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122-411: There are several codes of conduct. The Hippocratic Oath discusses basic principles for medical professionals. This document dates back to the fifth century BCE. Both The Declaration of Helsinki (1964) and The Nuremberg Code (1947) are two well-known and well respected documents contributing to medical ethics. Other important markings in the history of medical ethics include Roe v. Wade in 1973 and

244-399: A mental disorder may be treated involuntarily . Examples include when a patient does not want treatment because of, for example, religious or cultural views. In the case of euthanasia , the patient, or relatives of a patient, may want to end the life of the patient. Also, the patient may want an unnecessary treatment , as can be the case in hypochondria or with cosmetic surgery ; here,

366-445: A pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone , but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in

488-2144: A Latin translation. In this translation, the author translates πεσσὸν to the Latin fœtum . Below is the Hippocratic Oath, in Greek, from the 1923 Loeb edition, followed by the English translation: ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε: ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί. διαιτήμασί τε χρήσομαι ἐπ᾽ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε: ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν. οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε. ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾽ ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων. ἃ δ᾽ ἂν ἐνθεραπείῃ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα. ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον: παραβαίνοντι δὲ καὶ ἐπιορκέοντι, τἀναντία τούτων. I swear by Apollo Healer, by Asclepius , by Hygieia , by Panacea , and by all

610-415: A combination which was later shown to have no impact on COVID-19 survivorship and carried notable cardiotoxic side-effects — as well as a type of vaccine hesitancy specifically due to the speed at which COVID-19 vaccines were created and made publicly available. However, open science also allowed for the rapid implementation of life-saving public interventions like wearing masks and social distancing ,

732-443: A deep, almost monastic devotion to the art of medicine. He who keeps to the oath is promised "reputation among all men for my life and for my art". This contrasts heavily with Galenic writings on professional ethics, which employ a far more pragmatic approach, where good practice is defined as effective practice, without reference to deities. The oath's importance among the medical community is nonetheless attested by its appearance on

854-403: A description of an abortion, without any implication that it was morally wrong, and descriptions of abortifacient medications are numerous in the ancient medical literature. The oath's stance on abortion was unclear even in the ancient world where physicians debated whether the specification of pessaries was a ban on simply pessaries , or a blanket ban on all abortion methods. Scribonius Largus

976-447: A fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as

1098-426: A higher standard of behavior than the law dictates. The term medical ethics first dates back to 1803, when English author and physician Thomas Percival published a document describing the requirements and expectations of medical professionals within medical facilities. The Code of Ethics was then adapted in 1847, relying heavily on Percival's words. Over the years in 1903, 1912, and 1947, revisions have been made to

1220-446: A mere formality". In Nazi Germany , medical students did not take the Hippocratic Oath, although they knew the ethic of "nil nocere"—do no harm. In the 1960s, the Hippocratic Oath was changed to require "utmost respect for human life from its beginning", making it a more secular obligation, not to be taken in the presence of any gods, but before only other people. When the oath was rewritten in 1964 by Louis Lasagna , Academic Dean of

1342-529: A more general prohibition on, for example, doing physical or other harm to other persons. In the United States, several major judicial decisions have made reference to the classical Hippocratic Oath, either upholding or dismissing its bounds for medical ethics: Roe v. Wade , Washington v. Harper , Compassion in Dying v. State of Washington (1996), and Thorburn v. Department of Corrections (1998). In antiquity,

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1464-430: A non-heart beating donor ( NHBD ), where life support fails to restore the heartbeat and is now considered futile but brain death has not occurred. Classifying a patient as a NHBD can qualify someone to be subject to non-therapeutic intensive care, in which treatment is only given to preserve the organs that will be donated and not to preserve the life of the donor. This can bring up ethical issues as some may see respect for

1586-495: A patient's capacity for making life-and-death decisions at the end of life. Persons with a psychiatric condition such as delirium or clinical depression may lack capacity to make end-of-life decisions. For these persons, a request to refuse treatment may be taken in the context of their condition. Unless there is a clear advance directive to the contrary, persons lacking mental capacity are treated according to their best interests. This will involve an assessment involving people who know

1708-470: A patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat

1830-568: A person who does not have the capacity to consent under Article 5. As of December 2013, the convention had been ratified or acceded to by twenty-nine member-states of the Council of Europe. The United Nations Educational, Scientific and Cultural Organization (UNESCO) also promotes the protection of human rights and human dignity . According to UNESCO, "Declarations are another means of defining norms, which are not subject to ratification. Like recommendations, they set forth universal principles to which

1952-436: A profession that's committed to a shared set of essential ethical values." There is no direct punishment for breaking the Hippocratic Oath, although an arguable equivalent in modern times is medical malpractice , which carries a wide range of punishments, from imprisonment to civil penalties. Medical professionals may also be subject to other parts of the criminal and civil law for conduct contrary to both an oath taken and to

