MEDICAL ETHICS

1. MEDICAL ETHICS

CONTENTS

 Introduction

 Importance of Medical Ethics

 Principles of Medical Ethics

 Ethical Codes

 Research Ethics & forensic science

Introduction

In civilized life, law floats in a sea of ethics. - Earl Warren

 Ethics is concerned with moral principles, values and standards

of conduct. (WHO)

 Ethics is the study of morality – careful and systematic reflection

on and analysis of moral decisions and behaviour.

 Morality is the value dimension of human decision-making and

behaviour. # - World Medical Association Manual of Medical Ethics

 The Greek word ethike means habit, action, character.

 The Latin word mos (morals) means habit or custom.

 In simple words, Ethics is a set of philosophical beliefs and
practices concerned with the distinction between right and wrong.

 Ethics is a very large and complex field of study with many

branches or subdivisions.

 Medical Ethics is the branch of ethics that deals with moral issues
in medical practice.

 Medical ethics is closely related, but not identical to, bioethics

(biomedical ethics)

 Whereas medical ethics focuses primarily on issues arising out of

the practice of medicine, bioethics is a very broad subject that is
concerned with the moral issues raised by developments in the
biological sciences more generally.

Importance of Medical Ethics

 Ethical principles such as respect for persons, informed consent and

confidentiality are basic to the physician-patient relationship.

 Application of these principles in specific situations is often

problematic, since physicians, patients, their family members and
other healthcare personnel may disagree about what is the right way
to act in a situation.

 The study of ethics prepares medical professionals to recognize

difficult situations and to deal with them in a rational and principled
manner.
 Ethics is also important in physicians’ interactions with society and
their colleagues and for the conduct of medical research.

Principles of Medical Ethics

Autonomy
Voluntas aegroti suprema lex.

Beneficence
Salus aegroti suprema lex

Do no harm/ Non-maleficence

"first, do no harm" (primum non nocere).

Equity or Justice

Principles of Medical Ethics Autonomy

 Patient has freedom of thought, intention and action when making

decisions regarding health care procedures.

 For a patient to make a fully informed decision, she/he must

understand all risks and benefits of the procedure and the likelihood
of success.

 This includes the need to tell the truth (veracity) and to be faithful
to one’s commitments (fidelity).

Principles of Medical Ethics Beneficence

 The practitioner should act in “the best interest” of the patient - the
procedure be provided with the intent of doing good to the patient.

 Patient’s welfare is the first consideration.

Principles of Medical Ethics Confidentiality

 Based on loyalty and trust.

 Maintain the confidentiality of all personal, medical and treatment

information.

 Information to be revealed for the benefit of the patient and when

ethically and legally required.

Principles of Medical Ethics Do no harm/ Non-maleficence

 “Above all, do no harm”

 Make sure that the procedure does not harm the patient or others in
society.

 When interventions undertaken by physicians create a positive

outcome while also potentially doing harm it is known as the "double
effect." E.g. the use of morphine in the dying patient. Ease pain and
suffering while hastening the demise through suppression of the
respiratory drive.

Principles of Medical Ethics Equity or Justice

 Fair and equal distribution of scarce health resources, and the

decision of who gets what treatment.

 The burdens and benefits of new or experimental treatments must

be distributed equally among all groups in society.

Ethical Codes

 Hippocratic Oath – 5th century BC

 Nuremberg Code -1947

 Declaration of Geneva - 1948

 Universal Declaration of Human Rights-1948

 Helsinki Declaration -1964

 International Code of Medical ethics

 Indian Medical Council (Professional Conduct, Etiquettes and

Ethics) Regulations, 2002

Hippocratic Oath

 One of the earliest document in medical ethics – 5th century BC.

 Traditionally all doctors recite this oath at swearing in. It is

considered sacred for its religious foundation and sanctity.

Nuremberg Code - 1948

Declaration of Geneva

 Adopted at World Medical Association General Assembly in 1948.

 Amended in 1968, 1984, 1994, 2005 and 2006.

 Declaration of physicians’ dedication to the humanitarian goals of

medicine.

Helsinki Declaration

 Set of ethical principles regarding human experimentation

developed by the World Medical Association in 1964.

 Undergone 6 revisions since then. Last revision in 2008.

 More specifically addressed clinical research, reflecting changes in
medical practice from the term 'Human Experimentation' used in the
Nuremberg Code.

International Code of Medical Ethics -2006

 Given by World Medical Association

 The code applies both in peace and war.

 It codifies the duties of physician in general, duties to patients and

colleagues.

MCI Regulations - 2002

 The Medical Council of India notified the “Indian Medical Council

(Professional Conduct, Etiquettes and Ethics) Regulations, 2002” on
11 March 2002.

 Last amended in 2010.

 Declaration- Each applicant, at the time of making an application

for registration under the provisions of the Act, shall be provided a
copy of the declaration and shall submit a duly signed Declaration.

Duties and responsibilities of physician in general

 Character of Physician

 Uphold dignity and honour of his profession.

 Render service to humanity.

 Person with recognized qualification can only practice modern
system of medicine.

 Maintaining good medical practice.

 Render service to humanity with full respect for the dignity of

profession and man.

 Maintenance of Medical records

 Maintain the medical records pertaining to his / her indoor patients

for a period of 3 years.

 Records to be given within 72 hrs (if requested by patients/legal

authorities).

 Maintain a Register of Medical Certificates giving full details of

certificates issued.

