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Conscience and responsibility.

Those of us who have followed the editorial policy of the British Medical Journal during the past decade will have noticed increasing emphasis on ethical problems. They are posed by the changing character of medical practice in response to rapid technological advance, the pressures of public opinion ultimately reflected in more liberal legislation, and the deficiencies of a comprehensive National Health Service grappling with the problem of finite resources and infinite demand which confront the doctor with conflicting moral choices. We may also have concluded that any philosophical discussion on medical ethics too often leads to abstract and inconclusive intellectual argument?neither conducive to postprandial reflection nor necessarily relevant to the insistent demands on the busy practitioner throughout his day. In these the patient will expect the doctor to discharge his contractual obligation to him through what he rightly considers to be his due: the knowledge, experience, and clinical or administrative skills of an expert operating under the protective moral umbrella of some ill-understood, but hopefully all-embracing, professional code. The problem is that while the doctor is bound by that code to act responsibly towards his patient, the patient, whose expectations have been immoderately fuelled by the media operating under a code determined by the contemporary mores of our increasingly profane society, is under no obligation to reciprocate. Therein lies the doctor's moral dilemma between his conscience and his responsibility.