2074-581: A program conducted by medieval Christian thinkers attempting to harmonize the various authorities of their own tradition, and to reconcile Christian theology with classical and late antiquity philosophy, especially that of Aristotle but also of Neoplatonism . The Scholastics, also known as Schoolmen , included as its main figures Anselm of Canterbury ("the father of scholasticism" ), Peter Abelard , Alexander of Hales , Albertus Magnus , Duns Scotus , William of Ockham , Bonaventure , and Thomas Aquinas . Aquinas's masterwork Summa Theologica (1265–1274)

2196-484: A question to the teacher unannounced – disputationes de quodlibet . In this case, the teacher responded and the students rebutted; on the following day the teacher, having used notes taken during the disputation, summarised all arguments and presented his final position, riposting all rebuttals. The quaestio method of reasoning was initially used especially when two authoritative texts seemed to contradict one another. Two contradictory propositions would be considered in

2318-411: A range of works by William of Conches that attempted to reconcile the use of classical pagan and philosophical sources in a medieval Christian concept using the kludge of integumentum , treating the obviously heretical surface meanings as coverings disguising a deeper (and more orthodox) truth. Abelard himself was condemned by Bernard of Clairvaux at the 1141 Council of Sens and William avoided

2440-453: A recommended treatment, in order to be able to make a well-considered, voluntary decision about their care. To give informed consent, a patient must be competent to make a decision regarding their treatment and be presented with relevant information regarding a treatment recommendation, including its nature and purpose, and the burdens, risks and potential benefits of all options and alternatives. After receiving and understanding this information,

2562-409: A similar fate through systematic self-bowdlerization of his early work, but his commentaries and encyclopedic De Philosophia Mundi and Dragmaticon were miscredited to earlier scholars like Bede and widely disseminated. Anselm of Laon systematized the production of the gloss on Scripture, followed by the rise to prominence of dialectic (the middle subject of the medieval trivium ) in

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2684-410: A single action, and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence. A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient while simultaneously having the maleficent effect of shortening the life of

2806-433: A social reaction against the " paternalistic " tradition within healthcare. Some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism to the detriment of outcomes for some patients. The definition of autonomy is the ability of an individual to make a rational, uninfluenced decision. Therefore, it can be said that autonomy

2928-786: A “first, do no harm” approach vs. a “first, do good” approach, such as when deciding whether or not to operate when the balance between the risk and benefit of the operation is not known and must be estimated. Healthcare professionals who place beneficence below other principles like non-maleficence may decide not to help a patient more than a limited amount if they feel they have met the standard of care and are not morally obligated to provide additional services. Young and Wagner argued that, in general, beneficence takes priority over non-maleficence (“first, do good,” not “first, do no harm”), both historically and philosophically. Autonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in

3050-429: Is a general indicator of a healthy mind and body. The progression of many terminal diseases are characterized by loss of autonomy, in various manners and extents. For example, dementia , a chronic and progressive disease that attacks the brain can induce memory loss and cause a decrease in rational thinking, almost always results in the loss of autonomy. Psychiatrists and clinical psychologists are often asked to evaluate

3172-558: Is a part of the original Hippocratic oath. A related phrase is found in Epidemics, Book I, of the Hippocratic school: "Practice two things in your dealings with disease: either help or do not harm the patient". Although no such phrase from which "First" or "Primum" can be translated appears in any well recognized version of the oath, a similar intention is vowed by, "I will abstain from all intentional wrong-doing and harm". " Primum non nocere "

3294-424: Is also important to know how likely it is that your treatment will harm a patient. So a physician should go further than not prescribing medications they know to be harmful—he or she should not prescribe medications (or otherwise treat the patient) unless s/he knows that the treatment is unlikely to be harmful; or at the very least, that patient understands the risks and benefits, and that the likely benefits outweigh

3416-449: Is an extension of the principle of autonomy. On the other hand, autonomy and beneficence/non-maleficence may also overlap. For example, a breach of patients' autonomy may cause decreased confidence for medical services in the population and subsequently less willingness to seek help, which in turn may cause inability to perform beneficence. The principles of autonomy and beneficence/non-maleficence may also be expanded to include effects on

3538-709: Is considered to be the pinnacle of scholastic, medieval, and Christian philosophy; it began while Aquinas was regent master at the studium provinciale of Santa Sabina in Rome, the forerunner of the Pontifical University of Saint Thomas Aquinas , Angelicum . Important work in the scholastic tradition has been carried on well past Aquinas's time, such as English scholastics Robert Grosseteste and his student Roger Bacon , and for instance by Francisco Suárez and Luis de Molina , and also among Lutheran and Reformed thinkers. The terms "scholastic" and "scholasticism" derive from

3660-802: Is illuminated by religious faith. Other important Franciscan scholastics were Duns Scotus , Peter Auriol and William of Ockham . By contrast, the Dominican order, a teaching order founded by St Dominic in 1215, to propagate and defend Christian doctrine, placed more emphasis on the use of reason and made extensive use of the new Aristotelian sources derived from the East and Moorish Spain. The great representatives of Dominican thinking in this period were Albertus Magnus and (especially) Thomas Aquinas , whose artful synthesis of Greek rationalism and Christian doctrine eventually came to define Catholic philosophy. Aquinas placed more emphasis on reason and argumentation, and

