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Medical Ethics or Bioethics

Medical Ethics or Bioethics

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Published by Mohsin Mahmood

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Published by: Mohsin Mahmood on Aug 24, 2009
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Medical Ethics or Bioethics, study and application of moral values, rights, and duties inthe fields of medical treatment and research. Medical decisions involving moral issuesare made every day in diverse situations such as the relationship between patient and physician, the treatment of human and animal subjects in biomedical experimentation, theallocation of scarce medical resources, the complex questions that surround the beginningand the end of a human life, and the conduct of clinical medicine and life-sciencesresearch.Issues in Medical Ethics The advent of new medical and reproductive technologies inrecent years has complicated how ethical decisions are made in medical research and practice. This slide show highlights some of the most prominent issues in medical ethics:assisted reproductive technologies, human fetal tissue transplantation, cloning, andabortion. © Microsoft Corporation. All Rights Reserved.ExpandMedical ethics traces its roots back as far as ancient Greece, but the field gained particular prominence in the late 20th century. Many of the current issues in medicalethics are the product of advances in scientific knowledge and biomedical technology.These advances have presented humanity not only with great progress in treating and preventing disease but also with new questions and uncertainties about the basic nature of life and death. As people have grappled with issues on the frontier of medical science andresearch, medical ethics has grown into a separate profession and field of study.Professional medical ethicists bring expertise from fields such as philosophy, socialsciences, medicine, research science, law, and theology.sidebar SIDEBAR Fraud in ScienceScience is the search for truth. Its tools are rationality, objectivity, experimentation, andthe free exchange of reliable information. But what happens when a scientist reportsunreliable or fraudulent information? How common is fraud in science? Can sciencedistinguish the fraudulent from the genuine? What steps are scientists taking to policethemselves? Science journalist Christopher King reports on these questions and other controversies surrounding fraud in science.open sidebar Medical ethicists serve as advisors to hospitals and other health-care institutions. Theyhave also served as advisors to government at various levels. For example, experts inmedical ethics assisted the United States government from 1974 to 1978 as members of the National Commission for the Protection of Human Subjects of Medical Research. Thecommission was formed in response to several large-scale experiments that used humansubjects who were tricked into participating. In the late 1990s the National BioethicsAdvisory Commission, at the direction of President Bill Clinton, studied issues related tothe cloning of human beings. Ethicists also serve as advisors to state legislatures in thewriting of laws concerning the decision to end life support, the use of genetic testing, physician-assisted suicide, and other matters. Medical ethics has even become part of the
 
landscape in the commercial world of science. An increasing number of firms involved in biotechnology (the business of applying biological and genetic research to thedevelopment of new drugs and other products) regularly consult with medical ethicistsabout business and research practices.The field of medical ethics is also an international discipline. The World HealthOrganization founded the Council for International Organizations of Medical Sciences in1949 to collect worldwide data on the use of human subjects in research. In 1993 theUnited Nations Educational, Scientific, and Cultural Organization (UNESCO) establishedan International Bioethics Committee to examine and monitor worldwide issues inmedicine and life-sciences research. The UNESCO directory lists more than 500 centersoutside the United States. The International Association of Bioethics was founded in1997 to facilitate the exchange of information in medical ethics issues and to encourageresearch and teaching in the field.In the United States and Canada more than 25 universities offer degrees in medical ethics.In many instances, the subject is also part of the curriculum in the education of physiciansand other health-care professionals. Many medical schools include ethics courses thatexamine topics such as theories of moral decision-making and the responsible conduct of medical research.II HISTORYHippocrates Greek physician and philosopher Hippocrates (460?-377? bc), regarded asthe father of medicine, is considered the first to formally address the ethical issuesassociated with medical practices.Culver PicturesThe examination of moral issues in medicine largely began with the Greeks in the 4thcentury bc. The Greek physician Hippocrates is associated with more than 70 works pertaining to medicine. However, modern scholars are not certain how many of theseworks can be attributed to Hippocrates himself, as some may have been written by hisfollowers. One work that is generally credited to Hippocrates contains one of the firststatements on medical ethics. In Epidemics I, in the midst of instructions on how todiagnose various illnesses, Hippocrates offers the following, “As to diseases, make ahabit of two things—to help and not to harm.”The most famous ethical work—although the exact origin of the text is unknown—is theHippocratic Oath. In eight paragraphs, those swearing the oath pledge to “keep [patients]from harm and injustice.” The oath also requires physicians to give their loyalty andsupport to their fellow physicians, promise to apply dietetic measures for the benefit of the sick, refuse to provide abortion or euthanasia (the act of assisting a chronically ill person to die), and swear not to make improper sexual advances against any members of the household. “In purity and holiness I will guard my life and my art,” concludes onesection of the oath. For most of the 20th century, it was common for modified versions of the Hippocratic Oath to be recited by medical students upon the awarding of their degrees. For many people, the oath still symbolizes a physician’s duties and obligations.
 
The idea of ethical conduct is common in many early texts, including those from ancientIndia and China—cultures in which medical knowledge was viewed as divine or magicalin origin. Echoing the Hippocratic Oath, the Caraka Samhita, a Sanskrit text written inIndia roughly 2,000 years ago, urges the following commandment to physicians, “Dayand night, however you may be engaged, you shall strive for the relief of the patient withall your heart and soul. You shall not desert the patient even for the sake of your life or living.” Similar sentiments can be found in the Chinese text Nei Jing (The YellowEmperor's Classic of Inner Medicine), dating from the 2nd century bc. This work stressedthe connection between virtue and health. Three centuries later, the work of the Chinese physician Sun Simiao emphasized compassion and humility, “...a Great Physician shouldnot pay attention to status, wealth, or age.... He should meet everyone on equalground....”In Europe during the Middle Ages, the ethical standards of physicians were put to the test by the bubonic plague, the highly contagious Black Death that arrived around the mid-1300s and remained a threat for centuries. When plague broke out, physicians had achoice: They could stay and treat the sick—risking death in the process—or flee. The bubonic plague and other epidemics provide an early example of the challenges that stillexist today when doctors must decide whether they are willing to face personal riskswhen caring for their patients.By the 18th century, particularly in Britain, the emphasis in medical ethics centered on proper, honorable behavior. One of the best-known works from the period is MedicalEthics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons, published in 1803 by the British physician Thomas Percival. Inhis 72 precepts, Percival urged a level of care and attention such that doctors would“inspire the minds of their patients with gratitude, respect, and confidence.” His ethics,however, also permitted withholding the truth from a patient if the truth might be “deeplyinjurious to himself, to his family, and to the public.” At roughly the same time American physician Benjamin Rush, a signer of the Declaration of Independence, was promotingAmerican medical ethics. His lectures to medical students at the University of Pennsylvania in Philadelphia, spoke of the virtues of generosity, honesty, piety, andservice to the poor.By the early 19th century, it seemed that such virtues were in short supply, and the publicgenerally held physicians in North America in low esteem. Complicating the problemwas the existence of a variety of faith healers and other unconventional practitioners whoflourished in an almost entirely unregulated medical marketplace. In part to remedy thissituation, physicians convened in 1847 to form a national association devoted to theimprovement of standards in medical education and practice. The American MedicalAssociation (AMA), as the group called itself, issued its own code of ethics, stating, “A physician shall be dedicated to providing competent medical service with compassionand respect for human dignity. A physician shall recognize a responsibility to participatein activities contributing to an improved community.” This text was largely modeled onthe British code written by Percival, but it added the idea of mutually shared

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