Medical ethics in the 21st century (Reprinted from Journal of Internal Medicine, vol 248, pg 1-6, 2000)

Objectives, To foresee how medical ethics may develop in 21st century. Design. We have looked into our crystal ball to see what factors are likely to drive medical ethics over the next few decades, We have given examples of how such factors might affect specific issues, Results, Those factors that we identified as likely to shape the future of medical ethics are: Globalization. Medical ethics is likely to have to grapple increasingly wit h ethical issues arising from the huge discrepancies in the level of health care available in different countries, Increase in longevity. We predict that there will be, at least amongst the richer nations, a significant increase in life expectancy. This will result in issues of resource allocation becoming increasingly problematic within medicine. Child enhancement. Developments in genetics combined with control of reprod uction will make it possible to select our children for a broad range of ch aracteristics. There are optimistic and pessimistic predictions as to how s uch power will he used. In either case, this area will be an important focu s of concern in medical ethics. The biological determination of behaviour. Genetic research will lead to an increasing sense that undesirable behaviour is genetically determined. Thi s will lead to a re-examination of such concepts as criminal responsibility . Therapeutic research and clinical practice. We predict that an increasing a mount of clinical practice will be within the setting of clinical trials. T he ethics of therapeutic research and clinical practice will need to be bro ught within a coherent framework.