Where Medicine Meets Ethics

by Jonathan Pugh

Cross-posted with the Uncomfortable Oxford blog.

Medicine is often associated with questions that have scientific answers. How does the body work? How do we become unwell? Which treatments can help with the symptoms of a medical condition? What are the risks of a surgical operation? How might a new technology improve a patient’s health? Through this lens, the history of medicine is the story of how humanity has developed a better grasp of the information we need to answer these questions more accurately and comprehensively.

But this is not the whole story. Some of the hardest questions in medicine cannot be answered by evidence alone. One particularly important example concerns the limits that we should place on the kinds of experiments we perform in pursuit of better scientific understanding. The history of medicine is sadly replete with examples of research in which scientific knowledge has been pursued through gross moral violations. There are also important non-scientific questions at the heart of how medicine is practised every day. Should a patient be free to refuse a potentially life-saving treatment? How should doctors respond when their own moral convictions conflict with their professional responsibilities? And when a new medical technology becomes possible, does that mean we should use it?

These questions illustrate why ethics is not an optional addition to medicine; ethics is baked into good medical practice and research. Medical evidence can tell us about diagnoses and prognoses, and the likely consequences of different treatment choices. But it cannot by itself determine which values should take priority when autonomy, well-being, fairness and professional responsibility come into conflict, nor how we should understand these different values in the first place. It is this intersection between medicine and ethics that runs through much of the Uehiro Oxford Institute’s research.

Whilst researchers at the Institute continue to investigate these foundational questions in medical ethics, our research is also guided by pressing technological developments in medicine. Recent Uehiro research has, for example, examined whether large language models could support informed consent in medicine, including paediatric care, and how “black-box” AI systems might safely and ethically be introduced into healthcare. These technologies require us to reflect on the nature of trust, risk, patient autonomy and appropriate human oversight. Similarly, our researchers have been investigating how new technologies may alter our understanding of core ethical concepts such as well-being in the digital world. The future of medicine will continue to raise complex ethical questions, just as medicine has throughout its history.

A core element of our work at the UOI is to bring discussions about these questions to audiences outside academia. Our free Bitesize Ethics programme offers members of the public an introduction to current research and an opportunity to discuss it directly with researchers. This summer’s eight-week programme, Life, death and difficult decisions, has ranged from conscientious objection in healthcare and the badness of death to AI and life extension and the boundaries of our moral concern. Communicating this research beyond academia matters because these questions ultimately affect all of us. Philosophy has an important role to play in making these discussions more productive. It can help us identify assumptions that might otherwise go unnoticed, clarify the values at stake, and distinguish genuine disagreements from misunderstandings. It may not always provide a single answer to the difficult questions medicine presents, but it can give us better tools for thinking about them together.