WHAT ARE ETHICS

2. WHAT ARE ETHICS The science of ideal human character. The study of principles relating to right and wrong conduct. Moral principles that govern a persons behavior or the conducting of an activity. Three major areas of study, Meta ethics Normative ethics Applied ethics Bioethics are particular application of applied ethics.

3. Basic principles of medical ethics…. • Respect for autonomy respect the patients ability to take decisions on behalf of themselves • Beneficence do good • Non-maleficence do no harm • Justice treat equitably and distribute benefits fairly

4. EVOLUTION OF MEDICAL ETHICS • The system of medical ethics has a long history that can be traced back to ancient times. • Each and every empire / Dynasty had their own ethical principles concerned with the field of medicine. PRE-HIPPOCRATIC ERA Buddhist philosophy- according to the teachings of lord Buddha one should always be caring and kind towards the sick and should not abhor them.

5. Egyptian civilization • 2700 BC • Rigid rules were laid down as to experimental treatment. • Severe penalties were, however, threatened for those who ignore the instructions. • In Mesopotamian and Egyptian society women healers practiced medicine. Babylonian civilization • The code of Hammurabi (1900 BCE) was followed and it is the first known legal code. • A system of payment based on results and the ability to pay on the status of the patient • If the physician succeeds, he gets paid. If he fails,at worst ,losses his hands

6. Hindu philosophy • Vaidya’s oath(oath of Hindu physicians) 15thBC • It includes, 1) You must put behind your desire, anger, greed, folly, pride, egotism, jealousy, harshness, falsehood, sloth and improper conduct. You should be with short-cut nails, ritually clean and clad in the orange garment, you must be pledged to truth, and full of reverence. 2) If, however, you behave perfectly, while I profess false views, I shall be guilty of sin and my knowledge shall bear me no fruit. 3) (after having finished your studies) with your medicaments you shall assist Brahmins, venerable persons, poor people, women, ascetics, pious people seeking your assistance, widows and orphans and any one you meet on your errands, as if they were your own relatives. This will be right conduct.

7. Chinese civilization • Ming dynasty in 14th BC Five commandants- • Physician should be ever ready to respond any calls of patients, high or low, rich or poor • Physicians may visit a lady in the presence of an attendant but not alone. • Physicians must not ask patients to sent pearl or amber. • Physicians should not leave the office for excursion.patients should be examined punctually and personally. • Prostitutes should be treated just like patients from a good family

8. Christianity • 0ath of Asaph –appears in the book of Asaph the Physician the oldest Hebrew medical book. • Similar to hippocratic oath HIPPOCRATIC ERA Greek civilization The famous Hippocratic oath (4th BCE) is even followed today and he is also considered the father of medicine. • Shift the focus from class-based medical care to selfless service of individual patients. • Introduced friendly sympathetic and painless treatments

9. MEDICAL ETHICS AND SECOND WORLD WAR

10. Experiments during second world war • A number of German physicians conducted painful and often deadly medical experiments on thousands of concentration camps prisoners without their consent. Those were totally unethical. eg: Freezing experiments High altitude experiments Head injury experiment Experiment with poison Incendiary bomb experiments Blood coagulation experiments

11. During war time section of bones,muscles and nerves were removed from prisoners without use of anesthesia.As a result of these operations ,many victims suffered intense agony ,mutilations and permanent disability.

12. Red cross society carried out extensive services for the sick and wounded prisoners.

13. Second world war was a time when huge advances were made in medicine… “You couldn’t help but have the feelings that the medical community was impotent at that point.” Doctors “were prone to try anything.” Elliot Valenstein,VA psychiatrist in the early 1950

14. Hippocratic Oath & Medical Ethics

15. I swear by Apollo The Healer, by Asclepius, by Hygieia, by Panacea, and by all the Gods and Goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.

17. Pledge to Pagan Deities “Apollo Physician and Asclepius and Hygieia and Panacea and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:” Honor Thy Teacher “To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, …” Professional Courtesy “and if he is in need of money to give him a share of mine, …” Guild Secrets “and to regard his offspring as equal to my brothers in male lineage and to teach them this art — if they desire to learn it — without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else. (emphasis mine)” “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; …”

18. Non-maleficence “I will keep them from harm and injustice.” Euthanasia “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” Abortion “Similarly I will not give to a woman an abortive remedy.” Fidelity to Principle “In purity and holiness I will guard my life and my art.” Protecting Guild Turf “I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.”

20. Sexual Relations with Patients “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.” “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.” Concluding Piety “If I fulfill this path and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.”

21. A solemn promise: • Of solidarity with teachers and other physicians. • Of beneficence (to do good or avoid evil) and non-maleficence (from the Latin 'primum non nocere', or 'do no harm') towards patients. • Not to assist suicide or abortion. • To leave surgery to surgeons. • Not to harm, especially not to seduce patients. • To maintain confidentiality and never to gossip.

24. Communication, partnership and teamwork • Communicate effectively. • Work collaboratively with colleagues to maintain or improve patient care. • Teaching, training, supporting and assessing. • Continuity and co-ordination of care. • Establish and maintain partnerships with patients: • Listen to and respond to their concerns and preferences. • Give patients the information they want or need in a way they can understand. • Respect patients' right to reach decisions with you about their treatment and care. • Support patients in caring for themselves to improve and maintain their health. • Maintaining trust • Show respect for patients. • Treat patients as individuals and respect their dignity. • Treat patients politely and considerately. • Respect patients' right to confidentiality. • Treat patients and colleagues fairly and without discrimination. • Act with honesty and integrity. • Never abuse your patients' trust in you or the public's trust in the profession.

25. Medical ethics today • The Hippocratic Oath was modernized in 1948 and was named the declaration of Geneva. It was further amended in Sydney in 1968 and Stockholm in 1994. • This provides the basis for The International Code of Medical Ethics(ICME). • The ICME describes medical ethics in terms of duties of physician in general, duties of physicians to patients and duties of physicians to colleagues.

26. New concepts • Bioethics • Deals with typically controversial ethical issues emerging from new situations arising due to advances in medicine. • A common framework used in the analysis of medicle ethics is the “four principles” by Tom Beauchamp and James childress in their text book “principles of biochemical ethics”

27. Respect for autonomy – the patient has the right to refuse or choose their treatment. Beneficence – a practitioner should act in the best interest of the patient. Non-maleficence – "first, do no harm" Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment .