Wednesday, July 27, 2011

International Code of Medical Ethics (Part 1)

Lectured by: Dr. Srivinasa; Management & Science University
Notes by: Dr. Srinivasa, Malilith F. Ila

Evolution/History of Medical Ethics

1. Hippocrates (500 BC) is generally regarded as the founder of medical ethics. He was the originator of the concept of medicine as a profession whereby physicians make a public declaration to place the needs and interests of patients above their own.
He created the Hippocratic Oath.

2. During the middle ages, medical ethics was strongly influenced by religious thinkers.

3. The first book dedicated to medical ethics was written by Ishaq bin Ali Rahawi; "Practical Ethics of the Physician"
Other sources of medical ethics include;
- Muhammad ibn Zakariya ar-Razi (Muslim)
- Thomas Aquinas (Christian)
- Maimonides (Jewish)
- Thomas Percival; a British physician (1740-1804) wrote about medical juriprudence and reportedly coined the phrase "medical ethics"
- American Medical Association adopted its first code of ethics, based in large part of Percival work (1847)

Unethical Behaviours/Experiments

1. Nazi's "Medical" Experiments (1945)
- The "Doctor's Trial" - Nuremberg War Crime Trials (Gang of 23)
- They experiments on prisoners, inmates, and "others" without consent.
- Most subjects are tortured with cruelties and other inhuman acts.
- Ex: Freezing, malaria, high altitude, underwater, starvation, sound, mental

In respond to this, Nuremberg code (1947) was set. It's a set of pronciples governing ethical conduct of research with humans.

2. Tuskegee Syphilis Study (1932)
- To investigate the long term effects of untreated syphilis
- African Americans were recruited to participate to death.
- They weren't told the purpose of study, the disease they had and no treatment was offered even when it was available 8 years later
- They also couldn't quit the programme, were offered illegal inducements
- The study continued for 40 years
- Was stopped in 1972 due to newspaper article
- 1974; US government agreed to out-of-court settlement; the survivors were given compensation. U.S. government promised to provide a range of free services to the survivors of the study, their wives, widows, and children. All living participants became immediately entitled to free medical and burial services.

3. Jewish Chronic Diseases Hospital, Brooklyn (1963)
- Cancer cells were injected into delilitated elderly patients to see if they would immunologically reject the cells.

4. Willowbrook State Hospital, New York (1972)
- Retarded children were deliberately infected with viral hepatitis to study its natural history

World Medical Association

- Was founded in 18th Spetember 1947 by physicians from 27 countries
- Membership includes over 80 National Medical Associations; and over 10 million physicians
- Works to ensure the independance of physicians and the highest possible ethical standard of care and behaviour by physicians
- The purpose of the WMA is to serve humanity by endeavoring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world

Main decision making body; General Assembly
Political body; WMA Council
- Assembly elects the WMA council every 2 years
- Chairperson of council is the political head; elected every 2 years by the Council
- Ceremonial Head of WMA is the president; anually elected by Assembly
- Secretary-General is in full time employment at WMA Secretariat (Ferney-Voltaire, France); appointed by the Council

- Published the World Medical Journal
- Offers internet courses in its site
- Revived Hippocratic oath and the practice of it being administered as part of a medical licensing ceremony
- 1952; Committee of Medical Ethics is formed to discuss various ethical issues
- Has no legal powers

American Medical Association

- Founded in 1847; incorporated in 1897
- Largest association of physicians and medical students in the United States
- AMA's stated mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education

Continue; Part 2
Nuremberg Code
Declaration of Geneva
Declaration of Helsinki
Declaration of Tokyo
The Belmont Report
Principles of Medical Ethics

Continue; Part 3
Duties of Doctors to the Sick
Duties of Doctors in General
Duties of Doctors to Each Other

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