PRINCIPLES OF MEDICAL ETHICS

 TRADITIONAL PRINCIPLES OF MEDICAL ETHICS

There are seven principles of Medical Ethics: a Moral Code and moral justification; the Doctor-Patient Relationship; Patient Autonomy; Beneficence (the Good Samaritan); Do No Harm (or Nonmalificence); Justice; and the Physician's moral integrity and virtuous character. All seven principles must be in harmony for ethical medical care.

First, there must be a moral code and moral justification to guide the physician in his actions. We learn as early as the Old Testament from Hebrew Scripture the value of life. In the Book of Genesis, God said Let us make man in our image and likeness (Genesis 1:26). We learn that God instilled the "breath of life" in man (Genesis 2:7). Because all human beings are created according to God's image and given the breath of life, we are called to respect the dignity of each human being.

Moses, the originator of the first five books of the Old Testament, lived before 1250 BC. God gave Moses the Ten Commandments as noted in the Book of Exodus, the one concerning life stated in a clear and direct manner:

"Thou shalt not kill." Exodus 20:13

The Book of Leviticus is the third book of the Pentateuch and God tells his people "to love your neighbor as yourself" (Leviticus 19:18). The Ten Commandments are repeated in the Book of Deuteronomy 5:6-21.


The ancient writers of Greece were concerned with the principle of life. Plato considered the soul to be trapped within the body, happily released upon death. Aristotle saw the body and soul as one unit, the soul being the "life principle" of the body. Every physician who graduates from a medical school in the United States takes the Oath of Hippocrates, the Father of Medicine who lived in Greece from about 450-375 BC. The middle portion of the traditional Hippocratic Oath expressly forbids abortion and euthanasia:

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art.


Jesus Christ gave us the Beatitudes as recorded in the New Testament. The Beatitudes are presented in a positive sense, virtues in life which will ultimately lead to reward in Heaven. He taught us the Golden Rule in the Sermon on the Mount, to do unto others as you would have them do unto you (Matthew 7:12). He taught us the two greatest commandments are to love God, and to love your neighbor as yourself (Matthew 22:36-40, Mark 12:28-31, Luke 10:25-28). St. Paul taught us to respect the human body, for our bodies are temples of the Holy Spirit (I Corinthians 6:19).


Thus the tradition of Western Christian civilization and American medicine is founded upon the Biblical ethic and the traditions of our Greco-Roman heritage. Our Declaration of Independence speaks of God our Creator and the Natural Law, that every man has certain unalienable rights, namely, Life, Liberty and the Pursuit of happiness. Thomas Jefferson recognized that we have freedom and dignity as human beings because we are creatures of God. The U. S. Bill of Rights guarantees the rights of every American citizen.



The second principle of medical ethics is the doctor-patient relationship. Essential to this relationship is the element of trust. This relationship has been described by Paul Ramsey as a covenant similar to the pact between Yahweh and his people as recorded in Hebrew Scripture. The patient trusts the physician to counsel him to make the right decision regarding his care, to ensure his privacy, and to be a patient advocate. The physician should be compassionate, truthful, and respect the personal dignity of the patient by giving him informed consent. He is to fulfill his traditional role as healer and protector of the patient's life.

Free and informed consent is required for medical treatments and procedures, except in an emergency situation when informed consent cannot be obtained and there is no indication that a reasonable patient would refuse consent to the treatment, as, for example, an unconscious trauma patient from a motor vehicle accident that presents to the emergency department.

Free and informed consent requires that the person or person's surrogate (or proxy) receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all.

If a patient is incapable of making medical decisions, a proxy or surrogate, as an eldest son or a daughter who may be living with the parent and is in a position to best know the patient's wishes, is called upon to make treatment decisions. Should the proxy utilize the concept of substitute judgement or of best interest? Substitute judgement is a preference the patient has expressed in the past, whereas best interest decisions consider what treatment or lack of treatment would benefit the patient at that particular time. A balance of the two concepts often occurs in the clinical setting. For example, the family may remember the patient was adamant about not having gastric tube placement. The physician honors this request and the family and physician may decide it is in the best interest to give the patient intravenous fluids during the patient's final hours. Hopefully dialogue among the physician and family members can resolve the appropriate course of action.