3782-519: Is important to realize that normality is ambiguous and that ambiguity in healthcare and the acceptance of such ambiguity is necessary in order to practice humbler medicine and understand complex, sometimes unusual usual medical cases. Thus, society's views on central concepts in philosophy and clinical beneficence must be questioned and revisited, adopting ambiguity as a central player in medical practice. Beneficence can come into conflict with non-maleficence when healthcare professionals are deciding between

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3904-492: Is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods , to uphold specific ethical standards. The oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today. These include the principles of medical confidentiality and non-maleficence . As

4026-435: Is part of the Hippocratic oath that doctors take. This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no harm to the patient. Much harm has been done to patients as a result, as in the saying, "The treatment was a success, but the patient died." It is not only more important to do no harm than to do good; it

4148-564: Is taken in place of or in addition to the Hippocratic Oath. The Osteopathic Oath was first used in 1938, and the current version has been in use since 1954. In France, it is common for new medical graduates to sign a written oath. In 1995, Sir Joseph Rotblat , in his acceptance speech for the Nobel Peace Prize , suggested a Hippocratic Oath for Scientists . In November 2005, Saparmurat Niyazov , then leader of Turkmenistan , declared that doctors should swear an oath to him instead of

4270-606: Is traditionally attributed to the Greek doctor Hippocrates and it is usually included in the Hippocratic Corpus , some modern scholars do not regard it as having been written by Hippocrates himself. The oldest partial fragments of the oath date to circa AD 275. The oldest extant version dates to roughly the 10th–11th century, held in the Vatican Library . A commonly cited version, dated to 1595, appears in Koine Greek with

4392-527: The Franciscans and the Dominicans . The Franciscans were founded by Francis of Assisi in 1209. Their leader in the middle of the century was Bonaventure , a traditionalist who defended the theology of Augustine and the philosophy of Plato , incorporating only a little of Aristotle in with the more neoplatonist elements. Following Anselm, Bonaventure supposed that reason can only discover truth when philosophy

4514-755: The Latin word scholasticus , the Latinized form of the Greek σχολαστικός ( scholastikos ), an adjective derived from σχολή ( scholē ), " school ". Scholasticus means "of or pertaining to schools". The "scholastics" were, roughly, "schoolmen". The foundations of Christian scholasticism were laid by Boethius through his logical and theological essays, and later forerunners (and then companions) to scholasticism were Islamic Ilm al-Kalām , meaning "science of discourse", and Jewish philosophy , especially Jewish Kalam . The first significant renewal of learning in

4636-681: The Ostrogothic Christian king Theodoric the Great . In the medieval and early modern period, the field is indebted to Islamic scholarship such as Ishaq ibn Ali al-Ruhawi (who wrote the Conduct of a Physician , the first book dedicated to medical ethics), Avicenna 's Canon of Medicine and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides , Roman Catholic scholastic thinkers such as Thomas Aquinas , and

4758-681: The Parliament of the United Kingdom . It introduced compulsory apprenticeship and formal qualifications for the apothecaries of the day under the license of the Society of Apothecaries. This was the beginning of regulation of the medical profession in the UK. In 1847, the American Medical Association adopted its first code of ethics , with this being based in large part upon Percival's work. While

4880-513: The actus essendi or act of existence of finite beings by participating in being itself. Other scholars such as those involved with the "Progetto Tommaso" seek to establish an objective and universal reading of Aquinas' texts. Thomistic scholasticism in the English speaking world went into decline in the 1970s when the Thomistic revival that had been spearheaded by Jacques Maritain , Étienne Gilson , and others, diminished in influence. Partly, this

5002-571: The collected works of Aristotle . Endeavoring to harmonize his metaphysics and its account of a prime mover with the Latin Catholic dogmatic trinitarian theology, these monastic schools became the basis of the earliest European medieval universities , and thus became the bedrock for the development of modern science and philosophy in the Western world. Scholasticism dominated education in Europe from about 1100 to 1700. The rise of scholasticism

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5124-408: The quaestio students could ask questions ( quaestiones ) that might have occurred to them during meditatio . Eventually the discussion of questiones became a method of inquiry apart from the lectio and independent of authoritative texts. Disputationes were arranged to resolve controversial quaestiones . Questions to be disputed were ordinarily announced beforehand, but students could propose

5246-637: The 12th century also included figures like Constantine the African in Italy and James of Venice in Constantinople. Scholars such as Adelard of Bath traveled to Spain and Sicily, translating works on astronomy and mathematics, including the first complete translation of Euclid 's Elements into Latin. At the same time, the School of Chartres produced Bernard of Chartres 's commentaries on Plato 's Timaeus and

5368-440: The 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of Institutional Review Boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula. In December 2019, the virus COVID-19 emerged as a threat to worldwide public health and, over

5490-591: The American Medical Association's Code of Medical Ethics (first adopted in 1847), and the British General Medical Council's Good Medical Practice . These documents provide a comprehensive overview of the obligations and professional behaviour of a doctor to their patients and wider society. Doctors who violate these codes may be subjected to disciplinary proceedings, including the loss of their license to practice medicine. Nonetheless,

