Does Medicine Have Common Goals? An Analysis of US Medical Organizations’ Ethics Statements

Abstract

A philosophical framework defines medicine. Multiple competing frameworks lead to varying and sometimes conflicting understandings of the physician-patient relationship, medicine's goals, and physicians' duties. The objective of this study is to categorize the various goals, identify the underlying philosophical framework, and determine inconsistency among US medical organizations. Twenty-five American Board of Medical Specialties-related organizations, the American Medical Association, and the American Osteopathic Association were searched for key goal-related terms in their ethics-related statements. Direct goal statements were also analyzed. Key terms were grouped as physician-centric/objective (best interest, treat disease, prevent disease, cope with illness, health care/promotion) representing the traditional ends of medicine, patient-centric/subjective (welfare/well-being, patient benefit) reflecting social constructionist methodology, or relational (services to humanity, medical/patient care). Each organization was characterized overall as traditional, social constructionist, or relational. Inconsistency was defined as the smaller between the social constructionist and traditional with relational possibly inconsistent. Definitions of key terms and references to philosophical frameworks were reviewed. Twenty-two organizations were included; 73 percent of statements as a whole reflected a social constructionist model with 18 percent having traditional ends and 9 percent a relational framework. There was an 18 percent to 27 percent inconsistency among organization statements as a whole; 68 percent of organizations had direct statements; 47 percent of direct statements reflected a social constructionist methodology, 33 percent the traditional ends, and 20 percent the relational model; 33 percent to 53 percent of direct statements were inconsistent among organizations. No definitions of key terms or explicit references to philosophical frameworks were found. There is substantial inconsistency regarding the direct goals of medicine without any definitions of key terms. This inconsistency and lack of clarity underlie disagreement regarding physicians' roles and their duties. Clear core goals such as treat and prevent disease would consistently define the physician-patient relationship, restore medicine's objectivity, and provide a distinct understanding of physicians' obligations. American medical organizations use a multiplicity of terms and have substantial inconsistency regarding the direct goals of medicine with neither a clear underlying theoretical basis nor a definition of key terms. Our analysis suggests the most common theoretical basis for the goals of medicine was the social constructivist view followed closely by the traditional ends of medicine (e.g., treat and prevent disease) and finally the relational model. The authors contend that the traditional ends of medicine are the best option for a core mission of medicine whereby the physician-patient relationship is consistently defined, and a physician's duties derived.