Should doctors disclose potentially upsetting information about disease trajectories? When and how should we discontinue medical intervention for the dying? Who should have first access to scarce medical resources?
These are only a few of the ethical questions that arise in medicine. In order to sort through these challenging questions, the field of medical ethics developed in the latter half of the twentieth century.
Despite its relatively recent development as an independent field, medical ethics has a long history. The Hippocratic Oath, developed by Hippocrates in the fifth century BCE, calls for physicians to behave with honesty and integrity toward their patients. The most famous portion of the Hippocratic Oath is "first, do no harm," which calls on doctors to focus on doing good for their patients and minimizing harm.
Numerous unethical medical experiments conducted in the twentieth century, including the Tuskegee Syphilis study and the Mississippi Appendectomies, led to demands for ethical rules and guidelines that would protect the rights of patients. Today, Western medical ethics is based on the four principles of autonomy, justice, benevolence, and non-maleficence.
Autonomy means placing significance on the patient as an independent being, who would not be coerced or lied to throughout his or her treatment. Patients must be told all the risk and benefits of their potential treatment or participation in a research study. Valuing autonomy is made challenging due to the advent of genetic medicine, in which a genetic test performed on one family member can potentially reveal significant information about other members of the family.
Justice requires that the distribution of medicine and medical technologies be essentially fair, without privileging one group's access over another's. Moreover, patients should not be treated differently because of factors that they cannot change (like race or gender). Justice is often imperfectly realized in American medicine, since minority groups face continued barriers to accessing medicine, and insurance providers remain gatekeepers for medical care.
Benevolence demands that all medical interventions be performed with the highest good of the patient in mind. This principle was violated during many experiments during the mid-twentieth century. For example, John Moore's doctor David Golde asked that he make frequent trips to Los Angeles so that Golde could collect biological material for him for use in the creation of a new cell line. This had no medical benefit for Moore, and in fact inconvenienced him seriously by requiring him to undertake frequent travel.
Non-maleficence entails that medical procedures do not harm the patient or others in society. In other words, doctors should not offer medical interventions that would cause pain or illness for patients without any hope of a medical benefit. This principle was violated by researchers such as Chester Southam, who injected sick people with cancer cells.
It is often difficult to negotiate how to implement these principles into medical ethics, particularly in non-Western settings. For example, the value of autonomy might not be valued by patients from East Asian cultures, which often place a higher value on collective decision-making and may want relatives to make treatment choices. Medical ethics will continue to adapt and develop as medicine advances.
(For more information, see Beauchamp and Childress' book The Principles of Biomedical Ethics in the Book Citation section of this note.)
