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A Short History of Medical Ethics
Abstract
This survey of the origins and development of the ethics pertaining to the work of doctors, ranges from the Hippocratic medicine of ancient Greece through the Middle Ages, Renaissance and Enlightenment in Europe to the long history of medicine in India and China. Within this long, complex history, certain common themes about the duty of doctors appear. These themes are challenged by many of the current problems raised by modern science and practice.
... Ahlak felsefesinden tıbbi etiğe dönüldüğünde bu üç alan ortaya çıkar. Çünkü tıbbi bir yaşamda hekim, erdemli, hastalarına olan ödev ve yükümlülüklerini ifa eden, daha geniş topluluklar veya toplumda önemli roller üstlenerek refaha hizmet eden bir kişi olarak görülmektedir (2). ...
... Hipokrat metinlerinde, hekimin tıbbi bakıma ihtiyaç duyan herkese hizmet etme görevinden açıkça bahsedilmemektedir. Platon, vatandaş hekimlerin vatandaşları tedavi ederken, asistanların kölelere baktığını öne sürer, ancak sınıflar arasındaki bu engel resmini destekleyen yine de çok az kanıt vardır (2). Hatta bir yorumcu şu yorumu yapacak kadar ileri gitmektedir 'Hipokrat Koleksiyonu'nda yer alan pek çok tezin hiçbirinde köleler ve özgür insanlar arasında şimdiye kadar yapılmış en küçük ayrım yoktur. ...
... Platon, zehirlenerek kasıtlı olarak zarar verme niyetinde olan bir hekimin öldürülmesi gerektiğini, Aristoteles, hekimlerin tıbbi başarısızlıklarının herhangi bir vatandaş jüri üyesi tarafından değil, sadece tıp eğitimi almış kişiler tarafından yargılanması gerektiğini öne sürmüştür (bir hekimin beceri ve bilgisi özel bir değerlendirme gerektirir). Kısacası devlet ile hekimler arasında muğlak bir ilişki şekli önerilmiştir (2). Orta Çağ' da da aynı muğlaklık devam etmiş, her türden uygulayıcının (şifacılar, hekimler, büyücüler, rahipler vs.) tıp pratiğinde yer alması ve bölünmüş bir tıp mesleği (eczacılık, cerrahlık ve hekimlik), hekimleri, tıbbi eserlerin içlerine serpiştirilen ideal hekim tasvirleri ve nasihatler aracılığıyla mesleğin ve uygulayıcıların onurunu koruma yoluna itmiştir. ...
Bu makalede tıbbi etiğin, hekimin ceza sorumluluğu ve hukuk tarihi ile ilişkisinden ziyade kendi içinde tarihsel ve politik gelişimi ele alınmıştır. Hekimlik mesleği Antik Çağ’dan bugüne uzunca bir zaman aristokrasi ve erkeklerin tekelinde olmuştur. Bu tarihsel süreç, kendi içinde ahlaki bir kimlik arayışına koyulan hekimlerin kabul ettikleri ahlaki yükümlülükler ve tıp etiğinin kurumsallaşmasına dair bir derleme ortaya konulmaya çalışılmıştır. Bu tarihsel sürece tekil bazı çabaların ve kurumsallaşmanın, insanlık dramlarının şüphesiz etki ve katkıları olmuştur. Deontolojik prensipler ve etik kodların entegrasyonu uzun ve sancılı bir sürecin sonunda ortak mutabakatla ortaya çıkmıştır. Bugünün perspektifinden tıp etiği ve deontoloji literatürünün 18. Yüzyıl itibariyle rekabet, ticari kaygılar ve dayanışma ihtiyacı ile artmaya başladığı gözlenmektedir. Ortaya konulan ilk taslaklar genelde meslektaşlar arasındaki geleneksel ilişkilerin yeniden düzenlenmesi ve mevcut sorunların bertaraf edilmesine yönelik olmuştur. Hekimin ayrım gözetmeden herkese bakma yükümlülüğü farklı sosyokültürel, sosyoekonomik ve sosyopolitik unsur ve yapılardan, topluluk çıkarlarından dolayı yakın bir tarihe kadar tartışma konusu olamamıştır. Bugün bütün bu unsur ve yapılarda farklılıklar bulunuyor, ayrımcılık açık ve örtük biçimde sürüyor olsa da dünyadaki tüm deontoloji nizamnamelerinin ilk maddesi; hekimlerin başlıca vazifesinin ayrımcılık gözetmeden insan sağlığına, hayatına ve şahsiyetine ihtimam ve hürmet göstermek, muayene ve tedavi hususunda azami dikkat ve ihtimamı göstermesi gerektiği ile ilgilidir. Hekimin başlıca ödevlerinden biri ayrımcılık yapmamaktır.
... Modern medical law and bioethics has strongly evolved around issues of reproductive medicine since its very beginnings. It has to be noted in this respect that renowned Joseph Fletcher's Harvard lectures from the 1949 already included ethical issues on artificial insemination [1] after the first reports on the human artificial insemination came from Guttmacher-1943, Stoughton-1948, and Kohlberg-1953 [2]. Fletcher's lectures shall be considered as first academic inputs in contemporary (reproductive) ethics, while the term "bioethics" was not even commonly used until the late 1960s [1]. ...
... It has to be noted in this respect that renowned Joseph Fletcher's Harvard lectures from the 1949 already included ethical issues on artificial insemination [1] after the first reports on the human artificial insemination came from Guttmacher-1943, Stoughton-1948, and Kohlberg-1953 [2]. Fletcher's lectures shall be considered as first academic inputs in contemporary (reproductive) ethics, while the term "bioethics" was not even commonly used until the late 1960s [1]. Another milestone came with the first baby born as a result of in vitro fertilization in 1978 (Steptoe and Edwards, UK), which was not seen only as a revolution in the medical sense but it also brought strong reflections in the fields of social studies. ...
Legal and ethical theories see different approaches to the status of the embryo (full status, no status, limited status). The latter conception is upgraded with proportionality status in which the level of rights increases with gestational development. The development of assisted reproduction techniques (ART) from the late 1970s onward led us to the uncharted territories. The status of the embryo (fetus) is no longer debated only in relation to spontaneous conception and development in the mother’s womb but also in relation to the procedures in vitro. Therefore, issues related to embryo storage (surplus embryos), embryo research, and genetic diagnostics shall be examined in the course of the following chapter, along with different approaches to the protection of the (early) embryo in international and domestic laws. The final part shall be dedicated to the discussion on how to regulate the status of the embryo de lege ferenda, also acknowledging further developments in ART.
... How to resolve this dilemma of the physician according to the "do no harm" principle is a real question. Jonsen (2000) argues that the exhortation against taking on desperate cases, far from endorsing the abandonment of dying patients, was in fact a judicious caution against futile therapy. He also observes that Eastern and Western cultures shared similar ethical precepts, in contrast to the modern view that medical ethics is culture-specific (Jonsen 2000). ...
