Issues in Medical Ethics
Basic Principles for Medical Ethics
Beneficence, Non-Maleficence, and Justice
Science merely reveals what is; it does not and cannot tell us what should be done. Medicine, in contrast, is not merely a technical scientific vocation, but also a moral endeavor. In medicine, health professionals do not only gather and provide information to patients, they also advise patients as to what they should or should not do. Every medical recommendation to act, or not act, involves a moral choice predicated upon the physician’s philosophical worldview. The following readings are intended to enhance a physician's concept of medical ethics.
Medical Ethics Rooted in Natural Law
The American College of Pediatricians (the ACPeds) recognizes that medical science does not exist in a moral vacuum. Any claim of moral neutrality concerning the social questions that medical science confronts is but a pretense concealing a moral judgment of one kind or another. The ACPeds frankly acknowledges the existence of the natural law, i.e., a natural scientific order of the created universe and a set of moral absolutes, established by the Creator and discernible by all people through the use of reason alone.
Moreover, significant social science data, documented in the ACPeds position statements, show that following the natural law requires respect for what human nature itself requires for physical and mental health. When this is achieved, individuals and societies both flourish. The ACPeds further recognizes the natural rights of all persons, which come with correlative duties under the natural law. It is within this framework of science and the natural law that the ACPeds pursues its mission to enable all children to reach their optimal physical and emotional well-being.
Author: Dennis Sullivan, MD, MA (Ethics)
Dr. Sullivan is professor emeritus of pharmacy practice and former director of the Center for Bioethics at Cedarville University, now retired since 2019. He received his B.S. from Youngstown State University (1974) and his M.D. from Case Western Reserve University (1978). He also completed an M.A. in bioethics from Trinity University (2004).
In addition to being an Associate Member of the ACPeds, he is a member of several other professional organizations including the American Medical Association, the Christian Medical and Dental Association, and the Center for Bioethics and Human Dignity. His research and writing interests include biomedical ethics, moral philosophy, and reproductive ethics.
Lectures on Morality and Ethics
Dr. John Patrick and his wife Sally run the Hippocratic Registry, the objective of which is to provide a link with practitioners who practice or are preparing to practice Hippocratic Medicine, bringing together practitioners who have an ethical consensus.
Listen to some of his lectures on his website.
Presenter: John Patrick, MD, MB, BS, MRCP
Dr. Patrick graduated from the University of London and St. George’s Hospital Medical School in London. He has done extensive research into the treatment of childhood nutritional deficiency and related diseases in UK, the West Indies, Africa and Canada. In 2002 John retired from the University of Ottawa where he was Associate Professor in Clinical Nutrition in the Departments of Biochemistry and Pediatrics. He now lectures throughout the world to secular and Christian audiences on medical ethics, culture and public policy. He works with the Christian Medical Dental Association in US and the Christian Medical Dental Society in Canada.
Dr. Patrick is president of Augustine College, a liberal arts college teaching the History of Ideas from Greek and Roman times to the 21st Century. John teaches the History of Science, Medicine and Faith. In June each year he leads a Summer Conference for physicians, medical students and others on the development of modern medicine with professors from Augustine College and elsewhere.
Perspectives on Hippocratic Medicine and Freedom of Conscience
Freedom of Conscience Revisited
Author: Felipe Vizcarrondo, MD, MA, FCP
Dr. Vizcarrondo is currently on the faculty at Miller School of Medicine, University of Miami, Florida, where he is a member of the Ethics Program. He has been a member of the American College of Pediatricians (ACPeds) since 2003, and formerly served as a Board member of the ACPeds.
He attended Temple University Medical School in Philadelphia and received a Master's Degree in Bioethics from Trinity International University in Deerfield, Illinois. He completed a residency in pediatrics at University Hospital, University of Puerto Rico Medical Sciences Campus, and sub-specialty training in pediatric cardiology at University Hospital, Puerto Rico, and Kings County Medical Center at New York University.
An active duty U.S. Air Force officer, he held the positions of Pediatrics Chair, Pediatric Residency Program Director, and Chief of Medical Staff at major medical centers of the Department of Defense. Dr. Vizcarrondo retired from active duty but remained on the faculty of the Department of Pediatrics at the Uniformed Services University of Health Sciences in Bethesda, Maryland.
Dr. Vizcarrondo was an affiliated scholar at Georgetown University's Center for Clinical Bioethics where he taught clinical ethics. He has written on a variety of issues ranging from freedom of conscience of healthcare professionals to the doctor-patient relationship.
Ethics and Transgender Children
Presenter: Michelle Cretella, MD, FCP
Dr. Cretella is former President and current Executive Director of the American College of Pediatricians. She is a general pediatrician who retired after nearly 20 years of group practice to devote more time to her family and the College. She received her medical degree in 1994 from the University of Connecticut School of Medicine. She completed her internship and residency in pediatrics in 1997 at the Connecticut Children’s Medical Center in Hartford, Connecticut. After completing a fellowship in College Health through the University of Virginia, she and her husband settled in Westerly, Rhode Island to be close to family.
