This is the first in a series of articles about medical ethics. Medical ethics is a sub-category of bioethics, which also includes animal ethics and environmental ethics, according to the Internet Encyclopedia of Philosophy.
Although the academic inter-disciplinary field of medical ethics is relatively new, coming into existence in the late 20th century, the concept is not. The Hippocratic Oath in 500 B.C.E. and possibly even the Code of Hammurabi in 1750 B.C.E. provide descriptions of ethics in medical practice.
The Hippocratic Oath marked the onset of Western style ethical reasoning and medical decision-making. It lays out some of the concepts still employed today at the foundation of our ethical constructs: non-maleficence (do no harm) and beneficence (done for the benefit of others). You can read more about these terms here and here. These ancient ethical documents described generally “what should be done” for patients’ best interest. Modern day medical ethics has included the concept of “autonomy” of the patient, which is in contrast to the more patriarchal model of the physician-patient relationship, in which the “doctor knows best”.
The Declaration of Helsinki governs modern medical ethics, and applies to the practice of medicine as well as medical research using human patients as research subjects. Prior to World War II, there was no international consensus on ethical principles regarding the conduct of research on humans, and little had been written about it, save a German document from 1900, an AMA document from 1916, and a Russian text from 1936. The criminal trials of the World War II German medical doctors, famously known as the Nuremberg trials, brought to light the extent of human experimentation that occurred to prisoners during the war. These trials, by exposing the atrocities committed by medical professionals in the name of science, paved the way for the development of modern medical ethics constructs and for our current philosophies regarding the conduct of research on human patients.
For a thorough summary of the history and development of the original Declaration of Helsinki in 1964, look here.
In our next post in this series, we’ll continue to explore the foundations of medical ethics by reviewing the two main classical theories in ethics: deontology and utilitarianism, and how they have evolved to apply to modern day medical ethics.