Medical ethics
Encyclopedia
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine
. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
medical ethics may be traced to guidelines on the duty
of physicians in antiquity, such as the Hippocratic Oath
, and early rabbi
nic and Christian
teachings. In the medieval and early modern period, the field is indebted to Muslim medicine
such as Ishaq bin Ali Rahawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics) and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides
, Roman Catholic scholastic
thinkers such as Thomas Aquinas
, and the case-oriented analysis (casuistry
) of Catholic moral theology
. These intellectual traditions continue in Catholic, Islamic and Jewish medical ethics
.
By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as Thomas Percival
wrote about "medical jurisprudence" and reportedly coined the phrase "medical ethics." Percival's guidelines related to physician consultations have been criticized as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In 1847, the American Medical Association
adopted its first code of ethics
, with this being based in large part upon Percival's work http://www.uab.edu/reynolds/MajMedFigs/Percival.htm. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher
. In the 1960s and 1970s, building upon liberal theory and procedural justice
, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics
.
As a result of the Nuremberg Trials
, the Belmont Report
was entered into law in the United States. This lead to the creation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.
Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Board
s to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.
Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts.
When moral values are in conflict, the result may be an ethical dilemma
or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
" tradition within healthcare. Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism
to the detriment of outcomes for some patients. Respect for autonomy is the basis for informed consent and advance directives.
Autonomy is a general indicator of health. Many diseases are characterised by loss of autonomy, in various manners. This makes autonomy an indicator for both personal well-being, and for the well-being of the profession.
This has implications for the consideration of medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of health care to do good to others, and have them, and society, benefit from this?". (Ethics - by definition - tries to find a beneficial balance between the activities of the individual and its effects on a collective.)
By considering autonomy as a gauge parameter for (self) health care, the medical and ethical perspective both benefit from the implied reference to health.
Psychiatrists and clinical psychologists are often asked to evaluate a patient's capacity for making life-and-death decisions at the end of life. Persons with a psychiatric condition such as delirium or clinical depression may not have the capacity to make end-of-life decisions. Therefore, for these persons, a request to refuse treatment may be taken in consideration of their condition and not followed. Unless there is a clear advance directive to the contrary, persons who lack mental capacity are generally treated according to their best interests. On the other hand, persons who have the mental capacity to make end-of-life decisions have the right to refuse treatment and choose an early death if that is what they truly want. In such cases, psychiatrists and psychologists are typically part of protecting that right.
James Childress
and Tom Beauchamp
in Principle of Biomedical Ethics (1978) identify beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino
, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception
and euthanasia
fall beyond its purview.
. Many consider that should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than to do them good. This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no (or only acceptable levels of) harm. Much harm has been done to patients as a result, as in the saying, "The treatment was a success, but the patient died." It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not prescribing medications they know to be harmful - he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks.
In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and balances against the principle of beneficence (doing good), as the effects of the two principles together often give rise to a double effect (further described in next section).
Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of non-maleficence differs. Violation of non-maleficence is the subject of medical malpractice
litigation. Regulations therefore differ over time, per nation.
A commonly cited example of this phenomenon is the use of morphine or other analgesic
in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient, while simultaneously having the maleficent effect of hastening the death of the patient through suppression of the respiratory system.
Examples include when a patient does not want a treatment because of, for example, religious or cultural views. In the case of euthanasia
, the patient, or relatives of a patient, may want to end the life of the patient. Also, the patient may want an unnecessary treatment, as can be the case in hypochondria
or with cosmetic surgery; here, the practitioner may be required to balance the desires of the patient for medically unnecessary potential risks against the patient's informed autonomy in the issue. A doctor may want to prefer autonomy because refusal to please the patient's will would harm the doctor-patient relationship
.
Individuals' capacity for informed decision making may come into question during resolution of conflicts between autonomy and beneficence. The role of surrogate medical decision makers is an extension of the principle of autonomy.
On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a breach of patients' autonomy may cause decreased confidence for medical services in the population and subsequently less willingness to seek help, which in turn may cause inability to perform beneficence. Beneficence is a task worthy of many to complete due to its difficulty to perform under extreme circumstances that are not correlated directly with individuals seeking euthanasia.
The principles of autonomy and beneficence/non-maleficence may also be expanded to include effects on the relatives of patients or even the medical practitioners, the overall population and economic issues when making medical decisions.
, though not all concur. Probably the most extreme example in recent history of the violation of the non-maleficence dictum was Dr. Jack Kevorkian
, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show 60 Minutes.
In some countries, euthanasia is accepted as standard medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the "Primum no Nocere" is based on the realisation that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient.
"Not acting" in those cases is believed to be more damaging than actively relieving the suffering of the patient. Evidently the ability to offer help depends on the limitation of what the practitioner can do. These limitations are characteristic for each different form of healing, and the legal system of the specific culture.
The aim to "not do harm" is still the same. It gives the medical practitioner a responsibility to help the patient, in the intentional and active relief of suffering, in those cases where no cure can be offered.
make decisions for them. The value of informed consent is closely related to the values of autonomy
and truth telling.
A correlate to "informed consent" is the concept of informed refusal
.
Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.
Confidentiality is mandated in America
by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. Many states in the U.S. have laws governing parental notification in underage abortion.
Traditionally, medical ethics has viewed the duty of confidentiality as a relatively non-negotiable tenet of medical practice. More recently, critics like Jacob Appel have argued for a more nuanced approach to the duty that acknowledges the need for flexibility in many cases.
Routine regulatory professional bodies or the courts of law are valid social recourses.
. Communication breakdowns between patients and their healthcare team, between family members, or between members of the medical community, can all lead to disagreements and strong feelings. These breakdowns should be remedied, and many apparently insurmountable "ethics" problems can be solved with open lines of communication.
requires that ethical considerations are taken into account, for example with respect to physician integrity, conflicts of interest, research ethics and organ transplantation ethics.
is regarded as authoritative in human research ethics.
