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Ethics; the third dimension
  1. B J Marais
  1. Department of Paediatrics and Child Health, Centre for TB Research and Education (CENTRE), Faculty of Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa; bjmarais @sun.ac.za

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In essence, ethics provide the guidelines for civilised human interaction. It is an evolving concept, but through the ages some accepted ethical principles crystallised. The first crude definition focused on the individual’s responsibility towards his community, prioritising the interests of the community. However, the events preceding the French revolution and the brutality of the two world wars emphasised the need to protect individuals and minority groups against abuses of power. The ethical focus shifted from individual responsibility towards the protection of individual human rights. With the swing of the pendulum, individual rights were often protected to the detriment of the larger community.

In medicine the same shift in emphasis forced the current ethical debate on the delicate balance between the interests of the individual and that of the community, especially in resource limited settings. The reality of the third millennium is that all the world’s inhabitants are essentially part of the same global community. The two dimensional balance between the individual and the community need to reflect this global ethical responsibility.

The third millennium also confronts us with the neglected third dimension of our ethical responsibility. It is not only the interests of the individual versus that of the community that require a fair balance, but also the interests of future generations. No previous generation has been confronted with the importance of this third ethical dimension, as we have. Although current decisions may impact dramatically on the health of future generations, this has not entered into popular medical conscience or current ethical debate. As medical doctors the health of future generations is as much our ethical responsibility as the health of our individual patients or our immediate community.

Environmental issues are rarely viewed as medically relevant, but can the medical profession accept this status quo, when the health of future generations is at stake? The third millennium demands a broadened ethical perspective, where established ethical principles are applied, but within the setting of a global community and a vulnerable planet.

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