Development Of Medical Ethics Research Articles

History and development of medical ethics- the international norms

Medical ethics encompasses a broad field, including ethics in day to day medical practice, in research and publication. The historical development in the context of international norms of medical ethics is presented here, with brief mention of ‘research and publication ethics’, the latter two being a broad topic in itself.

Fertility Fraud, Legal Firsts, and Medical Ethics

On May 5, 2019, Indiana became the first state to legislate against a doctor’s failure to obtain his fertility patient’s consent before inseminating her using his own sperm. Less than a month later, Texas passed an even stricter law against fertility fraud, as the practice is called. The explosion of at-home DNA testing has recently uncovered dozens of doctors who conceived scores of offspring using their own sperm instead of the samples provided by a spouse, an unknown donor, or a donor that the patients had selected. This revelation has upended families, revealed webs of biological half-siblings, and confounded the legal system. Fertility fraud is a pressing case study about the demands of informed consent and modern struggles between patient wellbeing and autonomy in the clinical practice of obstetric and fertility medicine. The answers to these hard questions are also giving rise to new criminal and civil penalties that are codifying those developments in medical ethics into law.

慢性病诊疗带教中的“隐性课程”对医德养成有心理连带效果吗？—一项基于多教学医院数据的实证分析

慢性病诊疗带教中的“隐性课程”对医德养成有心理连带效果吗？—一项基于多教学医院数据的实证分析

Women and Ethics in Medicine: Historical Perspective and Contemporary Concern

The purpose of this paper is to provide an historical overview of the developments in the field of ethics concerning medicine and health. The discourse also focuses on morals and ethics. We summarize major principles around which much of ethics debates concerning medical and health care have been organized. Following this our paper connects the medical ethics in India with the contemporary concern. The present paper is divided into two parts. The first part attempts to discuss historical development of medical ethics at global level. In particular, western philosophy has been profoundly shaped by three theories of ethics: Aristotelianism, deontology and utilitarianism. Each of these three theories can in turn be seen as essentially a product of the times in which it was originally born. The medical ethics have come a long way and still a continuing process. Ethical discourse is generated out of and applied in local worlds, however, so that it gets taken up in moral processes that are inseparable from local elations and conditions. The discourse of ethics and moral concludes that they are inseparable from local relations and conditions and at the same times aspires for trans-local perspective. Importantly, the four principles of ethics i.e. , autonomy, beneficence, non-maleficence, and justice) are prima facie and binding for each individual to follow. In the second part of paper, an effort has also been made to discuss the historical aspects of medical ethics in India. Medical ethics are not merely a moral code but a legally sanctioned code of conduct acceptable and normal within the medical profession. A broad range of issues can be covered under the rubric of ethical issues, however, specific concerns related to the globalization, equity in health, technology and ethics, informed consent, emergency and health care and reproduction are the major concern of ethics. The ideas enshrined in the doctrine of informed consent though not legally binding yet, continue to percolate into the medical and lay discourse. The doctrine of informed consent is complicated and needs to be addressed in socio-cultural and other constraints of the society. Advances in bio-sciences and bio-technology, such as surrogacy, sex selection, genetics etc. widened the scope of medical ethics. Ethics are the bridge between health policy and values. Health policy is related with the equity and justice to its people in receiving the health care, and thus medical ethics examines the moral validity of it. There is a need to develop an ethical culture in society. Ethics, equity and respect for humanity must be incorporated in all aspects of health care. Ethics has to be institutionalized wherever it is needed. Given the events of the last decades it is a sad reality that at least in the Indian health care set up ethics are losing their sight and has been moving towards commercialization than science and healing.