In the United Kingdom, General Medical Council
provides clear overall modern guidance in the form of its 'Good Medical Practice' statement. Other organisations, such as the Medical Protection Society
and a number of university departments, are often consulted by British doctors regarding issues relating to ethics.
These bodies are composed primarily of health care professionals, but may also include philosophers, lay people, and clergy
- indeed, in many parts of the world their presence is considered mandatory in order to provide balance.
With respect to the expected composition of such bodies in the USA, Europe and Australia, the following applies http://www.chrcrm.org/main/modules/pageworks/index.php?page=015&id=231.
The assignment of philosophers or religious clerics will reflect the importance attached by the society
to the basic values involved. An example from Sweden
with Torbjörn Tännsjö
on a couple of such committees indicates secular trends gaining influence.
One issue that has arisen, however, is the disclosure of information. While researchers wish to quote from the original source in order to argue a point, this can have repercussions. The quotations and other information about the site can be used to identify the site, and researchers have reported cases where members of the site, bloggers and others have used this information as 'clues' in a game in an attempt to identify the site. Some researchers have employed various methods of "heavy disguise," including discussing a different condition from that under study, or even setting up bogus sites (called 'Maryut sites') to ensure that the researched site is not discovered.
now takes precedence over other ethical values, and patients are usually at least asked whether they want to know the diagnosis.
Fee splitting
and the payments of commissions to attract referrals of patients is considered unethical and unacceptable in most parts of the world.
(CME) programs influence prescribing patterns. Many patients surveyed in one study agreed that physician gifts from drug companies influence prescribing practices. A growing movement among physicians is attempting to diminish the influence of pharmaceutical industry marketing upon medical practice, as evidenced by Stanford University's ban on drug company-sponsored lunches and gifts. Other academic institutions that have banned pharmaceutical industry-sponsored gifts and food include the Johns Hopkins Medical Institutions, University of Michigan, University of Pennsylvania, and Yale University.
Advanced directives include living wills and durable powers of attorney
for health care. (See also Do Not Resuscitate
and cardiopulmonary resuscitation
) In many cases, the "expressed wishes" of the patient are documented in these directives, and this provides a framework to guide family members and health care
professionals in the decision making process when the patient is incapacitated. Undocumented expressed wishes can also help guide decisions in the absence of advanced directives, as in the Quinlan case in Missouri.
"Substituted judgment" is the concept that a family member can give consent for treatment if the patient is unable (or unwilling) to give consent themselves. The key question for the decision making surrogate is not, "What would you like to do?", but instead, "What do you think the patient would want in this situation?".
Courts have supported family's arbitrary definitions of futility to include simple biological survival, as in the Baby K
case (in which the courts ordered a child born with only a brain stem instead of a complete brain to be kept on a ventilator based on the religious belief that all life must be preserved).
In some hospitals, medical futility is referred to as "non-beneficial care."
Baby Doe Law
establishes state protection for a disabled child's right to life, ensuring that this right is protected even over the wishes of parents or guardians in cases where they want to withhold treatment.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.
History
Historically, WesternWestern world
The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...
medical ethics may be traced to guidelines on the duty
Duty
Duty is a term that conveys a sense of moral commitment to someone or something. The moral commitment is the sort that results in action and it is not a matter of passive feeling or mere recognition...
of physicians in antiquity, such as the Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
, and early rabbi
Rabbi
In Judaism, a rabbi is a teacher of Torah. This title derives from the Hebrew word רבי , meaning "My Master" , which is the way a student would address a master of Torah...
nic and Christian
Christian
A Christian is a person who adheres to Christianity, an Abrahamic, monotheistic religion based on the life and teachings of Jesus of Nazareth as recorded in the Canonical gospels and the letters of the New Testament...
teachings. In the medieval and early modern period, the field is indebted to Muslim medicine
Islamic medicine
In the history of medicine, Islamic medicine, Arabic medicine or Arabian medicine refers to medicine developed in the Islamic Golden Age, and written in Arabic, the lingua franca of Islamic civilization....
such as Ishaq bin Ali Rahawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics) and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides
Maimonides
Moses ben-Maimon, called Maimonides and also known as Mūsā ibn Maymūn in Arabic, or Rambam , was a preeminent medieval Jewish philosopher and one of the greatest Torah scholars and physicians of the Middle Ages...
, Roman Catholic scholastic
Scholasticism
Scholasticism is a method of critical thought which dominated teaching by the academics of medieval universities in Europe from about 1100–1500, and a program of employing that method in articulating and defending orthodoxy in an increasingly pluralistic context...
thinkers such as Thomas Aquinas
Thomas Aquinas
Thomas Aquinas, O.P. , also Thomas of Aquin or Aquino, was an Italian Dominican priest of the Catholic Church, and an immensely influential philosopher and theologian in the tradition of scholasticism, known as Doctor Angelicus, Doctor Communis, or Doctor Universalis...
, and the case-oriented analysis (casuistry
Casuistry
In applied ethics, casuistry is case-based reasoning. Casuistry is used in juridical and ethical discussions of law and ethics, and often is a critique of principle- or rule-based reasoning...
) of Catholic moral theology
Moral theology
Moral theology is a systematic theological treatment of Christian ethics. It is usually taught on Divinity faculties as a part of the basic curriculum.- External links :*...
. These intellectual traditions continue in Catholic, Islamic and Jewish medical ethics
Jewish medical ethics
Jewish medical ethics is a modern scholarly and clinical approach to medical ethics that draws upon Jewish thought and teachings. Pioneered by Rabbi Immanuel Jakobovits in the 1950s, Jewish medical ethics centers mainly around an applied ethics drawing upon traditional rabbinic law...
.
By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. For instance, authors such as Thomas Percival
Thomas Percival
Thomas Percival FRS FRSE FSA was an English physician and author, best known for crafting perhaps the first modern code of medical ethics...
wrote about "medical jurisprudence" and reportedly coined the phrase "medical ethics." Percival's guidelines related to physician consultations have been criticized as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In 1847, the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
adopted its first code of ethics
Ethical code
An ethical code is adopted by an organization in an attempt to assist those in the organization called upon to make a decision understand the difference between 'right' and 'wrong' and to apply this understanding to their decision...
, with this being based in large part upon Percival's work http://www.uab.edu/reynolds/MajMedFigs/Percival.htm. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher
Joseph Fletcher
Joseph Fletcher was an American professor who founded the theory of situational ethics in the 1960s, and was a pioneer in the field of bioethics. Fletcher was a leading academic involved in the topics of abortion, infanticide, euthanasia, eugenics, and cloning. Ordained as an Episcopal priest, he...
. In the 1960s and 1970s, building upon liberal theory and procedural justice
Procedural justice
Procedural justice refers to the idea of fairness in the processes that resolve disputes and allocate resources. One aspect of procedural justice is related to discussions of the administration of justice and legal proceedings...
, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics
Bioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
.
As a result of the Nuremberg Trials
Nuremberg Trials
The Nuremberg Trials were a series of military tribunals, held by the victorious Allied forces of World War II, most notable for the prosecution of prominent members of the political, military, and economic leadership of the defeated Nazi Germany....
, the Belmont Report
Belmont Report
The Belmont Report is a report created by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Its full title is the Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, Report of the National Commission...
was entered into law in the United States. This lead to the creation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.
Since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Board
Institutional review board
An institutional review board , also known as an independent ethics committee or ethical review board , is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans with the aim to protect the rights and welfare of the...
s to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula.
Values in medical ethics
Six of the values that commonly apply to medical ethics discussions are:- Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
- Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
- Non-maleficencePrimum non nocereis a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as .Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical...
- "first, do no harm" (primum non nocere). - JusticeJusticeJustice is a concept of moral rightness based on ethics, rationality, law, natural law, religion, or equity, along with the punishment of the breach of said ethics; justice is the act of being just and/or fair.-Concept of justice:...
- concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). - DignityDignityDignity is a term used in moral, ethical, and political discussions to signify that a being has an innate right to respect and ethical treatment. It is an extension of the Enlightenment-era concepts of inherent, inalienable rights...
- the patient (and the person treating the patient) have the right to be treated with dignity. - TruthTruthTruth has a variety of meanings, such as the state of being in accord with fact or reality. It can also mean having fidelity to an original or to a standard or ideal. In a common usage, it also means constancy or sincerity in action or character...
fulness and honestyHonestyHonesty refers to a facet of moral character and denotes positive, virtuous attributes such as integrity, truthfulness, and straightforwardness along with the absence of lying, cheating, or theft....
- the concept of informed consentInformed consentInformed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
has increased in importance since the historical events of the Doctors' TrialDoctors' TrialThe Doctors' Trial was the first of 12 trials for war crimes that the United States authorities held in their occupation zone in Nuremberg, Germany after the end of World War II. These trials were held before U.S...
of the Nuremberg trials and Tuskegee Syphilis StudyTuskegee Syphilis StudyThe Tuskegee syphilis experiment was an infamous clinical study conducted between 1932 and 1972 in Tuskegee, Alabama by the U.S. Public Health Service to study the natural progression of untreated syphilis in poor, rural black men who thought they were receiving free health care from the U.S...
.
Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts.
When moral values are in conflict, the result may be an ethical dilemma
Dilemma
A dilemma |proposition]]") is a problem offering two possibilities, neither of which is practically acceptable. One in this position has been traditionally described as "being on the horns of a dilemma", neither horn being comfortable...
or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. Some argue for example, that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving; and truth-telling was not emphasized to a large extent before the HIV era.
Autonomy
The principle of autonomy recognizes the rights of individuals to self-determination. This is rooted in society's respect for individuals' ability to make informed decisions about personal matters. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient rather than medical professionals. The increasing importance of autonomy can be seen as a social reaction to a "paternalisticPaternalism
Paternalism refers to attitudes or states of affairs that exemplify a traditional relationship between father and child. Two conditions of paternalism are usually identified: interference with liberty and a beneficent intention towards those whose liberty is interfered with...
" tradition within healthcare. Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism
Soft paternalism
Soft paternalism is a political philosophy that believes the state can...
to the detriment of outcomes for some patients. Respect for autonomy is the basis for informed consent and advance directives.
Autonomy is a general indicator of health. Many diseases are characterised by loss of autonomy, in various manners. This makes autonomy an indicator for both personal well-being, and for the well-being of the profession.
This has implications for the consideration of medical ethics: "is the aim of health care to do good, and benefit from it?"; or "is the aim of health care to do good to others, and have them, and society, benefit from this?". (Ethics - by definition - tries to find a beneficial balance between the activities of the individual and its effects on a collective.)
By considering autonomy as a gauge parameter for (self) health care, the medical and ethical perspective both benefit from the implied reference to health.
Psychiatrists and clinical psychologists are often asked to evaluate a patient's capacity for making life-and-death decisions at the end of life. Persons with a psychiatric condition such as delirium or clinical depression may not have the capacity to make end-of-life decisions. Therefore, for these persons, a request to refuse treatment may be taken in consideration of their condition and not followed. Unless there is a clear advance directive to the contrary, persons who lack mental capacity are generally treated according to their best interests. On the other hand, persons who have the mental capacity to make end-of-life decisions have the right to refuse treatment and choose an early death if that is what they truly want. In such cases, psychiatrists and psychologists are typically part of protecting that right.
Beneficence
The term beneficence refers to actions that promote the well being of others. In the medical context, this means taking actions that serve the best interests of patients. However, uncertainty surrounds the precise definition of which practices do in fact help patients.James Childress
James Childress
James Franklin Childress is a philosopher and theologian mainly concerned with ethics, particularly biomedical ethics. Currently he is the John Allen Hollingsworth Professor of Ethics at the Department of Religious Studies at the University of Virginia. He is also Professor of Medical Education at...
and Tom Beauchamp
Tom Beauchamp
Tom L. Beauchamp is an American philosopher and bioethicist. He currently serves as Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics at Georgetown University. He earned his B.A. from Southern Methodist University in 1963, a B.D. from Yale Divinity School, and...
in Principle of Biomedical Ethics (1978) identify beneficence as one of the core values of health care ethics. Some scholars, such as Edmund Pellegrino
Edmund D. Pellegrino
Edmund Daniel Pellegrino was the 11th president of The Catholic University of America and the second layman to hold the position....
, argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be the sole purpose of medicine, and that endeavors like cosmetic surgery, contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...
and euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
fall beyond its purview.
Non-Maleficence
The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin, primum non nocerePrimum non nocere
is a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as .Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical...
. Many consider that should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than to do them good. This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no (or only acceptable levels of) harm. Much harm has been done to patients as a result, as in the saying, "The treatment was a success, but the patient died." It is not only more important to do no harm than to do good; it is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not prescribing medications they know to be harmful - he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh the likely risks.
In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and balances against the principle of beneficence (doing good), as the effects of the two principles together often give rise to a double effect (further described in next section).
Depending on the cultural consensus conditioning (expressed by its religious, political and legal social system) the legal definition of non-maleficence differs. Violation of non-maleficence is the subject of medical malpractice
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...
litigation. Regulations therefore differ over time, per nation.
Double effect
Double effect refers to two types of consequences which may be produced by a single action, and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence.A commonly cited example of this phenomenon is the use of morphine or other analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient, while simultaneously having the maleficent effect of hastening the death of the patient through suppression of the respiratory system.
Conflicts between autonomy and beneficence/non-maleficence
Autonomy can come into conflict with beneficence when patients disagree with recommendations that health care professionals believe are in the patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. Western medicine generally defers to the wishes of a mentally competent patient to make his own decisions, even in cases where the medical team believes that he is not acting in his own best interests. However, many other societies prioritize beneficence over autonomy.Examples include when a patient does not want a treatment because of, for example, religious or cultural views. In the case of euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
, the patient, or relatives of a patient, may want to end the life of the patient. Also, the patient may want an unnecessary treatment, as can be the case in hypochondria
Hypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
or with cosmetic surgery; here, the practitioner may be required to balance the desires of the patient for medically unnecessary potential risks against the patient's informed autonomy in the issue. A doctor may want to prefer autonomy because refusal to please the patient's will would harm the doctor-patient relationship
Doctor-patient relationship
The doctor-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics...
.
Individuals' capacity for informed decision making may come into question during resolution of conflicts between autonomy and beneficence. The role of surrogate medical decision makers is an extension of the principle of autonomy.
On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a breach of patients' autonomy may cause decreased confidence for medical services in the population and subsequently less willingness to seek help, which in turn may cause inability to perform beneficence. Beneficence is a task worthy of many to complete due to its difficulty to perform under extreme circumstances that are not correlated directly with individuals seeking euthanasia.
The principles of autonomy and beneficence/non-maleficence may also be expanded to include effects on the relatives of patients or even the medical practitioners, the overall population and economic issues when making medical decisions.
Euthanasia
Some American physicians interpret the non-maleficence principle to exclude the practice of euthanasiaEuthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
, though not all concur. Probably the most extreme example in recent history of the violation of the non-maleficence dictum was Dr. Jack Kevorkian
Jack Kevorkian
Jacob "Jack" Kevorkian , commonly known as "Dr. Death", was an American pathologist, euthanasia activist, painter, composer and instrumentalist. He is best known for publicly championing a terminal patient's right to die via physician-assisted suicide; he said he assisted at least 130 patients to...
, who was convicted of second-degree homicide in Michigan in 1998 after demonstrating active euthanasia on the TV news show 60 Minutes.
In some countries, euthanasia is accepted as standard medical practice. Legal regulations assign this to the medical profession. In such nations, the aim is to alleviate the suffering of patients from diseases known to be incurable by the methods known in that culture. In that sense, the "Primum no Nocere" is based on the realisation that the inability of the medical expert to offer help, creates a known great and ongoing suffering in the patient.
"Not acting" in those cases is believed to be more damaging than actively relieving the suffering of the patient. Evidently the ability to offer help depends on the limitation of what the practitioner can do. These limitations are characteristic for each different form of healing, and the legal system of the specific culture.
The aim to "not do harm" is still the same. It gives the medical practitioner a responsibility to help the patient, in the intentional and active relief of suffering, in those cases where no cure can be offered.
Informed consent
Informed consent in ethics usually refers to the idea that a person must be fully informed about and understand the potential benefits and risks of their choice of treatment. An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes. It does not specifically mean the process of obtaining consent, nor the specific legal requirements, which vary from place to place, for capacity to consent. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. If the patient is incapacitated, laws around the world designate different processes for obtaining informed consent, typically by having a person appointed by the patient or their next of kinNext of kin
Next of kin is a term with many interpretations depending on the jurisdiction being referred to. In some jurisdictions, such as the United States, it is used to describe a person's closest living blood relative or relatives...
make decisions for them. The value of informed consent is closely related to the values of autonomy
Autonomy
Autonomy is a concept found in moral, political and bioethical philosophy. Within these contexts, it is the capacity of a rational individual to make an informed, un-coerced decision...
and truth telling.
A correlate to "informed consent" is the concept of informed refusal
Informed refusal
Informed refusal is a medico-legal concept whereby a person can be said to have given refusal to an intervention based upon an understanding of the facts and of the implications of not following a recommended diagnostic or therapeutic action...
.
Confidentiality
Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege.Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.
Confidentiality is mandated in America
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
by HIPAA laws, specifically the Privacy Rule, and various state laws, some more rigorous than HIPAA. However, numerous exceptions to the rules have been carved out over the years. For example, many states require physicians to report gunshot wounds to the police and impaired drivers to the Department of Motor Vehicles. Confidentiality is also challenged in cases involving the diagnosis of a sexually transmitted disease in a patient who refuses to reveal the diagnosis to a spouse, and in the termination of a pregnancy in an underage patient, without the knowledge of the patient's parents. Many states in the U.S. have laws governing parental notification in underage abortion.
