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Response from The Society for the Study of Medical Ethics

SIR, The British Medical Journal of November 5th 1977 carried two reviews side by side. The first was of Dr W A R Thomson's Dictionary of Medical Ethics and Practice reviewed by the Rev A V Campbell, and the second ofA S Duncan, R B Welbourn and G R Dunstan's Dictionary of Medical Ethics, by ProfP Rhodes. Two bold headings perhaps by the BMJ's editorial department labelled Dr Thomson's contributions as 'Medical Moralising' and the work of the composite editorship and authorship as 'Moral Problems in Medicine'. After reading the books and reflecting on the BMJ reviews we are constrained to ask one or two questions. Dr W A R Thomson, the distinguished former Editor of the Practitioner and currently Medical Correspondent of The Daily Telegraph, shows awareness throughout his dictionary ofthe problems ofbusy practitioners who sit in surgeries or consulting rooms and are confronted by anxious patients and emergency situations. He is evidently concerned, as the title shows, with the practice as well as the theory of medical ethics. He has aimed to bring sound principles and experience to bear upon the practitioner's difficulties in decision-making. Thereviewer, however, stigmatises him for making value judgments. But what other decisions should be made in a book on Ethics? Also, Dr Thomson is at fault, it seems, for building on the Judaeo-Christian tradition in the Nineteenth and early Twentieth Centuries. The BMA calls this 'moralising'. But, we might ask, what else is morality about but deciding what ought or ought not to be done. The second reviewer praises the ethically weaker offerings of the composite team, because he feels that morals 'for tolerant people should not be dogmatic, but a matter for gentle exploration with some understanding of the rival view-points'. The editors are praised for keeping their contributors 'cool, reasonable and undogmatic', and for leaving a good deal unsaid, 'for it makes the reader play his part in asking and trying to answer some of his own questions'. The articles are mainly exploratory and often describe things as they are rather than as they should be. A number ofquestions are unasked and unanswered. This, perhaps, is not surprising. For some of the contributors may not have had to cope with anxious patients in the consulting room at crucial moments. We understand that the editorial team of the JME has not been unconnected with the planning and production of this composite dictionary and have, therefore, directed our questions to the Journal. We were taught that Ethics is the science of the 'ought'. That is, it is concerned with what man in general (or professional people in particular) ought to doin certain given situationsand why. We heard, for example, of Immanuel Kant's categorical imperative and lecturers in philosophy taught that behind the concepts of any given philosophy (or for that matter any religion or system of ethics) there was, or should be, an overall principle. Hence, may we be allowed to ask what is the coordinating principle behind the Jowunal? For example, by what basic standard, apart from the Law, do reviewers and writers of articles measure their words ? By what yardstick do contributors assess any subject under discussion? Are they allowed to make any value judgments ? In the Middle Ages an uneasy association of Hippocrates, Galen and the doctrines of the Church did its best for doctors. British law itself has been heavily influenced by the Judaeo-Christian religion, which also by the late nineteenth century to a large extent controlled the practice and ethics of the Profession. But what now? Was not Dr Thomson right to try to assist doctors in making value judgments? Are the three editors of the other volume right to be content with what is in the main a presentation of what is current practice in medicine? Are the editors of the JME happy to allow the ought of medical practice to be determined by an empirical assortment of facts and by some kind of consensus thinking while having 'freedom for their own opinions'? We are not suggesting there should be dogmatic utterances but rather guidance based on clear principles to help the practitioner when he is confronted by an ethical dilemma.