Drug Dealing and the Internal Morality of Medicine

By contrast, philosophers of medical ethics have wrestled with the complexity of determining medicine's proper scope for at least half a century. 8rawing on this more rigorous debate could help refine and clarify legal standards governing prescribing.However, such an effort would have to contend with the fact that the philosophical literature on this question is strikingly inconclusive.Some prominent bioethicists contend medicine is defined by an "internal morality" that defines its scope.For example, some claim the essence of medical practice is healing, so that actions taken for other purposes, such as enhancing one's physical appearance, do not qualify as medical in nature and are therefore improper for physicians to perform. 9Others deny medicine's scope is limited by any internal morality, instead insisting that judgments regarding the propriety of physicians' conduct must be governed by considerations external to the practice of medicine. 10In this view, as long as cosmetic surgery is ethical in general (e.g., under universal moral principles), it is ethical for physicians to engage in that practice.There is no essential nature of medicine that physicians would transgress in so doing.Happily, this debate need not be resolved in order for the law to benefit from it.Rather than seeking to determine what medicine's "true" nature is, it may be useful to examine the various conceptions offered by these observers and seek an account that is consonant with existing legal standards while also helping refine them.Not every account of medicine's proper scope is equally suitable for informing the legal standards governing prescribing."Internal" accounts that reject nontherapeutic practices as "non-medical" are flatly inconsistent with existing law, which countenances cosmetic surgery, vasectomies, and other nontherapeutic practices as within medicine's ambit.Conversely, external accounts that deny the existence of an internal morality of medicine without providing an alternative definition of medicine's scope are of little use when specifying which acts doctors can lawfully perform.What is needed is a standard that is broadly consistent with existing legal standards, but that helps clarify them.An account of medicine's scope offered by philosopher Christopher Boorse meets these criteria.Although Boorse takes no position regarding whether medicine is governed by an internal morality, he argues that if such a morality exists, it is a broad one. 11Rather than limiting the practice of medicine to treating illnesses, in this view doctors can provide a wide range of interventions as long as they are seeking to use their expertise and skill