Dr. Cretella was elected to the College’s Board of Directors in 2005. Prior to being elected President in 2015, Dr. Cretella chaired the Adolescent Sexuality Committee, Pediatric Psychosocial Development Committee, and Scientific Policy Committee. In these roles, she became one of the College’s chief researchers, writers and spokespersons on issues of pediatric mental and sexual health. She is regularly consulted by Breitbart News, the Family Research Center, One News Now, Relevant Radio and many others. Her article Gender Dysphoria in Children and Suppression of Debate was published in the 2016 summer issue of Journal of American Physicians and Surgeons.
She has been a dedicated pro-life and traditional values advocate for most of her adult life, contributing articles to various local and national publications.
Ethics for the Pediatrician: The Persuasion of Enhancement in Pediatrics
Pediatric. Rev. 2010; 31:216-218
This article highlights some of the foundational ethical issues that interface with the use of enhancements in the pediatric population. While presenting the dichotomy of therapeutic and non-therapeutic uses of enhancements, the author considers the off-label use of traditional medications and other modalities – such as growth hormone – and draws a distinction between treating (restoring to or near baseline function) and enhancing (exceeding the baseline function: therefore, better than well). The ethical notions in this decision process are 1) leveling the playing field (‘everybody is doing it’), and 2) fairness (equal access for all involved). While the time-honored goals of medicine are preventative and restorative, access to new therapeutic modalities pushes practitioners to the vanguard of using or doing something only because the option is available. In these situations, we must not ignore our ethical underpinnings and acquiesce to request of services without due consideration of the medical-ethical-social ramifications of the action. As we safeguard the patient and future generations, we must focus on the intent of doing no harm.
Ethics for the Pediatrician: Religion and Spirituality in Pediatrics
Pediatrics in Review 2011; 32:e91-94
This article gives consideration to the notions of religion (R) and spirituality (S) primarily from the perspective of the patient and the patient’s family. Two major categories are identified: medical scenarios where there appears to be minimal ostensible effect, and scenarios where there is identifiable interaction – albeit not always only at the bedside. Whereas the author identifies ‘religion’ as participation with worship patterns and belief, and ‘spirituality’ as a dynamic personal experience, the article does not distinguish between the two notions (RS) while interfacing the medical system. Prayer, sacraments and artifacts are examples of RS that are important to the family and the faith community, and whereas the practitioner may not embrace these, (s)he should certainly openly tolerate and encourage the use of the family preferences. Those who engage in active prayer (not only in health care situations) acknowledge that whereas prayer may not always attend health recovery, it often ushers the restoration of community and the ability to engage life after tragedy. The author also considers RS preferences – such as the refusal of blood products and vaccinations – in the direct management of healthcare. These healthcare choices may be directly antagonistic to the practitioner’s care recommendations – but if so – the practitioner must never abandon his/her duty to the patient and the family. Thoughtful discussion of these issues prior to establishing a formal patient-doctor relationship may be very useful. Nonetheless, the practitioner must remain cordial and professional in approaching these situations.
Author: Ferdinand Yates, Jr., MD, MA, FCP
Dr. Yates serves on the Board of Directors for the American College of Pediatricians. Dr. Yates earned his Medical degree from the University of Virginia in Charlottesville in 1978. Subsequently, he went to Buffalo, New York where he trained in general pediatrics and practiced general pediatrics for nearly 36 years. His time in western New York culminated with his becoming Medical Director of an inner-city clinic and being appointed Professor of Clinical Pediatrics at the State University of New York at Buffalo.
Dr. Yates also holds a Master of Arts in Bioethics (from Trinity International University), and has published articles in several medical journals, and teaches medical ethics.
Other articles of interest regarding Medical Ethics:
January 2020, Letter to Honorable Azar protesting discriminatory policies towards disabled persons: Anti-assisted Suicide Coalition Letter
November 2017, I am a man with Down syndrome. Frank Stephen, in this impassioned speech, states why he doesn’t think he should have to justify his existence. (At the bottom right hand side of the video screen on the above link, be sure to click the sound ‘on.’)
October 2017. In this Op-ed piece, Dr. L. David Perry member of the ACPeds responds to an article Society for Adolescent Health and Medicine Position Paper regarding Abstinence only until Marriage School Sex Education Programs.
A Canadian academic analyses the battle over values in her new book, Bird on an Ethics Wire. Read about her perspective, Hope, the common good and our duty to the future.
Britain’s best-known rabbi says that religion must be a voice in the public square…his thoughts, The Limits of Secularization.
United Nations official for religious freedom, ‘conscience is at the core of humanity. It is at the foundation of human rights, and is “closely interwoven with human dignity.”’
Lawyer, activist and journalist Wesley J. Smith is a bioethical gadfly. His recent book, Culture of Death: The Age of ‘Do Harm’ Medicine, pulls no punches as he swings at euthanasia, transhumanism, health care rationing, futile care theory and other trends. This article at BioEdge asked him how he sees the future of bioethics and the “best” and “worst” bioethicists. Click here to read the vigorous exchange of ideas.
Tyranny comes disguised as ‘civil rights’. Read this article at Mercatornet.com: A de-sexed society is a de-humanised society
The fiercest debates today hinge on the question, ‘what is reality?’ Read this article at Mercatornet.com: The world we discover and the world we make
If same-sex marriage involved only adults it would be much easier to accept it from Mercatornet.com
August 8, 2018: The culture of death began as an academic exercise – Felipe E. Vizcarrondo, ACPeds Member.