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March 3, 1993

The Metamorphosis of Medical Ethics: A 30-Year Retrospective

Author Affiliations

From the Center for the Advanced Study of Ethics, Georgetown University Medical Center, Washington, DC.

JAMA. 1993;269(9):1158-1162. doi:10.1001/jama.1993.03500090094039

History is philosophy teaching by example.

Dionysius of Halicarnassus

When I entered medical school 50 years ago, medical ethics was, as it had been for centuries, solely the domain of the profession, protected from the mainstream of cultural change and framed in seemingly immutable moral precepts. This is the way medical ethics also appeared 30 years ago when I began to study, teach, and observe the field. If there was anything that seemed impervious to the metamorphosis we felt all of medicine to be undergoing, it was its ancient ethical framework.

Today, that framework is under the severest strain in its long history. Medical ethics has become a subject of the widest public concern. Every one of its tenets is being seriously questioned and is likely to be reformulated. Under pressure of moral conflicts buffeting our entire culture, traditional moral supports have been weakened and precepts disassembled. Just what medical

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