship in medical ethics, the doctor-patient relationship, and the physician's judgment, are being displaced by the intrusion of third parties who do not have the experiential prudence of the practicing physician. Perhaps