History of Medical Ethics

PH 350Norwich University

Spring 2010

Learning Objectives

• To understand early medicinal thought, especially the concept of paternalism

• To highlight some of the major events in history that developed patient autonomy

• To review the goals of medicine• To understand the major principles of

modern-day medical ethics

Early Medicinal Thought

• Paternalism

-Medical treatment as a father/child relationship

-Guiding principle: physician decides what is best for the patient and tries to follow that course of action

-Focus: patient care and outcomes, not the patient’s needs or rights

-Argument: maximum patient benefit can only be achieved when the doctor makes the final decision

Paternalism…Continued

• Types of Paternalism-Positive vs. Negative

Positive = promotes the patient’s goodNegative = seeks to prevent an existing harm

-Soft vs. HardSoft = appeals to the patient’s valuesHard = applies another’s values over the patient

-Direct vs. IndirectDirect = benefits the patient who has been restrictedIndirect = benefits a person other than the one restricted

The Father of Medicine

• Hippocrates -Rejected medical views of his time

-Based his medical practice on observations and study of the human body

-Believed that illness has a rational explanation

-Treated body as a whole unit, not just parts

-Founded a medical school on the island of Cos, Greece to teach his beliefs

Hippocratic Oath

• Original vs. Contemporary

-language and content has been updated to fit modern beliefs about medicine

-spells out physician responsibilities to both the patient and the medical profession

Evolution to Autonomy

• Making the shift from paternalism

-Patient given opportunity to determine benefit vs. harm- The Patient’s Bill of Rights

-Questions being raised regarding the patient’s wishes as to what is ethical

-How much do you tell the patient?-Do they even want to know?

Notable Cases in History

• Nuremberg Code: 1946

-Limits on medical research following Nazi testing of hypothermia & antimicrobialagents

-Subjects were put in ice tanksfor 3 hours, wounds were inflicted& purposely infected with bacteria

-Concepts of informed consent, avoiding all unnecessary physical & mental suffering, proper preparation & facilities, ability for subjects to

opt out, basing human experiments on results of animal testing

Notable Cases…Continued

• Tuskegee Syphilis Study: 1929

-Use of placebos in studies

-Participants were illiterate, black sharecroppers thoughtto have “bad blood”

-Deaths, chronic illness, andtransmission to wives & childrenresulted

Notable Cases…Continued

• Nancy Cruzan: 1983

-Was maintained in a persistent vegetative state for several years -Parents requested that artificial hydration and nutrition be withdrawn

-Courts rule in their favor, but healthcare team appeals the decision

-Incompetent patients need to be protected by law

-Encouraged the development of advance directives and appointmentof a health care proxy to carry out patient’s wishes

Goals of Medicine

• Relieve suffering- Example: The use of Chloroform and Ether

Chloroform was used more often because it was faster acting, less was needed to put someone under, and it was non-flammable. However, it was more dangerous than using Ether. The risk of drug overdose was greater with Chloroform.

Goals…Continued

• Promote health

- Flintstones Vitamins

- Acne Treatment

- Weight loss

Goals…Continued

• To cure disease and preserve life1900 – Average life expectancy was 492003 – Average Life expectancy is 78

• Vaccinations Definition: “A preparation of a weakened or killed pathogen, such as a bacterium or

virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.”-Swine Flu

• Cures- Breast Cancer

Principles of Medical Ethics

• Confidentiality-HIPAA (Health Insurance Portability & Accountability Act)

• Honesty-Telling patients what they need to know

• Justice-Treating all patients without discrimination

• Gatekeeping-Patients access to medicine through doctors

• Report impaired colleagues

Principles…Continued

• Avoid sexual relations with patients

• Conflicts of interest

• Scope of practice-Range of responsibility, abilities

• Gaming the system-Using patients to make more money

Thank you to all of our viewers!

The End

Produced by:J. Bielski, H. Black, V. Bruce, & J. Davis