Medical Ethics Health Article

Definition

Medical ethics refers to the discussion and application of moral values and responsibilities in the areas of medical practice and research. While questions of medical ethics have been debated since the beginnings of Western medicine in the fifth century B.C., medical ethics as a distinctive field came into prominence only since World War II. This change has come about largely as a result of advances in medical technology, scientific research, and telecommunications. These developments have affected nearly every aspect of clinical practice, from the confidentiality of patient records to end-of-life issues. Moreover, the increased involvement of government in medical research as well as the allocation of health care resources brings with it an additional set of ethical questions.

The Hippocratic tradition

Medical ethics generally traces its origins to the ancient Greek physician Hippocrates (460–377 BC), who is credited with defining the first ethical standard in medicine: "Do no harm." The oath attributed to Hippocrates was traditionally recited by medical students as part of their medical school's graduation ceremonies. A modernized version of the Hippocratic Oath that has been approved by the American Medical Association (AMA) reads as follows:

You do solemnly swear, each by whatever he or she holds most sacred

That you will be loyal to the Profession of Medicine and just and generous to its members

That you will lead your lives and practice your art in uprightness and honor

That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice

That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it

That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret

These things do you swear. Let each bow the head in sign of acquiescence

And now, if you will be true to this your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.

Religious traditions and medical ethics

Ancient Greece was not the only premodern culture that set ethical standards for physicians. Both Indian and Chinese medical texts from the third century B.C. list certain moral virtues that practitioners were to exemplify, among them humility, compassion, and concern for the patient's well-being. In the West, both Judaism and Christianity gave extensive consideration to the importance of the physician's moral character as well as his duties to patients. In Judaism, medical ethics is rooted in the study of specific case histories interpreted in the light of Jewish law. This case-based approach is known as casuistry. In Christianity, ethical reflection on medical questions has taken the form of an emphasis on duty, moral obligation, and right action. In both faiths, the relationship between the medical professional and the patient is still regarded as a covenant or sacred bond of trust rather than a business contract. In contemporary Buddhism, discussions of medical ethics reflect specifically Buddhist understandings of suffering, the meaning of human personhood, and the significance of death.

The Enlightenment and the nineteenth century

The eighteenth century in Europe witnessed a number of medical as well as general scientific advances, and the application of scientific principles to medical education led to a new interest in medical ethics. The first book on medical ethics in English was published by a British physician, Thomas Percival, in 1803. In the newly independent United States, Benjamin Rush—a signer of the Declaration of Independence as well as a physician—lectured to the medical students at the University of Pennsylvania on the importance of high ethical standards in their profession. Rush recommended service to the poor as well as the older Hippocratic virtues of honesty and justice.

In the middle of the nineteenth century, physicians in the United States and Canada began to form medical societies with stated codes of ethics. These codes were drawn up partly because there was no government licensing of physicians or regulation of medical practice at that time. The medical profession felt a need to regulate itself as well as set itself apart from quacks, faith healers, homeopaths, and other practitioners of what would now be called alternative medicine. The AMA, which was formed in 1847, has revised its Code of Ethics from time to time as new ethical issues have arisen. The present version consists of seven principles. The Canadian Medical Association (CMA) was formed in 1867 and has a Code of Ethics with 40 guidelines for the ethical practice of medicine.