Medical ethics applied in forensic research: a revisit to ethical guidelines

The knowledge on recent advances in research ethics is mandatory for the forensic community comprising mainly forensic pathologists, forensic scientists and members from the legal fraternity who support the smooth functioning of the medico-legal system. A revisit to the recent developments in medical ethics and understanding the implications towards forensic research would keep Sri Lanka in equal platform with other countries. The main objective of this paper is to revisit the recent developments in medical ethics and to understand the ethical principles applied in forensic research. The review article briefly explores the ethical aspects of research involving clinical patients, research involving dead bodies and skeletons, laboratory investigations in research and publications of research findings. The existing ethical norms in research practice had evolved over a long period of times. The sound knowledge of the internationally accepted ethical principles would make sure forensic researches are developed according to the accepted standards and be more scientifically valid.

Bioethics in Islamic Thought

AbstractThis article gives an overview of Islamic ethical thought and its relationship to bioethical issues. It argues that Islamic bioethics can be viewed both as a cumulative tradition building on the Islamic ethical resources and as an ongoing discourse that captures the effort to understand and implement Islamic moral precepts pertaining to a wide range of issues including the beginning and end of human life, treatment of the human body, and proper attitudes towards the environment. After a brief introduction on the term ‘bioethics’ and its history, the article is divided into three main sections exploring the foundations of Islamic (bio)ethics, the evolution and development of medical ethics in the Islamic tradition, and the main challenges confronting contemporary Islamic bioethical discourses.

Moderna medicinska etika

The Hippocratic Oath, millennium mainstay of medical ethics, has had many interpretations and challenges on its way to modern medical ethics and codes of ethics. Hippocrates learn­ing in history changed in accordance with cur­rent social, religious and political values and requirements. The most important reasons for the new approach in the new medical ethics lie in the ethical theories: utilitarianism (and welfare benefits), deontology (duty and behavior), the moral duties of doctors and health workers, and virtue ethics (set of Hippocrates). In all this, we should bear in mind the theoretical and practical values that are most relevant to each individual case. Today there are many theories of civil with the potential to grow into bioethical theories, such as the feminist movement in bioethics, Marxism, libertarianism (the doctrine of free­dom) and other theological theories. Howev­er, none of them are imposed from a practical point of view, able to deal with ethical dilem­mas and problems that gave birth to modern science and technology. In a similar trend in the development of medical ethics at the beginning of the new millennium, the Hippocratic oath is augmented with the Geneva Declaration, and in England, the General Medical Board provides a clear and stylish guide Hippocratic Oath in terms of the doctor's rights and obligations, as well as the Code of Ethics as a guide for good medi­cal practice (General Medical Council, 2006). Professional medical ethics has finally over­taken the Hippocratic ethic. What is encour­aging is the strong development of codes of ethics in modern medicine and health care in many countries, including Serbia.

Retainer Medicine: An Ethically Legitimate Form of Practice That Can Improve Primary Care

Retainer medicine has become an important yet controversial form of primary care practice in the United States, coming under attack for its purported failure to measure up to professional ethics. Critics opine that retainer medicine obstructs professional commitments to health care access and social justice. Some ethicists urge that society should restrict or ban retainer medicine; professional organizations have yet to take a stand. The authors believe that retainer medicine is compatible with professional ethics and will more likely aid in solving the difficulties facing primary care rather than add to them. Although professional ethics should evolve to address new conditions, a condemnation of retainer medicine is warranted neither by traditional ethical precepts nor by contemporary developments in medical ethics. Any move to sanction retainer medicine under the banner of professionalism or professional ethics will be counterproductive. The primary care shortage will only get worse if physicians in retainer practice leave primary care altogether, a likely outcome of legal or professional condemnation of retainer practice.