 Display of registration numbers.

 Use of Generic names of drugs.

 Highest Quality Assurance in patient care

 Exposure of Unethical Conduct

 Payment of Professional Services

 Personal financial interests of a physician should not conflict with

the medical interests of patients.

 Evasion of Legal Restrictions

 Physician shall observe the laws of the country in regulating the
practice of medicine.

Duties of Physician to their patients

 Obligations to the sick

 Always respond to the calls of the sick.

 Ailment not within range of experience he can refuse treatment and

refer.

 Patience, delicacy & secrecy

 Patience and delicacy should characterize the physician.

 Secrecy of patients to be maintained except when required by laws

of the state and to protect healthy individuals.

 Prognosis

 Neither exaggerate or minimize gravity of patient’s condition

 Do not neglect the patient

 Physician free to choose.

 Once undertaken should not neglect the case.

 Respond to request in emergency.

Duties of Physician in consultation

 Avoid un-necessary consultation

 Consulting pathologist, radiologist or asking for lab investigation
should be done judiciously.

 Consultation for patient benefit.

 Punctuality in consultation.

 Statement to patient after consultation.

 Treatment after consultation.

 Patient referred to specialist.

 Fees and other charges.

THE OATH OF HIPPOCRATES OF KOS

I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness
all the gods, all the goddesses, to keep according to my ability and judgment the following
oath:

To consider dear to me as my parents him who taught me this art; to live in common with
him and if necessary to share my goods with him; to look upon his children as my own
brothers, to teach them this art if they so desire without fee or written promise; to impart to
my sons and the sons of the master who taught me and to the disciples who have enrolled
themselves and have agreed to the rules of the profession, but to these alone, the precepts and
the instruction.
I will prescribe regimen for the good of my patients according to my ability and my judgment
and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice
which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will
preserve the purity of my life and my art.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this
operation to be performed by specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far
from all intentional ill-doing and all seduction, and especially from the pleasures of love with
women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or outside of my

profession or in daily commerce with men, which ought not to be spread abroad, I will keep
secret and never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art,
respected by all men and in all times; but if I swerve from it or violate it, may the reverse be
my lot.

No one knows who Hippocrates was. We can only say that he was an Attic citizen, born on
the island of Cos sometime between the fourth and fifth century BC, in all likelihood not an
aristocrat, but the heir of well-to-do merchants or artisans. On account of the extraordinary
circumstances of his time—circumstances that have been amply, but never fully, explained
and which stirred Greek society and influenced western values to this day—his work is the
fruit of democracy, for Hippocrates professionalized a craft. He turned the antics of
traditional healers into the art of medicine, just as Socrates’ followers invented the concept of
school, the tragedians of Aeschylus’ age turned primitive rituals into theater, and the teachers
of Iktinus made architecture out of the construction business. The original version of the
Hippocratic Oath is a text written in all likelihood by a follower or a learned scribe,
apparently from Pythagoras’ school. Ever since it was composed, students of medicine have
sworn to some version of it, freely re-fashioned over the centuries to fit the convictions of the
time, ranging from pale, legalistic texts to Maimonides’ prayer, a Jewish text composed in
Spanish Cordoba in the twelfth century—arguably the most poetic one. The key controversial
aspects of Hippocrates’ Oath have been its explicit injunctions against euthanasia, abortion,
and surgery, all of which have been cautiously reworked in later versions of the text. It bears
remembering that his words against administering a deadly medicine to a patient, “even if
asked in extreme pain,” have to be read in the context of the often fatal effects of ancient
sedatives and anaesthetics; that abortion was performed almost exclusively on adulteresses
and prostitutes and thus imposed upon women by men; and that surgery was not yet
integrated into the physician’s craft, a practice performed at great risk to the patient by
barbers and leather-workers. A mix of stern civic ethics and inspired humanitarianism,
Hippocrates’ text has endured to this day, not just by virtue of its literary merits, but because
it is the first definition of the medical profession, a covenant for teachers, colleagues, and
students of the healing arts. That is why the document has been rewritten and read out loud
for centuries and why it is revisited now.

The Hippocratic Oath (modern version)

I swear to fulfil, to the best of my ability & judgment, this covenant

I will respect the hard-won scientific gains of those physicians in whose steps I walk & gladly
share such knowledge as is mine with those who are to follow

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin
traps of overtreatment & therapeutic nihilism

I will remember that there is art to medicine as well as science & that warmth, sympathy &
understanding may outweigh the surgeon’s knife or the chemist’s drug

I will not be ashamed to say “I know not” nor will I fail to call in my colleagues when the
skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients for their problems are not disclosed to me that the
world may know.

Most especially must I tread with care in matters of life & death. If it is given me to save a
life, all thanks.

But it may also be within my power to take a life; this awesome responsibility must be faced
with great humbleness & awareness of my own frailty. Above all,

I must not play God. I will remember that I do not treat a fever chart, a cancerous growth, but
a sick human being, whose illness may affect the person’s family & economic stability.

My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure. I will remember
that I remain a member of society, with special obligations to all my fellow, with special
obligations to all my fellow beings, those sound of mind & body as well as the infirm

If I do not violate this oath, may I enjoy life & art, respected while I live & remembered with
affection thereafter. May I always act so as to preserve the finest traditions of my calling and
may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna Academic Dean of the School of Medicine, Tufts
University

"First do no harm"

Main article: Primum non nocere