Medical Ethics and Historical Perspectives

Summary of Ethical and Bioethical Issues

• The presentation discusses the problematics of ethics and bioethics in medicine, beginning with ancient times and progressing through later periods.
• Key figures in the evolution of these concepts are identified, such as Hippocrates and Hammurabi.
• The presentation notes the importance of understanding ethical dilemmas in medicine.
• The discussion covers the differences between medical ethics, bioethics, and medical deontology.
• The presentation highlights the importance of understanding the historical evolution of ethical thought in medicine.

Key Concepts and Historical Figures

• Ancient Times: Ancient healers in Greece emphasized evidence-based practice, as evident in Hippocrates' methods.
• The Code of Hammurabi: The first known law code from ancient Mesopotamia, based on the principle of "lex talionis" (an eye for an eye).
• Enlightenment Period: Philosophy and modern philosophy connected dignity with human rights; Immanuel Kant's philosophy emphasized treating persons as ends in themselves.
• Medical Ethics and Mental Health: From antiquity, philosophers recognized the importance of recognizing suffering and its connection to effective treatment of mental illness.
• Legal Aspects of Medical Ethics: The late 19th century saw the development of foundational medical codes of ethics and deontology. The American Medical Association (AMA) and British Medical Association (BMA) developed their first codes, emphasizing the rights of both patients and caregivers. The World Health Organization (WHO) introduced a medical code of ethics, based on Hippocratic ideals.
• Medical Bioethics: This evolved after WWII due to the critique of traditional medical codes and ethical issues.
• Medical Deontology: The focus shifted to the domain of physician's behaviors, attitudes, and moral habits.

Ethical Dilemmas

• Court Decision on Medication Refusal: A court decision illustrated a conflict between a patient's decision not to take medication and the need for maintaining discernment in cases of severe depression or anorexia nervosa.
• Informed Consent and Refusal: Ensuring that hospitalized patients are fully informed about risks and benefits of refusing medical treatments is vital, which is related to the concept of informed consent and the process of informed refusal. 
• Moral Development Model: Lawrence Kohlberg proposed that moral judgment is an individual and separate domain, based on personal values and principles..
• Medical Consent Origins: The origins of consent in medicine trace back to avoiding conflicts in medieval times, from unlawful violence, and the application of the principle of informed consent in U.S. law as well as the Nuremberg Code. The development of the Mental Capacity Act enabled the law of a particular country to advance and specify the medical action based on a person's ability and capabilities concerning their wellbeing and decisions.
• Valid Consent from the Perspective of Law: Situations involving coercion, deception, insufficient information provision by the provider invalidate consent, leading to potential legal repercussions for the physician.
• Distorting Factors in Medical Deontology: The presentation highlights paternalistic attitudes in medicine, suggesting that doctors frequently held power as decision makers instead of having patients as equal partners.
• Human Rights and Bioethics: The presentation emphasizes how the Universal Declaration of Human Rights, including protections against cultural diversity that violates human dignity, inform the practice of bioethics.
• Medical Ethics vs. Medical Bioethics: Ethics is limited to a practitioner's work, while wider ethical issues are raised through bioethics. 
• Medical Deontology (1 & 2): Detailed descriptions and obligations of physicians are presented.
• Ethical Dilemmas in Practice (Case Examples): Several case examples are presented, from the past through the present, involving moral dilemmas surrounding the use of medical treatments, procedures, and the doctor-patient professional relationship. 
• Moral Theories in Medicine: The presentation describes various moral theories (consequentialism, duty-based, virtue ethics), touching on diverse contexts in the evolution of medical practice.

Regulations of Medical Practice

• The Mental Capacity Act: The presentation discusses this legislation that regulates procedures involving the care of people who lack capacity.
• BOlam Test: This legal test provides safeguards for physicians' actions if they act in a way that is reasonable in a similar context by other medical professionals.
• Informed Consent: Its importance for respecting the right to self-determination of patients is stressed.
• Medical Consent Origins: The presentation traces the conceptual origins of consent to protect people from violence and ensure freedom to make choices regarding their health.
• Ethical Dilemmas in Medical Practice: The presentation includes discussion of situations where physicians face issues concerning the trade-off between patient welfare/health and the needs of the broader society (e.g., if actions may cause more harm than benefit), and legal regulations.
• Ethical Considerations in Medical Practice: The presentation highlights ethical procedures and legal contexts which involve patients' rights, treatment decisions, and physicians' duties/responsibilities.
• The Hippocratic Oath: Its importance in shaping ethical medical behavior and as a foundation for the concepts of patient benefit and non-maleficence is discussed.

Additional Topics

• Genetic Information and Confidentiality: The presentation discusses how recent developments in medical science, especially in reproductive technologies, raise ethical questions about the handling of genetic information relating to living and deceased individuals.
• The Problem of Living Abortus: The presentation covers the ethical and legal issues involving cases where a fetus survives an abortion procedure. 
• Abortion and Mental Health: The presentations highlights the association between abortion and mental health, which is a controversial topic.
• Medical Advance and Euthanasia: How medical advancements impacting ideas of death and dying affected legal and ethical debates surrounding euthanasia and physician-assisted suicide in different countries and ages.
• Physician Assisted Suicide: The presentation explores cases such as that of Dianne Pretty, showing diverse views regarding such decisions from human rights and moral standpoints.
• Paternalistic Perspective in Medicine: The presentation touches on times when physician actions that prioritize patient welfare may disregard autonomy, raising ethical concerns concerning the balance between beneficence and patient autonomy concerning a decisional or treatment capacity.
• Advance Care Planning: Discusses situations where patients lack the capacity to make medical decisions and outlines legal requirements for advance care planning, for which the Mental Capacity Act serves as a foundation.
• Medical Disclosure of Errors: The presentation analyzes the ethical responsibility to disclose medical errors.
• Payment for Organ Donation: The ethical issues of paying for organ donations and "transplant tourism". 

This quiz explores historical and philosophical perspectives on medical ethics, including the contributions of Hippocrates and the Code of Hammurabi. It addresses the evolution of human dignity and rights in modern philosophy, along with the principles of bioethics and medical deontology. Test your knowledge on these foundational concepts of medical ethics!