The third principle is patient autonomy. Individual self-determination is highly valued in our American tradition, and rightly so. Patients should have the right to accept or refuse treatment, or allow the natural course of events to take place. It is important to remember that one must respect autonomy as long as we live in harmony with the first principle of our moral law and the sanctity of life.


The fourth principle of medical ethics is beneficence, or the act of helping others. Beneficence refers to the traditional role of the physician as the Good Samaritan. The compassionate physician performs acts of charity, kindness, and mercy; comes to the aid of the injured, the sick, and the dying; and relieves suffering. Natural or comfort care, the offering of food and water and the maintenance of body temperature and cleanliness for the dying elderly patient is a form of beneficence, as well as comforting the patient through a loving presence, palliation, and prayer. Jesus gave us the Parable of the Good Samaritan, as recorded in the Gospel of Luke:

Jesus replied, "A man was going down from Jerusalem to Jericho, and he fell among robbers, who stripped him and beat him, and departed, leaving him half dead. Now by chance a priest was going down that road; and when he saw him he passed by on the other side. So likewise a Levite, when he came to the place and saw him, passed by on the other side.
But a Samaritan, as he journeyed, came to where he was; and when he saw him, he had compassion, and went to him and bound up his wounds, pouring on oil and wine; then he set him on his own beast and brought him to an inn, and took care of him. And the next day he took out two denarii and gave them to the innkeeper, saying, `Take care of him; and whatever more you spend, I will repay you when I come back.'
Which of these three, do you think, proved neighbor to the man who fell among the robbers?" He said, "The one who showed mercy on him." And Jesus said to him,"Go and do likewise."
Gospel of Luke 10:29-37



The fifth principle of medical ethics is nonmalificence. Nonmaleficence is the warning, "Never do harm to anyone." This speaks for itself! The physician must evaluate whether any particular treatment or procedure is clinically indicated, and whether the procedure will provide benefit or undue burden to the patient. When considering a medical treatment for a patient, one speaks of ordinary and proportionate care versus extraordinary and disproportionate care. For example, mechanical ventilation may be ordinary and proportionate for an otherwise healthy 25 year old who suffered a near-drowning accident, whereas a respirator for an 88 year-old near-terminal patient with cancer of the lung would be extraordinary and disproportionate. The reference point is the patient!


The sixth principle of medical ethics is justice. Justice means respecting the rights and dignity of each human being. The real purpose of civil law is to guarantee an ordered social coexistence in true justice, so that all may "lead a quiet and peacable life, godly and respectful in every way" (1 Timothy 2:2).

The physician must be fair to his patient, respect his rights as a person, and give the patient proper access to health care.

Today the principles of social justice often impact upon health care, as the corporate world has engulfed the profession of medicine. Scripture firmly supports the concepts of social justice, such as the New Testament Letters of St. Paul: in his First Letter to the Corinthians 3:8, he states that "every man shall receive his own reward according to his own labour."

The publication of Rerum Novarum on May 15, 1891 by Pope Leo XIII contributed greatly to improved treatment of workers during the Industrial Revolution. Pope John Paul II had a major impact in his call for social justice in the mistreatment of workers in Communist Poland, an event that ultimately led to the fall of the Iron Curtain. In his followup encyclical Centesimus Annus, published May 1, 1991, the Pope warned corporations against treating workers as "units of production" in their quest for profit.


Finally, the seventh principle of medical ethics is the physician, as a leader in the community, must be diligent to develop a virtuous character and exhibit moral integrity. The virtues are discussed below. We have the best role model - the great Physician, Jesus Christ!





These seven principles of medical ethics play an important part in our daily practice of medicine, in life-and-death decisions, and on modern human life issues. A review of the natural law and Christian morality will provide background for a discussion of the primary principle of the sanctity of life.   

Reference:http://www.jesuschristsavior.net/Ethics.html