5612-551: The Corpus: the Physician mentions the obligation to keep the "holy things" of medicine within the medical community (i.e. not to divulge secrets); it also mentions the special position of the doctor with regard to his patients, especially women and girls. However, several aspects of the oath contradict patterns of practice established elsewhere in the Corpus. Most notable is its ban on the use of

5734-516: The Declaration of Geneva, sixty-seven used a modified Hippocratic Oath, four used the Oath of Maimonides , one used a covenant, eight used another oath, one used an unknown oath, and two did not use any kind of oath. Seven medical schools did not reply to the survey. As of 1993, only 14% of medical oaths prohibited euthanasia, and only 8% prohibited abortion. In a 2000 survey of US medical schools, all of

5856-565: The Greek language and translated many works into Latin, affording access to the Cappadocian Fathers and the Greek theological tradition . Three other primary founders of scholasticism were the 11th-century archbishops Lanfranc and Anselm of Canterbury in England and Peter Abelard in France . This period saw the beginning of the " rediscovery " of many Greek works which had been lost to

5978-500: The Hippocratic Oath. In 2007, US citizen Rafiq Abdus Sabir was convicted for making a pledge to al-Qaeda , thus agreeing to provide medical aid to wounded terrorists. As of 2018, all US medical school graduates made some form of public oath but none used the original Hippocratic Oath. A modified form or an oath unique to that school is often used. A review of 18 of these oaths was criticized for their wide variability: "Consistency would help society see that physicians are members of

6100-613: The Latin West. As early as the latter half of the 10th century, the Toledo School of Translators in Muslim Spain had begun translating Arabic texts into Latin. After a successful burst of Reconquista in the 12th century, Spain opened even further for Christian scholars and, as these Europeans encountered Judeo-Islamic philosophies , they opened a wealth of Arab and Judaic knowledge of mathematics and astronomy. The Latin translations of

6222-534: The Reformation, Calvinists largely adopted the scholastic method of theology, while differing regarding sources of authority and content of theology. The revival and development from the second half of the 19th century of medieval scholastic philosophy is sometimes called neo- Thomism . As J. A. Weisheipl O.P. emphasizes, within the Dominican Order Thomistic scholasticism has been continuous since

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6344-474: The School of Medicine at Tufts University, the prayer was omitted, and that version has been widely accepted and is still in use today by many US medical schools: I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for

6466-467: The United States individualistic and self-interested healthcare norms are upheld, whereas in other countries, including European countries, a sense of respect for the community and personal support is more greatly upheld in relation to free healthcare. The concept of normality, that there is a human physiological standard contrasting with conditions of illness, abnormality and pain, leads to assumptions and bias that negatively affects health care practice. It

6588-653: The West came with the Carolingian Renaissance of the Early Middle Ages . Charlemagne , advised by Peter of Pisa and Alcuin of York , attracted the scholars of England and Ireland, where some Greek works continued to survive in the original. By a 787 decree, he established schools at every abbey in his empire. These schools, from which the name scholasticism derived, became centers of medieval learning. During this period, knowledge of Ancient Greek had vanished in

6710-582: The West except in Ireland, where its teaching and use was fairly common in its monastic schools . Irish scholars had a considerable presence in the Frankish court , where they were renowned for their learning. Among them was Johannes Scotus Eriugena (815–877), one of the founders of scholasticism. Eriugena was the most significant Irish intellectual of the early monastic period and an outstanding philosopher in terms of originality. He had considerable familiarity with

6832-740: The advent of a document that defines human rights has had its effect on medical ethics. Most codes of medical ethics now require respect for the human rights of the patient. The Council of Europe promotes the rule of law and observance of human rights in Europe . The Council of Europe adopted the European Convention on Human Rights and Biomedicine (1997) to create a uniform code of medical ethics for its 47 member-states. The Convention applies international human rights law to medical ethics. It provides special protection of physical integrity for those who are unable to consent, which includes children. No organ or tissue removal may be carried out on

6954-465: The author intended to prohibit any and all abortions. Olivia De Brabandere writes that regardless of the author's original intention, the vague and polyvalent nature of the relevant line has allowed both professionals and non-professionals to interpret and use the oath in several ways. While many Christian versions of the Hippocratic Oath, particularly from the Middle Ages, explicitly prohibited abortion,

7076-426: The benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism . I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for

7198-512: The best interests of patients and their families. However, uncertainty surrounds the precise definition of which practices do in fact help patients. James Childress and Tom Beauchamp in Principles of Biomedical Ethics (1978) identify beneficence as one of the core values of healthcare ethics . Some scholars, such as Edmund Pellegrino , argue that beneficence is the only fundamental principle of medical ethics. They argue that healing should be

7320-512: The case-oriented analysis ( casuistry ) of Catholic moral theology . These intellectual traditions continue in Catholic , Islamic and Jewish medical ethics . By the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. In England, Thomas Percival , a physician and author, crafted the first modern code of medical ethics. He drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, in which he coined

