Molecular Medicine, Managed Care, and the Moral Responsibilities of Patients and Physicians

Clinical ethics, as represented in this and previous “Clinical Ethics ” issues of the Journal of Medicine and Philosophy, has taken on a decided inter-national character. In this issue appear papers from three countries, and on four apparently diverse topics: the pursuit of genetic knowledge, organ transplantation, patenting medical and surgical devices and procedures, and conflicts of interest. Rosamond Rhodes opens with an account of the moral obligations of individuals to others regarding the pursuit and the avoidance of genetic knowledge about himself or herself. Rhodes argues against the grain that emphasizes the rights of patients regarding genetic information about them-selves, especially the right to refuse genetic testing when the interests of others are at risk through adverse effects that could follow from such refusal. Quite the contrary: no one, Rhodes argues, “has a moral right to genetic ignorance. ” Rhodes argues that the appeals usually made to re-spect for autonomy in this context lead, not to an emphasis on the patient’s right to refuse such testing, but to an obligation to accept it. Rhodes com-plements this line of reasoning by appealing to Kantian considerations of promise keeping in social relationships and to Aristotelian considerations of social bonds that define social roles. Rhodes ’ argument will have broad clinical applicability, inasmuch as molecular medicine has replaced the infectious disease model as the main explanatory framework or paradigm in biomedical science. The older model understood and explained diseases in terms of foreign agents, microbes, that were alien to our natural state and invaded us, causing disease. The purpose of medical and surgical management was to remove these sources of infection. The notion of disease as alien invader was generalized to include other disease entities, such as cancers, and coronary and cardio