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Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

This article views the Hippocratic Oath from a new perspective and draws consequences for modern health care. The Oath consists of two parts, a family-like alliance where the teacher of the "art" is equal to a father and a set of maxims how the "art" is to be practiced. Self-commitments stated before the gods tie the parts together and give the alliance trustworthiness. One might call this a proto-profession. Modern physicians form a similar alliance. Specific knowledge and skills and specific action guiding rules are elements of a profession but its trustworthiness rests on a combination of professional autonomy and public control. In order to be granted autonomy the profession must show some effort in enforcing its specific rules and in order to do so its members need to be convinced of the intrinsic value of their profession (the "soul of professionalism" according to Freidson). Whereas in antiquity physicians acted as single individuals the modern alliance is shaped by division of labour. Physicians use each other and other professions by mutual consent and the health care system as means in the diagnostic-therapeutic process. As any actor is reponsible for the means he uses physicians are co-responsible accordingly. Thus, professional conduct now entails care for the organisation of the alliance as detailed in the "Charter on Medical Professionalism". The effort the profession gives to this task will confirm its trustworthiness.

There is a move away from a market economy in health care in the United States and a move towards such a market in Germany. This article tries to make explicit what underlies the moral intuition that there is a tension between a market economy and health care. First, health care is analyzed in terms of the economic theory of the market and incompatibilities are described. The moral problem is identified as the danger of liquefying the distinction between persons and things. The basic moral intuition seems to be the classical social contract: as a functioning market is governed by the principle of commutative justice, free riders have to be kept away, which is achieved by coercion that is not provided by the market; coercion can be justified by a social contract. The special moral problems of a social contract for health care are discussed. It is argued that public coercion in order to collect contributions for essential health care is justified.

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