7442-407: The classroom and in writing, it often takes the form of explicit disputation ; a topic drawn from the tradition is broached in the form of a question, oppositional responses are given, a counterproposal is argued and oppositional arguments rebutted. Because of its emphasis on rigorous dialectical method, scholasticism was eventually applied to many other fields of study. Scholasticism was initially

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7564-650: The community of States wished to attribute the greatest possible authority and to afford the broadest possible support." UNESCO adopted the Universal Declaration on Human Rights and Biomedicine (2005) to advance the application of international human rights law in medical ethics. The Declaration provides special protection of human rights for incompetent persons. In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and

7686-466: The course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me. It is often said that "First do no harm" ( Latin : Primum non nocere )

7808-608: The development of hemodialysis in the 1960s. With hemodialysis now available, but a limited number of dialysis machines to treat patients, an ethical question arose on which patients to treat and which ones not to treat, and which factors to use in making such a decision. More recently, new techniques for gene editing aiming at treating, preventing and curing diseases utilizing gene editing, are raising important moral questions about their applications in medicine and treatments as well as societal impacts on future generations. As this field continues to develop and change throughout history,

7930-402: The doctor and the patient. Medical ethics is closely related to bioethics , but these are not identical concepts. Since the science of bioethics arose in an evolutionary way in the continuation of the development of medical ethics, it covers a wider range of issues. Medical ethics is also related to the law . But ethics and law are not identical concepts . More often than not, ethics implies

8052-559: The donors wishes to donate their healthy organs as respect for autonomy, while others may view the sustaining of futile treatment during vegetative state maleficence for the patient and the patient's family. Some are worried making this process a worldwide customary measure may dehumanize and take away from the natural process of dying and what it brings along with it. Individuals' capacity for informed decision-making may come into question during resolution of conflicts between autonomy and beneficence. The role of surrogate medical decision-makers

8174-536: The end of the pandemic which, as of September 12, 2022, is still ongoing. A common framework used when analysing medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook Principles of Biomedical Ethics . It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. The four principles are: The principle of autonomy , broken down into "autos" (self) and "nomos (rule), views

8296-476: The era between the deaths of William of Ockham and Nicholas of Cusa , there was a distinct period characterized by "robust and independent philosophers" who departed from high scholasticism on issues such as institutional criticism and materialism but retained scholasticism's method. These philosophers include Marsilius of Padua , Thomas Bradwardine , John Wycliffe , Catherine of Sienna , Jean Gerson , Gabriel Biel and ended with Nicholas of Cusa. Following

8418-433: The expressions "medical ethics" and "medical jurisprudence". However, there are some who see Percival's guidelines that relate to physician consultations as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In addition, since

8540-651: The focus remains on fair, balanced, and moral thinking across all cultural and religious backgrounds around the world. The field of medical ethics encompasses both practical application in clinical settings and scholarly work in philosophy , history , and sociology . Medical ethics encompasses beneficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. In addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying

8662-523: The following years, ignited novel inquiry into modern-age medical ethics. For example, since the first discovery of COVID-19 in Wuhan, China and subsequent global spread by mid-2020, calls for the adoption of open science principles dominated research communities. Some academics believed that open science principles — like constant communication between research groups, rapid translation of study results into public policy, and transparency of scientific processes to

8784-493: The foundational articulation of certain principles that continue to guide and inform medical practice, the ancient text is of more than historic and symbolic value. It is enshrined in the legal statutes of various jurisdictions, such that violations of the oath may carry criminal or other liability beyond the oath's symbolic nature. The original oath was written in Ionic Greek , between the fifth and third centuries BC. Although it

8906-565: The fourth or fifth century BC. Alternatively, classical scholar Ludwig Edelstein proposed that the oath was written by the Pythagoreans , an idea that others questioned for lack of evidence for a school of Pythagorean medicine. While Pythagorean philosophy displays a correlation to the Oath's values, the proposal of a direct relationship has been mostly discredited in more recent studies. Its general ethical principles are also found in other works of

9028-492: The gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons,

9150-417: The high period of scholasticism. The early 13th century witnessed the culmination of the recovery of Greek philosophy . Schools of translation grew up in Italy and Sicily, and eventually in the rest of Europe. Powerful Norman kings gathered men of knowledge from Italy and other areas into their courts as a sign of their prestige. William of Moerbeke 's translations and editions of Greek philosophical texts in

9272-466: The importance of autonomy. This leads to an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings. Medical ethics defines relationships in the following directions: a medical worker — a patient; a medical worker — a healthy person (relatives); a medical worker — a medical worker. Medical ethics includes provisions on medical confidentiality , medical errors , iatrogenesis , duties of

9394-399: The infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. In a 1989 survey of 126 US medical schools, only three of them reported use of the original oath, while thirty-three used

9516-566: The issue of physician-assisted death , or PAD. Examples of such organizations are the Hemlock Society of the United States and the Dignity in Dying campaign in the United Kingdom. These groups believe that doctors should be given the right to end a patient's life only if the patient is conscious enough to decide for themselves, is knowledgeable about the possibility of alternative care, and has willingly asked to end their life or requested access to

