MEDICAL ETHICS: INTRODUCTION AND HISTORY OF BIOETHICS

Transcription

1 MEDICAL ETHICS: INTRODUCTION AND HISTORY OF BIOETHICS DR.MAHJABEEN KHAN Assistant Professor MCPS, MS, MHSc in Bioethics (Canada) Research Department, Clinical Trials Unit DUHS LEARNING OBJECTIVES At the end of this module the students will be able to: 1. List the common practical examples from Medical Ethics 2. Describe Medical Ethics 3. Describe Bioethics 4. Discuss the importance of Bioethics 5. Describe the milestones in the history of Medical Ethic Plan of Module A didactic discussion in the following order with the students: 1. Common practical examples from Medical Ethics 2. What is Medical Ethics? 3. What is Bioethics? 4. What is the importance of Bioethics? 5. Describe the milestones in the history of Medical Ethic 6. Summary 7. References MEDICAL ETHICS: Doctor-patient relationships Experimentation with human subjects and animals

2 Organ transplant Resources allocation in health care system Human cloning Stem cell research WHAT IS ETHICS? A science which judges human conduct to be right or wrong, to be good or bad. Socrates 360 BC, 352d WHAT IS ETHICS? Medical Ethics and Practical Applications Medical Ethics is all about relationship and choices of person in the form of conduct Medical Ethics provide the standard for human actions to be right or wrong Medical Ethics provides validity and trust on these standards Medical Ethics and Practical Applications Who has the final authority in medical decision making?

3 Patient / individual Family Physician(s) Medical Ethics Medical ethics are concerned with the ethics of the health care professionals and their relationship with the patient Medical Ethics: Patients have their rights for: Standard of medical care Autonomous / informed choice Decision making Privacy / confidentiality Health Education PHYSICIANS AND PATIENTS RELATIONSHIP To save the patient s life To promote and protect the patient s health To respect the patient s autonomy /dignity To protect privacy / confidentiality

4 CLINICAL ETHICS A practical discipline that provides a structured approach for identifying,analyzing, and resolving ethical issues in clinical medicine / Practice A practical and applied discipline that aims to improve patient care and health outcomes by focusing on reaching a right and good decision in individual cases. It focuses on the doctor-patient relationship and takes account of the ethical and legal issues What is Bioethics?

5 Bioethics is the branch of ethics that studies problems in life sciences, medicine, and biotechnology. Clinical Ethics, Research ethics, organization Ethics and Environmental Ethics are some of the topics that are considered branches within bioethics. What is Bioethics? Bioethics in medical practice is defined as the study of ethical issues and decision-making associated with the living organisms Bioethics is learning how to balance different benefits, risks and duties in medical practice What is Bioethics? Major branch in Applied Ethics The study of the ethical issues arising from health care, biological and medical sciences. Practical Applications of Bioethics Major branch in Applied Ethics The study of the ethical issues arising from health care, biological and medical sciences. Why is Bioethics Important? Behaving ethically can improve patient care Behaving ethically can improve the quality of staff work life

6 Quality health care requires behaving ethically Most bioethical issues relate human beings MILESTONES IN THE HISTORY OF MEDICAL ETHICS The repulsions of many "experiments on human subjects were exposed during and after World War II. THE NUREMBERG TRIAL 1946 TUSKEGEE STUDY ( ) In the 1950s, Thalidomide was approved and German manufacturer of the drug had collected no systematic human safety data. The drug was recommended for use to treat morning sickness during pregnancy. Thalidomide trial The Nuremberg Code became the first international code of ethics for research involving human subjects THE MILLIGRAM STUDY:

7 The "learners, actual members of the research team were seated in an electric chair. The "teachers" actual research subjects were told by the researcher to give electric shocks of increasing intensity. After each wrong answer to a question the electric shock was given. Study subjects did not know that the learner was actually an actor who received no shocks, but acted as if he/she had. OBEDIENCE TO AUTHORITY In the 1950s, Thalidomide was approved and German manufacturer of the drug had collected no systematic human safety data. The drug was recommended for use to treat morning sickness during pregnancy. THE MILLIGRAM STUDY: OBEDIENCE TO AUTHORITY The "learners, actual members of the research team were seated in an electric chair. The "teachers" actual research subjects were told by the researcher to give electric shocks of increasing intensity. After each wrong answer to a question the electric shock was given. Study subjects did not know that the learner was actually an actor who received no shocks, but acted as if he/she had. THE BELMONT REPORT Ethical Principles and Guidelines for the Protection of Human Subjects was written by the National Commission and published in The three principles of The Belmont Report govern all research supported by the U.S. government.

8 Chronology of events impacting human subjects research Oath of Hippocrates (4th c BC) 1930's-1960'sTuskegee Syphilis Study 1946 Nuremberg Doctors Trial 1947 Nuremberg Code (Issue of human experimentation) 'sThalidomide Tragedy 1960 Milgram tudy Chronology of events impacting human 1964 Declaration of Helsinki (Issue of human experimentation) 1974 National Commission for the Protection of Human Subjects 1974 U.S. Human Subjects Regulation 1979 Belmont Report 1993 The Council for International Organizations of Medical Sciences, CIOMS Guidelines 2005 Universal Declaration on Bioethics and Human Rights (UNESCO: United Nations Educational, Scientific, and Cultural Organisation) Summary of the Module on Medical Ethics

9 Ethics is a science which judges human conduct to be right or wrong, to be good or bad Medical ethics is concerned with the ethics of the health care professionals and their relationship with the patient Bioethics A practical discipline that provides a structured approach for identifying,analyzing, and resolving ethical issues in clinical medicine / Practice Bioethics is the branch of ethics that studies problems in life sciences, medicine, and biotechnology. Summary of the Module on Medical Ethics The repulsions of many "experiments on human subjects were exposed during and after World War II. The Nuremberg Code is the first international code of ethics for research involving human subjects Tuskegee Study Thalidomide trial The Milligram study: obedience to authority The Belmont report The Council for International Organizations of Medical Sciences, CIOMS Guidelines Universal Declaration on Bioethics and Human Rights References Beauchamp TL, Childress JF. Principles of Biomedical Ethics, Third Edition. New York: Oxford University Press, 1989: Ethics as Process and Practice by A.W. Frank.

10 Internal Medicine Journal 2004, 34: Four Appointments with a Discus Thrower. In: The Doctor Stories by R. Selzer. New York: Picador USA, 1998, Finely Aware and Richly Responsible : moral attention and the moral task of imagination by M. Nussbaum. Journal of Philosophy : Beauchamp TL, Childress JF. Principles of Biomedical Ethics, Third Edition. New York: Oxford University Press, 1989: Ethics as Process and Practice by A.W. Frank. Internal Medicine Journal 2004, 34: Four Appointments with a Discus Thrower. In: The Doctor Stories by R. Selzer. New York: Picador USA, 1998, Finely Aware and Richly Responsible : moral attention and the moral task of imagination by M. Nussbaum. Journal of Philosophy : THANK YOU