Medical Ethics & Good Clinical Practice - Historical Evolution PDF

MEDICAL ETHICS AND GOOD CLINICAL PRACTICE Prepared by: Aleeza Week 1: Historical Evolution of Bioethics. August 10, 2024 Lecturer: Dr. Jerillie Anne Cordero-Saipud...

MEDICAL ETHICS AND GOOD CLINICAL PRACTICE Prepared by: Aleeza Week 1: Historical Evolution of Bioethics. August 10, 2024 Lecturer: Dr. Jerillie Anne Cordero-Saipuddin, MD HISTORICAL EVOLUTION OF BIOETHICS Roman Medical Ethics  Influenced by stoic philosophy and with emphasis on 16th Century B.C. Egyptian Papyri virtue and duty  Outline methods of establishing diagnosis  Galen (AD 130-201): a Greek philosopher who worked in  Making decisions whether to treat or not Rome and sought to advocate the science of medicine  What therapy is appropriate  All aspiring physicians were required to learn his teachings especially in therapeutics. 2000 BC (500 years before Moses brought down the Ten Commandments)  During the middle ages, medical science and philosophy Hammurabi: were sustained and brought to the west by the Arabs and  Devised a code of laws for those who practiced medicine their allies as they moved along the Mediterranean littoral and surgery. and into Spain.  Set surgical fees according to the ②social status of the  Moses Maimonides (AD 1135-1204): one of the greatest patient. physicians and philosophers, compiled the canon of  Established punishment for poor technical performance. Jewish law and medicine which has remained influential to this day. He condemned “thirst for profit” and ambition Jewish Medical Ethics emphasized: for “renown and admiration.”  Close relationship between medicine and religion  Primacy in all its norms of respect for human life.  St. Thomas Aquinas (AD 1224-1274): integrated the  Excelled in judicious applications of absolute norms to philosophy and ethics of Aristotle with Christian theology individual cases. and developed the classical doctrine of virtue ethics. Greeks absorbed the Egyptian and Babylonian experiences  In AD 1200, Frederick II involved the state in the with whom they traded: governance of medicine.  Aesculapius was their medical model who was believed to  Established progressive rules for: have treated the Greek army at the siege of Troy. a) the education of future physicians  Priests of Aesculapius healed with magic and little b) their method of practice science. c) charges for their services  Stresses equality of cure for rich and poor. d) mechanism for assuring the purity of drugs. 460-377 BC  In 1520, Royal College of Physicians of London up a penal  Hippocratic writings introduced the tradition of clinical code for physicians, which in 1543, the “penal” was observation and critical reasoning. changed to “ethical” to avoid implication of criminality.  Oath which has been the touchstone of Western Bioethics.  John Gregory (1724-1773): gave lectures on the duties  Hippocratic corpus became the Hippocratic Ethics, and qualifications of physicians. essential feature is the physician’s responsibility to the patient.  Thomas Percival’s medical ethics (1803): originally  In contrast with Aesculapius medicine, it tolerated commissioned to address conflicts among physicians, different standards of care for the rich and the poor. surgeons and apothecaries at Manchester infirmary. Percival’s Ethics Hindu medical ethics  Rules governing inter-professional behaviour serve the  Similar to those of the Babylonians and the Greeks dual purpose of maintaining the profession and serving  Hindu Oath of initiation into the medical profession: “Day the well-being of society. and night: thou shalt endeavour for the relief of patients  Public criticism of colleagues undermines the credibility of with all their heart and soul. Thou shalt not desert or injure the professional which might ultimately damage the thy patient even for the sake of thy living.” reputation of the profession.  Percival’s medical ethics became the foundation of the Chinese medicine modern Anglo-American professional ethics.  established a canon written between 200 BC and 200 AD  It has many features in common with Hippocratic oath but which holds: is more socially aware. a) That the physician should have mercy on the sick, b) Pledge himself to relieve suffering among all Half a century later, American medicine was involved in a classes, aristocrat or commoner, poor or rich, dispute among several schools of medicine. aged or young, beautiful or ugly, enemy or friend,  The group that eventually became known as orthodox native or foreigners, educated or uneducated, all practitioners formed the American Medical Association are to be treated equally. in 1847 and drafted their code of ethics which followed “He should look upon the misery of the patient as Percival’s ethics. if it were his own.”  