Anek Suwanbundit, Ph.D.

Abstract
Medical ethics in the contemporary world operates within an increasingly complex framework of technological advancement, pluralistic values, and institutional power. From a moderate postmodern philosophical perspective, this afterthought reconsiders the foundations, expansion, and enforcement of medical ethical principles. It maps the evolution of key doctrines, scrutinizes the means by which ethical conduct is maintained among professionals, and offers a critique of its foundational assumptions and operational blind spots.

Introduction
Modern medical ethics, while historically rooted in Enlightenment rationalism and bioethical liberalism, faces increasing pressures from postmodern conditions: epistemic plurality, sociocultural fragmentation, and the rise of systems-thinking over individualism.

Moderate postmodernism does not reject the ethical project entirely but insists on contextualizing its claims, acknowledging structural biases, and resisting universalism without retreating to nihilism. A afterthought of medical ethics today is interested.

Conceptual Order of Contemporary Medical Ethics
Medical ethics is typically structured around four principled pillars (Beauchamp and Childress)

1. Autonomy – respecting the patient’s right to self-determination
2. Beneficence – acting in the patient’s best interest
3. Non-maleficence – avoiding harm
4. Justice – ensuring fairness in distribution of care

From a moderate postmodernist viewpoint, these principles are narratives of normativity, emerging from specific Western liberal-democratic contexts. They represent aspirational norms, not universal truths. Nonetheless, they offer a workable structure, which must be continually reinterpreted in context.

Expansion of Ethical Principles in the Postmodern Condition
Medical ethics has evolved in response to both technological changes and identity politics

1. Cultural sensitivity and narrative ethics have challenged rigid, decontextualized applications of principles, favoring case-based reasoning (casuistry) and dialogical ethics.
2. The emergence of digital medicine, AI diagnostics, and genetic engineering has necessitated new subfields e.g., data ethics, algorithmic accountability.
3. Concepts like relational autonomy and structural competence have emerged, reflecting awareness of social determinants of health and systemic injustice.

Moderate postmodernism supports this adaptive pluralism, but cautions against relativism without accountability.

Ethical Governance and the Role of Institutions
Contemporary ethical regulation relies heavily on Professional codes of ethics (AMA, GMC), Institutional Review Boards (IRBs), Licensing bodies, and medical tribunals.

While these mechanisms aim to discipline conduct and ensure public trust, moderate postmodernism asks: “Who designs these frameworks?” “Whose interests do they serve?”, Ethical governance, while necessary, often privileges dominant epistemologies and overlooks the voices of marginalized communities.

Critique and Weaknesses of the Current Ethical Paradigm
A moderate postmodernist critique identifies several vulnerabilities

1. Over-reliance on abstraction: The principlist approach assumes that decontextualized values can be neutrally applied. In reality, patient experiences are culturally laden and historically situated.
2. Institutional dogmatism: Codes of ethics may congeal into bureaucratic rituals, losing moral force and flexibility.
3. Neglect of power: Ethics too often overlooks the power asymmetry between physician and patient, or between medical institutions and vulnerable populations.
4. Epistemic exclusion: Non-Western, indigenous, and patient-generated knowledge systems are often marginalized, if not entirely dismissed, in ethical deliberations.

Moderate postmodernism calls not for the destruction of ethical structures but for their reflexive openness, historical humility, and pluralistic adaptability.

Conclusion
Medical ethics today must move beyond principled formalism without collapsing into moral relativism. Moderate postmodernism offers a middle path, it critiques the absolutism of modern ethics, but affirms the ongoing ethical project, provided it remains self-critical, inclusive, and responsive to changing cultural and technological realities.

In a world where the medical domain increasingly intersects with data capitalism, biopolitics, and global inequities, ethics must be less about protecting doctrine and more about listening, revising, and contextualizing.