... Jonsen (2000) argues that the exhortation against taking on desperate cases, far from endorsing the abandonment of dying patients, was in fact a judicious caution against futile therapy. He also observes that Eastern and Western cultures shared similar ethical precepts, in contrast to the modern view that medical ethics is culture-specific (Jonsen 2000). Today's bioethics is enriched by a conceptual framework that goes beyond decorum and deontology and that takes the patient's perspective as its starting point. ...
A new world has probably emerged through the progression of technology which has led to significant debates on social, cultural, legal, and ethical issues, especially in the biomedical field in this century. Application of physician-patient relationship, principles of pluralism, autonomy, democracy, human dignity, and human rights is being challenged within the medicine and health-care system of today. Development of technology-based remedies has fostered greater degrees of medicalization. Hence, the automatic application of such technologies risks distorting the nature of medicine. To be sure, there is a cultural shift that is affecting the society that is increasingly unable to adapt to traditional legal systems. This cultural shift, perhaps, demands new ethics. This entry aims to evaluate the gap between traditional deontological nature of medicine and the emerging new ethics and assess why bioethical reflection is needed.
... In some rare cases there may also be autonomy reasons for not telling the truth -for instance in order to protect a patient's wish not to know or, in convoluted cases, to restore or increase patient autonomy (Brummett and Salter 2023). Older texts on medical ethics, including the Hippocratic school and Percival, generally encouraged beneficent deception (Jonsen 2000) whereas the modern view is generally negative (Jonsen and Siegler 2010;Bostick et al. 2006). Nowadays, withholding information and lying to patients is usually associated with disrespect for patient autonomy and unjustified paternalism. ...
The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin’s distinction between an “ethics of strangers” and an “ethics of intimacy”, can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an “ethics of intimacy”) and situations where HCP do not know their patients (corresponding to “an ethics of strangers”). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by “knowing the patient”, we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.
... Animal rights movements in the eighteenth and nineteenth centuries in Europe and the United States, as well as contemporary moral philosophy, particularly utilitarianism, are the sources of the belief that animals have a moral status and ought to be protected [3]. In the nineteenth century, utilitarianism's ethics-led most famously by Jeremy Bentham, who famously argued that it matters more morally whether animals can suffer than whether they can reason-were the main environment in which the idea that animals should be part of the moral community evolved [4]. ...
Animal welfare advocates and veterinarians are concerned with bioethical issues. The need for high animal production efficiency has been satisfied with the aid of biotechnological production systems. But it's believed that these are jeopardizing welfare and posing moral and ethical dilemmas, especially for vets. In light of the paucity of information on this topic, a survey was conducted to ascertain scientists' and students' opinions regarding animal ethics at the Lala Lajpat Rai University of Veterinary and Animal Sciences in Hisar, Haryana. Random selection was used to select the scientists and students in the sample. The perception—which was defined as a positive or negative tendency toward acceptance of cloning, xenotransplantation, animal rights, stem cell research, and factory farming—was measured using a questionnaire. It was clear from the average response score that respondents' opinions on scientific advancements were unbiased. Researchers found that respondents' average response score indicated a neutral opinion regarding scientific advancements, with scientists being much more accepting than students. Religion does not seem to have a significant influence on perception about bioethical matters. It is further supported by the fact that there is little variation in the respondents' opinions that cultural and traditional values, as well as veterinary education, play a role. It is stated that further research into the factors related to perception is necessary.
... The inception of bioethics in medicine can be traced back to 500 B.C.E, the Hippocratic Oath in antiquity (1). The phenomenon possibly goes back in time if one considers the Code of Hammurabi (1750 B.C.E.), which contains some such written practices pertaining to medical practice (2). ...
... Medicine Hippocratic Oath e [11] a. ...
This paper explores how AI-owners can develop safeguards for AI-generated content by drawing from established codes of conduct and ethical standards in other content-creation industries. It delves into the current state of ethical awareness on Large Language Models (LLMs). By dissecting the mechanism of content generation by LLMs, four key areas (upstream/downstream and at user prompt/answer), where safeguards could be effectively applied, are identified. A comparative analysis of these four areas follows and includes an evaluation of the existing ethical safeguards in terms of cost, effectiveness, and alignment with established industry practices. The paper's key argument is that existing IT-related ethical codes, while adequate for traditional IT engineering, are inadequate for the challenges posed by LLM-based content generation. Drawing from established practices within journalism, we propose potential standards for businesses involved in distributing and selling LLM-generated content. Finally, potential conflicts of interest between dataset curation at upstream and ethical benchmarking downstream are highlighted to underscore the need for a broader evaluation beyond mere output. This study prompts a nuanced conversation around ethical implications in this rapidly evolving field of content generation.
... Bioethics is a new and popular term mostly used interchangeably with medical ethics and healthcare ethics. Albert R. Jonsen (2000) defines bioethics as the "newer version" of and a progression in medical ethics without elaborating on the features of the old and new versions (p. vi). ...
All religions should develop convincing responses to emerging bioethical problems stemming from medical and technological advancements. Additionally, believers need to know their faiths’ interpretations of bioethical issues to be able to make medical decisions in line with their religious values. Therefore, Islamic bioethics should provide Muslims with conclusive and credible answers regarding newly rising problems in health care by revisiting the religious norms and decrees. However, the diversity in the Islamic denominations, the traditionalist aspect of the Sunni jurisprudence demanding strict compliance with the scriptural texts, the lack of unanimously accepted authority, and the limited number of academic works in Islamic bioethics (at least in English) complicate exploring new standards or rules for new ethical matters. In this view, the present paper aims to delineate two primary Islamic theological schools and propose al-Ghazali’s maslaha as a general framework to analyze bioethical issues in the Sunni tradition. Maslaha allows exercising discretion in light of the protection of five fundamental values: religion, life, reason, lineage, and property. Maslaha has the potential to enable Sunni Muslims to appraise contemporary ethical questions, concerns, and dilemmas through an Islamic view and make more autonomous decisions by having religious guidelines.
... No hablamos de los también reprochables abusos sexuales por lascivia sobre los pacientes o el violar la confidencialidad sobre la situación orgánica de los pacientes. Hablamos de dos temas que también quedan proscritos de las costumbres médicas clásicas: la eutanasia y el aborto (Jonsen, 2000). ...
La película “El padre” es una narración perfecta para explorar la vida humana en su complejidad. El tiempo nos hace y deshace. Proponemos un ejercicio comprensivo de bioética narrativa. Se ha escogido una narración cinematográfica para tratar el poder del olvido Y contar las historias les historias que no pueden ser contadas, que no tienen voz o la han perdido.
