Introduction to Ethics, Medical
ethics, Bioethics
Main ethical approaches
Dr. Archana Chaudhary
Associate Professor
Faculty of Science
The picture won the Pulitzer Prize for Feature Photography award in
1994. Carter took his own life four months after winning the prize.
ETHICS / MORAL
⚫ The oldest scientific and philosophical discipline
⚫ ? Demarcation: science / subject
ethics moral
(gr. ethos = custom, (lat. mos = character,
practice) nature)
- Ethics – discipline about moral or philosophy
on moral
- Moral – system of norms or rules, written or not,
about human behavior
Ethics is a philosophical
discipline about moral
problems, deals with art of
living
What is Ethics?
⚫ The formal study of:
⚫ What is right and wrong.
⚫ The study of the bases or principles
for deciding right and wrong.
⚫ The analyses of the processes by
which we decide what is right and
wrong.
Ethics is not:
⚫ Merely obeying the law
⚫ Compliance
Although in many instances laws are
statements of considered ethical
positions and most of the time
obeying the law is an element of
ethical behavior.
Traditional arrangements
of the field of ethics:
⚫ Meta-ethics (nature of right or good, nature
and justification of ethical issues)
⚫ Normative ethics ( standards, principles)
⚫ Applied ethics (actual application of ethical
principles to particular situation)
Traditional arrangements of ethics:
Metaethics investigates the origin and meaning of ethical concepts. It studies
where our ethical principles come from and what they mean. It tries to analyse
the underlying principles of ethical values;
Normative ethics tries to arrive at moral standards that regulate right and
wrong conduct. It is a more practical task. It is a search for an ideal litmus test
of proper behaviour;
Applied ethics involves examining specific controversial issues, such as
abortion, infanticide, animal rights, environmental concerns, homosexuality, and
so on. In applied ethics, using the conceptual tools of metaethics and normative
ethics, one tries to resolve these controversial issues.
Often the lines of distinction between metaethics, normative ethics, and applied
ethics are often blurry.
For instance, the issue of abortion is an applied ethical topic in as much as it
involves a specific type of controversial behaviour. But it is also an issue
involving normative principles such as the right of self-rule and the right to life
and an issue having metaethical issues such as, “where do rights come from?”
and “what kind of beings have rights?”.
Three Broad Types of
Ethical Theory:
⚫ 1) Consequentialist theories (primarily
concerned with the ethical consequences of
particular actions)
⚫ 2) Non-consequentialist theories (broadly
concerned with the intentions of the person
making ethical decisions about particular
actions)
⚫ 3) Agent-centered theories (more concerned
with the overall ethical status of individuals)
Types of Ethics
⚫ Professional Ethics: Obligations of the
profession
- Self-regulation
- Education of self and others
⚫ Medical Ethics:
- human: medical (in narrow sense) and dental
- veterinarian
Knowledge, deliberation, understanding of medical
practice that should be in perspective of right,
honorable, accurate behavior
Medical Ethics
⚫ a field of applied ethics, the study of moral
values and judgments as they apply to
medicine. As a scholarly discipline, medical
ethics encompasses its practical application in
clinical settings as well as work on its history,
philosophy, theology, sociology, and
anthropology.
Based on definition of “Medical Ethics” http://en.wikipedia.org/wiki/Medical_ethics
Medical Ethics
⚫ Long history
⚫ Third Dynasty (Egypt) 2700 BCE
⚫ Code of Hammurabi (Babylon) 1750 BCE
⚫ Oath of the Hindu Physician (Vaidya’s Oath) 15th cy. BCE
⚫ Hippocratic oath (Hippocrates, ca 460-370 BCE)
⚫ The Oath of Asaph and Yohanan (ca 6th cy. CE)
⚫ Advice to a Physician (Persia) 10th cy. CE
⚫ Oath of Maimonides 12th cy. CE
⚫ Ming Dynasty (China) 14th cy. CE
⚫ Seventeen Rules of Enjun (Japanese Buddhist Physicians) 16th
cy. CE)
Drawn from Codes of Medical and Human Experimentation Ethics by Victoria Berdon
and Jennifer Flavin viewable at http://wisdomtools.com/poynter/codes.html
History cont.
⚫ Percival's Code (England), 1803: basis for first AMA
Code of Medical Ethics.
⚫ Beaumont's Code (United States), 1833: experimental treatments,
voluntary, informed consent.
⚫ American Medical Association (AMA) - Code of Medical Ethics,
1847.
⚫ Claude Bernard (France), 1865.
⚫ Walter Reed (United States), 1898: introduces written consent
“contracts”. Allows healthy human subjects in medical experiments.
⚫ Berlin Code or Prussian Code (Germany), 1900: no medical
experiments when subject not competent to give informed consent, in
the absence of unambiguous consent, or when information not properly
explained to subject.
⚫ Reich Circular (Germany), 1932: concerned with consent and well-
being of the subjects.
Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and
Jennifer Flavin viewable at http://wisdomtools.com/poynter/codes.html
Modern issues and statements
⚫ Nuremberg Code (1947)
⚫ Medical research
⚫ Declaration of Geneva, W.M.A. (1948, 1968, 1984, 1994, 2005, 2006)
⚫ World Medical Association International Code of Medical
Ethics
⚫ AMA revision (1957)
⚫ Declaration of Helsinki, application to medical research (1964,
rev. 1975, 1983, 1989, 1996, 2000)
⚫ Belmont Report (1979)
⚫ AMA revision (2001)
Drawn from “Codes of Medical and Human Experimentation Ethics” by Victoria Berdon and
Jennifer Flavin viewable at http://wisdomtools.com/poynter/codes.html
Why study medical ethics?
⚫ “As long as the physician is a knowledgeable and
skilful clinician, ethics doesn’t matter.”
⚫ “Ethics is learned in the family, not in medical
school.”
⚫ “Medical ethics is learned by observing how senior
physicians act, not from books or lectures.”
⚫ “Ethics is important, but our curriculum is already too
crowded and there is no room for ethics teaching.”
Why study medical ethics?
⚫ ethics is and always has been an essential
component of medical practice
⚫ some ethical principles are basic to the physician-
patient relationship, but application in specific
situations is often problematic due to disagreement
about what is the right way to act)
⚫ study of ethics prepares medical students to
recognize difficult situations and to deal with them in
a rational and principled manner
Why study medical ethics?
⚫ integral part of medicine at least since the time of Hippocrates
concept of medicine as a profession
⚫ in recent times - influence by developments in human rights
(e.g., violations of human rights, such as forced migration and
torture; whether healthcare is a human right)
⚫ closely related to law (e.g., medical licensing and regulatory
officials), but
ethics prescribes higher standards; occasionally requires that
physicians disobey laws that demand unethical behaviour;
laws differ significantly from one country to another while
ethics is applicable across national boundaries
Bioethics
⚫ Medical ethics closely related to bioethics
(biomedical ethics), but
not identical
- medical ethics focuses primarily on issues arising
out of the practice of medicine
- bioethics: very broad subject, concerned with the
moral issues raised by developments in the
biological sciences
- bioethics does not require the acceptance of certain
traditional values that are fundamental to medical
ethics
Bioethics
⚫ branch of applied ethics that studies the
philosophical, social, and legal issues arising in
medicine and the life sciences
⚫ it is chiefly concerned with human life and well-
being, though it sometimes also treats ethical
questions relating to the nonhuman biological
environment
As Practical Ethics, Medical Ethics
focuses on:
The process of deciding what is the most
appropriate (right) course of action in a particular
situation:
⚫ given these facts
⚫ given my skills and abilities
⚫ operating with finite knowledge
⚫ in real time
⚫ and then effecting that course of action.
Ethical Problems
⚫ Problems caused by fact of having to
choose between goods or things to which
we owe an obligation
⚫ Bad rankings of goods
⚫ Failure to grasp facts
⚫ Ignorance
⚫ Incompetence
⚫ Willful blindness
⚫ Bad factual analysis
⚫ Often caused by personal or institutional
distortion
Organizational Problems
⚫ General organizational culture
⚫ Ego and narcissism
⚫ Overly punitive responses
⚫ Lack of a culture of responsibility
⚫ Failure to acknowledge information
distortion
⚫ Bad communication flows
⚫ High transaction costs for doing the
“right” thing
Process of making ethical decisions
⚫ Awareness—Is there a moral issue here?
⚫ What is its nature? How important?
⚫ What are the facts?
⚫ What are the issues?
⚫ What rules or values apply here?
⚫ To whom or what do I owe a duty?
⚫ How should they be applied?
⚫ Who needs to decide and act? Who ought to?
⚫ To what am I obligated because of role/position?
⚫ What are the consequences?
⚫ What are the options?!
Duties to whom or what?
⚫ Individuals
⚫ Patients
⚫ Patients’ families/guardians
⚫ Colleagues
⚫ Co-workers
⚫ Self
⚫ Groups
⚫ Profession
⚫ Society
⚫ The weak
⚫ Ideas/Principles
⚫ The Law
⚫ Truth
⚫ Justice
⚫ Individual value
Duties—Sources
⚫ Legal Obligations
⚫ Health insurance
⚫ Emergency treatment
⚫ Reporting duties
⚫ Institutional Obligations
⚫ Practices of hospital
⚫ Professional norms and
obligations
⚫ Inhere with being a physician
Professional codes as a framework for
decision making
- Over centuries medical profession has developed
its own standards of behavior for its members –
expressed in codes of ethics and related policy
documents
- Global level: WMA, UN Principles of medical ethics
- Ethical directives of medical associations are
general in nature but
- “in making decisions, it is helpful to know what other
physicians would do in similar situations”
