oath1In a book review on Trusting Doctors: The Decline of Moral Authority in American Medicine By Jonathan B. Imber in the New Republic Sherwin Nuland makes an eloquent case for the inherent morality that comes with the profession. He points out that this morality is not a product of our modern Judeo-Christian mindset but has been infused into the profession through an unbroken chain of healers leading from then Hippocratic tradition into the Jewish and Arabic physician tradition first before becoming a western medical principle.  The books thesis is that the ethical construct of modern medical care is at risk due to an increased emphasis on technology and a decreased societal emphasis on religious (Catholic and main line Protestant) ethical principles. Dr Nuland points out that the risk to the profession and the public’s skepticism dates back much further than one might think and is grounded in findings of fact (the Tuskeegee Syphilis experiment is one such ethical lapse). He feels that physicians need to eschew religious justification for their actions and instead be guided by higher moral priciples as befits our profession.

Nuland states “For more than two thousand years, that interaction, and its setting of medical morality, was the primary basis of the trust and the authority placed in the members of the medical profession and the profession as a whole by those who depend on them for healing. Now the uniqueness and intimacy of the interaction has been allowed to fray. That is the moral crisis. It behooves the profession and the laity to recognize its gravity and to seek measures to restore as much of the old relationship between patient and physician as is reparable.”

As we find ourselves learning of such large conflicts as Frederick Goodwin’s $1.3 check from pharmaceutical companies not reported to his audience on the Infinite Mind  until pointed out by Senator Grassely  we need to consider much smaller conflicts. Are we able to make recommendations to our patients without conflicts arising? One hopes that physician payment re4form will emphasize only needed care and not excessive procedures and prescribing that forces us to check our ethics at the office door.