As practising physicians, we make ethical decisions every day, sometimes without even realizing it. This special issue is designed not only to help resolve ethical dilemmas and prevent potential problems from arising, but also to bring this ever-present factor to the foreground.
Medicine is a self-governing profession, and physicians’ first responsibility is to ensure that they give their patients good health care. But giving good care means much more than providing the best interventions possible: it means asking—and often helping to answer—difficult questions about the care of our fellow humans.
What is the difference between removing life support and euthanasia? What is futility, and when—if ever—is it a legitimate reason to refuse treatment? What’s the difference between an instructional advance directive and a proxy advance directive? Is it ethical to accept airplane tickets and hotel accommodations to attend a drug company-sponsored CME event? Do I have an ethical duty to help a terminally ill patient commit suicide? How can I resolve conflicts with families over the treatment of a seriously ill family member?
Gathered here in this special issue of the BCMJ are four articles on medical ethics. Bioethics is, of course, a vast field, and we cannot even hope to touch on all the major issues in such a short collection. Instead, we have tried to focus on topics that are of practical value to the busy clinician.
In the first article, “Ethics resources in health care institutions,” Dr Alister Browne, the chair of the Langara College Department of Philosophy and an ethics consultant in Vancouver Hospital & Health Sciences Centre, puts ethics resource committees in their proper context to help you better use their services.
In the second article, “Practical bioethics for the clinician,” Dr Davidicus Wong, chair of the Burnaby Hospital Ethical Resources Committee, explains how his committee conducts ethics consultations and discusses his experience with preventive bioethics at the clinic level with the use of patient information handouts, forms, and cards.
In the third article, “Autonomy and the terminally ill patient,” Mr William Sullivan, QC, a Vancouver lawyer, discusses the law and ethics on advance medical directives and the duty to treat.
I have written the final paper, entitled “The physician and the pharmaceutical industry.” A number of strategies to avoid conflicts of interest are suggested, and an ethical position between patients and the pharmaceutical industry is proposed.
—Kimit Rai, MD, FRCSC
Ethics Committee of the Canadian Medical Association