History Of Medical Ethics

THE ORIGINS OF MEDICAL ETHICS

Medical ethics traces its roots back as far as ancient Greece, but the field gained particular prominence in the late 20th century. Many of the current issues in medical ethics are the product of advances in scientific knowledge and biomedical technology. These advances have presented humanity not only with great progress in treating and preventing disease but also with new questions and uncertainties about the basic nature of life and death. As people have grappled with issues on the frontier of medical science and research, medical ethics has grown into a separate profession and field of study. Professional medical ethicists bring expertise from fields such as philosophy, social sciences, medicine, research science,

Echoing the Hippocratic Oath, the CarakaSamhita, a Sanskrit text written in India roughly 2,000 years ago, urges the following commandment to physicians, “Day and night, however you may be engaged, you shall strive for the relief of the patient with all your heart and soul. You shall not desert the patient even for the sake of your life or living.” Similar sentiments can be found in the Chinese text Nei Jing (The Yellow Emperor's Classic of Inner Medicine), dating from the 2nd century BC. This work stressed the connection between virtue and health. Three centuries later, the work of the Chinese physician Sun Simiao emphasized compassion and humility, “...a Great Physician should not pay attention to status, wealth, or age.... He should meet everyone on equal ground....”

In Europe during the Middle Ages, the ethical standards of physicians were put to the test by the bubonic plague, the highly contagious Black Death that arrived around the mid-1300s and remained a threat for centuries. When plague broke out, physicians had a choice: They could stay and treat the sick—risking death in the process—or flee. The bubonic plague and other epidemics provide an early example of the challenges that still exist today when doctors must decide whether they are willing to face personal risks when caring for their

Complicating the problem was the existence of a variety of faith healers and other unconventional practitioners who flourished in an almost entirely unregulated medical marketplace. In part to remedy this situation, physicians convened in 1847 to form a national association devoted to the improvement of standards in medical education and practice. The American Medical Association (AMA) issued its own code of ethics, stating, “A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity. A physician shall recognize a responsibility to participate in activities contributing to an improved community.” This text was largely modeled on the British code written by Percival, but it added the idea of mutually shared responsibilities and obligations among doctor, patient, and society. Since its creation, the AMA Code has been updated as challenging ethical issues have arisen in science and medicine. The code now consists of seven principles centered on compassionate service along with respect for patients, colleagues, and the law. The Canadian Medical Association (CMA), established in 1867, also developed a Code of Ethics as a guide for physicians. Today the CMA code provides over 40 guidelines about physician responsibilities to patients, society, and the medical