Dilemmas, ethics and intent--a commentary.

Responding to a preceding article by Michael J. Newton ("Moral dilemmas in surgical training: intent and the case for ethical ambiguity"), Downie comments on three of Newton's themes. He agrees that trainees should engage in ethical self-appraisal but cautions that introspection is inappropriate at the time of an operation. Regarding Newton's downplaying of philosophical analysis in medical ethics, Downie agrees that there are limitations to the philosophical approach but contends that it can serve a very worthwhile function in helping doctors deal with ethical uncertainties. Finally, Downie perceives ambiguities in Newton's emphasis on the central importance of "ethical intent," which rejects the idea of ethical standards while urging individuals to take "personal responsibility" for their actions.