THE HISTORY OF MEDICAL ETHICS
Because of their special knowledge and the vulnerability of their patients, members of the medical profession have traditionally been regarded as particularly trustworthy and responsible by the public. From the profession, therefore, society expects high standards, not only of scientific education and clinical skill, but also of professional and humane conduct. In the earliest civilizations medical practitioners were paid or punished on their results. In Babylon, Hammurabi separated civil from priestly jurisdiction, and in his Code of Laws ( 1790 BC) regulated the fees of physicians who were at that time still priests, and not yet distinguished from surgeons. For successful treatment, physicians were paid in proportion to their patient’s status; but if an operation was fatal, the physician’s hands were cut off. There was a scale, however, and if the patient were a salve his replacement would suffice. These early laws were harsh but they demonstrate how, from the beginning, organized society has felt the need to regulate the rights and duties of physicians.
Regulation of professional standards, not by the state but by the profession itself, can be traced atleast as far as the Hippocratic Oath (4 Th Century BC). The oath was a covenant between the physician and his teacher which set out an ideal by which he promised to practice. Greek Philosophy provided intellectual foundations not only for medicines, but also for the church. At the beginning of the Christian Era, when medical opinion was hardening against suicide and abortion, and surgery was separated from medical practice, the Hippocratic Oath gained general acceptance. In medieval Christian Europe, the spirit of pre – Christian medical humanism, with its emphasis on human brotherhood still provided general guidelines for the conduct of physicians. Beside these flourished the equally ancient traditions of etiquette, medical manners, and professional deportment – factors which had always helped the physician to establish his patient’s confidence.
Modern medical ethics emerged towards the end of the 18 th century. Aspirations of the middle classes were undermining the Aristocratic order, and with it the tripartite establishment of physicians, surgeons, and apothecaries. New voluntary hospitals not only raised public expectations but also showed how far provision felt short of need, particularly during epidemics. One particular epidemic, in Manchester during 1789, created so much difficulty and friction among the hospital staff that a local physician, Thomas Percival was asked to draw up a scheme of professional conduct to avoid further trouble. His scheme was finally published in 1803 under the title medical ethics: or, Code of Institutes and Precepts adapted to the Professional Conduct of Physicians and Surgeons. It followed the same pattern of precept and example which its author had employed in the moral education of his own children.
In 1832, one of the objects of the newly-formed Provincial Medical Surgical Association, has outlined in its prospectus, was “the maintenance of the honor and respectability of the profession generally in the provinces, by promoting friendly intercourse and free communication of its members, and by establishing the harmony and good feeling which ought ever to characterize a liberal profession.” That association became the British Medical Association in 1856. The PMSA had appointed a Committee on Medical Ethics in 1849 and two years later following a report by its Committee on Quackery, a Committee was appointed to frame a code of ethical laws.
It was at the instigation of the BMA that the General Medical Council was established under the Medical Act 1858.
The principle of the Act is expressed in these words:”It is expedient that persons requiring medical aid should be able to distinguish qualified from unqualified practitioners.” It did not prohibit unqualified practice in medicine, but any person who falsely represented himself as a qualified medical practitioner could be fined Euros 20. The enforcement practitioner convicted of felony or misdemeanour could have his name erased from the Register .The same penalty was to be imposed on any practitioner who “shall, after due inquiry be judged by the General Council to be guilty of infamous conduct in any professional respect.”
In the 20 th century, wartime experiences have marked a certain loss of innocence and idealism, while scientific progress has created new moral dilemmas in medicine and intensified old ones. Contemporary medical ethics, while retaining some of the etiquette of an earlier era is faced with new an evermore complex problems to which the past offers no solution.
ISSUES IN BIO-MEDICAL ETHICS
Life! What is Life?
The Dictionaries and encyclopedias have many definitions. Some are simple and others complex but the most germane was simply: Being Alive.
We take life for granted. Most of us do not have a feel for it and not know what it is or means to ourselves or others. We only appreciate life when it is in danger and then we are prepared to do anything or just about anything to protect to protect life. At that stage we leave no stone unturned and, as we have learnt over the past few years, some persists in attempting to preserve life even when life does not exist. Prominent personalities often realize that they are indeed mortal only when they approach the end of their days.
Human life is universally held to be unique and of infinite value. Unfortunately, in recent times, dissenting opinions have been increasingly expressed. It is therefore incumbent upon those who considered life as a gift, to come together and speak of the joys of living; to sing the praises of those great ones who have done so much for the disabled , the destitute and the sick : and to declare to the world that we shall do our utmost to preserve , protect and promote life in our pluralistic world.
Abstract taken from Issues in Bio Medical Ethics Dr. CJ Vas Founder F.I.A.M.C Bio-Medical ethics Centre
Bioethics concerns itself with addressing ethical issues in healthcare, medicine, research, biotechnology, and the environment. Examples of topic areas that have been the focus of bioethics for a long time are organ donation and transplantation, genetic research, death and dying, and environmental concerns.
Tremendous advances have been made in the field of medicine and it is therefore important that we should be aware of the ethical dimensions of various issues from beginning of life to end of life.
Some of the ethical dilemmas that could arise in the Bio-Medical arena in the beginning of life issues: is abortion ,sex determination and sex pre-selection, Reproductive Health and Natural Conception, NFT, IVF wherein protecting and promoting life plays an important role. Concerns regarding Current Sexual Behaviours. Ethical issues in Human Organ Donation & transplantation, Mental Health diagnosis and Treatment . Ethical issues in acutely ill and Intensive Care Settings and issues arising in Surgical and Cancer Care. Ethical issues in handling deviant behaviours and End of Life Issues and Palliative Care.
F.I.A.M.C focusses on the aspect of Bio-Medical Ethics to preserve ,promote and protect life.
Principles of Bio-Medical Ethics
• Principle of respect for autonomy,
• Principle of nonmaleficence,
• Principle of beneficence, and.
• Principle of justice.