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A Piece of My Mind
August 8, 2001

A Golden Rule: Remember the Gift

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2001;286(6):648-650. doi:10.1001/jama.286.6.648

I would like to offer a simple formula that physicians can readily apply to act humanistically when faced with moral dilemmas in medical practice that they do not know how to handle. Since this formula really is quite simple, I am hoping those who use it will be able to pass it on to their students, residents, and colleagues and thereby enhance humanism in medicine, even under the modern pressures of cost containment, managed care, and other forces.

The 20-year tale of my search for this simple moral rule or formula is itself instructive and dates back to the wonderful opportunity I had to study moral philosophy for a couple of years between college and medical school. With that academic background, I arrived at medical school knowing a lot about what all the great thinkers thought about questions of right and wrong, and I was conversant in a host of theoretical frameworks and models for moral decision making. But I obviously did not know the first thing about the practical side: how to put all of this theory into practice. So in my first year of medical school, I went around to some of the most distinguished professors of medicine I could find, asking them what framework or rule they applied when faced with some moral dilemma in medicine. Most of them replied to me in the same way, saying something like, "What the heck are you talking about?"

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