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 autonomy
respect 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 not
to 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.
 World War II
• 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.
 High Altitude Experiments:
Dissect several of the victims'
brains, while they were still
alive, to demonstrate that high
altitude sickness

Sulfanilamide Experiments: Wartime wounds

were recreated and inflicted on healthy Jews
designated to be treated by the new drug. Tuberculosis Experiments: Injected live
tubercle bacilli into the subjects' lungs to
immunize against TB

Freezing Experiments: Prisoners Sea Water Experiments: given unaltered sea

were immersed into tanks of ice water and sea water whose taste was
water camouflaged as their sole source of fluid.
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
• Bioethics
Deals with typically controversial ethical issues emerging from new
situations arising due to advances in medicine.