Moral dilemmas in medicine: Why some problems have no solutions

Every now and then I go back to a book I read decades ago. Sometimes it feels dated, a period piece. Sometimes it sounds uncannily current, as if it has been waiting. And sometimes it does both at once, which is more unsettling.

Recently I reread Moral Dilemmas in Medicine, first published in 1975. I read it as a younger physician, still believing that if you learned enough and tried hard enough, medicine would eventually line up morally. You would figure it out.

Reading it now, later in life, I was struck by how familiar it felt. Not comforting. Familiar. The problems Campbell described have not gone away. They have simply been surrounded by more noise.

Campbell’s argument is almost plainspoken. Medicine is not mainly a technical activity. It is a moral one. And many of the hardest moments in a doctor’s life are not problems waiting for solutions. They are dilemmas. You do not solve them. You choose, and something important is lost no matter what you do.

That difference matters more than we usually admit. A problem implies progress. A dilemma implies cost.

The persistence of dilemmas

End-of-life decisions. How much truth to tell, and when. Scarce resources. Consent that is technically valid but humanly fragile. These were not unusual situations to Campbell. They were everyday medicine. He did not treat them as failures of skill or knowledge. He treated them as the work itself.

What I had forgotten, and what struck me most on rereading, was his insistence on responsibility without certainty. Doctors act without full information. Under pressure. Often tired. Often alone. And still, the responsibility cannot be handed off. Not to protocols. Not to committees. Not to technology.

Campbell did not use the language we use now. He did not talk about burnout or moral injury. But he understood something that feels very current. When dilemmas pile up and are never named, they do not disappear. They leave a residue. Doubt. Guilt. Fatigue. A sense of having failed even when you did your best.

Practical moral wisdom

He was also cautious about moral rigidity. Principles matter, of course. But autonomy, beneficence, sanctity of life, taken one at a time and applied without context, can distort judgment rather than guide it. Campbell leaned toward something harder to teach and harder to measure: Practical moral wisdom. The kind that grows slowly, through experience and reflection, and is never finished.

Reading this book now, in a medical culture shaped by metrics, productivity targets, and prior authorizations, its relevance is almost uncomfortable. Campbell assumed that doctors still owned their moral decisions, even when constrained. Many physicians today feel the opposite. The responsibility remains with them, but the authority has drifted elsewhere.

That gap does damage.

The book offers no reassurance. Campbell does not pretend that ethics will make medicine easier. What he offers instead is permission. Permission to name dilemmas honestly. Permission to stop pretending that every hard decision is a technical problem in disguise. Permission to recognize that some of what weighs on doctors is not weakness or failure, but the moral cost of caring seriously in imperfect systems.

Rereading this book did not make me nostalgic for an earlier era. It made me clearer about this one.

Some of what troubles physicians today is not something to fix. It is something to acknowledge. And sometimes, simply naming what you are carrying is the beginning of relief.

Some dilemmas never resolve. They follow a physician across a career, changing shape as the physician changes. Learning how to live with that, without hardening or pretending otherwise, may still be one of the most important skills medicine asks of us.

Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.

Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.

Patrick is the author of the Coaching for Physicians series, including:

He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.