The Evolution Of Medical Ethics: An Historical Perspective
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The Evolution Of Medical Ethics: An Historical Perspective

(Disclaimer: This article was written to provide an history of the evolution of Medical Ethics and is descriptive and not in any manner prescriptive to the readers)

While most of the practitioners of Western medicine are aware of The Oath of Hippocrates, many are yet at a loss when it comes to the knowledge of evolution of ethics of medical practice over time. The ethical foundations of Western medicine in practical terms are as diachronic as any philosophical underpinnings of human affairs owing to changes in technology and in paradigms that govern the methods in practice. To begin with, The Oath Of Hippocrates itself has been published in two editions: the one classical (circa AD 275) and the other modern (circa 1948 the Declaration of Geneva). It's said (at the risk of sounding clichéd) change is the only constant in the world. This quality of ever-changing relationships and processes and its reflections in human ethics and morality is called diachrony. With globalization of the world, mass production of goods and services, climate change, bad decisions by leaderships and poor lifestyle choices and habits, the world is witnessing diseases at a much more profound scale qualitatively and quantitatively. This has led to, historically speaking, the evolution of the ethical foundations of Western medicine. With the individual at the centre of care guided by unalterable universal laws, The Oath Of Hippocrates has been the guiding light for the men and women of medicine since ages.

With the evolution of the political philosophy and advent of Communism in Europe, the Soviet Union altered medical ethics in favour of totalitarianism, a political philosophy wherein the absolute authority reigned in the hands of the government. In the totalitarian Soviet Union, the rights of the individual were subjugated to the welfare of the state. Thus, the Soviet Union abolished The Oath Of Hippocrates from its State-run colleges and hospitals. In the totalitarian regime, matters of ethics did not fully assist in patients' welfare but yielded to and were amenable to the demands of the Communist regime. With its spread to East Germany, Communist government-run detention camps and state policing, malnutrition and infectious diseases like Tuberculosis witnessed a massive increase. India under the Indira Gandhi regime followed suite with compulsory sterilisation camps wherein forced vasectomies were performed at a cash prize of few hundred rupees. This is the totalitarian phase of the history of medical ethics and it brought immense violations to the individual rights in the name of controlling public health.

The post-modern globalised world saw an advent of Utilitarianism in Medical Ethics. The greatest good of the greatest number with Humanity or even the planet as the patient. This approach is very relevant in public health services and thus mass screening and medical camps find a place under Utilitarianism. The Oath Of Hippocrates is compatible with the Judeo-Christian ethic, the belief that humankind has inherent flaws, and the view that government should be constitutionally limited and is incompatible with totalitarianism. Utilitarian modernist codes are compatible with an expansive, even totalitarian state, and reflect the utopian view that humankind is perfectible (Orient, 2010).

The medical ethics of "prehistory" -- prior to about 1947 -- is being supplanted by bioethics. Moral absolutes are swept aside in favour of rules and mathematical risk-benefit ratios. Behaviour directly forbidden by the Oath Of Hippocrates is now defined as ethical, especially when it involves nonpersons or those deemed to be "nonsentient" or otherwise unworthy of life. Replacing the firm, immutable, timeless principles derived from natural law is a dialectic of internally contradictory demands (Arnett, 2002): the primacy of patient welfare, patient autonomy, and social justice. These are the three fundamental principles of the Charter on Medical Professionalism, put forth in response to "unprecedented challenges" of the new millennium, and "intended to be applicable to different cultures and political systems" (Medical Professionalism Project, 2002).

Thus, founded on the basis of these bases in Medical Ethics, the laws are sometimes in direct contradiction to The Oath Of Hippocrates (loyalty to individual patients). Thus, it becomes a question of following the law to direct treatment for the patient rather than practicing the ethics prescribed in The Oath Of Hippocrates. In principle, some laws can be unethical. That's the harsh truth.

© Marcus Maelstrom