All posts by Michele Paine

Medicine, A Moral Community

In his essay “The Medical Profession as a Moral Community,” Pellegrino addresses the characteristics of a moral community:

  1. Members of the group share a covenantal relationship both with each other and with society.
  2. The community has certain standards that remain constant regardless of contemporary leaders or members.
  3. The community is more than the sum of all its members.

By this definition, the field of medicine can be considered a moral community.  The medical profession is more than each physician treating his or her respective patients.  The moral nature of the medical profession can actually be seen as completely necessary for the continued ethical function of the profession, given the vulnerability of patients.


Pellegrino describes the vulnerability of patients, and how this imposes even more of a need for doctors to remain moral as individuals and as a community.  In the not infrequent event of illness or disease, Pellegrino argues that the patient, no matter how self-sufficient they may be in other situations, becomes vulnerable in the medical setting. This inescapable vulnerability then creates a moral obligation for the physician.


This balance between beneficence and patient autonomy in a complex medical situation brings us back to what we discussed at the beginning of this semester.  While the physician has the obligation to “First, do no harm,” they must also, Pellegrino says, protect their patients against exploitation, which may include protection from the patient themselves or the physicians themselves.  One aspect of protecting the patient from themselves may be in the case of routine vaccination.


If physicians belong to a moral community that share a covenantal relationship with both each other and with society at large, then it would follow that they should support public health policies that protect the population majority.  One of these policies is mandatory vaccination.


While vaccinations are considered mandatory for children to attend public school, the majority of the states in the US allow both religious and philosophical exemptions, which allow parents to refuse vaccination on any terms.  If the medical profession is a moral community, then they have the obligation to protect their patients from the exploitation of the media with regards to anti-vaccination campaigns.


If physicians were to truly take a stand as moral agents in the medical profession, vaccination rates could possibly increase, which would decrease the number of outbreaks in communities, like the measles outbreaks which have gained attention recently.  If physicians were to make their case for vaccination instead of deferring to the opinions of uninformed parents, they might be able to make a difference.




Pellegrino, Edmund (1990).  The Medical Profession as a Moral Community.  Bulletin of the New York Academy of Medicine. 66/3 221-232.

Canterbury v. Spence

The opinion in Canterbury v. Spence provides a great opportunity for discourse on the patient’s right to informed consent, which sometimes opposes what the physician may think is best for their patient.  Just as soon as there is a rule regarding guidelines to informed consent, there is bound to be an exception to that rule.


As this case so clearly demonstrates, it is far from uncommon for a physician to be sued for malpractice in the event that something has gone wrong.  Because of this constant threat, one might think that doctors would be completely on board with informing their patient as thoroughly as possible, if only to prevent cases like Canterbury v. Spence from happening.  While ideally the fear of malpractice suits should not be the only factor motivating physicians to fully inform their patients, it may be a good starting point.


While Dr. Spence claims to have withheld the information because he had the patient’s wellness in mind, it seems reasonable that Canterbury may have been better served by being completely informed.  When a minute but potentially significant risk is involved, it may be better to over share, especially if the patient is of sound mind, as Canterbury allegedly was.  At that point, the patient has all the cards in his hand and makes a fully informed decision. This would also bring into account the relationship between the patient and physician. Ideally, the physician would be able to inform the patient of all potential risks and still trust that the patient would have enough faith in the physician’s educated opinion on what the course of action should be, as the doctor is clearly more well-versed on current medical practice.


An interesting point that O’neill brings up in his article “Some Limits of Informed Consent,” is how problematic informed consent can become when relating to issues of public health policy.  The examples he gives are those of water purity levels and food safety requirements.  It is simply not feasible to adjust these levels or regulations to individual choice, and it is unreasonable to assume that each individual would have the knowledge necessary to make a decision like that. The reason we have professionals who devote their lives to this field of study is for precisely that reason, and for the most part, we do well in trusting their expertise.




O’neill, O. “Some Limits of Informed Consent.” Journal of Medical Ethics 29.1 (2003): 4-7. Print.