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September 8, 1999

Professional Medical AssociationsEthical and Practical Guidelines

Author Affiliations

Author Affiliations: Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC (Dr Pellegrino), and Departments of Medicine and Social Medicine, Harvard Medical School, Boston, Mass (Dr Relman).

JAMA. 1999;282(10):984-986. doi:10.1001/jama.282.10.984

Medicine is, in essence, a moral enterprise, and its professional associations should therefore be built on ethically sound foundations. At the very least, when physicians form associations, such associations should promote the interests of those they serve. This, sadly, has not always been the case, when economic, commercial, and political agendas so often take precedence over ethical obligations.

The history of professional medical associations reflects a constant tension between self-interest and ethical ideals that has never been resolved. This tension is the result of the mixed origins and aims of the social institutions from which professional associations arose. For example, some associations originated in the Renaissance from groups of scholars whose aim was the exchange of knowledge and ideas about natural science, medicine, and philosophy. Other associations were founded by royal fiat to set standards of education and practice in the public interest. Still others were inspired by the elitist ethos of the medieval guilds. Today, the dominant influence on professional associations is economic, and the tension between self-interest and ethical principles is greater than ever. This conflict is eroding the moral foundations of all professional associations, not only in medicine, but in law, education, and even the ministry.

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