Traditionally, medical ethics has viewed the duty of confidentiality as a relatively non-negotiable tenet of medical practice. More recently, critics like Jacob Appel have argued for a more nuanced approach to the duty that acknowledges the need for flexibility in many cases.
Criticisms of orthodox medical ethics
It has been argued that mainstream medical ethics is biased by the assumption of a framework in which individuals are not simply free to contract with one another to provide whatever medical treatment is demanded, subject to the ability to pay. Because a high proportion of medical care is typically provided via the welfare state, and because there are legal restrictions on what treatment may be provided and by whom, an automatic divergence may exist between the wishes of patients and the preferences of medical practitioners and other parties. Tassano has questioned the idea that Beneficence might in some cases have priority over Autonomy. He argues that violations of Autonomy more often reflect the interests of the state or of the supplier group than those of the patient.Routine regulatory professional bodies or the courts of law are valid social recourses.
Importance of communication
Many so-called "ethical conflicts" in medical ethics are traceable back to a lack of communicationCommunication
Communication is the activity of conveying meaningful information. Communication requires a sender, a message, and an intended recipient, although the receiver need not be present or aware of the sender's intent to communicate at the time of communication; thus communication can occur across vast...
. Communication breakdowns between patients and their healthcare team, between family members, or between members of the medical community, can all lead to disagreements and strong feelings. These breakdowns should be remedied, and many apparently insurmountable "ethics" problems can be solved with open lines of communication.
Control and resolution
To ensure that appropriate ethical values are being applied within hospitals, effective hospital accreditationHospital accreditation
Hospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
requires that ethical considerations are taken into account, for example with respect to physician integrity, conflicts of interest, research ethics and organ transplantation ethics.
Guidelines
There are various ethical guidelines. For example, the Declaration of HelsinkiDeclaration of Helsinki
The Declaration of Helsinki is a set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association . It is widely regarded as the cornerstone document of human research ethics...
is regarded as authoritative in human research ethics.
In the United Kingdom, General Medical Council
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
provides clear overall modern guidance in the form of its 'Good Medical Practice' statement. Other organisations, such as the Medical Protection Society
Medical Protection Society
The Medical Protection Society is a not for profit organisation which offers legal and ethical help to medical and dental professionals...
and a number of university departments, are often consulted by British doctors regarding issues relating to ethics.
Ethics committees
Often, simple communication is not enough to resolve a conflict, and a hospital ethics committee must convene to decide a complex matter.These bodies are composed primarily of health care professionals, but may also include philosophers, lay people, and clergy
Clergy
Clergy is the generic term used to describe the formal religious leadership within a given religion. A clergyman, churchman or cleric is a member of the clergy, especially one who is a priest, preacher, pastor, or other religious professional....
- indeed, in many parts of the world their presence is considered mandatory in order to provide balance.
With respect to the expected composition of such bodies in the USA, Europe and Australia, the following applies http://www.chrcrm.org/main/modules/pageworks/index.php?page=015&id=231.
U.S. recommendations suggest that Research and Ethical Boards (REBs) should have five or more members, including at least one scientist, one non-scientist and one person not affiliated with the institution. The REB should include people knowledgeable in the law and standards of practice and professional conduct. Special memberships are advocated for handicapped or disabled concerns, if required by the protocol under review.
The European Forum for Good Clinical Practice (EFGCP) suggests that REBs include two practicing physicians who share experience in biomedical research and are independent from the institution where the research is conducted; one lay person; one lawyer; and one paramedical professional, e.g. nurse or pharmacist. They recommend that a quorum include both sexes from a wide age range and reflect the cultural make-up of the local community.
The 1996 Australian Health Ethics Committee recommendations were entitled, "Membership Generally of Institutional Ethics Committees". They suggest a chairperson be preferably someone not employed or otherwise connected with the institution. Members should include a person with knowledge and experience in professional care, counselling or treatment of humans; a minister of religion or equivalent, e.g. Aboriginal elder; a layman; a laywoman; a lawyer and, in the case of a hospital-based ethics committee, a nurse.
The assignment of philosophers or religious clerics will reflect the importance attached by the society
Society
A society, or a human society, is a group of people related to each other through persistent relations, or a large social grouping sharing the same geographical or virtual territory, subject to the same political authority and dominant cultural expectations...
to the basic values involved. An example from Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
with Torbjörn Tännsjö
Torbjörn Tännsjö
Torbjörn Tännsjö is a Swedish professor of philosophy. He has held a chair in Practical Philosophy at Stockholm University since 2002 and he is Affiliated Professor of Medical Ethics at Karolinska Institute...
on a couple of such committees indicates secular trends gaining influence.
Medical ethics in an online world
Increasingly, medical researchers are researching activities in online environments such as discussion boards and bulletin boards, and there is concern that the requirements of informed consent and privacy are not as stringently applied as they should be, although some guidelines do exist.One issue that has arisen, however, is the disclosure of information. While researchers wish to quote from the original source in order to argue a point, this can have repercussions. The quotations and other information about the site can be used to identify the site, and researchers have reported cases where members of the site, bloggers and others have used this information as 'clues' in a game in an attempt to identify the site. Some researchers have employed various methods of "heavy disguise," including discussing a different condition from that under study, or even setting up bogus sites (called 'Maryut sites') to ensure that the researched site is not discovered.
Cultural concerns
Culture differences can create difficult medical ethics problems. Some cultures have spiritual or magical theories about the origins of disease, for example, and reconciling these beliefs with the tenets of Western medicine can be difficult.Truth-telling
Some cultures do not place a great emphasis on informing the patient of the diagnosis, especially when cancer is the diagnosis. American culture rarely used truth-telling especially in medical cases, up until the 1970s. In American medicine, the principle of informed consentInformed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
now takes precedence over other ethical values, and patients are usually at least asked whether they want to know the diagnosis.