... Often cited as "Robin Hood" pricing, taking from the rich and giving to the poor, was a strangely ethical, though totally informal approach to paying for professional services and distributing their availability through society (Moreno, 1990). In a sense, this carried on the Roman tradition of "honoraria" in which classical physicians "were paid with a gift determined by the satisfaction of the employer or client" (Jonsen, 2000). ...
An examination of organization development in health care reveals a pattern of increasing reliance of academic medical centers toward new sources of revenue in support of operations. This trend is partly in response to the reduction of traditional funding sources such as public appropriations and tuition. Clinical income from faculty earnings and hospital transfer payments have supplanted heritage funding sources and are now predominantly institutional transactions rather than physician-patient interactions. Grateful patient philanthropy can be viewed as moving toward transactional status, with challenging ethical questions for the involved physician and patient as institutional control increases.
... No hablamos de los también reprochables abusos sexuales por lascivia sobre los pacientes o el violar la confidencialidad sobre la situación orgánica de los pacientes. Hablamos de dos temas que también quedan proscritos de las costumbres médicas clásicas: la eutanasia y el aborto (Jonsen, 2000). ...
ABSTRACT
Euthanasia is in vogue. It has not been associated with concepts such as misanthropy, depopulation, and/or anti-life philosophical proposals. Nevertheless, its public imposition through the so-called Muddling through techniques follows public policies methodologies distant from rational justifications. Precisely, this point resembles the classical medical oaths from the Mediterranean cultures (Hippocratic’s oath and Maimonides’ prayer). Under the rational classical medical view, death cannot be granted by health professionals due to emotive plea. In contrast, international professional councils have admitted, nowadays, this ancient (pre-oaths) procedure although it implies the mala praxis that Pythagorean and Hippocratic physicians battled against to.
To induce colleagues to commit either perjury or suborning perjury is a crime considered for several Nations. Going deeper into humanistic reasons by including comparative law, etymologies, history of the subject leads to a different reading of the issue.
Key words: Medical oaths, Perjury, Suborning perjury, Misanthropy, Euthanasia.
... 8 To compensate, recommendations to provide care for poor patients have been fundamental in the practice of medicine since antiquity with persistent advocacy to treat those in most need. [9][10][11][12][13] Modern strategies to mitigate inequities tend to focus on situational barriers (eg, access to care) or patient factors (eg, life ...
Objectives
Economic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.
Design
Population-based case–control study of adults who died.
Setting
Ontario, Canada, between 1 June 2016 and 1 June 2019.
Patients
Patients receiving palliative care under universal insurance with no user fees.
Exposure
Patient’s socioeconomic status identified using standardised quintiles.
Main outcome measure
Whether the patient received medical assistance in dying.
Results
A total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.
Conclusions
Patients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.
... Ethics, charity, and egalitarianism form the foundational framework of healthcare delivery, with roots going back to antiquity. 1 Providing care to the sick, the elderly, and the poor is a foundational moral practice in nearly every culture; despite many modern disagreements about how to deliver such care, the moral imperative to treat those who are sick remains persistent across the spectrum of religious, cultural, and political traditions. Modernity has presented increasingly sophisticated challenges to this moral framework, even among those devoted to advancing the efficiency, universality, and effectiveness of healthcare delivery. ...
There is little debate about the importance of ethics in health care, and clearly defined rules, regulations, and oaths help ensure patients’ trust in the care they receive. However, standards are not as well established for the data professions within health care, even though the responsibility to treat patients in an ethical way extends to the data collected about them. Increasingly, data scientists, analysts, and engineers are becoming fiduciarily responsible for patient safety, treatment, and outcomes, and will require training and tools to meet this responsibility. We developed a data ethics checklist that enables users to consider the possible ethical issues that arise from the development and use of data products. The combination of ethics training for data professionals, a data ethics checklist as part of project management, and a data ethics committee holds potential for providing a framework to initiate dialogues about data ethics and can serve as an ethical touchstone for rapid use within typical analytic workflows, and we recommend the use of this or equivalent tools in deploying new data products in hospitals.
... The regulation and operation of formal bodies that supervise the ethical aspects of biomedical experiments is considered a recent and relatively modern development (Baker et al., 1999;Guillemin et al., 2012;Hedgecoe, 2009;Jonsen, 2000;Rubin, 2011;Stark, 2007Stark, , 2010. ...
The debate around ethics review boards (IRBs) has assumed an increasingly central place in academic practice and discourse. In this article, we summarize a unique workshop (study-group) that convened at the University of Haifa, attended by 27 academics from around the globe, representing nine countries in four continents. The participants presented data and points of view, which served as the basis for an open, interdisciplinary discussion. The group developed a set of recommendations, including working toward a transition from a review system to an advisory and validation system; focusing on respectful research approach to participants, rather than “ethical” research; building a procedure that focuses on feedback, rather than the process itself; recognizing that a unified examination need not necessarily be standardized; and constructing a feedback procedure in which researchers can respond to the review of their research.
... На початку 70-х років ХХ століття гостра необхідність знайти рішення етичних проблем у біомедицині стала ще нагальнішою та була усвідомлена не тільки спеціалістами в галузі охорони здоров'я, але й суспільством загалом [9][10][11]. Це питання досі залишається актуальним, адже існування нормативно-етичних систем повинно регламентувати діяльність людини через реалізацію принципів прикладної та практичної етики з урахуванням розвитку медико-біологічних технологій і нових відкриттів [12]. ...
Пандемія COVID-19 поставила перед людством низку питань, що потребують детального розгляду, обговорення та прийняття зважених рішень. Серед цих питань чи не найважчими для практичного розв’язання є питання біоетики: взаємодія лікаря й пацієнта в умовах відсутності визнаних методів і протоколів лікування, рекомендації та засоби безпеки для медичних працівників, етичність проведення протиепідемічних заходів, дослідження та публікації на тему COVID-19, розгляд клінічних випробовувань з точки зору етики та їхнє безпосереднє проведення, прийняття рішень в умовах обмежених ресурсів, лікування пацієнтів в інтенсивній терапії, надання паліативної допомоги, проблеми, що пов’язані з психічним здоров’ям населення, захист даних та обмін ними, прискорення розробки й оцінка ефективності вакцини для профілактики COVID-19. За таких умов ресурси системи охорони здоров’я багатьох країн виявились недостатніми для надання всім пацієнтам якісного медичного обслуговування, на яке вони мають право за міжнародними документами. Питання життя та смерті хворих постало так само гостро, як у ті часи, коли технології, що підтримують життя, тільки вводились у клінічну практику.Пандемія COVID-19 суттєво змінила біоетичний дискурс із репродуктивних технологій, штучного інтелекту та можливостей молекулярної генетики на утилітарну етику з підтриманням заходів охорони громадського здоров’я.
