The philosophical background: from principles to rules and analysis

Encounters between doctors and patients are subtle but complex forms of social interaction. Attempts to regulate aspects of the doctor-patient relationship have a long history. Initially, the production of guidance on principles and conduct was the domain of practitioners. In the 21st century, modern medical ethics still reflects some of this traditional thinking even though the responsibility for formulating ethical guidance increasingly falls to policy-makers, lawyers and theoreticians rather than doctors. Ethical concepts are also increasingly interwoven with contemporaneous concepts of patient autonomy, human rights and law. In a brief and necessarily sketchy overview of some of the key influences on European ethical development, this article traces the development of medical ethics through three broad stages: from principles to rules to providing tools for detailed moral analysis. It also discusses whether the original Hippocratic principles still find echo with modern doctors.