Ethical considerations in gastroenterology and endoscopy

Previously doctors decided what was right or wrong in medicine, today our individual freedom is more limited. External influences including the human rights act, government initiatives, management protocols, professional guidelines, multi-disciplinary decision-making and financial restrictions intervene between the doctor and the patient. Furthermore the move away from paternalism in the doctor-patient relationship to patient empowerment (informed consent) has put patients in charge of their medical destiny. Increased public expectations leading to health screening, genetic profiling and treatment of unwanted physiological changes mean that doctors now manage healthy patients for 'potential' or 'virtual' disease. This implies a greater ethical burden than treatment of the sick. Finally, death is no longer regarded by many as a physiological process, but a consequence of disease. The investigation and management of patients with incurable conditions can lead to difficult ethical dilemmas. Gastroenterology and endoscopy generate specific ethical problems which among others include training in endoscopy, percutaneous endoscopic gastrostomy placement, informed consent and live endoscopy demonstrations. This article addresses some of these issues in order to draw attention to potential difficulties in modern ethical practice. It should be read in conjunction with the other publications stemming from the 1st Symposium on Ethics in Gastroenterology and Endoscopy, Kos, June 2002.