... Medical ethics traditions began in the era of Hippocrates, but a Code was first written in 1803 by the English physician-philosopher, Thomas Percival, and first adopted around the mid-19 th century. (2) This Code helped formalize the standards of conduct for physicians in relation to their patients, their fellow physicians, and the profession at large. The Code has evolved over time to align with the contemporary demands of medical practice. ...
... During the twentieth century, informed consent practices have been incorporated in healthcare in large parts of the Western world with the aim of respecting and promoting patient autonomy (Jonsen 2000;Faden and Beauchamp 1986). In recent years, various bioethicists have raised the possibility of incorporating authenticity in autonomy-based practices in healthcare (Ahlin Marceta 2018a, b;Sjöstrand and Juth 2014;Villafranca 2019;White 2018;Zürcher et al. 2019). ...
Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when (decision-competent) anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine.
... It guides doctors' relationship with patients, other colleagues and wider society. The first notion of medical ethics can be traced back to Hypocrate (Jonsen, 2000;Miles, 2005). The umbrella term "clinical ethics" is used for practical application of principles, guidelines, and treatment protocols in treating patients either in government run hospitals or private clinics (Taylor, 2013). ...
This paper investigates the influence of pharmaceutical marketing strategies on physicians' behaviors. It is argued that physicians are compelled into unethical behavior which is detrimental to the patients as well as the environment in general. Patients are unnecessarily exposed to high doses of antibiotics that is giving rise to globally threatening phenomenon like "superbug". Data is collected and analyzed by following grounded theory method. It is found that pharmaceutical marketing practices have led to physicians' loose adherence to ethics that exploits their materialistic approach. The pharmaceutical companies use personalized services, product incentivization and even sometimes misleading and partially proven scientific claim as marketing strategies. As a result, physicians are compelled into over prescription leading to the development of antibiotic resistance in patients. It is recommended that ethical standards should be enforced through personal, organizational and institutional wide mechanisms for both pharmaceutical companies and physicians.
... When predicting the impact of the Act, it must be considered that biomedical ethics is an "imported discipline" in Korea. While the history of biomedical ethics traces back to the long tradition of healing practices or the history of the healing profession itself, the modern meaning of biomedical ethics emerged in the late 1960s in the US, thereafter becoming formalized as an academic field (17). Accordingly, in many countries, including Korea, biomedical ethics is not an indigenous discipline, but rather an imported one in which already advanced theories are introduced in academic settings and taught to succeeding generations. ...
This paper examines the possible impacts of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life in Korea (Korea’s end-of-life act), legislated in 2016, on the development of hospital ethics committees and clinical ethics consultation services in South Korea. Clinical ethics in Korea has not made much progress in comparison to other subdisciplines of biomedical ethics. While the enactment of this law may give rise to beneficial clinical ethics services, it is possible that customary practices and traditional authorities in Korean society will come into conflict with the norms of clinical ethics. This paper examines how the three main agents of Korean society—family, government, and medical professionals—may clash with end-of-life stage norms in clinical ethics, thus posing obstacles to the development of hospital committees and consultation services. A brief outline of what lies ahead for the progress of clinical ethics practice is explored.
In my duties, the rights of others are included, and in my rights, the duties of others are also included. Just as we can see in the education field where the teacher's duty is to give the right education and it is the right of the learner to get the right education, in the same way, the learner's duty to respect the teacher and the teacher's right to respect of his autonomy. Duty and right are the two parts of one coin (life). Generally, there are some duties to protect human rights (education, information, health, freedom of speech and expression) same some duties (duty of care, not to harm, to benefit, to give good faculties, respect others, to speak the truth) prescribed by medical ethics towards the Patient and Physician to protect rights (right to life, respect to autonomy and dignity, right to health, right to cure, right to select the cases). So we see here, that the Physician's duties become the rights of the Patient, for example, the Physician's duty is to do best for the Patient's health, and the Patient's right is the right to health. In the medical field, the Physician's duty is to respect the Patient's choice and Patient's right is to select an excellent medical option. We always discussed the Patient's rights (Respect, dignity, and autonomy) and the Physician's duties (Doing his best for the Patient's health) and obligations ( not harming the Patient) instead of the Physician's rights (Rights to reject and select treatment and cases) and the Patient's duties ( Respecting the physician and following the physician’s suggestion, Prescriptions) and obligations ( not harming the Physician), If we start to give priority to duties of patients and the rights of physicians, then we will create an actual , mutual partnership model which will connect truly both parties and give equal importance and respect ultimately ending all the conflict related to Physician-Patient relationship. We can also fill the gap in thoughts and motives between both because if both begin to realize their responsibilities and obligations and respect each other's rights, all the clashes between them will come to an end. In this paper, I will discuss the duties and rights of doctors and patients, which can help bridge the gap between both relations and make them equal participants with each contributing actively and not just passively.
Bioethics is sometimes presented as a set of universal guidelines to regulate health care practices and human research. However, the history of the discipline does not support such a narrative. Bioethics was born in the ideological context that prevailed in the United States in the 1960s and 1970s. Should we then abandon all hope of universality for ethical benchmarks that have proven their usefulness in illuminating health practices?
By carefully distinguishing the universal from the uniform, this paper shows, that it is possible to respect the specificities of cultures around the world, while maintaining a universal goal for bioethics.
En el presente estudio nos proponemos analizar y valorar críticamente una serie de caracterizaciones que permiten reconocer la evolución de la noción de bioética durante las primeras décadas del desarrollo de la disciplina. Más precisamente, a través del análisis comparativo de las definiciones y descripciones seleccionadas, procuraremos poner de manifiesto el progresivo avance hacia nociones más amplias e integradoras que intentan evitar tanto la reducción de la disciplina a un ámbito o a un aspecto determinado como la restricción de la significación del nombre “bioética” a un mero núcleo paradigmático. Comenzaremos con el análisis de algunas caracterizaciones que expresan una noción de bioética más restringida en cuanto al campo o ámbito propio abordando, en un segundo momento, el estudio de otras que responden, en principio, a una noción más integral.
This chapter describes the process of shaping ethical guidelines for an influenza pandemic by the North Carolina Institute of Medicine (NC IOM)/North Carolina Department of Public Health (NCDPH) Task Force. The author discusses the threat of a pandemic in the twenty-first century, comparing a potential pandemic with past flu pandemics as well as the Severe Acute Respiratory Syndrome (SARS) outbreak in Canada and parts of Asia. Also discussed are the ways in which influenza would spread, be treated, and hopefully contained. Addressed are the ways in which one becomes ethically prepared for an influenza pandemic, as well as the challenges to incorporating ethical guidelines in preparations. Tong also addresses the role of a duty/obligation/responsibility to work by health care personnel, the role of volunteers, and when health care personnel may refuse to treat someone. Also taken into consideration are such issues as the distribution of food and vaccines, quarantines, work stoppage, both physical and social infrastructure, the role of military and police forces, and the effect of a pandemic, isolation, and quarantine on various industries. Tong shows the complicated nature of working on a task force and the complexity of incorporating ethics into logistical planning.
