Our last meeting covered the topic of Professional Codes & Ethics and was admirably presented by Dr. Gordon Wilson of UNCA. He took what could have been a rather dry topic and made it interesting by showing the different codes of ethics drawn up by various medical organizations.

Following a brief review of our overall program thus far, which has emphasized various ethical principles and guidelines by which ethical decisions are made, he launched us into the essentials of the Hippocratic Oath, The American Medical Association's Principles of Medical Ethics', The American Hospital Association's 'Patient's Bill of Rights'. The American Nursing Association's Code of Ethics, The International Nurses Association's Code of Ethics, and others. The most salient and persistent theme found in all these professional codes of ethics is their emphasis on 'for the benefit of the patient'. As Ken Young pointed out, the essentials of many of these codes could pertain to many other professions. Perhaps they even appeared to be good public relations statements rather than relating specifically to medical practices. Perhaps this is a bit cynical but here is also much truth to the comment. What was in these codes that made them specifically 'medical' codes of ethics? How do 'medical ethics' differ from ethical/moral behavior in the other professions, such a teaching, psychology, law, accounting, etc? These are good questions!

While codes of ethics generally propose guides to behavior under certain circumstantial relationships, they are always, of course, between human beings. Therefore, it should not be surprising that there are certain fundamentals shared by all codes of ethics. We can almost count on there being emphasis on the patient or client. All professions exist 'for the benefit' of the patient or client'.

We are not surprised that the professional also gains by providing his/her services. Yet, we expect the balance of concern to be on the patient/client and that decisions are always made "in the best interest of the patient/client". We can almost always count on there being some concern for honesty, openness, truth-telling, privacy, & confidentiality. But unique to medicine is the concern for the very physical being of the patient. No other profession concerns itself with the 'the corpus,' the fundamental aspect of being and the seat of life itself. The medical profession, for the most part, has as its primary concern the physical well-being and/or ill-being of the patient. This exposure of one's most intimate being to another person is fraught with the sense of vulnerability, fear of loss of control, need for deep trust and endurance of awkward intimacies thrust upon patients in their most vulnerable states. Thus we find concerns for patient autonomy and informed consent important.

In our increasingly pragmatic world, we also find increasing emphasis on physician education, training, and competence. People want results today and competence. People want results today and competence may be a new virtue.

Dr. David Liden, from Murphy Medical Center in Murphy, NC responded by outlining the extensive program he and his hospital have developed to make medical ethics a living and breathing code inculcated into the general practice of medicine at all levels of the hospital, from the maintenance people through the dietary department, the paramedical personnel, nurses and phyusicians. In the face of today's cynicism, it was refreshing to the audience to hear that the midical people are indeed concerned about ethics in medical practice on a real level.

The audience participation was active and astute, as usual. My final comments: There are so many codes of ethics thatperhaps we can always find one to justify our actions! Furthermore, what ever happened to MORALITY?