The Decline in Medical Ethics and Professionalism
SUPAWAT CHUTIVONGSE, M.D.*
Affiliation : *Professor and Dean, Graduate School, Chulalongkorn University, Bangkok 10330, Thailand.
Ethical attitudes of individuals are based on character and may thus be at least partly in- herited. They are later modified by life experience and the influence of others. Today it is not only the medical profession that has been singled out as needing better ethics. Attorneys, businessmen and mass communication workers as well as poli- ticians are likewise being scrutinized by the public worldwide. What is good governance and profes- sionalism? It is many things: judgement, empathy for others, honesty, transparency and accountability are most important. This means that others should know what one does. With doctors in our country, it is usually only he or she that knows what is being done and why. He or she communicates little with colleagues and less with the patient. Accoun- tability in medicine means to me that every step in diagnosis and treatment should withstand exami- nation and logical analysis by the doctor and his colleagues. Medical students pay little attention to lectures on ethics and the same or worse is true for the new graduate being let loose on the public. It is only when malpractice litigation heads for the court that these issues become personal. The doctor being accused of malpractice, rightly or wrongly, will go through a prolonged and very traumatic process. It may take several years in our court sys- tem. He or she may well be left shattered and with- out much confidence in their professional abilities after it is all over. Reverent Phra Dhamapitaka, a well respected monk, elaborated that globalization has mostly business success as a goal. The quest for social standing is another factor which has in- troduced more consumerism into Thai society. This resulted in a state where materialism and consu- merism became dominant int1uences. The tremen- dous advances in information technology. which could do much good, are mostly used as weapons to dominate human beings, mould their thinking and sell more products. It used to be said that in old Thailand there were 3 professions, teachers, monks and doctors, whom clients or patients paid with gratitude and respect. Modern doctors see patients mostly as clients, objects that pay them a fee. He or she often does not value anymore the feeling of satisfaction that comes with having solved an other human being problems. Doctors are afraid that their patients are unable to pay their fees and, even worse, that they may sue them for malpractice. This trend started in North America and is now spread- ing worldwide. A prominent American educator recently observed the decline of medical ethics in the USA to the point where attorneys now often fulfill a necessary function to keep physicians and surgeons honest. He said, "We are doing God's work, forget it, this will go away" This downward spiral, where the public views physicians as busi- nessmen, could go away again. However, only if
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