Literature, Science, and Public Policy shows how literature can influence public policy concerning scientific controversies in genetics and other areas. Literature brings unique insights to issues involving cloning, GMOs, gene editing, and more by dramatizing their full human complexity. Literature's value for public policy is demonstrated by striking examples that range from the literary response to evolution in the Victorian era through the modern synthesis of evolution and genetics in the mid-twentieth century to present-day genomics. Outlining practical steps for humanists who want to help shape public policy, this book offers vivid readings of novels by H. G. Wells, H. Rider Haggard, Aldous Huxley, Robert Heinlein, Octavia Butler, Samuel R. Delany, David Mitchell, Margaret Atwood, Ian McEwan, Kazuo Ishiguro, Gary Shteyngart, and others that illustrate the important insights that literary studies can bring to debates about science and society. This title is also available as Open Access on Cambridge Core.
Epidemics and diseases, especially pandemics, raise—as Covid-19 has been proving for months—a wealth of questions that touch on fundamental aspects of the conditio humana. Since antiquity, when the everyday reality of epidemics was first addressed (Herodotus, Thucydides, Diodorus Siculus), the political, legal, organizational and ethical problems associated with them were considered highly complex; contradictions, trade-offs, corrections and compromises determined the medical, but also the social debates. The struggle for moral interpretive authority was already influenced by science and religion in ancient Greece—it shaped the behavior of the authorities as well as the medical profession (Schmitz 2005). Together with nursing staff, non-academically trained healers and—first documented in Italy in the High Middle Ages—local health authorities, doctors were in the forefront of everyday life during epidemics since antiquity. In the 14th century, the task of “government advice” was added to the individual care of the sick, which was increasingly institutionalized over the centuries, first in Italy and France, through guild regulations and (in the academic field) collegia. “Health authorities” played a particularly important role in the 16th and 17th centuries, for example in Milan, Venice, Florence or Lucca, only to be copied in numerous northern cities, including 1576 in Berlin, then a small town (Eikermann and Kaiser 2012, pp. 55 ff.). In the 17th century, there were even plans for “international cooperation” between Genoa, Florence, Rome and Naples, which pointed far into the future despite initial problems (Naphy and Spicer 2003, pp. 85 ff.).
Con ocasión de la aparición de la edición española (2019) de la obra The Virtues in Medical Practice (1993) de Pellegrino y Thomasma, se ofrece un estudio pormenorizado y crítico de la parte teórica que la preside, en el que se puntualiza su objetivo, así como su contenido y el orden de los capítulos que la componen. Dicho estudio está precedido por tres acercamientos convergentes referidos al estado de la refl exión sobre ética médica al momento de la aparición de la primera edición del libro, a su lugar en el conjunto de la obra escrita de E. Pellegrino, su autor principal, y al lugar de esta parte en la estructura de conjunto del libro. Para Pellegrino es fundamental dejar establecido desde el principio que la vida virtuosa es el principal recurso con el que cuenta el médico para contribuir a la sanación de su paciente. Por eso consagra el primer capítulo al concepto de virtud desde una perspectiva histórica. El siguiente capítulo estudia el vínculo entre virtudes, principios y deberes respondiendo al desafío de mostrar cómo se puede combinar la teoría de la virtud con elprincipialismo. La temática de la medicina como comunidad moral, sobre la que versa el tercer capítulo, se impone desde el momento en que las virtudes, los principios y los deberes de los médicos requieren de un soporte institucional adecuado para que su accionar se oriente sin desfallecer a los fines propios de la profesión. El capítulo cuarto estudia estos fi nes mostrando que no se reducen a la curación del paciente, sino que miran a su bien integral. Ante la vulnerabilidad del enfermo, la primera respuesta del profesional médico y de toda la comunidad a la que pertenece será la benefi cencia en la confianza.
This chapter examines the ethical dilemma of deactivating pacemakers at the end of life. It offers an ontological and phenomenological approach to withdrawing pacemakers and discusses the strengths and weaknesses of the internality and the externality approaches while dealing with this dilemma.
Furthermore, the chapter presents a practical approach to deactivating pacemakers. This approach examines the concepts of futility and autonomy, highlighting their significant roles in decision-making. Additionally, it delves into the nuanced differences between various terminologies and concepts related to end-of-life care, clarifying many of the ambiguities in this sensitive area.
Die bisher fehlende Relevanz der strafrechtlichen Haftung der Mitglieder von Ethikkommissio-nen für die klinische Forschung vor deutschen Gerichten spiegelt noch nicht die Brisanz dieser Frage wider. Die Rolle der Ethikkommissionen wurde entscheidend gestärkt: Sie hat nicht mehr nur beratende Funktion, sondern ihre Zustimmung ist zwingend erforderlich, um klinische Stu-dien durchzuführen. Diese erhöhte Verantwortlichkeit bedeutet aber auch, dass selbst nur fahr-lässiges Fehlverhalten von Kommissionsmitgliedern gravierende Folgen haben kann, was letztlich ein strafrechtliches Haftungsrisiko birgt.
Auch wenn der Tatbestand des § 95 Abs. 1 Nr. 1 AMG wegen eines anderen Täterkreises und nach § 96 Nr. 10 AMG wegen fehlenden Vorsatzes regelmäßig nicht gegeben sein wird, kommt eine Strafbarkeit nach den Fahrlässigkeitstatbeständen des Kernstrafrechts (Körperverletzung und Tötung) in Betracht. Dabei ist aus zweierlei Gründen ein besonderes Augenmerk auf den Nachweis der Kausalität zwischen Handlung und Erfolg zu legen. Einmal, da im Bereich der klini-schen Forschung die Wechselbeziehung zwischen einer Handlung (beispielsweise der Verabrei-chung eines bestimmten Wirkstoffes) und einem eingetretenen Erfolg (beispielsweise eine kör-perliche Schädigung) nicht mit Sicherheit bekannt ist (gerade deshalb finden klinische Studien statt). Das zweite Kausalitätsproblem rührt aus der Situation einer Gremienentscheidung: Wenn die Ethikkommission eine rechtswidrige Entscheidung trifft, könnte sich jedes Mitglied dahinge-hend entlasten wollen, dass die notwendige Mehrheit auch ohne seine Zustimmung erreicht worden wäre. Auf die Behandlung dieser Kausalitätsprobleme wird im Tagungsbeitrag ein be-sonderes Augenmerk gerichtet. Ferner wird aufgezeigt, dass auch der Qualifikationstatbestand der Körperverletzung im Amt selbst bei nur fahrlässiger Verwirklichung einschlägig sein kann.
