The medical profession is going through changes on many fronts. Advances in technology have opened new vistas in monitoring and treatment of disease. On the other hand the profession is regarded less of a service and more of a business.
Disease control and longer life expectancy are increasing the population of the aged and with it, its incidental problems and the issues of quality of life. Longer survival of patients with diseases like diabetes, hypertension and cancer are creating greater morbidity due to long-term effect of these diseases. The challenge of AIDS is now well-known and much talked about. Newer treatments are providing hope but at more cost.
And yet the age old scourges like tuberculosis and malaria have made a come back, that too in resistant forms. Viral epidemics, diarrheas and environmental diseases still haunt those in developing countries. These diseases pose greater challenges to the profession.
New forms of diagnosis and treatment are throwing newer challenges. Artificial life sustaining devices, organ transplants, foetal cell, cadaver and xeno transplants, genetic engineering, gene manipulation, and assisted  reproductive technology are opening up new ethical issues like right to live, selective foeticide, quality versus sanctity of life, euthanasia or physician-assisted suicide, and a right to  die?
Market forces seem to dictate healthcare. Healthcare is going into private hands. Corporate hospitals and medical insurance companies are taking over medicare. In the advanced countries the profession and often the decision making has gone into the hands of insurance agencies   and health management organisations. It is observed that the insurance companies are making huge profits.
Each  regulatory agency, the government, municipal corporation, commercial tax department, Pollution Control Board, etc, consider them as sources of revenue and collect licence fee or tax them. There is no single window system. With doctors and healthcare establishments coming under the Consumer Protection Act, the professional indemnity insurance has become a necessity. Defensive medicine has become a practice.
In these changing times what takes care of the profession? The ethics show the path and guide the doctor. The term ethics has come from ethike (Greek) meaning “the practical virtue”. Aristotle (384-322 BC) has said the practical virtues are concerned with conduct of human affairs which confirm to the happiness and good. And who is concerned with human affairs more than the physician.
The Gospel of St Luke says: “Much is required from those to whom much is given, for their responsibility is greater”. Sir Thomas Huxley, the famous English Biologist (1825-1895) talking of evolution and ethics said, “evolution is struggle for existence and survival of the fittest and ethics is for making as  many as possible fit to survive”.
Traditionally, the patient’s expectations were that they are heard, cared, treated with professional competence as a fellow being, kept informed and not abandoned. Legally the doctor has certain obligations. He has to exercise the “duty of care” with reasonable competence, respecting the autonomy of the patient, obtaining an informed consent and within the ethical practices of veracity, fidelity, confidentiality. The ethics are based on the principles of justice, rights, virtues, values and morality. The physician has to consider the autonomy of the patient and the principles of beneficence and non-maleficence.