Patient/doctor confidentiality, euthanasia, abortion. These are the kinds of tough philosophical issues in the medical profession that Richard Sherlock and his students discuss in his medical ethics course at Utah State University.

Many of these issues, such as abortion, "are still and forever enormously complicated," and will be debated for years, said Sherlock, professor in the department of languages and philosophy at USU.Other issues, like patient/doctor confidentiality, have taken on new ramifications in the era of AIDS and drug testing, Sherlock said.

"Does an AIDS patient have a right to privacy? After all, he's likely to lose his job and insurance coverage if word gets out. On the other hand, do other people have the right to know they are hiring, insuring or working in proximity to someone with AIDS?" he said.

"Access" issues are another topic debated in class. "These essentially relate to how limited resources should be distributed," Sherlock said.

Examples include who should pay for adequate health care for the poor and uninsured, how to encourage pharmaceutical companies to develop medicines that are important but not profitable, guidelines for testing experimental drugs, and national health insurance.

Sherlock and his students study these issues by looking at them from a variety of perspectives. Essentially, ethical points of view can be divided into two large streams of thought, he said.

One, utilitarianism, is "cost/benefit analysis." On a case by case basis, you weigh the alternatives and take the course of action that benefits the greater number of people, or is more positive than negative," he said.

"For example, when a utilitarian is considering whether a middle-class white woman should have an abortion, he might take the attitude that babies born of such women are at a premium for adoption, so the greater good for society would be for the baby to be born," he said.

The other general ethical perspective is formalism, or "rights-based" theory.

"This point of view holds that certain moral principles don't have a price, or have one that is extremely high," Sherlock said.

A formalist might say that a doctor should never violate the doctor/patient confidentiality rule, with the possible exception of a case where she knew the patient was on the way to murder another human being, Sherlock said.

Formalists and utilitarians may come up with different conclusions on ethical issues, or they may simply look at them differently, Sherlock said.

An example would the case of a physician hired to screen potential employees of a particular company. If a particular applicant tested positive for AIDS, the utilitarian physician would consider the effect of that person's employment on the company as a whole, including potential insurance costs, in addition to the concerns of the applicant.

For the formalist, it becomes instead an issue of confidentiality that could not be violated except in an extreme example, such as a particular job where that worker might pass the disease to co-workers or clients.

Sherlock uses real-life case examples to spark lively debate in his class. The examples also serve another purpose.

"People tend to see a real-life case in a different light than they do hypothetical examples," he said.