Edmund D. Pellegrino
Until very recently, both in Eastern and Western medicine, codes of ethical conduct provided the only source of judgment of good and bad, right and wrong, professional conduct. They were, therefore, the only “method” of ethical argumentation. However, from the beginning of the contemporary era of medical ethics, ethical codes have been challenged by a wide variety of alternate modes of argumentation, as the other chapters in this book attest. Nonetheless, in most of the world, among professionals and laypersons, codes continue to set standards for ethical conduct, to define new ethical issues, and to support one position or another in ethical discourse.
The purpose of this chapter is to examine the use of codes in medical ethics argumentation, to define the sources of their authority, and to delineate their use and abuse in ethical discourse. This chapter will attempt to show that, properly used, professional ethical codes still have an important place in the field, provided their limitations are taken into account.
The chapter consists of five sections: (1) an overview of the ubiquity and historical presence of ethical codes in medicine; (2) the technique or “method” underlying the use of codes in argumentation; (3) a critique of the moral authority of codes, proposed sources of their moral authority, and the use and abuse of codes in ethical argumentation; and (4) advice about training in the use of codes, as well as suggested resources for further study.
The subject of this chapter is professional codes. It is important at the outset, therefore, to distinguish codes from oaths with which they are frequently confused. Sulmasy has made this distinction quite explicit (Sulmasy 1999). He understands an oath to be a formal, solemn, publicly proclaimed commitment to conduct oneself in certain morally specified ways. Codes, on the other hand, are simply enumerations, codifications, or collations of a set of moral precepts. One may or may not swear fidelity to a code. When one does swear solemnly to abide by a specific codification of moral precepts, then code and oath coincide but do not lose their separate identities. When I speak of codes in this chapter, I refer to the codification and not necessarily the oath to abide by that codification.