Anhand von drei Beispielen (Genehmigung zur Prüfung von Arzneimitteln, obwohl rechtlich re-levante Mängel bei der Aufklärungsinformation für die Testteilnehmer bestehen, Durchführung fremdnütziger Forschung an einwilligungsunfähigen Menschen und Mängel bei der Probanden-versicherung), wird die strafrechtliche Relevanz des Handelns von Mitgliedern von Ethikkommis-sionen für diese Konstellationen aufgezeigt. Zur Abrundung wird am Ende des Beitrages auf die kommissionsinterne Verantwortungsabgrenzung hingewiesen und es werden Ratschläge zur Vermeidung strafrechtlicher Haftungsrisiken gegeben.
A 4ª Revolução Industrial é o culminar da era digital. Atualmente, tecnologias como robótica, nanotecnologia, genética e inteligência artificial prometem transformar nosso mundo e a maneira como vivemos. O campo da Segurança e da Ética da Inteligência Artificial (IA) são áreas de pesquisa emergentes que vêm ganhando popularidade nos últimos anos. Diversas organizações de cunho privado, público e não governamentais têm publicado diretrizes propondo princípios éticos para a regulamentação do uso e desenvolvimento de sistemas inteligentes autônomos. Meta-análises do campo de pesquisa em Ética da IA apontam uma convergência sobre certos princípios éticos que, supostamente, governam a indústria da IA. Entretanto, pouco se sabe sobre a eficiência desta forma de “Ética”. Neste estudo, gostaríamos de realizar uma análise crítica do atual estado da Ética da IA, e sugerir que essa forma de governança baseada em diretrizes éticas principialista não é suficiente para normatizar a indústria da IA e seus desenvolvedores. Acreditamos que drásticas mudanças sejam necessárias, tanto nos processos de formação de profissionais das áreas ligadas ao desenvolvimento de software e sistemas inteligentes quanto no aumento da regulamentação desses profissionais e sua indústria. Para tanto, sugerimos que o Direito se beneficie das contribuições recentes da Bioética, de forma a explicitar em termos legais as contribuições da Ética da IA para a governança.
In discussions on Nazi medicine, it is often presumed that the Nazi physicians abandoned or ignored all forms of medical ethics. This notion is far from the truth even though it is very difficult to come to terms with. It would be more comfortable to believe that Nazi physicians were a marginal group of madmen and what transpired in medicine during that period was unique and irrelevant to modern medicine. However, today we know that the Nazi physicians not only had a very detailed ethical code in place, but also that they were the first in the world to teach medical ethics at medical schools. These ethics courses were compulsory at every medical school in Nazi Germany and were based on the use of a specially published textbook, called Medical Jurisprudence and Rules of the Medical Profession . The textbook provides a unique insight into the values and beliefs systems of the Nazi physicians, many of which were greatly influenced by the political and social culture of the time, and some that resonate with the current practice of medicine. Discourse on medical ethics during the Nazi period, as demonstrated by this manual, serves to remind physicians that we are all vulnerable to ethical transgressions and could do well by learning the lessons from this past.
This article analyses the fluidity of a human condition in terms of ethical boundaries. Recent technological developments have made the ethical framework of the notion of a human volatile and prone to revaluation. This revaluation requires established practices of conduct and interpretation of an ethical expertise. The article describes such new forms and ways to make them part of the repertoire of established institutions. In addition, the article differentiates the specifics of an ethical expertise and a humanitarian one. The former is focused on protecting the human condition from technologically-borne distortions and on making such protection a part of political and social institutions. The latter, in turn, is designed for the purposes of social engineering. It is supposed to help in the development of new social contexts, including ones that merge humanity with the results of high-tech endeavours. An ethical expertise is more focused on preserving the status quo. A humanitarian expertise is proactive and based on non-linear social foresights. The authors believe the reactionary nature of an ethical expertise to be the result of widespread shifts in the established definition of a human. This can be easily illustrated in such fields as biomedicine and gene research. Namely gene editing and major organ transplants can blur the line between human and non-human entities. The article points out an ongoing deficiency, on a methodological and conceptual level, when it comes to a humanitarian expertise. Furthermore, the article contains the groundwork for articulation of a humanitarian expertise. This form of expertise is unique due to its institutional nature and inclusion of the role of “researcher-participant,” which an expert is supposed to play. While elaborating on the differences between a humanitarian and an ethical expertise, it is noted that an ethical expertise aims at preserving the existing norms and boundaries of the notion of a human, outlined in treatise and conventions, while a humanitarian expertise strives to recreate the norm of a human in accordance with its new state — as a fluid and dynamic category.
The article draws a conceptual distinction between two different institutional forms of assessment of technological innovations in different spheres of human life - between the practices and procedures of ethical expertise and precedent cases of humanitarian expertise. The authors suggest that the aims and objectives of these types of expertise are fundamentally different, despite the precedents in which, in fact, the aims for humanitarian expertise have already been set within the framework of ethical expertise. Ethical expertise implies the inviolability of a person's identity, norms and boundaries. It is called upon to protect human being from all kinds of intrusions and interventions (in medicine, digital environment, education) and treats him or her as a passive object of protection and care. But in an unfolding situation of human identity radical changes, when human beings themselves are choosing the trend of their identity extreme transformation, turning to an application of smart technologies, the task of redefining, restoring human norms and boundaries is being raised. The latter becomes the crucial aim of humanitarian expertise. Accordingly, the role of experts, the design of expertise itself, procedures and normative framework are also changing within these forms of expertise.
Medizinethik fragt nach dem moralisch Gesollten, Erlaubten und Zulässigen im Umgang mit menschlicher Krankheit, Gesundheit und angrenzenden medizinischen Tätigkeitsfeldern. Von der Antike bis in die Mitte des vergangenen Jahrhunderts stand im Zentrum der Medizinethik das, was Ärzte zum Wohle ihrer Patienten tun oder nicht tun sollten. Medizinethik wurde überwiegend im Sinne einer Fürsorgeethik innerhalb der ärztlichen Zunft betrieben. Im Laufe der Zeit wandelte sich die Medizinethik von einer intraprofessionellen Fürsorgeethik zu einem multiprofessionellen Gebiet der angewandten Ethik, in dem neue Herausforderungen im Rahmen einer pluralistischen Gesellschaft zu tragfähigen, guten Lösungen geführt werden müssen. Insbesondere im Bereich der Palliativversorgung, in der immer wieder schwierige – mitunter auch im Team kontrovers diskutierte – Entscheidungen zu treffen sind, ist es sinnvoll die wichtigsten Grundsätze der Ethik zu kennen, um zu einem für alle Beteiligten tragfähigen Ergebnis zu kommen.
This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper understanding of some of the most controversial issues in modern medicine.
