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Ethics, Opening Thoughts

When I was asked to write about relevant issues and significant dilemmas in bioethics for the IJAHSP, the first dilemma I faced was how to introduce the column. Introductions always present an author with the challenge of the tabula rasa; what one writes on that "clean slate” will set the climate for future discourse. Afterall, bioethics can be viewed as the foundation of everything we do in medical research and healthcare. Ethics can be used to evaluate motives, techniques, and outcomes. So, I sent out an email to the allied health faculty and students, asking them to complete the following sentence: "The biggest ethical problem in healthcare is _________.” So far, fewer than 10% of the faculty and about 25% of the students have responded. I will discuss and compare their answers in a future column; for now, I want to make three basic contentions for the meager response.

First of all, I want to argue that although allied health students and professionals are encouraged to live by a code of conduct, we are sometimes as uncomfortable discussing our ethical beliefs as we are discussing our political and religious affiliations. In other words, I don’t think those who didn’t respond feel that the world is perfect and that there are no ethical problems in healthcare. For someone to imply that stem cell research, for example, is a big ethical problem is to suggest that they will be expected to defend their pro or con position. We are often silent because we fear judgment for our beliefs.

The second possible explanation is that some of us believe that bioethics is solely the domain of the ethicist. Many health professionals hear the word "ethics” and envision an expert task force. Some professionals even believe that ethics is merely an academic game with no practical applications or weight in the real world. To the pragmatist, legal ramifications take precedence over ethical considerations in healthcare and research. Even students recognize how the wishes and rights of patients and research subjects can be ignored, and how a nation can be thrown into moral paralysis by meddling politicians, celebrities and religious zealots. Healthcare professionals are often silent on ethical issues because "the buck stops” somewhere over there.

This leads into my third contention: although most professionals know about healthcare ethics, many don’t really know what an ethicist is. An ethicist is simply "one who specializes in or is very concerned about ethics” (Merriam -Webster Medical Dictionary, 2002). All healthcare professionals who have an interest in ethics should consider themselves "ethicists.” That doesn’t mean all are qualified to teach the subject, but it does qualify their opinions based on their educational and clinical experiences. For professionals and students who are silent because they question the value of their own authority, well, your responses are valuable because we are all fellow ethicists.

While watching the Tour de France in July, I saw a commercial for an investment firm. The commercial showed Lance Armstrong cycling up a mountain while the narrator said, "Lance Armstrong is not a cyclist. He is a leader.” Lance is a cyclist AND a leader. He is both. Likewise, you can be both a healthcare professional AND an ethicist. Ethics is the "bike” you ride to the top of your profession. If you feel weak on that "bike,” seek extra training, enroll in an ethics course, read the relevant publications and, most importantly, participate in the discourse. In this way, the future of healthcare can be molded by the professionals who are providing ethical care and research.

I am interested in your input on future discussions. As a fellow ethicist, please complete the following sentence: "The biggest ethical problem in healthcare is ______.” Email your responses to me at holub@nsu.nova.edu. See you at the top of the mountain!

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