Practical practitioner principles

As a physician, I am fully aware that our code of ethics requires us to put our patients' wellbeing first. We generally assume that we are ethical people, making decisions in an ethical manner, but how are we to know? There is little education or practical discussion of this aspect of our care. We take the Hippocratic oath, but how much time have we spent analysing and understanding that oath, particularly in the context of daily clinical practice? It is all taken for granted. Would we leave any other aspect of our clinical practice to assumption? It would be considered intolerable.

The American Journal of Bioethics is a welcome recent addition to a nascent field of study. Each issue contains one or two "target" articles, followed by extensive open peer commentary, which allows for deep discussion of broad and difficult questions such as stem-cell use, placebo-controlled trials, consent to heroin prescription and the patenting of genes. It concludes with reviews of recent publications, forthcoming conferences and job opportunities.

The advent of such a journal, with its reflections from scientists, academics and clinicians, suggests that what was once referred to as applied philosophy may now be considered an applied science. Is it not time to apply a more rigorous and scientific method to our analysis of ethics in general and of bioethics in particular? Even a decade or two ago, one might have questioned such thinking, but this journal is proof of a change of attitude.

The journal is trying to create a venue where a definition of bioethics may be arrived at by debate. Although ethical questions have always been with us, the current rate of discovery in molecular biology and medicine is throwing up new and ever-more complex dilemmas. It seems impossible to define bioethics without engaging rigorously with the philosophical and theological underpinnings of ethics. To scientists, this may come as a bit of a shock since we have long seen our role as rational and objective, as against that of the philosopher/theologian as subjective and emotional. But a true definition and analysis of bioethics is possible only if we cooperate with philosophers and theologians in the search for truth - which is the ultimate aim of any science.

My only concern is that the journal may limit its target audience to a few academics already well versed in the debate rather than make bioethics comprehensible and useful to those scientists and clinicians who daily face ethical decisions. Who can say that he or she holds the absolute answers? The important thing is to provide an ethical construct that practitioners can use, whether they are in the research laboratory, at the clinical bedside or in the corporate headquarters. Ethics requires context.

The American Journal of Bioethics has the right idea. With the one reservation, I commend it for its approach. It provides excellent, thoughtful reading for anyone engaged in the bioethical debate.

Joan LaRovere is associate director of paediatric intensive care, Royal Brompton Hospital, London.