Pain medicine's role in the restoration and reformation of medical ethics.

Abstract

Laws tell us what should not be done. A code of ethics guides us to what should be done [1]. —American College of Physicians, 1998 (We ought to perform) those actions which will cause more good to exist in the universe than any possible kind of alternative [2]. —GE Moore, Principia Ethica, 1903 Today there is a massive void in decreed ethical principles. Of the dozen elements in the Hippocratic Oath, only nonmaleficence remains. Table 1 identifies the separate elements of the Hippocratic Oath and the author's view of its modern interpretation. This moral residual is exceeded in endurance only by the Decalogue's admonition to refrain from killing. The fallback is the American Medical Association's (AMA) Code of Medical Ethics , primarily the “Principles of Medical Ethics” that were initially adopted in 1847 from Sir Thomas Percival's 1803 codification of the Manchester Infirmary's “Scheme of Professional Conduct Relative to Hospitals and Other Charities.” There have been several revisions of the “Principles,” the latest of which has been incorporated into the proceedings of the Council on Ethical and Judicial Affairs (CEJA) [3]. While having strength in its “thou shall” format, the “Principles,” listed in Table 2 …