9638-460: The knife, even for small procedures such as lithotomy , even though other works in the Corpus provide guidance on performing surgical procedures. Providing poisonous drugs would certainly have been viewed as immoral by contemporary physicians if it resulted in murder. However, the absolute ban described in the oath also forbids euthanasia . Several accounts of ancient physicians willingly assisting suicides have survived. Multiple explanations for

9760-526: The length of these documents has made their distillations into shorter oaths an attractive proposition. In light of this fact, several updates to the oath have been offered in modern times, some facetious. The oath has been modified numerous times. One of the most significant revisions was first drafted in 1948 by the World Medical Association (WMA), called the Declaration of Geneva . "During

9882-405: The likely risks. In practice, however, many treatments carry some risk of harm. In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm. So the principle of non-maleficence is not absolute, and balances against

10004-441: The means to do so. This argument is disputed in other parts of the world. For example, in the state of Louisiana, giving advice or supplying the means to end a person's life is considered a criminal act and can be charged as a felony. In state courts, this crime is comparable to manslaughter. The same laws apply in the states of Mississippi and Nebraska. Informed consent refers to a patient's right to receive information relevant to

10126-466: The mid 19th century up to the 20th century, physician-patient relationships that once were more familiar became less prominent and less intimate, sometimes leading to malpractice, which resulted in less public trust and a shift in decision-making power from the paternalistic physician model to today's emphasis on patient autonomy and self-determination . In 1815, the Apothecaries Act was passed by

10248-464: The middle half of the thirteenth century helped form a clearer picture of Greek philosophy, particularly of Aristotle, than was given by the Arabic versions on which they had previously relied. Edward Grant writes "Not only was the structure of the Arabic language radically different from that of Latin, but some Arabic versions had been derived from earlier Syriac translations and were thus twice removed from

10370-493: The original Greek text. Word-for-word translations of such Arabic texts could produce tortured readings. By contrast, the structural closeness of Latin to Greek, permitted literal, but intelligible, word-for-word translations." Universities developed in the large cities of Europe during this period, and rival clerical orders within the church began to battle for political and intellectual control over these centers of educational life. The two main orders founded in this period were

10492-464: The original document. The practice of medical ethics is widely accepted and practiced throughout the world. Historically, Western medical ethics may be traced to guidelines on the duty of physicians in antiquity, such as the Hippocratic Oath , and early Christian teachings. The first code of medical ethics, Formula Comitis Archiatrorum , was published in the 5th century, during the reign of

10614-426: The patient can then make a fully informed decision to either consent or refuse treatment. In certain circumstances, there can be an exception to the need for informed consent, including, but not limited to, in cases of a medical emergency or patient incompetency. The ethical concept of informed consent also applies in a clinical research setting; all human participants in research must voluntarily decide to participate in

10736-465: The patient through the deactivation of the respiratory system. The human rights era started with the formation of the United Nations in 1945, which was charged with the promotion of human rights. The Universal Declaration of Human Rights (1948) was the first major document to define human rights. Medical doctors have an ethical duty to protect the human rights and human dignity of the patient so

10858-496: The patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. In general, Western medicine defers to the wishes of a mentally competent patient to make their own decisions, even in cases where the medical team believes that they are not acting in their own best interests. However, many other societies prioritize beneficence over autonomy. People deemed to not be mentally competent or having

10980-444: The person best to what decisions the person would have made had they not lost capacity. Persons with the mental capacity to make end-of-life decisions may refuse treatment with the understanding that it may shorten their life. Psychiatrists and psychologists may be involved to support decision making. The term beneficence refers to actions that promote the well-being of others. In the medical context, this means taking actions that serve

11102-471: The personal integrity of such individuals respected. Individualistic standards of autonomy and personal human rights as they relate to social justice seen in the Anglo-Saxon community, clash with and can also supplement the concept of solidarity , which stands closer to a European healthcare perspective focused on community, universal welfare, and the unselfish wish to provide healthcare equally for all. In

11224-1088: The philosophical and theological tradition stretching back to the time of St. Thomas. It focuses not only on exegesis of the historical Aquinas but also on the articulation of a rigorous system of orthodox Thomism to be used as an instrument of critique of contemporary thought. Due to its suspicion of attempts to harmonize Aquinas with non-Thomistic categories and assumptions, Scholastic Thomism has sometimes been called, according to philosophers like Edward Feser , "Strict Observance Thomism". A discussion of recent and current Thomistic scholasticism can be found in La Metafisica di san Tommaso d'Aquino e i suoi interpreti (2002) by Battista Mondin  [ it ] , which includes such figures as Sofia Vanni Rovighi (1908–1990), Cornelio Fabro (1911–1995), Carlo Giacon (1900–1984), Tomas Tyn O.P. (1950–1990), Abelardo Lobato O.P. (1925–2012), Leo Elders (1926– ) and Giovanni Ventimiglia (1964– ) among others. Fabro in particular emphasizes Aquinas' originality, especially with respect to

