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The Inescapable Relevance of Bioethics for the Practicing Clinician^*

^* From the Program on Ethics in Clinical Practice, Phoebe R. Berman Bioethics Institute, Johns Hopkins University, Baltimore, MD.

Correspondence to: Joseph A. Carrese, MD, MPH, Johns Hopkins University, Division of General Internal Medicine, 4940 Eastern Ave, Baltimore, MD 21224; e-mail: jcarrese{at}jhmi.edu

Abstract

Key Points

1. Historically, medical ethics focused on the proper conduct of physicians as members of a profession.

2. Bioethics has emerged as a distinct field over the past several decades and has a broader scope than traditional medical ethics. The field of bioethics includes research ethics, public health ethics, organizational ethics, and clinical ethics.

3. Several factors contributed to the emergence of bioethics, helping to shape it, including the following: abuses of human subjects in research; advances in medical therapeutics and medical technology; and complex societal changes.

4. Principlism is an important approach to ethics, and in bioethics it includes the following core principles: respect for autonomy; beneficence; nonmaleficence; and justice.

5. Clinical ethics is a major part of bioethics and is concerned with ethical issues encountered in the care of patients.

6. Clinicians should recognize that every interaction between a doctor and a patient has a moral component, and that competency in bioethics is required to competently practice medicine.

7. Deficiencies exist in bioethics knowledge and performance among practicing clinicians and trainees; therefore, bioethics education is needed for learners at all levels (ie, medical students, trainees, and practicing clinicians).

8. Bioethics is a dynamic, multidisciplinary field with several dedicated journals, a national organization, and numerous centers and institutes

9. Important scholarly work in bioethics, both empirical and conceptual, is being conducted and disseminated, providing important information for practicing clinicians.

Key Words: bioethics • clinical ethics • medical ethics • research ethics

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