Balancing Act pp 133-154 | Cite as

The New Medical Ethics of Medicine’s New Economics

Part of the Clinical Medical Ethics book series (CMET, volume 3)


Probably the most important implication of medicine’s economic revolution is that it forces us to reconsider, not just financial arrangements, but some long- and widely-held tenets of medical ethics. Initially, physicians’ obligations of fidelity stemmed from patients’ substantial vulnerability. Illness, impairment, ignorance, and an imbalance of power in the physician-patient relationship gave rise to strong duties of personal and professional fidelity. Since the advent of modern bioethics over the past two to three decades, this traditional view has been powerfully augmented by another concept, patient autonomy. Coincident with early legal cases establishing the doctrine of informed consent1, early bioethics literature argued vigorously against longstanding physician paternalism in favor of the view that competent patients are entitled to make their own medical decisions.2 Whereas the older, vulnerability-based ethic of fidelity required the physician to promote the patient’s benefit in whatever ways the physician thought best, autonomy-based fidelity requires the physician to promote the patient’s benefit as the patient himself defines it.


Health Plan Medical Ethic Moral Agent Health Care Plan Competent Person 
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Copyright information

© Kluwer Academic Publishers 1991

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