Human rights from the Nuremberg Doctors Trial to the Geneva Declaration. Persons and institutions in medical ethics and history

The "Universal Declaration of Human Rights" and the "Geneva Declaration" by the World Medical Association, both in 1948, were preceded by the foundation of the United Nations in New York (1945), the World Medical Association in London (1946) and the World Health Organization in Geneva (1948). After the end of World War II the community of nations strove to achieve and sustain their primary goals of peace and security, as well as their basic premise, namely the health of human beings. All these associations were well aware of the crimes by medicine, in particular by the accused Nazi physicians at the Nuremberg Doctors Trial (1946/47, sentence: August 1947). During the first conference of the World Medical Association (September 1947) issues of medical ethics played a major role: and a new document was drafted concerning the values of the medical profession. After the catastrophe of the War and the criminal activities of scientists, the late 1940s saw increased scrutiny paid to fundamental questions of human rights and medical ethics, which are still highly relevant for today's medicine and morality. The article focuses on the development of medical ethics and human rights reflected in the statement of important persons, codes and institutions in the field.

The noncompliant patient in psychiatry: the case for and against covert/surreptitious medication.

Nonadherence to treatment continues to be one of psychiatry’s greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients’ family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient’s competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means ‘parent of the country’; it permitted a court to consent or refuse treatment on behalf of an ‘incapacity’, or alternatively to appoint a guardian with such powers].

Public Health Research Ethics: A Research Agenda

One plausible way to structure a narrative about the origin and development of medical ethics is to see much of it as a commentary on the ethical issues that have arisen in biomedical research with human subjects over the last 75 years. Whilst it is obvious that for medical progress to occur scientific studies involving human subjects are necessary, research ethics tends to focus on the examples in which vulnerable persons were harmed, or other moral problems arose. It is important to see that controversial studies are not limited to the work of malevolent ‘scientists’ like Josef Mengele, but are often carried out by researchers and groups that assumed at the time that they were contributing to improvements in the health and well-being of the public. Much discussed examples of controversial studies include Tuskegee (Jones, 1993), Willowbrook (Murphy, 2004), the Kennedy Krieger Institute Lead Paint Study (Mastroianni and Kahn, 2002), and some of the AZT preventive studies in developing countries (Hawkins and Emanuel, 2008). Clearly, research with human beings can create many moral issues that require ethical reflection and analysis: on what ground can it be justified to use individuals as research subjects? What is the meaning and scope of informed consent? How should risks be evaluated vis-à-vis the importance of the study objectives and the proposed methodology? When (if ever) can placebos or otherwise substandard medical interventions be used? However, while we believe that the discussion of such issues needs to continue, we suggest that there are a number of problems with the way that contemporary research ethics is framed. We will focus on just two issues in this brief editorial. First, the dominant approach to research ethics has focused on producing numerous regulations. This is potentially problematic for a number of reasons. Second, research ethics is dominated by a very particular paradigm of research, namely the clinical drug trial. This results in limitations in the range of ethical issues discussed and problems in applying this model to other perfectly legitimate types of research. We will illustrate both points by making reference to the recently issued revised CIOMS International Ethical Guidelines for Epidemiological Research (1991, 2008).

Experimental rage: the development of medical ethics and the genesis of scientific facts. Ludwik Fleck: an answer to the crisis of modern medicine in interwar Germany?

In 1930, the large-scale introduction of the BCG vaccination in the city of Lübeck in northern Germany led to a major scandal that focused public attention on medical experimentation with human beings as well as reviving criticism of the medical profession that had been voiced before. The trial following the catastrophe raised the first clearly identifiable public discussions on medical ethics in Europe, and led to the establishment of the first regulations for medical research on human beings in the western hemisphere; the German 'Richtlinien' of 1931. In 1935, Ludwik Fleck (1896-1961) published a now classic monograph entitled Genesis and Development of a Scientific Fact. The central hypothesis of this article is that, when Fleck published his book four years after the Lübeck trial, he was proposing answers to questions raised, at least partially, by the Lübeck case, although he never explicitly mentions it. Most interestingly, Fleck proposed a different approach to the fundamental dilemma of modern experimental medicine, the potential opposition between an individual's well-being, and the production and application of scientific knowledge in medicine. Where the standard answer to these questions has, since the 1930s, become moral reasoning and ethical regulation, known today as bioethics, Fleck portrays a different approach that could be characterized as the attempt to foster a deeper and more democratic understanding of science through an examination of its intimate functioning.