11346-475: The post World War II and immediately after its foundation, the WMA showed concern over the state of medical ethics in general and over the world. The WMA took up the responsibility for setting ethical guidelines for the world's physicians. It noted that in those years the custom of medical schools to administer an oath to its doctors upon graduation or receiving a license to practice medicine had fallen into disuse or become

11468-407: The practitioner may be required to balance the desires of the patient for medically unnecessary potential risks against the patient's informed autonomy in the issue. A doctor may want to prefer autonomy because refusal to respect the patient's self-determination would harm the doctor-patient relationship . Organ donations can sometimes pose interesting scenarios, in which a patient is classified as

11590-487: The principle of beneficence (doing good), as the effects of the two principles together often give rise to a double effect (further described in next section). Even basic actions like taking a blood sample or an injection of a drug cause harm to the patient's body. Euthanasia also goes against the principle of beneficence because the patient dies as a result of the medical treatment by the doctor. Double effect refers to two types of consequences that may be produced by

11712-456: The prohibition is often omitted from many oaths taken in US medical schools today, though it remains controversial. The oath stands out among comparable ancient texts on medical ethics and professionalism through its heavily religious tone, a factor which makes attributing its authorship to Hippocrates particularly difficult. Phrases such as "but I will keep pure and holy both my life and my art" suggest

11834-513: The prohibition of euthanasia in the oath have been proposed: it is possible that not all physicians swore the oath, or that the oath was seeking to prevent widely held concerns that physicians could be employed as political assassins. The interpreted AD 275 fragment of the oath contains a prohibition of abortion that is in contradiction to original Hippocratic text On the Nature of the Child , which contains

11956-414: The public — represented the only solutions to halt the impact of the virus. Others, however, cautioned that these interventions may lead to side-stepping safety in favor of speed, wasteful use of research capital, and creation of public confusion. Drawbacks of these practices include resource-wasting and public confusion surrounding the use of hydroxychloroquine and azithromycin as treatment for COVID-19 —

12078-646: The punishment for breaking the Hippocratic oath could range from a penalty to losing the right to practice medicine. In 2022, at a college in the Indian state of Tamil Nadu , medical students took the Charaka shapath , a Sanskrit oath attributed to ancient sage and physician Maharishi Charak instead of the Hippocratic oath. The state government subsequently dismissed the Dean of the Madurai medical college for this act. However, he

12200-542: The rapid development of multiple vaccines and monoclonal antibodies that have significantly lowered transmission and death rates, and increased public awareness about the severity of the pandemic as well as explanation of daily protective actions against COVID-19 infection, like hand washing . Other notable areas of medicine impacted by COVID-19 ethics include: The ethics of COVID-19 spans many more areas of medicine and society than represented in this paragraph — some of these principles will likely not be discovered until

12322-479: The relatives of patients or even the medical practitioners, the overall population and economic issues when making medical decisions. There is disagreement among American physicians as to whether the non-maleficence principle excludes the practice of euthanasia. Euthanasia is currently legal in the states of Washington, DC, California, Colorado, Oregon, Vermont, and Washington. Around the world, there are different organizations that campaign to change legislation about

12444-428: The rights of an individual to self-determination. This is rooted in society's respect for individuals' ability to make informed decisions about personal matters with freedom . Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient and their family rather than medical professionals. The increasing importance of autonomy can be seen as

12566-441: The secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher . In the 1960s and 1970s, building upon liberal theory and procedural justice , much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics . Well-known medical ethics cases include: Since

12688-427: The sole purpose of medicine, and that endeavors like cosmetic surgery and euthanasia are severely unethical and against the Hippocratic Oath . The concept of non-maleficence is embodied by the phrase, "first, do no harm," or the Latin, primum non nocere . Many consider that should be the main or primary consideration (hence primum ): that it is more important not to harm your patient, than to do them good, which

12810-450: The sons of my teacher, and to indentured pupils who have taken the Healer's oath, but to nobody else. I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman

12932-454: The specific requirements for obtaining informed consent vary state to state. Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court. Hippocratic Oath The Hippocratic Oath is an oath of ethics historically taken by physicians . It

13054-429: The study after being fully informed of all relevant aspects of the research trial necessary to decide whether to participate or not. Informed consent is both an ethical and legal duty; if proper consent is not received prior to a procedure, treatment, or participation in research, providers can be held liable for battery and/or other torts. In the United States, informed consent is governed by both federal and state law, and

13176-507: The subject, be it ancient or contemporary. The points of disagreement and contention between multiple sources would be written down in individual sentences or snippets of text, known as sententiae . Once the sources and points of disagreement had been laid out through a series of dialectics , the two sides of an argument would be made whole so that they would be found to be in agreement and not contradictory. (Of course, sometimes opinions would be totally rejected, or new positions proposed.) This

13298-480: The then extant medical schools administered some type of professional oath. Among schools of modern medicine, sixty-two of 122 used the Hippocratic Oath, or a modified version of it. The other sixty schools used the original or modified Declaration of Geneva, Oath of Maimonides, or an oath authored by students or faculty or both. All nineteen osteopathic schools in the United States used the Osteopathic Oath , which

