MEDICAL ETHICS

Medical ethics

• A system of moral principals that apply values and judgments to the practice of medicine• Help the doctor to decide what is morally right

Why it is necessary in medicine?

• Doctors are dealing with lives of patients• They have the power to cure as well as the power to kill• Ensure highest care to community• Prevent doctors abusing trust and power

Basic principles of medical ethics….

• Respect for autonomyrespect the patients ability to take decisions on behalf of themselves• Beneficence

do good• Non-maleficence

do no harm• Justice

treat equitably and distribute benefits fairly

Evolution of Medical Ethics

•Pre Hippocratic era•Hippocratic era•World War II

Pre-Hippocratic Era

• Hindu principles of “respect for all life and the virtues of honesty, generosity, and hospitality” provided a firm ethical foundation for medical practice.• Male doctors were unable to touch female patients according to

examination protocol and hence did not perform obstetrics in ancient Korea• Mesopotamian and Egyptian society, women healers practiced medicine.

They provided care based on the belief that “health was associated with correct living, being at peace with the gods, spirits and the dead; illness was a matter of imbalance which could be restored to equilibrium by supplication, spells, magic, empirical practices and rituals.”• In middle eastern countries physicians believed that they should “practice

for the love of mankind” but also accept appropriate fame and rewards.

• In India Caraka Samhita had an oath of initiation similar to the Hippocratic Oath, but there were some differences : A pupil in Ayurvedic medicine had to vow to be celibate, to speak the truth, to adhere to a vegetarian diet, to be free of envy, and never to carry weapons. He was to obey his master and pledge himself to the relief of his patients, never abandoning or taking sexual advantage of them. He was notto treat enemies of the king or wicked people, and had to desist from treating women unattended by their husbands or guardians. The student had to visit the patient’s home properly chaperoned, and respect the confidentiality of all privileged information pertaining to the patient and his or her household

Hippocratic Era• shift the focus from class-based medical care to selfless service of

individual patients.• He introduced the friendly, sympathetic, pleasing and painless treatment

of patients into medical practice• use his knowledge and craft “in a pure and holy way” to succour his

patients and “keep them from harm and injustice.” • The prohibitions against euthanasia, abortion, cutting for stone, sexual

misconduct and breaking patient confidentiality signal the types of problems that practitioners faced. • They also indicate the behaviour that was expected of a student of the

art of Hippocratic medicine and his commitment to personal and professional good conduct.

• The Nazi physicians performed brutal medical experiments upon helpless concentration camp inmates. These acts of torture were characterized by several shocking features: (1) persons were forced to become subjects in very dangerous studies against their will; (2) nearly all subjects endured incredible suffering, mutilation, and indescribable pain; and (3) the experiments often were deliberately designed to terminate in a fatal outcome for their victims.

World War II

Tuberculosis Experiments: Injected live tubercle bacilli into the subjects' lungs to immunize against TB

Sulfanilamide Experiments: Wartime wounds were recreated and inflicted on healthy Jews designated to be treated by the new drug.

Sea Water Experiments: given unaltered sea water and sea water whose taste was camouflaged as their sole source of fluid.

High Altitude Experiments: Dissect several of the victims' brains, while they were still alive, to demonstrate that high altitude sickness

Freezing Experiments: Prisoners were immersed into tanks of ice water

Medical ethics today

• The Hippocratic Oath was modernized in 1948 and was named the declaration of Geneva. It was further amended in Sydney in 1968 and Stockholm in 1994.• This provides the basis for The International Code of Medical

Ethics(ICME).• The ICME describes medical ethics in terms of duties of physician in

general, duties of physicians to patients and duties of physicians to colleagues.

New concepts

• BioethicsDeals with typically controversial ethical issues emerging from new

situations arising due to advances in medicine.