FinermanWorks

Vernon Loucks Jr., Chairman and CEO of Baxter International, addressed the Harvard School of Business.

excerpts

People tend to confuse morality and ethics. These two ideas are not as synonymous as we might wish. In fact, they are more contradictory than we might like. Morality is the individual’s sense of right and wrong, defined by one personal values and beliefs. Ethics represents the group standard of conduct, determined by the prevailing attitudes of society. Morality asks us what is right. Ethics tells us what is acceptable. Morality is personal. Ethics is consensus.

A code of ethics ensures standards of professionalism and integrity that any society needs. Yet, ethics can be a constraint upon innovation, protecting the conventional from new ideas and technology. Innovation has inherent risks, but so does stagnation. The conflict between ethics and innovation is far from new.

Ethics is derived from the Greek word ‘ethos’ meaning custom. In ancient Greece, ethics was defined as the rules and customs in each city state. Adhering to those customs was the measure of patriotism. Disobeying or even questioning them was tantamount to treason. Socrates was executed for being unethical. He questioned the status quo of Athens, and Athens could not tolerate such doubts. Today skepticism in not a capital crime, but ethics remains the bulwark of the status quo.

For medicine in particular, there is a conflict between ethics and innovation. Medicine was one of the first professions bound by a code of ethics. The Hippocratic Oath is 2500 years old, but today’s doctors still ‘swear by Apollo’ to these ideals: “I will use treatment to help the sick according to my ability and judgment, refraining from all wrongdoing or corruption.”

The specifics of the oath indicate some of the ethical failings occurring among doctors even 25 centuries ago. There was also a scandalous discrepancy in the quality of doctors. In exasperation, Hippocrates wrote, “Medicine is the most distinguished of all the arts, but through the ignorance of those who practice it, it is now of all arts by far the least esteemed.” Hippocrates succeeded in establishing professional standards of medicine that are still practiced today.

Those standards include a commitment to knowledge and research, intellectual principles that have continually challenged the prevailing ethics of their times. In 13th century Italy the study of anatomy clashed with Christian values. If man were created in God’s image, dissecting a corpse would seem sacrilegious. The Church and the Universities, however, reached a compromise. Physicians and medical students could dissect executed criminals, who evidently weren’t going to look good on Judgment Day in any case.

For a more recent example, in late 18th century England the British medical establishment regarded vaccination as a public danger. What responsible doctor could accept the idea of contaminating a patient with one disease in the hope of averting a worse disease. It is a tribute to British tolerance that Edward Jenner was merely criticized rather than put on trial and exiled to Australia.

These misjudgments may seem like jokes today, but they were profound ethical debates in their times. The medieval Italians were trying to guide science by their religious values. The critics of vaccination were rightfully questioning if the risks and side effects of that unconventional treatment were worse than the risks of smallpox.

Today, perhaps as never before, medical and technological advances have confounded us with a number of ethical questions. Just consider these examples.

There are one million Americans suffering from Parkinson’s Disease. The use of fetal material has proved effective in halting the disease’s deteriorating effects and even allowing partial recovery. Is it ethical to use fetal material from abortions to treat the victims of Parkinson’s Disease? Will this medical success encourage or justify abortions to produce fetal material?

Another example: Medicine can indefinitely sustain the life of a patient who is brain-dead or in a irreversible condition, but for what purpose? Doctors cannot promise immortality, yet current practices are determined to prolong life, regardless of the quality of that existence. What are the limits of medicine?

If you want some other examples, just read today’s headlines. Gene therapy is promising breakthroughs in the treatment of cystic fibrosis, sickle cell anemia, hemophilia and other hereditary diseases. A genetically altered virus is implanted as a replacement for the defective gene. Think of the therapeutic value it promises. For instance, more than three million Americans have sickle cell anemia. One in four hundred Afro-Americans dies of the disease. Gene therapy could save their lives. The question is, will it work and at what risk to the patient?

These are the same questions that conventional ethics demanded of Edward Jenner. Can we be certain that the implanted virus will not trigger side-effects worse than the disease being treated? No, we cannot. The fact is that medicine is a science of calculated risks, and the battle against disease demands and justifies those risks.

Our medical advances challenge our traditional ethics, causing us to evaluate and reappraise them. It is essential that we make these difficult judgments, because ethics should reflect both our ideals and the realities of today’s world.