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Physician Self-interest and Medical Ethics

Stephen E. Silver, MD
JAMA. 1993;270(5):577-578. doi:10.1001/jama.1993.03510050043018.
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To the Editor.  —As a physician who has never studied the subject of medical ethics, I was perplexed by the technical language and historical references in the article entitled "The Metamorphosis of Medical Ethics: A 30-Year Retrospective" by Dr Pellegrino.1I must admit that I am not at all sure what medical ethics is, but I think that the term must embrace two broad categories of material.The first consists of those ethics that are societal but are specifically related to matters of health, birth, and death. In these areas, physicians have special technical expertise to offer, and they are also the ones who perform the actions expressive of society's values. But these are not specifically medical ethics. They are societal ethics that are carried out by medical personnel. Physicians in these matters can provide advice and consent, but they do not autonomously establish any code of behavior for


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