Online business practices
The delivery of diagnosis online leads patients to believe that doctors in some parts of the country are at the direct service of drug companies. Finding diagnosis as convenient as what drug still has patent rights on it. Physicians and drug companies are found to be competing for top ten search engine ranks to lower costs of selling these drugs with little to no patient involvement.Conflicts of interest
Physicians should not allow a conflict of interest to influence medical judgment. In some cases, conflicts are hard to avoid, and doctors have a responsibility to avoid entering such situations. Unfortunately, research has shown that conflicts of interests are very common among both academic physicians and physicians in practice. The The Pew Charitable Trusts has announced the Prescription Project for "academic medical centers, professional medical societies and public and private payers to end conflicts of interest resulting from the $12 billion spent annually on pharmaceutical marketing".Referral
For example, doctors who receive income from referring patients for medical tests have been shown to refer more patients for medical tests. This practice is proscribed by the American College of Physicians Ethics Manual.Fee splitting
Fee splitting
Fee splitting is the practice of sharing fees with professional colleagues, such as physicians or lawyers, in return for being sent referrals .-Fee splitting in medicine and healthcare:...
and the payments of commissions to attract referrals of patients is considered unethical and unacceptable in most parts of the world.
Vendor relationships
Studies show that doctors can be influenced by drug company inducements, including gifts and food. Industry-sponsored Continuing Medical EducationContinuing medical education
Continuing medical education refers to a specific form of continuing education that helps those in the medical field maintain competence and learn about new and developing areas of their field. These activities may take place as live events, written publications, online programs, audio, video, or...
(CME) programs influence prescribing patterns. Many patients surveyed in one study agreed that physician gifts from drug companies influence prescribing practices. A growing movement among physicians is attempting to diminish the influence of pharmaceutical industry marketing upon medical practice, as evidenced by Stanford University's ban on drug company-sponsored lunches and gifts. Other academic institutions that have banned pharmaceutical industry-sponsored gifts and food include the Johns Hopkins Medical Institutions, University of Michigan, University of Pennsylvania, and Yale University.
Treatment of family members
Many doctors treat their family members. Doctors who do so must be vigilant not to create conflicts of interest or treat inappropriately.Sexual relationships
Sexual relationships between doctors and patients can create ethical conflicts, since sexual consent may conflict with the fiduciary responsibility of the physician. Doctors who enter into sexual relationships with patients face the threats of deregistration and prosecution. In the early 1990s, it was estimated that 2-9% of doctors had violated this rule. Sexual relationships between physicians and patients' relatives may also be prohibited in some jurisdictions, although this prohibition is highly controversial.Futility
The concept of medical futility has been an important topic in discussions of medical ethics. What should be done if there is no chance that a patient will survive but the family members insist on advanced care? Previously, some articles defined futility as the patient having less than a one percent chance of surviving. Some of these cases wind up in the courts.Advanced directives include living wills and durable powers of attorney
Power of attorney
A power of attorney or letter of attorney is a written authorization to represent or act on another's behalf in private affairs, business, or some other legal matter...
for health care. (See also Do Not Resuscitate
Do not resuscitate
In medicine, a "do not resuscitate" or "DNR" is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support if their heart were to stop or they were to stop breathing...
and cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
) In many cases, the "expressed wishes" of the patient are documented in these directives, and this provides a framework to guide family members and health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
professionals in the decision making process when the patient is incapacitated. Undocumented expressed wishes can also help guide decisions in the absence of advanced directives, as in the Quinlan case in Missouri.
"Substituted judgment" is the concept that a family member can give consent for treatment if the patient is unable (or unwilling) to give consent themselves. The key question for the decision making surrogate is not, "What would you like to do?", but instead, "What do you think the patient would want in this situation?".
Courts have supported family's arbitrary definitions of futility to include simple biological survival, as in the Baby K
Baby K
Baby K was an anencephalic baby who became the center of a major U.S. court case and a debate among bioethicists.-Prenatal assessment:...
case (in which the courts ordered a child born with only a brain stem instead of a complete brain to be kept on a ventilator based on the religious belief that all life must be preserved).
In some hospitals, medical futility is referred to as "non-beneficial care."
Baby Doe Law
Baby Doe Law
The Baby Doe Law or Baby Doe Amendment is the name of an amendment to the Child Abuse Law passed in 1984 in the United States that sets forth specific criteria and guidelines for the treatment of seriously ill and/or disabled newborns. The law is controversial in that it dictates what must be done...
establishes state protection for a disabled child's right to life, ensuring that this right is protected even over the wishes of parents or guardians in cases where they want to withhold treatment.
Further reading
- The Journal of Law, Medicine & Ethics, ISSN: 1748-720X (electronic) 1073-1105 (paper), Blackwell Publishing
- Linacre QuarterlyLinacre QuarterlyLinacre Quarterly is an academic journal published by the Catholic Medical Association that was established in 1932. The journal primarily focuses on the relationship between medicine and spirituality and in particular on medical ethics...
- A History and Theory of Informed Consent by Ruth FadenRuth FadenRuth R. Faden, M.P.H., Ph.D., is the Philip Franklin Wagley Professor of Biomedical Ethics and Executive Director of The Johns Hopkins Berman Institute of Bioethics at Johns Hopkins University. She is also a Senior Research Scholar at the Kennedy Institute of Ethics, Georgetown University.She has...
- Core Content Of Learning by The Institute Of Medical Ethics
See also
- BioethicsBioethicsBioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
- Clinical governanceClinical governanceClinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care within a health system. The term became widely used in health care following the Bristol heart scandal in 1995, during which anaesthetist Dr Stephen Bolsin exposed the...
- The CitadelThe Citadel (novel)The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking with its treatment of the contentious theme of medical ethics. It is credited with laying the foundation in Great Britain for the introduction of the NHS a decade later...
- EmpathyEmpathyEmpathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...
- EuthanasiaEuthanasiaEuthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
- Evidence-based medical ethicsEvidence-based medical ethicsEvidence-based medical ethics is a form of medical ethics that uses knowledge from ethical principles, legal precedent, and evidence-based medicine to draw solutions to ethical dilemmas in the health care field. Sometimes this is also referred to as argument-based medical ethics. It is also the...
- Resources for clinical ethics consultationResources for clinical ethics consultationClinical ethics support services initially developed in the United States of America, following court cases such as the Karen Quinlan case, which stressed the need for mechanisms to resolve ethical disputes within health care...
