Medical ethos and social responsibility in clinical medicine

The medical profession will face many challenges in the new millenium. As m edicine looks forward to advances in molecular genetics and the prospect of unprecedented understanding of the causes and cures of human disease, clin icians, scientists, and bioethicists may benefit from reflection on the ori gins of the medical ethos and its relevance to postmodern medicine. Past di stortions of the medical ethos, such as Nazism and the Tuskegee Syphilis St udy, as well as more recent experience with the ethical challenges of emplo yer-based, market-driven managed care, provide important lessons as medicin e contemplates the future. Racial and ethnic disparities in health status a nd access to care serve as reminders that the racial doctrines that fostere d the horrors of the Holocaust and the Tuskegee Syphilis Study have not bee n removed completely from contemporary thinking. Inequalities in health sta tus based on race and ethnicity, as well as socioeconomic status, attest to the inescapable reality of racism in America. When viewed against a backgr ound of historical distortions and disregard for the traditional tenets of the medical ethos, persistent racial and ethnic disparities in health and t he prospect of genetic engineering raise the specter of discrimination beca use of genotype, a postmodern version of "racist medicine" or of a "new eug enics." There is a need to balance medicine's devotion to the well-being of the patient and the primacy of the patient-physician relationship against the need to meet the health care needs of society. The challenge facing the medical profession in the new millennium is to establish an equilibrium be tween the responsibility to ensure quality health care for the individual p atient while effecting societal changes to achieve "health for all."