Introduction of Bioethic

dr. Amelia Eka Damayanty, M.Gizi

Faculty of Medicine, UMSU

Ethics is a philosophical
discipline about moral
problems, deals with art of
living

Faculty of Medicine, UMSU

ETHICS / MORAL
The oldest scientific and philosophical discipline?
Demarcation: science / subject

ethics moral
(gr. ethos = custom, (lat. mos = character,
practice) nature)
-Ethics – discipline about moral or philosophy on moral
-Moral – system of norms or rules, written or not, about human behavior

Faculty of Medicine, UMSU

What is Ethics?

The formal study of:

◦ What is right and wrong.

◦ The study of the bases or principles for

deciding right and wrong.

◦ The analyses of the processes by which

we decide what is right and wrong.

Faculty of Medicine, UMSU

Ethics is not:
Merely obeying the law
Compliance
Although in many instances laws are statements of
considered ethical positions and most of the time obeying
the law is an element of ethical behavior.

Faculty of Medicine, UMSU

Medical Ethics

A field of applied ethics, the study of moral values and judgments as

they apply to medicine. As a scholarly discipline, medical ethics
encompasses its practical application in clinical settings as well as
work on its history, philosophy, theology, sociology, and
anthropology.

Faculty of Medicine, UMSU

Medical Ethics

Long history

◦ Third Dynasty (Egypt) 2700 BCE

◦ Code of Hammurabi (Babylon) 1750 BCE
◦ Oath of the Hindu Physician (Vaidya’s Oath) 15th cy. BCE
◦ Hippocratic oath (Hippocrates, ca 460-370 BCE)
◦ The Oath of Asaph and Yohanan (ca 6th cy. CE)
◦ Advice to a Physician (Persia) 10th cy. CE
◦ Oath of Maimonides 12th cy. CE
◦ Ming Dynasty (China) 14th cy. CE
◦ Seventeen Rules of Enjun (Japanese Buddhist Physicians) 16th cy. CE)

Drawn from Codes of Medical and Human Experimentation Ethics by Victoria Berdon and Jennifer
Flavin viewable at http://wisdomtools.com/poynter/codes.html

Faculty of Medicine, UMSU

History cont.
Percival's Code (England), 1803: basis for first AMA
Code of Medical Ethics.
Beaumont's Code (United States), 1833: experimental treatments,
voluntary, informed consent.
American Medical Association (AMA) - Code of Medical Ethics, 1847.
Claude Bernard (France), 1865.
Walter Reed (United States), 1898: introduces written consent “contracts”. Allows healthy human
subjects in medical experiments.
Berlin Code or Prussian Code (Germany), 1900: no medical experiments when subject not competent
to give informed consent, in the absence of unambiguous consent, or when information not properly
explained to subject.
Reich Circular (Germany), 1932: concerned with consent and well-being of the subjects.

Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and Jennifer Flavin viewable at
http://wisdomtools.com/poynter/codes.html

Faculty of Medicine, UMSU

Modern issues and statements
Nuremberg Code (1947)
◦ Medical research
Declaration of Geneva, W.M.A. (1948, 1968, 1984, 1994, 2005, 2006)
World Medical Association International Code of Medical Ethics
AMA revision (1957)
Declaration of Helsinki, application to medical research (1964, rev. 1975, 1983, 1989,
1996, 2000)

Belmont Report (1979)

AMA revision (2001)

Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and Jennifer Flavin viewable
at http://wisdomtools.com/poynter/codes.html

Faculty of Medicine, UMSU

Faculty of Medicine, UMSU
Why study medical ethics?
Ethics is and always has been an essential component of medical practice
some ethical principles are basic to the physician-patient relationship, but
application in specific situations is often problematic due to disagreement
about what is the right way to act
study of ethics prepares medical students to recognize difficult situations and
to deal with them in a rational and principled manner
“As long as the physician is a knowledgeable and skillful clinician, ethics
doesn’t matter.”
“Ethics is learned in the family, not in medical school.”
“Medical ethics is learned by observing how senior physicians act, not from
books or lectures.”
“Ethics is important, but our curriculum is already too crowded and there is no
room for ethics teaching.”

Faculty of Medicine, UMSU

Why study medical ethics?

Integral part of medicine at least since the time of Hippocrates

concept of medicine as a profession
In recent times - influence by developments in human rights (e.g.,
violations of human rights, such as forced migration and torture;
whether healthcare is a human right) closely related to law (e.g.,
medical licensing and regulatory officials), but
Ethics prescribes higher standards; occasionally requires that physicians
disobey laws that demand unethical behaviour; laws differ significantly
from one country to another while ethics is applicable across national
boundaries

Faculty of Medicine, UMSU

 Bioethics

Medical ethics closely related to bioethics (biomedical ethics), but not

identical
- medical ethics focuses primarily on issues arising out of the practice of
medicine
- bioethics: very broad subject, concerned with the moral issues raised
by developments in the biological sciences
- bioethics does not require the acceptance of certain traditional values
that are fundamental to medical ethics

Faculty of Medicine, UMSU

Branch of applied ethics that studies the
philosophical, social, and legal issues arising in
medicine and the life sciences
it is chiefly concerned with human life and well-being,
though it sometimes also treats ethical questions
relating to the nonhuman biological environment

Faculty of Medicine, UMSU

Faculty of Medicine, UMSU
Process of making ethical decisions
Awareness—Is there a moral issue here?
◦ What is its nature? How important?
What are the facts?
What are the issues?
What rules or values apply here?
To whom or what do I owe a duty?
How should they be applied?
Who needs to decide and act? Who ought to?
To what am I obligated because of role/position?
What are the consequences?
What are the options?!

Faculty of Medicine, UMSU

The Principles of Bioethics
◦ Autonomy
◦ Right of self-determination
◦ Related to ‘informed consent’
◦ In order to give consent: autonomy/competency/capacity must be possessed.
◦ Beneficence – to do well, to promote well-being
◦ Non-maleficence – to do no harm, to avoid doing harm
◦ Justice – treat like alike

Faculty of Medicine, UMSU

Prinsip-prinsip etis bioetika modern yang paling terkenal berasal
dari buku tentang etika medis, yakni Principle of Biomedical Ethics
oleh Tom L. Beauchamp dan James F. Childress
Reference
- The UNESCO Universal Declaration on Bioethics, Background, priciples and
application. Edited by Henk A.M.J ten Have and Michele S. Jen. Ethics Series.
Unesco 2009
- T. Beauchamp and J. Childress, Principles of Biomedical Ethics, 5th edition, New
York/Oxford: Oxford University Press, 2001