Letter to the Editor

Letter to the Editor

Teaching old dogs new tricks—a personal perspective on a decade of efforts by a clinical ethics committee to promote awareness of medical ethics

To incorporate medical ethics into clinical practice, it must first be understood and valued by health care professionals. The recognition of this principle led to an expanding and continuing educational...

On the Development of Teachers of Medical Ethics in China

Despite a long history in China, medical ethics didn't become a popular course until the 1980s. At present, medical ethics is either a required or an optional course in most medical schools in China, but lack of qualified teachers is a conspicuous problem. As Tao Liu, who teaches medical ethics at Bao Tou Medical College in Inner Mongolia, has noted, problem of lack of qualified teachers worries us even more, as most teachers originally majored in philosophy, medicine, psychology, sociology, and law. There are even some teachers who were originally administrators who lacked much-needed knowledge. Of the current teaching faculty, few possess a comprehensive knowledge of medicine, philosophy, psychology, sociology, and law.[1] Ruguang Liu, vice president of Nanjing Health School, also remarked on this difficulty: Medical ethics in China, as a newborn frontier science, has no specialized professionals of its own, which results in the shortage of competent teachers in this field. People engaged in medical ethical education and research are those who have transferred from other fields. Quite a few teachers were asked to teach shortly after shifting from other fields, and it is not surprising that they are poorly educated [in terms of] professional knowledge and ethical theories.[2] The development of medical ethics in China thus must place great emphasis on the training of teachers. In China as in the United States, teachers play a key role in the development and promotion of medical ethics. How competent the ethics teachers actually are reflects the status of the discipline in the whole country. We have every reason to do a better job in teacher training in medical ethics. The Goals and Objectives of Faculty Development Let us first define the goals and objectives of faculty development in medical ethics. What are the qualifications for these teachers and what goals should they pursue? To answer these questions, we should first be aware of the current situation of medical ethics in China and know the challenges the profession is facing. Nowadays, with the progress in biological technology, medicine is troubled by many ethical problems that it has never faced before. Consequently, traditional medical ethics is also facing new challenges. As I have noted elsewhere, Although traditional medical ethics holds saving life to be its principle, the problems it encounters differ greatly from the problems of ethics caused by the advance of biology. Bioethics is not only simply a continuation of traditional medical ethics but also a challenge to traditional medical ethics.[3] Every society faces the question of whether and how much to invest in a high technology but also high cost and often in-efficient health care system. These decisions are not only economic but also ethical, and bioethics increasingly focuses on distribution of health resources, the adaptability of advanced medical technology, and decisionmaking at times of conflict between intuition and ethical understanding.[4] Thus medical ethics has entered a new phase. Medical ethics as a discipline has to carry out four tasks today: (1) To portray outstanding doctors and to nurture humanitarianism in medical service--the tradition of medical ethics that continues to have its significance today. (2) To pave the way for reasonable use of new medical technology. In recent decades, we have seen many breakthroughs in biology--the discovery of the double helix structure of DNA in 1953 gave birth to molecular biology, while the revelation of genetic codes and the realization of genetic engineering have made it possible to change the life course, to improve the quality of life, and to prevent many diseases. But the new wonders of biology must be evaluated as to whether they are ethically permissible. Literally speaking, bioethics is a bridge as well as a pioneer leading us to the medicine of the future. …

The American medical ethics revolution: how the AMA's code of ethics has transformed physicians' relationships to patients, professionals, and society

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as springboard for discussions of the problems of the present, including what the editors call a sense of moral crisis precipitated by the shift from system of fee-for-service medicine to system of fee-for-system medicine, better known as 'managed care.' The authors begin with look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D.