- Fee splittingFee splittingFee splitting is the practice of sharing fees with professional colleagues, such as physicians or lawyers, in return for being sent referrals .-Fee splitting in medicine and healthcare:...
- Hastings CenterHastings CenterThe Hastings Center, founded in 1969, is an independent, non-partisan, non-profit bioethics research institute based in the United States. It is dedicated to the examination of essential questions in health care, biotechnology, and the environment...
- Health careHealth careHealth care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
- Health ethics
- Human experimentation in the United StatesHuman experimentation in the United StatesThere have been numerous experiments performed on human test subjects in the United States that have been considered unethical, and were often performed illegally, without the knowledge, consent, or informed consent of the test subjects....
- Human radiation experimentsHuman radiation experimentsSince the discovery of ionizing radiation, a number of human radiation experiments have been performed to understand the effects of ionizing radiation and radioactive contamination on the human body, specifically with the element plutonium....
- Jewish medical ethicsJewish medical ethicsJewish medical ethics is a modern scholarly and clinical approach to medical ethics that draws upon Jewish thought and teachings. Pioneered by Rabbi Immanuel Jakobovits in the 1950s, Jewish medical ethics centers mainly around an applied ethics drawing upon traditional rabbinic law...
- Joint Commission International, JCIJCIJCI is a three-letter abbreviation with multiple meanings, as described below:* JCI, Jakarta Composite Index of Indonesia Stock Exchange* JCI Limited or Johannesburg Consolidated Investment Company Limited - One of the oldest listed companies on the JSE Securities Exchange having been formed in 1889...
- Military medical ethicsMilitary medical ethicsMilitary medical ethics is a specialized branch of medical ethics with implications for military ethics. Both are primarily fields of applied ethics, the study of moral values and judgments as they apply to the specific contexts of medicine and military affairs, respectively...
- Nazi human experimentationNazi human experimentationNazi human experimentation was a series of medical experiments on large numbers of prisoners by the Nazi German regime in its concentration camps mainly in the early 1940s, during World War II and the Holocaust. Prisoners were coerced into participating: they did not willingly volunteer and there...
- Medical tortureMedical tortureMedical torture describes the involvement and sometimes active participation of medical professionals in acts of torture, either to judge what victims can endure, to apply treatments which will enhance torture, or as torturers in their own right...
- Philosophy of HealthcarePhilosophy of healthcareThe philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component...
- Nursing ethicsNursing ethicsNursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy...
- Hippocratic OathHippocratic OathThe Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
- Project MKULTRAProject MKULTRAProject MKULTRA, or MK-ULTRA, was the code name for a covert, illegal CIA human experimentation program, run by the CIA's Office of Scientific Intelligence. This official U.S. government program began in the early 1950s, continued at least through the late 1960s, and used U.S...
- Asher's Seven Sins of MedicineSeven Sins of MedicineThe Seven Sins of Medicine, by Richard Asher, are a perspective on medical ethics first published in The Lancet in 1949.Considered as poor personal conduct by doctors The Seven Sins describes behavior that in itself might not be grounds for professional complaint or discipline but would be...
- Medical Code of EthicsMedical Code of EthicsMedical Code of Ethics - in Poland the document, establishing the ethical rules of behaviour of physicians and dental practitioners, defining the priorities of their professional work, showing the principles in the relations with patients, other physicians and the rest of community.The greatest...
- Medical lawMedical lawMedical law is the branch of law which concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law....
- Medical Law InternationalMedical Law InternationalMedical Law International is an academic legal periodical . It was published by A B Academic Publishers from 1993 to 2011. It is peer reviewed, and deals with the legal and ethical aspects of medicine throughout the world, with a strong emphasis on international and comparative trends in law and...
- UN Principles of Medical EthicsUN Principles of Medical EthicsThe UN Principles of Medical Ethics is a code of medical ethics relating to the "roles of health personnel in the protection of persons against torture and other cruel, inhuman or degrading treatment or punishment.", adopted by the United Nations on 18 December 1982 at the 111th plenary meeting of...
- World Medical AssociationWorld Medical AssociationThe World Medical Association is an international and independent confederation of free professional Medical Associations, therefore representing physicians worldwide...
Reproductive medicine
- AbortionAbortionAbortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
/Abortion debateAbortion debateThe abortion debate refers to discussion and controversy surrounding the moral and legal status of abortion. The two main groups involved in the abortion debate are the self-described "pro-choice" movement and the "pro-life" movement... - CircumcisionCircumcisionMale circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
/Bioethics of neonatal circumcisionBioethics of neonatal circumcisionMale circumcision involves the excision of genital tissue from the human body, so the ethics of circumcision are sometimes controversial.Some studies indicate that the foreskin and frenulum perform certain physiological functions among the men tested, which would be destroyed by excision... - Human cloningHuman cloningHuman cloning is the creation of a genetically identical copy of a human. It does not usually refer to monozygotic multiple births nor the reproduction of human cells or tissue. The ethics of cloning is an extremely controversial issue...
- Gene splicing
- Human genetic engineeringHuman genetic engineeringHuman genetic engineering is the alteration of an individual's genotype with the aim of choosing the phenotype of a newborn or changing the existing phenotype of a child or adult....
- EugenicsEugenicsEugenics is the "applied science or the bio-social movement which advocates the use of practices aimed at improving the genetic composition of a population", usually referring to human populations. The origins of the concept of eugenics began with certain interpretations of Mendelian inheritance,...
Medical research
- Animal researchAnimal testingAnimal testing, also known as animal experimentation, animal research, and in vivo testing, is the use of non-human animals in experiments. Worldwide it is estimated that the number of vertebrate animals—from zebrafish to non-human primates—ranges from the tens of millions to more than 100 million...
- CIOMS Guidelines
- Declaration of GenevaDeclaration of GenevaThe Declaration of Geneva was adopted by the General Assembly of the World Medical Association at Geneva in 1948 and amended in 1968, 1984, 1994, 2005 and 2006. It is a declaration of physicians' dedication to the humanitarian goals of medicine, a declaration that was especially important in view...
