Memo From The Editor

Right, wrong, and medicine

Marianne Dekker Mattera

When I went to school, all students at the Jesuit college I attended came out with enough credits—24—for a minor in philosophy, whether they wanted one or not. I can't remember if we had one or two semesters of ethics, but it was certainly enough to give us a good grounding in the discipline and to learn how to look at a situation from a variety of angles before choosing a course of action.

So I got excited when we decided to do this special issue. It's fun to sit around and talk about the big issues—what's right, what's wrong, whether there is a right or wrong or whether every action must be tailored to the needs of the particular players and circumstances of the moment, whether there's a difference between the moral thing to do and the right thing to do. And it would be fun to see what you readers think about the biggest ethical issues of our day, and what you do when facing those issues.

But it wasn't fun. It was months and months of hard work. Articles Editor Mark Crane and his staff of writers spent hours just whittling down the topics we would cover in our survey to a manageable size. Mark, Senior Editor Leslie Kane, and I spent more hours working and reworking the questionnaire to be sure we were asking the right questions in the right way to capture the situations you'd find yourselves in and the choices you'd be likely to face.

Once the questionnaires came back, Mark, Managing Editor David Azevedo, and I grappled with how to present the wealth of information you provided in chunks that you wouldn't find daunting to read. Then we sat with Senior Art Director Roger Dowd and Assistant Art Director Bob Siani to come up with a design for the issue that would capture the spirit, the gravity, and yes, the morality of the subject and your response to it. We wanted elegance, reality, and inspiration all in one neat package. Bob spent hours working with typefaces, color treatments, and graphic elements to achieve that goal, and I think he and his team have succeeded.

My excitement came back once we'd decided on the beautiful staff of Aesculapius you see on the cover. It's simple, elegant, and speaks to the long tradition in medicine of blending solid, grounded action (symbolized for me by the staff) with the thorny, often harrowing decisions I see represented by the snake. For thousands of years physicians have had to heal both body and soul, often at great peril to their own spiritual well being.

We hope this issue helps you confront the difficult situations that are a part of every day in medicine. We hope that by showing you what your colleagues think and do in given circumstances and what ethicists say about those choices, you can find confirmation for your own difficult decisions or a new way of looking at the problem.

We also hope that by doing a survey of this magnitude, the likes of which I can't find in the literature for a very long time, and publicizing it—as we intend to—we'll be able to inform the thinking of the public and the politicians. To let them know the beliefs and behaviors of those who must act on the issues they theorize about and legislate on.

Finally, we hope that reading this issue gives you the pause and focus to appreciate the complexity of the life you lead every day. Members of no other profession are faced with the kinds of choices you have to make each day. Reading the responses to our survey, I'm convinced that members of no other profession would handle them as well.

 

Marianne Mattera. Memo from the Editor. Medical Economics 2002;19:7.