1. Dr Hidayathulla Shaikh Lecturer, College Of Dentistry, Majmaah University.

2. Ethical Codes of Modern Era  Nuremberg Code (1947).  Belmont Report (1979).  AMA (American Medical Association) revision (2001).  Declaration of Helsinki, application to medical research (1964, rev. 1975, 1983, 1989, 1996, 2000)  Declaration of Geneva, W.M.A. (1948, 1968, 1984, 1994, 2005, 2006).  World Medical Association International Code of Medical Ethics

3. 1) The Nuremberg Code  The human experimental trials were conducted in the city of Nuremberg, Germany from 1945-1949.  The experiments were conducted on the unconsenting prisoners and detainees, during the second world war.  Most of the subjects of this experiment died or became permanently crippled. This promulgated the establishment of Nuremberg code.

4. Nuremberg trial  23 doctors were tried for the medical experiments and related crimes committed during the war.  At the end of the trial, 7 of the doctors were acquitted, 7 were charged with death, 5 were sentenced to life in prison, and 4 were charged for 10-20 years in prison

5. Content of the code  The voluntary informed consent of the human subject is absolutely essential.  The experiment should be such as to yield fruitful results for the good of the society.  The experiment should be designed based on animal experimentation and knowledge of the natural history of the disease.  The experiment should be designed to avoid all unnecessary physical and mental injury.  No experiment should be conducted if known prior, that it will result in death or disabling injury.

6.  The experiments should be conducted only by the scientifically qualified persons.  Adequate facilities should be there to avert any risks to the subjects.  During the experiment the human subject should be at liberty to end the experiment.

7. 2) Belmont Report Foundational Document for Medical and Biomedical Research Ethics Guided by Four Principles 1. Respect for Persons 1. Autonomy 2. Those with diminished capacity/status deserve protection 2. Beneficence 1. Act in best interest of patient 3. Non-maleficence 1. Do no harm 2. Maximize benefits/minimize harm 4. Justice 1. Giving every person her or his due 2. Injustice occurs when a person entitled to a benefit is denied it without sufficient reason or when an undue burden is imposed.

8. 3) AMA (American Medical Association’s) 9 Principles of Medical Ethics Principles of medical ethics I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. III. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

9. V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. IX. A physician shall support access to medical care for all people.

10. 4) Declaration of Helsinki  Another important milestone is the “Declaration of Helsinki”, in 1964 the World Medical Association (WMA) established recommendations guiding medical doctors in biomedical research involving human subjects.  The declaration governs international research ethics and defines rules for research combined with clinical care.  The declaration of Helsinki was revised in 1975, 1983, 1989, 1996 and latest being in 2008 at Seoul, South Korea.  It is the basis for good clinical practices used nowadays.

11. Important issues addressed in the Declaration of Helsinki include -  Research with humans should be based on the results from laboratory and animal experiments.  Research protocols should be revived by an independent committee prior to initiation of research.  Informed consent from the research participants is necessary.  Research should be conducted by scientifically / Medically qualified individuals.  Risks should not exceed benefits.

12. 5) Declaration of Geneva (amended 2006)  Adopted by the 2 nd General Assembly of the World Medical Association (WMA), at Geneva, Switzerland in September 1948.  This oath was a response to the atrocities committed by the doctors in the Nazi, Germany during 2 nd world war.  Notably this oath requires the physicians to not to use his/her medical knowledge against the laws of humanity.

13. At the time of being admitted as a member of the medical profession:  I solemnly pledge to consecrate my life to the service of humanity.  I will give to my teachers the respect and gratitude that is their due.  I will practice my profession with conscience and dignity.  The health of my patient will be my first consideration;.  I will respect the secrets that are confided in me, even after the patient has died.  I will maintain by all the means in my power, the honor and the noble traditions of the medical profession.

14.  My colleagues will be my sisters and brothers.  I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.  I will maintain the utmost respect for human life.  I will not use my medical knowledge to violate human rights and civil liberties, even under threat.  I make these promises solemnly, freely and upon my honor.

15. 6) World Medical Association International Code of Medical Ethics :  This was adopted by the 3 rd Assembly of the World Medical Association (WMA) at London, England in October 1949.  WMA is an organization of National Medical Associations.  The codes of WMA were amended many times and the latest being at the WMA General Assembly, Pilansberg, South Africa, in October 2006.