13420-806: The time of Aquinas: "Thomism was always alive in the Dominican Order, small as it was after the ravages of the Reformation, the French Revolution, and the Napoleonic occupation. Repeated legislation of the General Chapters, beginning after the death of St. Thomas, as well as the Constitutions of the Order, required all Dominicans to teach the doctrine of St. Thomas both in philosophy and in theology." Thomistic scholasticism or scholastic Thomism identifies with

13542-410: The time – to show that contradictions did not exist but were subjective to the reader. Scholastic instruction consisted of several elements. The first was the lectio : a teacher would read an authoritative text followed by a commentary, but no questions were permitted. This was followed by the meditatio ( meditation or reflection) in which students reflected on and appropriated the text. Finally, in

13664-555: The tombstones of physicians, and by the fourth century AD it had come to stand for the medical profession. The oath continued to be in use in the Byzantine Christian world with its references to pagan deities replaced by a Christian preamble, as in the 12th-century manuscript pictured in the shape of a cross. The Hippocratic Oath has been eclipsed as a document of professional ethics by more extensive, regularly updated ethical codes issued by national medical associations, such as

13786-510: The work of Abelard . Peter Lombard produced a collection of Sentences , or opinions of the Church Fathers and other authorities. More recently, Leinsle , Novikoff , and others have argued against the idea that scholasticism primarily derived from philosophical contact, emphasizing its continuity with earlier Patristic Christianity . This remains, however, a minority viewpoint. The 13th and early 14th centuries are generally seen as

13908-541: Was adamant in AD 43 (the earliest surviving reference to the oath) that it precluded abortion. In the 1st or 2nd century AD work Gynaecology , Soranus of Ephesus wrote that one party of medical practitioners followed the Oath and banished all abortifacients, while the other party—to which he belonged—was willing to prescribe abortions, but only for the sake of the mother's health. William Henry Samuel Jones states that "abortion   [...] though doctors are forbidden to cause it,

14030-743: Was because this branch of Thomism had become a quest to understand the historical Aquinas after the Second Vatican Council . A renewed interest in the "scholastic" way of doing philosophy has recently awoken in the confines of the analytic philosophy . Attempts emerged to combine elements of scholastic and analytic methodology in pursuit of a contemporary philosophical synthesis. Proponents of various incarnations of this approach include Anthony Kenny , Peter King, Thomas Williams or David Oderberg . Cornelius O'Boyle explained that Scholasticism focuses on how to acquire knowledge and how to communicate effectively so that it may be acquired by others. It

14152-467: Was claimed by the 19th-century English surgeon Thomas Inman to date from the 17th-century English physician Thomas Sydenham , but Sydenham's available writings contain no such phrase or equivalent, and it more likely took shape from longstanding popular nonmedical expression. The oath is arguably the best known text of the Hippocratic Corpus , although most modern scholars do not attribute it to Hippocrates himself, estimating it to have been written in

14274-479: Was closely associated with these schools that flourished in Italy , France , Portugal , Spain and England . Scholasticism is a method of learning more than a philosophy or a theology, since it places a strong emphasis on dialectical reasoning to extend knowledge by inference and to resolve contradictions . Scholastic thought is also known for rigorous conceptual analysis and the careful drawing of distinctions. In

14396-437: Was done in two ways. The first was through philological analysis. Words were examined and argued to have multiple meanings. It was also considered that the auctor might have intended a certain word to mean something different. Ambiguity could be used to find common ground between two otherwise contradictory statements. The second was through logical analysis, which relied on the rules of formal logic – as they were known at

14518-559: Was one of the first to use the new translation of Aristotle's metaphysical and epistemological writing. This was a significant departure from the Neoplatonic and Augustinian thinking that had dominated much of early scholasticism. Aquinas showed how it was possible to incorporate much of the philosophy of Aristotle without falling into the "errors" of the Commentator, Averroes . Philosopher Johann Beukes has suggested that from 1349 to 1464,

14640-451: Was possibly not condemned in all cases". He believed that the oath prohibited abortions, though not under all circumstances. John M. Riddle argues that because Hippocrates specified pessaries, he only meant pessaries and therefore it was acceptable for a Hippocratic doctor to perform abortions using oral drugs, violent means, a disruption of daily routine or eating habits, and more. Other scholars, most notably Ludwig Edelstein , believe that

14762-535: Was reinstated by the Tamil Nadu government and assumed office 4 days later. Scholasticism Scholasticism was a medieval school of philosophy that employed a critical organic method of philosophical analysis predicated upon Aristotelianism and the Ten Categories . Christian scholasticism emerged within the monastic schools that translated scholastic Judeo-Islamic philosophies , and "rediscovered"

14884-458: Was thought that the best way to achieve this was by replicating the discovery process ( modus inveniendi ). The scholasticists would choose a book by a renowned scholar, auctor (author), as a subject for investigation. By reading it thoroughly and critically, the disciples learned to appreciate the theories of the author. Other documents related to the book would be referenced, such as Church councils, papal letters and anything else written on

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