Physician integrity, religious belief, and the adequacy of medical ethics

Contemporary medical ethics lacks an overall moral framework and coherence. Efforts to repair this inadequacy need to attend to the personal and the professional spheres of value that influence the physician's ethical judgments. Attending to the personal sphere of value acknowledges that the physician comes to medicine with foundational ethical beliefs and values that are explicitly or implicitly religious. Chapter 1 presents original data from a survey of physicians about physician assisted suicide and related issues to provide an empirical example of how influential the physician's personal moral sphere can be. Chapter 2 assesses the principlism of Tom Beauchamp and James Childress and describes their failure to provide a normative framework to guide the use of principles. Chapter 3 assesses Edmund Pellegrino and David Thomasma's attempt to locate a morality internal to medicine and finds their attempt unsatisfactory because too much normative value is silently imported in the process of phenomenological interpretation. Chapter 4 addresses the physician's personal sphere by exploring the role of religious beliefs in medical ethics and argues for the adoption of John Reeder's inclusive concept of religious ethics that maintains that any account of what is ultimately real and ultimately good should count as “religious.” This chapter is Christian in its assumptions but addresses issues relevant to other religious traditions. Chapter 5 argues for the integration of the personal and professional spheres of value in the moral life of the physician. Rawls' opposition to the expression of religious belief in public life is questioned and an alternative view of reason and religion that allows for candid religious expression is proposed. The work of Charles Taylor is employed to argue that ethics and integrity are intertwined as part of the physician's personal identity. I conclude that the relationship between ethics, integrity, and identity calls for a vigorous pluralism and invites the medical profession to engage the religious values of physicians as vital resources for a medical ethics that adequately reflects the broader and deeper realities of medical practice and the moral life.