Ethical decisions at the edge

Medicine grows incrementally in its ability to treat patients and at the growing edge it poses problems about the appropriateness of treatments that are different from those where good practice conforms to widely agreed standards. The growth of access to medical knowledge and the diversity of contemporary theoretical and clinical medicine have spawned deep divisions in the profession and divergent opinions about what constitutes reasonable care. That hallmark of acceptable practice is also under pressures from the threat of litigation, a highly commercialised contemporary medical environment, patient demands based on medical journalism and the internet and the exponential growth of bio-medical technology. Patient empowerment can result in complaints arising in new and complex areas and expert opinion can often differ markedly depending on where on the medical spectrum the experts are aligned. This column lays out some broad-brush principles to assess the adequacy of medical advice in such a climate.