This issue of Pediatric Annals, compiled by Guest Editor John M. Freeman, MD, Professor of Pediatrics and Neurology at Johns Hopkins University, addresses decision making and medical ethics. He and the contributing authors define the rules for making ethical decisions that we as pediatric practitioners should follow in caring for our patients. The rules are loose ones guided by considerations of patient (and parental) autonomy, justice, and beneficence and influenced by the law, community values, and our desire to do the right thing. The articles make for good reading and should stimulate thinking about what is right and what is wrong in a variety of clinical situations.
In recent years, editors have become increasingly concerned about the ethical rules under which they operate - the ethics of writing and publishing. The public media (newspapers, magazines, radio, and television) have been accused of assassinating the characters of presidential candidates and other public figures, using unsubstantiated allegations, fabricated information, and rumor. Dan Rather, speaking before the National Press Club in Washington, DC, on March 16, 1992 (National Freedom of Information Day), was quite "riled up" on the subject, particularly as it related to vilified members of the Fourth Estate. He reminded his colleagues of their responsibility to their readers, listeners, and viewers to report events accurately and fairly and to cover all aspects of the subject in question, playing no favorites and pulling no punches.
Medical writers, editors, and publishers need to do the same thing. Indeed, the International Committee of Medical Journal Editors has made recommendations since 1978 about the ethical aspects of medical writing and publishing, dealing with, among other subjects, authenticity of authorship, duplicate submission of manuscripts, falsification of data, plagiarism, omission of information critical to the discussion at hand, and financial conflicts of interest, as they relate to the subject reported.1 The recommendations are adhered to by most medical journals. Some even go a step or two further in requiring their editors and reviewers to reveal potential financial conflicts of interest and intellectual conflicts of interest, hoping thereby to avoid biases in selection of articles for publication.2 This is a serious matter, as evidenced by recent charges of political bias leveled against Science, generally considered to be the most prestigious scientific journal in the United States. The charges relate to publication of editorials and articles over the past two decades that have trivialized concerns about industrial environmental pollution and occupational hazards.3 These charges may or may not be true. What is true, as the editor of Science points out, must be validated by scientific data.4
Editors also must avoid being influenced by their advertisers in selecting articles for publication.5 Perhaps the most rigorous of all medical journals is The Pharos (published by the AOA honorary medical society), which requires its authors to provide photocopies of all articles cited or referenced in manuscripts submitted to assure that there is no modification of quotations that might distort the original author's meaning and that the articles referenced are done so correctly.6
Trie ethics of writing editorials in medical journals follow those rules applied to all authors, as well as some other rules, none of which are written down anywhere, but most of which are understood by those who do the writing. They are:
* Avoid paternalism in the sense of invading the autonomy of the readership by using editorial "authority" to thrust personal opinion and biases on it.
* Be accurate in making recommendations by providing reliable references to support them.
* Be beneficent without being paternalistic, by attempting to influence the readership appropriately to provide better care for their patients.
In other words, editors need to use the "power" of their opinion fairly and constructively.
1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals, Br Med J. 1988;296:401-405.
2. Rennie D, Flanagin A1 Glass RM. Conflicti of interest in the publication of Science. JAMA. 1991;266:266-267.
3. Epstein SS. Editorial misconduct in Science, int) HeM Sew. 1990:20:349-352.
4. Koshland DE Jr. Credibility in science and the press. Science. 1991:254:629.
5. Squires BR Medical journals and conflicts of interest. Con Med Assoc ). 1991:145:14391440.
6. Glaser RJ. Taking liberties with words. The Pharos, 1990:53:45.