Ethics and Etiquette in Biomedical Communication

ETHICS AND ETIQUETTE IN BIOMEDICAL COMMUNICATION LOIS DeBAKEY, Ph.D.* and SELMA DeBAKEY, ?.?? What Conscience dictates to be done, Or warns me not to do; This teach me more than Hell to shun, That more than Heav'n pursue. [Alexander Pope, "Universal Prayer"] Until the past decade or so, the term medical ethics evoked visions of patient stealing, fee splitting, and self-advertising, all ofwhich reputable physicians shunned. The spectacular discoveries by medical researchers within the recent past, however, have redirected the focus of medical ethics from mere decorum and professional etiquette to serious moral precepts involving human conscience and basic human values. Since the biomedical report, as the permanent record of the results, is an integral part of laboratory and clinical experimentation, the ethics of biomedical communication is interwoven with the ethics of biomedical science. As science and technology continue to penetrate previously unexplored intellectual terrain, ethical issues can be expected to multiply, and debates about the propriety of disseminating new knowledge acquired by ethically questionable means can be expected to increase. These deserve exploration, along with less complex ethical literary precepts, violation of which can seriously affect relations among biomedical authors, editors, and readers, and between the scientific community at large and the public. Because the ethics of biomedical reporting receives little attention in the scientific curriculum, some novice biomedical authors are unfamiliar with the most rudimentary ethical literary precepts, such as the need to obtain permission from the source before citing, in one's own manuscript , the unpublished data or personal communication of another. ?Professor of scientific communication, Baylor College of Medicine, Houston, Texas 77025; and lecturer, Tulane University School of Medicine, New Orleans, Louisiana. tProfessor of scientific communication, Baylor College of Medicine, Houston, Texas 77025. 522 I Lois DeBakey and Selma DeBakey · Biomedical Communication Other ethical problems in scientific communication are more enigmatic, and their resolution is more arduous. Some violations are relatively innocuous , whereas others are potentially dangerous. If an author claims an idea of another as his own, the harm done is not life threatening, whereas the scientist who falsely reports a dangerous drug as a "cure" for obesity or wrinkles may imperil the lives of credulous victims. Ethical principles are generally ill-defined, reflecting, as they do, largely an intuitive guide to social behavior. So ingrained in most of us are some of these dicta that we are scarcely aware of them. Foras long as we can remember, we have known that there are some things we ought to do and some things we ought not to do. From infancy, certain behavior is encouraged and rewarded, and other behavior is censured or forbidden. As a result, we develop, to varying degrees, a moral sense of conscience, which Kant called the categorical imperative. But morality has a chameleon quality. "Morality is the custom of one's country . . . ," wrote Samuel Butler. "Cannibalism is moral in a cannibal country." The inconstancy of moral codes, and of their handmaiden, manners, is responsible for many dilemmas in human behavior. Ethics and etiquette vary not only from one community and one culture to another, but also from one era to another, whether these concepts of right and wrong relate to property, fashions, or scientific discoveries. Topless dress for women is conventional in some nomadic African tribes, whereas such public exposure is still unacceptable to many Americans. Contemporary views of nudity, however, are rapidly changing as designers have advanced from microminis and see-through fabrics to bikinis, monokinis, and strings. In the nineteenth century, physicians were expected to examine women without having them disrobe, and less than 75 years ago it was scandalous for a lady to expose her ankles; yet today women streakers arouse amusement more often than outrage, and skinny-dipping is now common at some public beaches. Like other forms of morality, medical ethical codes have been modified gradually through the years, but the remarkable scientific ingenuity and the unprecedented technologic advances of the past decade have introduced particularly thorny problems. When the first human heart was transplanted, the medical profession was unprepared to cope with all the moral implications it raised, and controversy erupted. Some contended that this clinical trial was premature, having preceded adequate scientific...