In Reply.
—certainly agree that "autonomy and beneficence are both essential and necessary in caring for patients." My considerations were actually meant to emphasize these Reply.—I pects of our profession. Facing the reality of modern medicine, a reappraisal of the physician's role is probably necessary everywhere in the world.
I remain convinced, however, that cultural differences influence, if not the principles, certainly the expression of ethics and medical ethics in different countries. For instance, the "variables unrelated to the patient" are part of what defines a culture. Cultural issues thus should not be underestimated; rather, they need to be more deeply explored.
Only the combination of personal and cultural efforts, in my opinion,1 will guarantee that true respect for our patients, and a correct balance between the ethical principles2 will be achieved in individual circumstances as well as in the formulation of the rules guiding the practice
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