Epidemien und Seuchen, vor allem Pandemien, werfen – wie Covid-19 seit Monaten unter Beweis stellt – eine Fülle von Fragen auf, die grundsätzliche Aspekte der conditio humana berühren. Seit der Antike, als der Seuchenalltag erstmals thematisiert wurde (Herodot, Thukydides, Diodorus Siculus), galten die mit ihm verbundenen politischen, juristischen, organisatorischen und ethischen Probleme als höchst komplex; Widersprüche, Abwägungen, Korrekturen und Kompromisse bestimmten die medizinischen, aber auch gesellschaftlichen Debatten. Der Kampf um die moralische Deutungshoheit war bereits im alten Griechenland wissenschaftlich und religiös beeinflusst – er prägte das Verhalten der Obrigkeiten wie der Ärzteschaft (Schmitz 2005). Zusammen mit dem Pflegepersonal, nicht akademisch ausgebildeten Heilern und den – in Europa seit dem Hochmittelalter zuerst in Italien nachweisbaren – lokalen Gesundheitsbehörden standen im Seuchenalltag seit der Antike vor allem Ärzte an vorderster Front. Im 14. Jahrhundert kam zur individuellen Krankenfürsorge, ihrer „klassischen“ Aufgabe, die Aufgabe der Regierungsberatung hinzu, die im Lauf der Jahrhunderte, zunächst in Italien und Frankreich, durch Zunftordnungen und (im akademischen Bereich) Collegia zunehmend institutionalisiert wurde. „Gesundheitsbehörden“ spielten besonders im 16. und 17. Jahrhundert, etwa in Mailand, Venedig, Florenz oder Lucca eine herausragende Rolle, um dann in zahlreichen nordalpinen Städten, so selbst 1576 in Berlin, damals einer kleinen Stadt, kopiert zu werden (Eikermann und Kaiser 2012, S. 55 f.). Im 17. Jahrhundert gab es zwischen Genua, Florenz, Rom und Neapel sogar Pläne einer „internationalen Kooperation“, die trotz anfänglicher Probleme weit in die Zukunft wiesen (Naphy und Spicer 2003, S. 85 ff.).
Diante dos avanços materiais e tecnológicos da medicina, a expectativa de vida aumentou significativamente. No entanto, em que pese a redução de doenças e mortalidades, quando o paciente se encontra acometido por doenças incuráveis ou não mais responsivas a tratamentos, surgem os conflitos de fim de vida. A contemporaneidade nos coloca diante de novos tipos de conflitos, tão complexos que ultrapassam as concepções tradicionais de Direito ou Medicina. Levando isso em consideração, o presente artigo busca explicitar como as Práticas Colaborativas podem auxiliar na transição dos conflitos de fim de vida a partir de um diálogo interdisciplinar, considerando a Bioética e seus princípios. O método de abordagem utilizado é o dedutivo, com técnica de pesquisa bibliográfica e procedimento monográfico.
Janet L. Storch gehört zu den wichtigen Persönlichkeiten der neueren Pflegeethik. Die heute emeritierte Professorin für Pflegewissenschaft an der University of Victoria, Kanada, leitete die dortige School of Nursing. Ihre akademische und klinische Tätigkeit umfasste u. a. Grundlagen der Pflegeethik, klinische Ethik und Patientensicherheit.
This historiographic survey of extant English translations and interpretations of the renowned Hippocratic first aphorism has demonstrated a concerning acceptance and application of ancient deontological principles that have been used to justify a practice of medicine that has been both paternalistic and heteronomous. Such principles reflect an enduring Hippocratism that has perpetuated an insufficient appreciation of the moral nature of the aphorism's second sentence in the practice of the art of medicine. That oversight has been constrained by a philological discourse that has centred on the meanings of the aphorism's first sentence, while little consideration has been given to the more important ethical consideration within the second sentence's imperatives.
Resumen
Las pandemias y otras catástrofes de alto impacto sanitario azotan periódicamente a la humanidad, aumentando desproporcionadamente la demanda por atención en servicios de urgencia, unidades de cuidados intensivos y medios de soporte vital avanzado. Este desequilibrio obliga a una compleja toma de decisiones en que se deben asignar recursos proporcionalmente escasos en relación a una gran demanda. Así, los equipos clínicos asistenciales necesitan actuar bajo criterios consensuados, que orienten sus decisiones y alivien la pesada carga moral de seleccionar pacientes para terapias, en detrimento de otros. El triaje es una estrategia que permite establecer, bajo racionalidades propias a cada escenario, objetivos y criterios que faciliten la toma de decisiones complejas para el logro del mejor resultado. Estas estrategias deben considerar el marco de valores intangibles que apreciamos y que nos identifican cultural y socialmente, como son el respeto a la vida, la igualdad, la justicia y la libertad. Sin embargo, en escenarios excepcionales como el de la actual pandemia COVID-19, en que el sistema sanitario puede no dar abasto, deberán establecerse objetivos prioritarios, como salvar la mayor cantidad de vida, del modo más humano, justo y eficiente posible. A la vez, deberán redefinirse jerarquías en los valores y principios clásicos de la práctica clínica cotidiana, adecuadas a la catástrofe sanitaria, bajo una ética propia de la salud pública, el mayor bien para la mayoría y el mejor cuidado de los que no pueden ser curados.
The Hellenic medical ideas have found appreciation among people over centuries. Though the initial concept remained the same, methods or ways to achieve desired aims have changed. Since Hippocrates, new generations of physicians have worked hard to find more powerful types of therapies to relieve their patients and make treatment less burdensome. The struggle of medicine is very specific and requires, apart from practical skills, a clear personal commitment to help people wisely. From the Early Antiquity, both medicine and medical ethics go together. Wherever Hippocratic medicine is practiced, an appropriate moral pattern accompanies it because the Hellenic doctor offered purely clinical data and his art should not be separated from anthropology, ethics and religion.
A code of ethics for the practice of nursing seeks to capture, in a written document, the normative values, ethical principles and standards of good care to guide nurses – qua moral agents. A codification of the accepted collective values of nursing can play a constitutional and directional role for the profession. It can further stimulate discussions about nursing that reflect the dynamic essence of the profession. Consequently, there is merit to continually reflecting on a code’s function and role especially when a new or revised code is introduced to the nursing profession and the wider public such as the European Nursing Council’s Code of Ethics and Conduct for European Nursing. This paper examines codes of ethics in general and the European Nursing Council Code in particular using the framework of Gaumnitz and Lere. Although the European Nursing Council Code has all the ingredients of a contemporary professional ethics code, our position is that future iterations or addenda to this Code should be aligned to the UN Sustainable Development Goals and take a more radical step in becoming an exemplar of a nursing code that can be a catalyst for the advancement of the Sustainable Development Goals.
