Legal and Ethical Problems in the Provision of Medical Care. I **

A profession is distinguished from a trade or business in that it is said to possess a self-governing system of ethical standards above and apart from the norms of society as a whole. Medicine, being a profession, has a formal code of ethics, ancient in its origin and consistent in its application, which stands as a guide for conduct when dealing with (a) other members of the profession and (b) with the public. That portion of our ethical code which deals with doctor-doctor relationships seldom comes under discussion. It works well generally and is not usually thought of when we talk about ethical "problems." That portion, however, which deals with doctor-patient relationships is fraught with enough difficulty to warrant devoting these lectures to their consideration. One might ask why the ethical standards of a profession should ever create problems. It may be that society as a whole does not understand our standards; it may be that our code of ethics does not conform to the behavioral norm of the society in which we live, or it may be that our ethical code does not address itself to the questions that the public considers important. I think it is unlikely that there is real misunderstanding between the public and ourselves; hence, it seems to me important to see where we either do not conform to the societal norm or simply do not address ourselves to issues of importance to the public. In order to do this, I propose to divide the subject matter of my lecture somewhat arbitrarily. I should like to attempt an examination of our profession's standards and the norms of society in general, and conduct this examination in two ways. First, I would like to deal with the one-to-one relationship of the individual physician and the individual patient to see where the standards of our profession and the norms of society impinge and to see what problems arise from this impingement. Then I should