It contained three sections: a) Duties of physicians to patients b) Obligations of patients to their physicians MEDICAL ETHICS AND GOOD CLINICAL PRACTICE Week 1 Prepared by: Aleeza MEDICAL ETHICS AND GOOD CLINICAL PRACTICE Prepared by: Aleeza Week 1: Historical Evolution of Bioethics. August 10, 2024 Lecturer: Dr. Jerillie Anne Cordero-Saipuddin, MD c) Duties of physicians to each other and to the  Functions as a promise to society that the profession will profession at large. maintain specified standard of practice in return for the  This underwent several revisions: power and autonomy that society is being asked to grant o 1948: World Medical Association adopted the the profession. declaration of Geneva, which was designed for those  Protection of the unity, integrity, and power of the being admitted to the medical profession, profession which appears to be a primary goal of the rules represented a revision of the Hippocratic oath. of etiquette governing the relationship between o 1949: Nuremberg code was drafted because of the professionals. atrocities committed by the Nazi physician  Serve as a guide for determining when sanctions should researchers. be brought to bear against a member of the profession. o 1964: Helsinki declaration, which emphasized the concept of voluntary consent for human research Requirements for the members of a profession subjects.  Competency to practice  Restriction of professional status to those who have Some religious contributions: undergone specific educational and training program. Protestant thoughts:  Keeping one’s knowledge current.  1930: Anglican’s openness to contraception, sterilization  Working to advance the existing knowledge in one’s field and abortion (Lambeth Conference) through research.  Openness to decisions to refuse life-prolonging treatment. Purposes of these requirements:  Patient’s rights movements have affinity with Protestant  Protecting the profession thought including Anti-paternalism.  Safeguarding the patient Roman Catholicism  Roman Catholic scholars since the middle ages have Effective medical practice requires: written on medical ethical problems from the perspective  Scientific knowledge and mastery of technology of Christian theological ethics.  Art of taking care of the patient guided by appropriate  Papal statements on abortion, contraception, and sexual sensibility to ethical issues. ethics.  Issues on the care of the terminally and critically ill Why is there a need for a code of ethics? patients.  Dramatic increase in scientific knowledge  Opposition to active killing of terminally ill on grounds of  Rapid development and far advances in technology mercy.  Violation of the rights of human subjects in research  Justifiability of withdrawal and withholding extraordinary  Far advanced information technology that may breach means of life supports. confidentiality and allows patients to have more  Developed the principle of double effect. knowledge about their condition through information  Ethical and religious directives for Catholic health care technology. services. It is a compendium of Catholic positions on the  Disrespect to life and dignity of the human person. full range of medical ethical issues.  Ability of health care professionals to affect the course of people’s lives and deaths. Professionally generated ethics documents:  Erosions in the inter-professional relationships  Prayers such as that attributed to Jewish physician  Issues on physicians relationships with other members of philosopher Moses Maimonides: health care systems. a) Express gratitude to a deity b) Ask for divine assistance in developing one’s skills and meeting one’s responsibilities. Oaths are vows taken by individuals entering a profession to uphold specified obligations (e.g. Hippocratic Oath) Codes are collective summaries of the moral ideals and conduct that are expected of the professional. Most medical codes intermingle etiquette and ethics.  Etiquettes provide guidelines on relationship with other physicians and proper decorum in the presence of patients.  Ethics concerns itself with the moral principles that underlie the physician’s obligations to the sick and to society. Roles of Professional Code of Ethics  Help to define and legitimate a profession as well as to maintain, promote and protect its prestige. MEDICAL ETHICS AND GOOD CLINICAL PRACTICE Week 1 Prepared by: Aleeza