Re-Examining the idea of internal morality in medicine

Abstract

This article considers the idea of medicine’s internal morality as it is understood by its various proponents. Although the use of the phrase ‘internal morality’ in relation to medicine predates Edmund Pellegrino, he can be credited with cementing its place in the vocabulary of medical ethics. Yet, while ‘internal morality’ and its related terms are now readily recognizable, they are used to denote irreconcilable ideas. Our aims, therefore, are to, firstly, clarify and, secondly, evaluate the different uses of ‘internal morality’, showing that there is little agreement on its definition. Thirdly, we argue that the terminology relating to ‘internal morality’ requires substantial revision, and that the term itself should be jettisoned. Finally, we briefly set out our own account of how morality should be understood in relation to the practice of medicine along similar but clearer lines to Pellegrino.

KEYWORDS:

• Medical morality
• internal morality
• medical ethics
• natural law theory
• essentialism
• moral authority

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 See The Nicomachean Ethics, 1094a

2 The first principle upon which natural law is based is identified by Thomas Aquinas as ‘Good is to be done and pursued, and evil is to be avoided’ in Summa Theologia II-I Q94.2

Additional information

Notes on contributors

Christopher Chen-Wei Ng

Christopher Chen-Wei Ng, BSc (Hons), MBChB, MA, MRCPsych, is a core trainee psychiatrist with Cardiff and Vale University Health Board, Cardiff, UK.

Toni C. Saad

Toni C. Saad, MA, MBBCH, is a core trainee in internal medicine with Gloucestershire Hospitals NHS Foundation Trust.