Every now and again, revisiting a book from years gone by is akin to reconnecting with an old friend, now imbued with fresh insights. While certain works may appear as artifacts of their time, mirroring the thoughts and values of their period, others resonate with remarkable relevance, as if they foresee future trials. Such is the situation with “Moral Dilemmas in Medicine,” originally released in 1975, which still converses with contemporary physicians.
As a novice physician, I approached medicine with the notion that moral clarity was simply a matter of gaining knowledge and experience. However, revisiting Campbell’s book today uncovers a reality that feels both disturbing and familiar: the moral dilemmas Campbell articulated are as enduring now as they were back then.
Campbell’s premise is clear: medicine is fundamentally a moral pursuit, not merely a technical one. The most difficult choices a doctor encounters are not puzzles to be deciphered but dilemmas in which something vital is forfeited, irrespective of the decision taken. Problems present opportunities for advancement, while dilemmas impose a cost.
Among the persistent dilemmas Campbell emphasized are end-of-life choices, the threshold for truth-telling, resource distribution, and the intricacies of consent. These are not exceptions but the core of everyday medical practice. Campbell recognized these as inherent challenges, not shortcomings of skill or knowledge, highlighting the responsibility carried by doctors working amidst uncertainty, fatigue, and often in solitude.
Campbell’s work avoids contemporary terms such as ‘burnout’ or ‘moral injury,’ yet it captures their essence. Unresolved dilemmas, unnamed, leave behind a residue—doubt, guilt, and exhaustion—fostering a sense of failure even in the face of one’s best efforts.
Practical moral insight, as Campbell indicates, is more intricate and challenging to measure than strict adherence to principles. It is a developing skill molded by experience and reflection, vital in today’s metrics-driven medical environment. Campbell maintained that physicians must take ownership of their moral choices, even under challenging conditions. However, many current doctors feel that while the burden remains theirs, the authority has shifted elsewhere.
Rather than offering reassurance, Campbell provides permission: to candidly identify dilemmas, recognize that not every difficult choice is a technical matter, and accept the moral costs inherent in practicing within flawed systems. This recognition may offer a grounding clarity instead of a longing for former certainties.
This book serves as a reminder that some of the challenges we face today resist straightforward resolutions. Acknowledging and carrying them without becoming hardened or in denial is an essential aspect of medical practice.