Author: McGoldrick K E
Anesthesiology, January 21, 2026, 10.1097/ALN.0000000000005907
This article is a scholarly commentary reviewing the book The Trusted Doctor: Medical Ethics and Professionalism by Rosamond Rhodes. It explores the foundations of medical ethics, the historical development of bioethics, and the responsibilities physicians assume as trusted professionals in society.
The author begins by placing medical ethics within a long historical tradition. The moral obligations of physicians date back thousands of years, with early formulations such as the Hippocratic Oath emphasizing duties such as beneficence and the principle of doing no harm. Even earlier traditions existed, including teachings attributed to the ancient Indian physician Suśhruta, who required his surgical trainees to swear an oath to prioritize healing and avoid harming others.
Although the ethical responsibilities of physicians have deep historical roots, the formal academic field of bioethics emerged only in the late twentieth century. Technological advances in medicine, including mechanical ventilation and dialysis, forced society to confront new ethical dilemmas related to life support and end-of-life care. These developments led to the creation of bioethics research centers and academic programs, as well as the publication of influential frameworks such as Principles of Biomedical Ethics by Beauchamp and Childress. Their work introduced the widely recognized four principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.
The article highlights the important role anesthesiology has played in the development of modern medical ethics. Henry Knowles Beecher, a pioneering anesthesiology researcher at Harvard, helped transform ethical standards in clinical research. He advocated for the use of placebo-controlled trials, emphasized the necessity of informed consent, and promoted the ethical review of research protocols. Beecher’s work contributed significantly to the modern framework governing clinical trials and patient autonomy.
The author also notes that anesthesiology frequently confronts complex ethical situations in clinical practice. These include issues surrounding informed consent and informed refusal, particularly when patients decline life-saving treatments such as blood transfusions. End-of-life decisions also raise difficult ethical questions, especially when high doses of medications used for symptom relief may unintentionally hasten death, a phenomenon known as the doctrine of double effect. Additional challenges arise in surrogate decision-making, maternal–fetal conflicts, and research integrity, including concerns about data fabrication or authorship misrepresentation.
The central focus of the article is Rhodes’s ethical framework presented in The Trusted Doctor. Rhodes challenges the traditional model of medical ethics based on universal moral principles. Instead, she argues that the physician–patient relationship operates within a unique moral framework distinct from everyday morality. According to Rhodes, society grants physicians special privileges and authority that require a correspondingly distinct ethical framework, which she calls the “uncommon morality” of medicine.
Rather than organizing medical ethics around broad principles, Rhodes proposes a set of sixteen professional duties that physicians must accept when entering the profession. The most fundamental duty, she argues, is to seek trust and to deserve that trust. Trust becomes the foundation upon which the physician–patient relationship is built. The second central duty is to promote the interests of both patients and society.
From these foundational duties flow other professional obligations such as maintaining competence, respecting scientific evidence, communicating truthfully, protecting confidentiality, and respecting patient autonomy. Rhodes emphasizes that these duties reflect the unique responsibilities entrusted to physicians by society and that ethical reasoning in medicine should begin from these professional commitments rather than abstract philosophical principles.
The author notes that Rhodes’s framework may initially appear controversial because it challenges the dominant bioethical model based on the four principles of autonomy, beneficence, nonmaleficence, and justice. Rhodes herself refers to her theory as potential “bioethical heresy.” However, the reviewer suggests that the emphasis on trust is not truly radical. Instead, Rhodes’s approach may offer a useful alternative perspective when clinicians face ethical dilemmas involving competing principles.
The article concludes that The Trusted Doctor provides a valuable framework for understanding ethical decision-making in medicine. By focusing on the responsibilities inherent in the physician’s role, Rhodes offers clinicians another tool for analyzing the complex moral situations that arise in everyday clinical practice. The book is presented as accessible and relevant for medical students, trainees, and practicing physicians alike.
What You Should Know
Medical ethics has ancient origins but developed as a formal academic discipline primarily in the late twentieth century.
Anesthesiology has played an important role in shaping modern bioethics, particularly through contributions to research ethics and informed consent.
The book The Trusted Doctor proposes an alternative ethical framework that centers on professional duties rather than traditional ethical principles.
Trust between physicians and patients is presented as the foundational obligation of medical practice.
This perspective may help clinicians navigate difficult ethical situations where traditional principles conflict.
Key Points
Medical ethics historically derives from traditions such as the Hippocratic Oath and other early physician pledges.
Modern bioethics gained prominence in the 1960s and 1970s due to technological advances and new ethical challenges in medicine.
Henry Beecher’s work helped establish modern standards for informed consent and ethical clinical research.
The Trusted Doctor proposes sixteen professional duties as the basis for medical ethics.
Trust is described as the primary ethical obligation of physicians.
This framework emphasizes the unique moral responsibilities granted to physicians by society.
Thank you to Anesthesiology for allowing us to summarize this article.