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ss Turning the Tide - Turning the Tide,  Why is ethical decision making more difficult?

Why is ethical decision making more difficult?

Earlier this century there was a broad consensus about ethical decision making in medicine. Ethical codes such as the Hippocratic Oath and its modern restatement The Declaration of Geneva (1948) were broadly accepted by secular bodies and largely consistent with the Bible. This is no longer the case.

Both medicine and society have changed dramatically over the last few decades in ways that have made ethical decision-making much more complicated than before.

First, medical knowledge and technology have advanced astronomically. The general practitioner managing a case of lobar pneumonia at the turn of the century did not have to make a decision about whether or not to give antibiotics. There weren't any. We now have surgical operations for the patient with an aortic aneurysm, ventilators for the premature infant with respiratory distress and phenothiazines for the schizophrenic, and we have to decide whether to use them.

Second, because of the influence of the mass media, medical knowledge is less and less secret and more and more public property. An increasingly educated public knows what technology is available and is demanding it. This increased scrutiny is making our decisions more visible and our practice more accountable.

Third, the specialisation that has resulted from the increase in knowledge and technology available has meant a move to team decision-making. The solitary doctor at the bedside has been replaced by a team of subspecialists, a hierarchy of medical staff, a host of paramedical specialties and a vast array of technical and management personnel - each expert in his or her own small field.

Fourth, financial and resource constraints in the face of rapidly advancing knowledge and technology have meant that we have more acute decisions of resource allocation to make. What should our priorities be - heart transplants or hypertension, ventilators or venereal disease, geriatrics or gene therapy?

Finally, and most importantly, all this is taking place in a moral vacuum. We live in a post-Christian society where there is no agreement on the underlying basis for decision-making. The plurality of religious traditions, cultural backgrounds, world-views and ideologies makes any real consensus impossible.

These factors have combine to create a minefield of ethical conflicts for Christian health professionals. Every new advance in knowledge and technology creates new dilemmas and our patients have higher expectations. We have to make our decisions in an atmosphere of increasing financial constraint, increasing public scrutiny and in consultation with those who increasingly do not share our faith.

Tolerance is paraded as the supreme virtue in such an ethical environment but tolerance of mutually contradictory views is both ludicrous and unworkable when decisions have to be made. It's simply impossible to please all of the people all of the time - so one view ends up prevailing.

In practice, the secular humanist world-view has become dominant and ethical codes have become increasingly 'politically correct'. Over the last few years traditional codes have been amended and new ones drafted to reflect the new ideology. The World Medical Association has moved quickly to endorse them.

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