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August 12, 1988

It's Almost Over— More Letters on Debbie-Reply

JAMA. 1988;260(6):789. doi:10.1001/jama.1988.03410060057017

In Reply.—  Dr Brody has raised an interesting and important question: Should medical ethics consist merely of the intellectual analysis of alternative value positions or should it also embody the professional virtues and norms of medicine?Dr Brody clearly subscribes to the former view. In his book he writes, "Ethics is the study of rational processes for determining the best course of action in the face of conflicting choices."1 On this view of ethics, any moral claim that asserts a boundary or proscription will, by definition, seem rhetorical.This rationalistic view of ethics, however, has come under scrutiny by moral philosophers.2 It also stands in opposition to well-respected articulations of the patient-physician relationship.3,4 We agree that the vast majority of medicalethical decisions exist in a discretionary zone, where multiple positions can be argued with cogency. Our point is that there are a limited number of medical actions,