Ethical dilemmas for healers have existed since the beginning of time. To treat or not to treat was a difficult question for thousands of years, because healers--and later academically trained physicians--had no guarantee of what would happen to a patient; they rarely had any statistical research that would provide data that might be helpful in deciding what to do for a sick patient. In childbirth, midwives constantly faced the issue of losing the mother but saving the baby or vice versa. When physicians began to be on the sidelines of the battlefield, the decision as to who to treat first often dictated the fate of the injured men. Until military surgeon Dominique-Jean Larrey (1766-1842), priority treatment was given to officers--a triage method that would not be tolerated today.

While physicians of the past have long faced vexing problems, the medical profession today has an even more daunting range of dilemmas. As science continues to expand the medical possibilities, physicians are faced with enormous ethical questions for which there are no easy answers. As cloning and genetic manipulation and all types of transplants--the latest being face transplants--become possible, doctors will have to reckon with whether they should just because they can.

And as medicine makes it possible for the aged to become even older, with many attendant health problems, is science prepared to help out with quality of life issues? The person who is treated for cancer at the age of 92 who survives may be so debilitated by other health issues or by the cancer treatment itself that his or her quality of life is severely affected. In addition, the cost of the cancer treatment and future hospitalizations are all covered by Medicare, the government funding of health care for those over 65 years of age. Hospital administrators need to weigh in on whether financial considerations are ever a part of the medical decision-making process.

Another big issue has to do with conflict of interest. Physicians are sometimes in circumstances where they have a vested interest in a procedure. In some cases, it can be as simple as income: one procedure is more profitable--not necessarily more effective--than another. Physicians also often have relationships with vendors. For example, a surgeon might have been instrumental in helping a company create a particular device, so he wants hospitals to buy it. Or a physician may have recently accepted a paid speaking engagement to address a particular pharmaceutical company. This type of problem has become prevalent enough that some academic institutions are banning pharmaceutical industry-sponsored gifts, food, and trips for physicians who affiliate with these universities.

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