An AIDS lexicon

The sudden appearance of a truly new disease is a wake-up call. A new global pandemic of an infectious agent, transmitted through sexual contact and blood, affecting alienated and/or deprived...

The development of medical ethics for the new millennium.

The development of medical ethics for the new millennium.

Reconceiving the Family: The Process of Consent in Medical Decisionmaking

Medical ethics has rediscovered family. At least two factors have contributed to widening focus from individual. There has been a general revival of communitarian rhetoric in United States that, of course, brings role of social relations to fore. Similarly, we should not underestimate natural progression and development of medical ethics. Having focused on rights of patient for so long, it follows that ethicists now wish to map relationships surrounding individual that may affect medical decisionmaking. Because this interest in family is a concern with significant relationships that surround patient, family is described in terms of closeness, not biology. This way of describing family is commonplace in medical ethics and is a meritorious convention.[1] Thus, when John Hardwig asks, What about Family?[2] he asks whether there is any role in medical decision-making for those close to patient This is question because our thinking about medical decisionmaking is entirely patient-centered. This patient-centered ethic is systematized as doctrine of informed consent. Without much exaggeration it can be said that all of medical ethics is but a footnote to informed consent. It is concept that first called medicine out of its paternalistic slumber and into open light of public scrutiny. Informed consent serves as foundation upon which answers to new questions and problems are constructed. Informed consent is a kind of doctrine, that is, an amalgam of legal and philosophical reasoning with a conceptual framework and a number of specific prescriptions. This framework entails a few basic actions and presupposes certain conditions. At heart of doctrine is legal principle that the right of a competent person to refuse medical treatment is virtually absolute.[3] The exercise of this right presupposes that patient must receive all information relevant to decision to undergo or forgo a proposed treatment and that he or she must comprehend information. The legal principle indicates that patient needs to be competent and it is also implicit that choice is relatively freely made. Although influence is acceptable, all forms of coercion are beyond pale.[4] The individualistic nature of this line of thought is clear. The person is conceptualized as possessing a sphere of protected activity or privacy free from unwanted interference. Within this zone of privacy, one is able to exercise his or her liberty and discretion. Within this protected sphere take place disclosure, comprehension, and choice, which express patient's right of self-determination over her body.[5] Of course, these are legal formulations. The philosophical justification for them draws on egalitarian or democratic intuitions regarding personhood. The person is opaque to others and therefore best judge and guardian of his or her own interests. Although physician may be expert on medical facts, patient is only individual with genuine insight into his private sphere of values. Because treatment plans should reflect personal values as well as medical realities, patient must be ultimate decisionmaker.[6] Once we sketch person in this way, problem for ethicists is obvious. The doctrine of informed consent is based on an individual profile rather than a family portrait. The individual is outlined first, and only then do we ask where close others may be added to picture. Because philosophical and legal premises of doctrine leave few other reasonable options, family is usually conceived as comprising competing interests. Such a result is not adequate to our ordinary intuitions regarding relationship of patient to family. Furthermore, these premises limit ethicists to arguing about relative merits of these rival bundles of interests. Once we understand relationship between doctrine of informed consent and inability of medical ethicists to adequately describe role of family in medical decisionmaking, tasks become clear. …

Measurement of moral development in medicine.

The past two decades have been a time of heightened interest in the moral aspects of the practice of medicine. This interest has been reflected in medical education by the establishment of medical humanities programs in both preclinical and clinical education in many medical schools. It has also been reflected in the literature with a dramatic increase in journal articles on medical ethics as well as the development of medical ethics in textbooks. A number of journals have developed that are specifically devoted to medical ethics, includingThe Journal of Medical Ethics, The Journal of Medicine and Philosophy, The Journal of Medical Humanities, Theoretical Medicine, Cambridge Quarterly of Healthcare Ethics, just to name a few. The literature includes both theoretical foundations and conceptual analyses of particular issues as well as practical advice and general suggestions for how to implement programs in medical humanities.