1. History of Medical Ethics
PH 350
Norwich University
Spring 2010

2. Learning Objectives
To understand early medicinal thought, especially the concept of paternalism
To highlight some of the major events in history that developed patient autonomy
To review the goals of medicine
To understand the major principles of modern-day medical ethics

3. Early Medicinal Thought
Paternalism
-Medical treatment as a father/child relationship
-Guiding principle: physician decides what is best for the patient and tries to follow that course of action
-Focus: patient care and outcomes,
not the patient’s needs or rights
-Argument: maximum patient benefit
can only be achieved when the doctor
makes the final decision

4. Paternalism…Continued
Types of Paternalism
-Positive vs. Negative
Positive = promotes the patient’s good
Negative = seeks to prevent an existing harm
-Soft vs. Hard
Soft = appeals to the patient’s values
Hard = applies another’s values over the patient
-Direct vs. Indirect
Direct = benefits the patient who has been restricted
Indirect = benefits a person other than the one restricted

5. The Father of Medicine Hippocrates -Rejected medical views of his time
-Based his medical practice on observations and study of the human body
-Believed that illness has a rational explanation
-Treated body as a whole unit, not just parts
-Founded a medical school on the island of Cos, Greece to teach his beliefs

6. Hippocratic Oath Original vs. Contemporary
-language and content has been
updated to fit modern beliefs about
medicine
-spells out physician responsibilities
to both the patient and the medical profession

7. Evolution to Autonomy Making the shift from paternalism
-Patient given opportunity to determine benefit vs. harm
- The Patient’s Bill of Rights
-Questions being raised regarding the patient’s wishes as to what is ethical
-How much do you tell the patient?
-Do they even want to know?

8. Notable Cases in History
Nuremberg Code: 1946
-Limits on medical research
following Nazi testing of
hypothermia & antimicrobial
agents
-Subjects were put in ice tanks
for 3 hours, wounds were inflicted
& purposely infected with bacteria
-Concepts of informed consent, avoiding all unnecessary physical
& mental suffering, proper preparation & facilities, ability for subjects to opt out, basing human experiments on results of animal testing

9. Notable Cases…Continued
Tuskegee Syphilis Study: 1929
-Use of placebos in studies
-Participants were illiterate,
black sharecroppers thought
to have “bad blood”
-Deaths, chronic illness, and
transmission to wives & children
resulted

10. Notable Cases…Continued
Nancy Cruzan: 1983
-Was maintained in a persistent
vegetative state for several years
-Parents requested that artificial
hydration and nutrition be withdrawn
-Courts rule in their favor, but healthcare team appeals the decision
-Incompetent patients need to be protected by law
-Encouraged the development of advance directives and appointment
of a health care proxy to carry out patient’s wishes

11. Goals of Medicine Relieve suffering
- Example: The use of Chloroform and Ether
Chloroform was used more often because it was
faster acting, less was needed to put someone under,
and it was non-flammable.
However, it was more
dangerous than using Ether.
The risk of drug overdose was
greater with Chloroform.

12. Goals…Continued Promote health - Flintstones Vitamins - Acne Treatment
- Weight loss

13. Goals…Continued To cure disease and preserve life
1900 – Average life expectancy was 49
2003 – Average Life expectancy is 78
Vaccinations
Definition: “A preparation of a weakened or killed pathogen, such as a bacterium or virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.”
-Swine Flu
Cures
- Breast Cancer

14. Principles of Medical Ethics
Confidentiality
-HIPAA (Health Insurance Portability & Accountability Act)
Honesty
-Telling patients what they need to know
Justice
-Treating all patients without discrimination
Gatekeeping
-Patients access to medicine through doctors
Report impaired colleagues

15. Principles…Continued
Avoid sexual relations with patients
Conflicts of interest
Scope of practice
-Range of responsibility, abilities
Gaming the system
-Using patients to make more money

16. The End Thank you to all of our viewers! Produced by:
J. Bielski, H. Black, V. Bruce, & J. Davis