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Annual Oration of 1983

The Tools of the Trade

Orator: Samuel Bachrach, M.D.

Synopsis of Oration:

Dr. Bachrach believes ethics need to have a more prominent position in medicine, for they play a larger role in medical decisions and treatments than usually considered. Ethics are the "tools of the trade" in Bachrach's mind.

In light of the recognition of ethics' strong influence in medicine, many medical schools are trying to integrate ethics training into their curricula, to a mixed reception. Some claim evidence shows that these courses do little to alter the existing downward trend in ethical implementation in medicine. They say that the values necessary to be an ethical physician are learned as part of one's upbringing, and by medical school it is too late for students to acquire them. Others, though, say that medical ethics training is necessary for medical students to learn how to apply their ethical standards to medical situations, and when and how to expect issues and confrontations to arise.

Dr. Bachrach describes Institutional Review Boards (IRBs), the committees put in place to ensure ethical practices in human research studies. As a model for IRB intervention, he uses the example of an artificial heart being placed into Dr. Clark in Utah, and gives each specific point of his informed consent.

Next he discusses the social and political responsibilities of physicians, as outlined by the philosophers Albert Jonsen and Andrew Jameton. They consolidated these responsibilities into three principles by which physicians should operate: Doctors must take responsibility for the economic and social direction of medicine; they are accountable for the medical environment; and they are responsible for how medical skills are used. But a physician's principal responsibility is to provide medical care to his patients in a compassionate, concerned manner, and the preceding duties do not override this obligation.

Dr. Bachrach stresses the issue that doctors need to take a stand against immoral use of medical skill and technology, namely nuclear arms building and passage of capital punishment. Fortunately, doctors' efforts in these areas have been effective and beneficial to society. However, as he reminds his audience, physicians have also played roles in some of society's worst abuses of human rights, such as concentration camp experiments in World War II and the Tuskeegee syphilis experiment.


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