Medical ethics in the 21st century

Abstract. Parker M, Hope T (Institute of Health Sciences, Headington, Oxford, UK). Medical ethics in the 21st century. J Intern Med 2000; 248: 1–6. Objectives. To foresee how medical ethics may develop in the 21st century. Design. We have looked into our crystal ball to see what factors are likely to drive medical ethics over the next few decades. We have given examples of how such factors might affect specific issues. Results. Those factors that we identified as likely to shape the future of medical ethics are: Globalization . Medical ethics is likely to have to grapple increasingly with ethical issues arising from the huge discrepancies in the level of health care available in different countries. Increase in longevity . We predict that there will be, at least amongst the richer nations, a significant increase in life expectancy. This will result in issues of resource allocation becoming increasingly problematic within medicine. Child enhancement . Developments in genetics combined with control of reproduction will make it possible to select our children for a broad range of characteristics. There are optimistic and pessimistic predictions as to how such power will be used. In either case, this area will be an important focus of concern in medical ethics. The biological determination of behaviour . Genetic research will lead to an increasing sense that undesirable behaviour is genetically determined. This will lead to a re‐examination of such concepts as criminal responsibility. Therapeutic research and clinical practice . We predict that an increasing amount of clinical practice will be within the setting of clinical trials. The ethics of therapeutic research and clinical practice will need to be brought within a coherent framework.