[Bioethics: philosophic bases and application].

Medical ethics have traditionally been guided by principles based on classical philosophical ideas about the place of man in nature, his relation to God, health, and disease, and on the epistemological and methodological concepts of diagnosis, risk evaluation, and treatment. The virtues expected of a physician were to cause no harm, to make patients better, and to refrain from using his skills for manipulation or coercion. The good patient was supposed to trust the physician and follow the treatment. Today, technological progress and the advent of a pluralistic society that emphasizes the autonomy of informed patients make for a much more complex and changing situation. However, some pragmatic principles found in bioethical arguments may assist in resolving moral dilemmas. Sass proposes that a basis be sought in "intermediate moral principles" that have found support in various ideologies and in complementary application of several models of doctor-patient hermeneutics and communication. Responsibility for health should be shared by physician and patient and founded on knowledge, mutual respect, and a combination of skill and ethics.