Physician Brody, director of the Center for Ethics and Humanities in the Life Sciences at Michigan State, offers new perspective on and fresh insights into medical ethics. Arguing that the central ethical problem in medicine is the responsible use of power, Brody draws on literary examples as well as the literature of medical ethics. In an unusual opening, he borrows freely from Dostoyevsky's chapter ``The Grand Inquisitor'' in The Brothers Karamazov to present the powerful ``Chief of Medicine'''s views on the proper use of the physician's power. Brody then contrasts this view with that provided by the healer known as ``Snake'' in Vonda McIntyre's short story ``Of Mist and Grass and Sand'' (reprinted in the appendix). Brody sees the physician's power as having three components: Aesculapian, based on knowledge of medicine; charismatic, based on the physician's personal qualities; and social, derived from the physician's status in society. His guidelines for responsible use of this power are that it be exercised to bring about a good outcome for patients; that physicians share power with their patients by informing them, in so far as patients wish, about the nature of their illness and the proposed treatment; and that physicians be sensitive to their patients' sense of powerlessness. Brody applies these guidelines to issues that commonly arise within medical ethics—informed consent, confidentiality, quality of life, etc.—and some less commonly discussed, such as the physician's income. Although his discussion is not comprehensive—ethical questions involving reproductive technology, brain death, medical research, and behavior control, for example, are not explored here—Brody offers a new conceptual framework for analyzing them. Erudite yet accessible: an excellent springboard for discussion of a compelling subject.
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