Relatively little has been written about ethics in the practice of forensic pathology, considering its critical importance to the individual practitioner and the specialty's long-term survival. While the general foundation of highly ethical behavior has hopefully been established prior to entering the fellowship year, the practice of forensic pathology is unique and has its own special ethical issues, requiring active intentional education. The fellowship training year is the best setting in which to formally discuss the ethical behaviors required in the daily practice of forensic pathology. The American Counsel for Graduate Medical Education (ACGME) also requires the demonstration of professionalism and ethical behavior during the fellowship, which includes ethics education. Almost all forensic pathology program directors report that ethics training is conducted on an opportunistic case-based basis as ethical issues arise during training. The majority of forensic pathology program directors would welcome a focused “Ethical Issues in Forensic Pathology” educational module following the Core Curriculum lecture platform and based upon the ACGME Core Competencies and developed by the National Association of Medical Examiners (NAME).
Już od blisko 50 lat etyka medyczna realizowana jako odrębny przedmiot znajduje się w programach kształcenia studentów medycyny. W trakcie wieloletnich dyskusji o formach i treściach takiego nauczania wykształciły się dwa, alternatywne modele nauczania etyki medycznej. Pierwszy model – aplikacyjny traktuje nauczanie etyki, jako etyki stosowanej, w ramach tradycyjnego modelu akademickiego. Przybiera on formę wiedzy podawanej na wykładach i utrwalanej w trakcie seminariów. Drugi model nauczania etyki – transformacyjny ma na celu ukształtowanie moralnego lekarza. Metody stosowane w kształceniu etycznym lekarzy nie są jednomyślnie zaakceptowane przez wszystkie uczelnie medyczne i wciąż trwają poszukiwania najskuteczniejszego sposobu nauczania etyki. Idealnym rozwiązaniem byłoby nauczania etyki zintegrowane z nauczaniem klinicznym, lecz nie jest to w praktyce nigdzie osiągalne. Postuluje się aby nauczanie to było skupione na zdefiniowanych wynikach nauczania i stosowało sprawdzone metody nauczania i zwalidowane metody oceny. Nauczanie etyki medycznej wciąż nie dopracowało się jednolitego powszechnie zaakceptowanego standardu. Wynika to zarówno z braku uniwersalnej teorii etyki medycznej, jak i braku dowodów na skuteczność jakiekolwiek modelu edukacji etycznej.
The standard of the patient's best interests is the main bioethical standard used in the decision-making process that involves incompetent patients (i.e. neonatology, pediatric patients and incompetent adults). This standard has been widely criticized as being self-destructive, individualistic, vague, unknown, dangerous and open to abuse. With the purpose of defending it, several reforms of this standard have been proposed, especially in the pediatric field. We propose a redefinition of the standard based on two concepts: 1) medical futility as a negative criterion, and 2) the principle of proportionality as a positive criterion. Our work includes a new relationship between concepts in classical moral theology (i.e. ordinary / extraordinary; proportionate / disproportionate) applied to the bioethics of life-sustaining treatments for incompetent patients. RESUMEN: El estándar del mejor interés del paciente es el único estándar bioético utilizado en los procesos de de-cisión de tratamientos en enfermos no competentes (neonatología, pediatría y adultos no competentes). Este estándar ha sido ampliamente criticado por autodestructivo, individualista, vago, desconocido, peli-groso y abierto a abusos. Para defender el estándar se han propuesto varias reformulaciones especialmente en el ámbito pediátrico. Nosotros proponemos una redefinición del estándar basada en dos conceptos: 1) el de futilidad médica como criterio negativo, y 2) el principio de proporcionalidad como criterio positivo. Nuestro trabajo incluye una nueva relación entre los conceptos de la teología moral clásica (ordinario / extraordinario; proporcionado / desproporcionado) aplicados a la bioética de los tratamientos de soporte vital en pacientes no competentes.
Los aprendices de cirugía en cualquiera de sus divisiones precisan un conjunto de conocimientos básicos de los aspectos teórico-prácticos que rigen el quehacer quirúrgico. Aunque muchas de estas habilidades son las mismas que usaban sus predecesores del siglo XX, los aprendices de hoy deben mantenerse al tanto de las tecnologías que cambian y avanzan rápidamente.
El presente trabajo tiene como objetivo facilitar el aprendizaje más rápido requerido en un programa quirúrgico moderno, con capítulos concisos sobre las principales técnicas y destrezas que deben dominarse en los primeros años de entrenamiento. Está dirigido tanto a estudiantes de medicina, residentes de las distintas áreas quirúrgicas en sus primeros años de residencia, adjuntos jóvenes, al equipo de enfermería, y al público en general interesado en conocer algunos de los principios básicos que rigen las habilidades técnicas quirúrgicas, y su relación con el manejo del paciente en torno al perioperatorio.
El desarrollo del libro se ha estructurado en 17 capítulos. Cada autor ha presentado una gran cantidad de valiosa información, a partir de su experiencia, que resume el abordaje más oportuno aceptado al momento de publicación del presente libro.
También es una colaboración entre los variados
Drawing on a wide range of primary historical and sociological sources and employing sharp philosophical analysis, this book investigates medical ethics from a Chinese-Western comparative perspective. In doing so, it offers a fascinating exploration of both cultural differences and commonalities exhibited by China and the West in medicine and medical ethics.
The book carefully examines a number of key bioethical issues in the Chinese socio-cultural context including: attitudes toward foetuses; disclosure of information by medical professionals; informed consent; professional medical ethics; health promotion; feminist bioethics; and human rights.
It not only provides insights into Chinese perspectives, but also sheds light on the appropriate methods for comparative cultural and ethical studies. Through his pioneering study, Jing-Bao Nie has put forward a theory of "trans-cultural bioethics," an ethical paradigm which upholds the primacy of morality whilst resisting cultural stereotypes, and appreciating the internal plurality, richness, dynamism and openness of medical ethics in any culture.
The aim of this doctoral thesis is to bridge the gap between theoretical ideals of authenticity and practical authenticity-related problems in healthcare. In this context, authenticity means being "genuine," "real," "true to oneself," or similar, and is assumed to be closely connected to the autonomy of persons. The thesis includes an introduction and four articles related to authenticity. The first article collects various theories intended to explain the distinction between authenticity and inauthenticity in a taxonomy that enables oversight and analysis. It is argued that (in-)authenticity is difficult to observe in others. The second article offers a solution to this difficulty in one theory of authenticity. It is proposed that under certain circumstances, it is morally justified to judge that the desires underlying a person's decisions are inauthentic. The third article incorporates this proposition into an already established theory of personal autonomy. It is argued that the resulting conceptualization of autonomy is fruitful for action-guidance in authenticity-related problems in healthcare. The fourth article collects nine cases of possible authenticity-related problems in healthcare. The theory developed in the third article is applied to the problems, when this is allowed by the case-description, to provide guidance with regard to them. It is argued that there is not one universal authenticity-related problem but many different problems, and that there is thus likely not one universal solution to such problems but various particular solutions.
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