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Editorial
Medicine and the moral compass Rob George This summer has been an interesting time for observers of human behaviour and to eyes like mine, dominated by the peculiarly English pastime of anguished self-examination. Mind you, it has been with good reason, given the orgy of moral crises and an apparent wholesale collapse of trust that has escalated over the last couple of years, to fi nd form in the anarchy of recent weeks. We seem to have eventually woken up to realise that we have lost an important cultural tool— the moral compass. We are told that we know this because those we are meant to trust in stewarding wealth do no such thing, but have been gambling it away; because those who are meant to govern and model probity have been lining their pockets along the way instead; because the pursuit of truth has been replaced with the pursuit of voyeurism and titillation; because personal confidences are now on sale not just from private eyes, but the police, or so says that untrustworthy press; and because apparently our teachers do not, rather than cannot, control the children in their charge and neither do their parents, that is if they have them. Medicine and healthcare have not escaped either: we can go back Correspondence to Rob George, KCL, Cicely Saunders Institute, London SE1 7RT, UK; [email protected]
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to Bristol or Shipman or come forward to the power games around reform that are too often driven by self-interest or the mean-mindedness of rich doctors objecting to paying more for their copper bottomed pensions. However, I always worry when anyone wants to start getting out the moral compass, not because there is no such thing or that right and wrong are a matter of opinion, but something else. Compasses point away from the user and when I use them, eyes are conveniently kept off what is wrong with me. That is, of course, unless I use a mirror or get someone to point at me. This matters. Medicine is supposed to be founded on a morality that most of the public still believe—that despite Shipman and Bristol we do and indeed continue to do as we ought—we act in the best interest of our patients. So amidst all the froth and words about what is wrong with society, can it be said about me that I act always in my patients’ best interest? In supportive and palliative care, two questions probably suffice as starters for 10: ▶ Do I respect my patients’ autonomy such that I am prepared to tell them the truth about their disease or prognosis and their realistic options, or do I continue to deceive both them and myself and waste their remaining life by behaving as though they
▶
will stay alive so long as I keep treating them? When looking at what may benefit them, do I ask them what good or bad looks like through their eyes, and seek to act upon it, or do I assume that I know best and carry on regardless?
Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 3 October 2011 Published Online First 17 October 2011 BMJ Supportive & Palliative Care 2011;1:278. doi:10.1136/bmjspcare-2011-000123
BMJ Supportive & Palliative Care December 2011 Vol 1 No 3
Downloaded from http://spcare.bmj.com/ on August 4, 2015 - Published by group.bmj.com
Medicine and the moral compass Rob George BMJ Support Palliat Care 2011 1: 278 originally published online October 17, 2011
doi: 10.1136/bmjspcare-2011-000123 Updated information and services can be found at: http://spcare.bmj.com/content/1/3/278
These include:
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Editorial
Medicine and the moral compass Rob George This summer has been an interesting time for observers of human behaviour and to eyes like mine, dominated by the peculiarly English pastime of anguished self-examination. Mind you, it has been with good reason, given the orgy of moral crises and an apparent wholesale collapse of trust that has escalated over the last couple of years, to fi nd form in the anarchy of recent weeks. We seem to have eventually woken up to realise that we have lost an important cultural tool— the moral compass. We are told that we know this because those we are meant to trust in stewarding wealth do no such thing, but have been gambling it away; because those who are meant to govern and model probity have been lining their pockets along the way instead; because the pursuit of truth has been replaced with the pursuit of voyeurism and titillation; because personal confidences are now on sale not just from private eyes, but the police, or so says that untrustworthy press; and because apparently our teachers do not, rather than cannot, control the children in their charge and neither do their parents, that is if they have them. Medicine and healthcare have not escaped either: we can go back Correspondence to Rob George, KCL, Cicely Saunders Institute, London SE1 7RT, UK; [email protected]
278
to Bristol or Shipman or come forward to the power games around reform that are too often driven by self-interest or the mean-mindedness of rich doctors objecting to paying more for their copper bottomed pensions. However, I always worry when anyone wants to start getting out the moral compass, not because there is no such thing or that right and wrong are a matter of opinion, but something else. Compasses point away from the user and when I use them, eyes are conveniently kept off what is wrong with me. That is, of course, unless I use a mirror or get someone to point at me. This matters. Medicine is supposed to be founded on a morality that most of the public still believe—that despite Shipman and Bristol we do and indeed continue to do as we ought—we act in the best interest of our patients. So amidst all the froth and words about what is wrong with society, can it be said about me that I act always in my patients’ best interest? In supportive and palliative care, two questions probably suffice as starters for 10: ▶ Do I respect my patients’ autonomy such that I am prepared to tell them the truth about their disease or prognosis and their realistic options, or do I continue to deceive both them and myself and waste their remaining life by behaving as though they
▶
will stay alive so long as I keep treating them? When looking at what may benefit them, do I ask them what good or bad looks like through their eyes, and seek to act upon it, or do I assume that I know best and carry on regardless?
Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 3 October 2011 Published Online First 17 October 2011 BMJ Supportive & Palliative Care 2011;1:278. doi:10.1136/bmjspcare-2011-000123
BMJ Supportive & Palliative Care December 2011 Vol 1 No 3
Downloaded from http://spcare.bmj.com/ on August 4, 2015 - Published by group.bmj.com
Medicine and the moral compass Rob George BMJ Support Palliat Care 2011 1: 278 originally published online October 17, 2011
doi: 10.1136/bmjspcare-2011-000123 Updated information and services can be found at: http://spcare.bmj.com/content/1/3/278
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