- Declaration of HelsinkiDeclaration of HelsinkiThe Declaration of Helsinki is a set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association . It is widely regarded as the cornerstone document of human research ethics...
- Declaration of TokyoDeclaration of TokyoThe Declaration of Tokyo is a set of international guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment, which was adopted in October 1975 during the 29th General assembly of the World Medical...
- Ethical problems using children in clinical trialsEthical problems using children in clinical trialsIn health care, a clinical trial is a comparison test of a medication or other medical treatment , versus a placebo , other medications or devices, or the standard medical treatment for a patient's condition....
- First-in-man studyFirst-in-man studyA first-in-man study is a clinical trial where a medical procedure, previously developed and assessed through in vitro or animal testing, or through mathematical modelling is tested on human subjects for the first time....
- Good clinical practiceGood clinical practiceGood Clinical Practice is an international quality standard that is provided by International Conference on Harmonisation , an international body that defines standards, which governments can transpose into regulations for clinical trials involving human subjects.Good Clinical Practice guidelines...
- Health Insurance Portability and Accountability ActHealth Insurance Portability and Accountability ActThe Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
- Institutional Review BoardInstitutional review boardAn institutional review board , also known as an independent ethics committee or ethical review board , is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans with the aim to protect the rights and welfare of the...
- Nuremberg CodeNuremberg CodeThe Nuremberg Code is a set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War.-Background:...
- Clinical EquipoiseClinical equipoiseClinical equipoise, also known as the principle of equipoise, provides the ethical basis for medical research involving patients assigned to different treatment arms of a clinical trial...
- Patients' Bill of Rights
- Universal Declaration of Human RightsUniversal Declaration of Human RightsThe Universal Declaration of Human Rights is a declaration adopted by the United Nations General Assembly . The Declaration arose directly from the experience of the Second World War and represents the first global expression of rights to which all human beings are inherently entitled...
Sources and references
- Beauchamp, Tom L., and Childress, James F. 2001. Principles of Biomedical Ethics. New York: Oxford University Press.
- Bioethics introduction
- Brody, BaruchBaruch BrodyBaruch Brody is an American bioethicist who was among the first scholars in the field of applied ethics to write about abortion in the era following Roe v. Wade...
A. 1988. Life and Death Decision Making. New York: Oxford University Press. - Curran, CharlesCharles Curran (theologian)The Rev. Charles E. Curran is a moral theologian. He currently serves at Southern Methodist University in Dallas, Texas, as the Elizabeth Scurlock University Professor of Human Values.-Biography:...
E. "The Catholic Moral Tradition in Bioethics" in Walter and Klein (below). - Fletcher, JosephJoseph FletcherJoseph Fletcher was an American professor who founded the theory of situational ethics in the 1960s, and was a pioneer in the field of bioethics. Fletcher was a leading academic involved in the topics of abortion, infanticide, euthanasia, eugenics, and cloning. Ordained as an Episcopal priest, he...
F. 1954. Morals and Medicine: The Moral Problems of: The Patient's Right to Know the Truth, Contraception, Artificial Insemination, Sterilization, Euthanasia. Boston: Beacon. - The Hastings Center's Bibliography of Ethics, Biomedicine, and Professional Responsibility.
- Kelly, David. The Emergence of Roman Catholic Medical Ethics in North America. New York: The Edwin Mellen Press, 1979. See especially chapter 1, "Historical background to the discipline."
- Sherwin, Susan. 1992. No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press.
- Veatch, Robert M. 1988. A Theory of Medical Ethics. New York: Basic Books.
- Walter, Jennifer and Eran P. Klein eds. The Story of Bioethics: From seminal works to contemporary explorations Georgetown University Press, 2003
External links
- The Hastings Center, an independent, nonpartisan, and nonprofit bioethics research institute founded in 1969
- Ethical Decision-Making at the End of Life - video and summary of event held at the Woodrow Wilson International Center for Scholars, March 2008
- German Reference Centre for Ethics in the Life Sciences (DRZE)
- BEKIS- the Bioethics Communication and Information System
- Thesaurus Ethics in the Life Sciences
- BMJJournals.com - An international peer review journal for health professionals and researchers in medical ethics
- Johns Hopkins Berman Institute of Bioethics
- International Association of Bioethics
- WHO Global bioethics calendar
- The Dark History of Medical Experimentation from the Nazis to Tuskegee to Puerto Rico - video report by Democracy Now!Democracy Now!Democracy Now! and its staff have received several journalism awards, including the Gracie Award from American Women in Radio & Television; the George Polk Award for its 1998 radio documentary Drilling and Killing: Chevron and Nigeria's Oil Dictatorship, on the Chevron Corporation and the deaths of...
- American National Reference Center for Bioethics Literature
- Bioethics for Latin America and Colombia
- EURETHICS (European database on ethics in medicine) and ENDEBIT (European database on ethics in non-medical technologies)
- German Reference Centre for Ethics in the Life Sciences (DRZE)
- BELIT: an extensive world-wide bibliographic directory of literature in the area of bioethics, containing references to monographs, grey literature, legal documents, journal articles, newspaper articles and book contributions
- BioEthicWorld: A bioethics information site
- Medical Ethics - OpenCourseWare from the University of Notre Dame featuring audio lectures and other resources.
- BEKIS The Bioethics Communication and Information System
- Nutritional Genomics (NuGO) Bioethics Online Tool
- http://www.bioethics.upenn.edu/
- Universal Declaration on the Human Genome and Human Rights
- International Declaration on Human Genetic Data
- Universal Declaration on Bioethics and Human Rights
- The Bio-Medical Ethics Reference Server at Stanford University
- UNESCO Bioethics Section
- Moral Matters in Medicine
- Medical Ethics from the Encyclopedia of Jewish Medical Ethics by Prof. Avraham Steinberg]
- The Clinic for Boundaries Studies, a UK service providing education on ethics and professional boundary violations