History of bioethics
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This document provides a history of the development of bioethics and medical ethics from ancient civilizations to modern times. It describes some of the earliest ethical codes from ancient Egypt, Babylon, India, Greece, Rome, and Islamic and Jewish traditions. It then outlines the progression of medical ethics standards over time, including influential codes and guidelines developed in response to unethical human experimentation, with a focus on the atrocities that occurred in the United States in the 20th century. Key milestones discussed include the Nuremberg Code, Declaration of Helsinki, and Belmont Report.
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History of bioethics
- 1. History of Bioethics Seema Daud
- 2. 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.
- 3. Medical Ethics According to the World Medical Association • It is the study of morality, careful and systematic reflection on, and analysis or moral decisions and behavior. • 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. • Ethical codes in different era were based on the religious beliefs of the people or needs of humanity. Based on definition of “Medical Ethics” http://en.wikipedia.org/wiki/Medical_ethics
- 4. • Rigid rules were laid down as to experimental treatment. • There was no accountability in failure to cure as long as the standards text book were followed. • Severe penalties were, however, threatened for those who ignore the instructions. Ethics in Egyptian Medicine 2700 BC Hieroglyphic Writing
- 5. • The code of Hammurabi (Babylon 1900 BC) was the first written laws in the world (282 laws). • King Hammurabi is one of several influential lawgivers depicted in a marble frieze found in the chambers of the United States Supreme Court. • A system of payment based on results and the ability to pay on the status of the patient. • There were penalties for negligent failure, some of which were harsh & severe. • If the physician succeeds, he gets paid. If he fails, at worst he loses his hands. Code of Hammurabi (Louvre Museum, Paris)
- 6. • Laws with regard to healing the sick, with best diet, according to physician’s judgment and means; • Taking care that patients suffer no hurt or damage. • No administration of poison to anyone. • Not giving any sort of medicine to any pregnant woman, with a view to destroy the child. • Keeping sacred and secret patient’s information within my own breast. Hippocratic Oath 4 BC
- 7. • Rules about entering patients’ homes, respecting and honoring them by dressing properly and maintaining modesty. • Having entered, the speech, mind, intellect and senses shall be entirely devoted to no other thought than that of being helpful to the patient and of things concerning only him. • The peculiar customs of the patient's household shall not be made public. Oath of Initiation of professional ethics (Charaka Samhita) 1st Century India
- 8. • Oldest Hebrew medical text, written by a Hebrew physician from Syria • Not to kill not any man with the sap of a root; • Not to dispense a potion to a woman with child by adultery to cause her to miscarry; • Not to disclose secrets confided by the patient; • Not to take bribes to cause injury and to kill; • Not to harden hearts against the poor and the needy, but heal them; The Oath of Asaph in Judaism (3rd Century)
- 9. • Sources Quran & Sunnah • Islam made it an obligation upon the sick to seek treatment. • Human life is sacred. The saving of one life is regarded to be the same as saving the life of all of humanity. • For every ailment (except old age) there is a remedy. • Actions will be judged according to intentions. • Rulings exist for Euthanasia, Contraception, organ transplant and Abortion etc. Islamic Medical Ethics (7th Century)
- 10. • Haly Abbas (Ahwazi), devoted the first chapter of his work Liber Regius (Kamel Al Sanaah al Tibbia) to the ethics of medicine. A physician should: • Prudently treat his patients with food and medicine out of good and spiritual motives, not for the sake of gain. • Never to prescribe or use a harmful drug or abortifacient. • Respect confidences and protect the patient’s secrets. • Be kind, compassionate, merciful and benevolent, and give himself unstintingly to the treatment of patients, especially the poor. Advice to a Physician by Haly Abbas Persian physician (10th Century AD)
- 11. • In Japan: Buddhist Physicians crafted Seventeen Rules of Enjun (6th century) & • In China: Ming Dynasty (14th century) Ethical instruction for healers were discovered which were similar to Hippocratic oath
- 12. • Thomas Percival (1740–1804) was an English physician and author, best known for crafting perhaps the first modern code of medical ethics. • He drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons in which he coined the expression "medical ethics". • He was also a pioneering campaigner for public health measures and factory regulation in Manchester (Occupational Bioethics) Percival Code of Medical Ethics (UK: 1794)
- 13. • Bioethics is a native American product. • Bioethics occurred as a ‘reactive response’ to biomedicine’s technology advances and cultural pluralism. • International bioethics began more then a decade after the birth of bioethics in USA. • In the 20th century, there have been numerous unethical & inhumane experiments performed on human test subjects in the United States that were often performed illegally, without the knowledge, or informed consent of the test subjects. • These experiments were funded by USA government, CIA , military & private agencies.
- 14. Exposure of people to biological and chemical weapons • Mustard Gas Tested on Soldiers via Involuntary Gas Chambers • CIA sprayed: whooping cough virus on Tampa Bay; 12 people died. • The Navy sprayed bacterial pathogens of pneumonia in San Francisco • The Army released millions of mosquitoes in the hope they would spread yellow fever and dengue fever upon Savannah, GA, and Avon Park, FL
- 15. The deliberate infection of people with deadly or debilitating diseases US Infected Guatemalans with Syphilis and did not give them penicillin
- 16. Post world war II, Human Radiation Experiments on pregnant women, men & infants Over 4,000 secret and classified radiation experiments were conducted by the Atomic Energy Commission (AEC) and other government agencies involving introduction of radio-active material to Black infants, gonads of Blacks and other ethnics and even cereals for teenagers
- 17. Surgical experiments • Throughout the 1840s, J Marion Sims, who is often referred to as "the father of Gynecology", performed surgical experiments on enslaved African women, without anesthesia. • One of whom was operated on 30 times—regularly died from infections resulting from the experiments.
- 18. Surgical experiments • In 1874, Mary Rafferty, an Irish servant woman, came to Dr. Robert Bartholow of the Good Samaritan Hospital in Cincinnati for treatment of her cancer. • Seeing a research opportunity, he cut open her head, and inserted needle electrodes into her exposed brain matter.
- 19. Psychological & Torture experiments CIA conducted experiments on prisoners & mentally retarded, exposing them to: • Pain • Fear • Sexual abuse
- 20. • Beaumont's Code (United States) 1833: experimental treatments when all else fails. Get voluntary, informed consent. Stop experiment at subject’s request. • American Medical Association (AMA) Code of Medical Ethics 1847 • 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. • 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 (1949) • Declaration of Helsinki, application to medical research (1964, rev. 1975, 1983, 1989, 1996, 2000) • Belmont Report (1979) • AMA Code of Medical Ethics revision (2001)