Ethical codes and oaths

Definition

Ethical codes and oaths are statements of the moral principles and values that govern the conduct of a group, profession, or individual. In the health professions, ethical codes embody the ideals of compassion for the suffering and respect for the dignity of all human beings, as well as the highest standards of clinical research and practice.

Ethics as a discipline is the study of moral values and moral reasoning. There are two major approaches to ethics, normative and non-normative. Non-normative ethics describes and studies moral beliefs without making value judgments about right and wrong. Normative ethics tries to define and distinguish between right and wrong.

Description

Ethical codes and oaths are formal statements that serve to remind practitioners of their obligations to their patients and to the larger society. In the United States and Canada, the ethical codes that have been drafted by the various health professions are also regarded as the foun dation of the legal obligations of health care professionals—including disciplinary standards. For example, a patient who files a complaint with the ethics committee of a physician's medical society or hospital can take the complaint to the state licensing board as well. Ethics committees in the health professions have the power to suspend or expel members who have violated the ethical code that governs the profession.

The ethical standard set by the professional organization may be simple and forthright like the Hippocratic Oath for physicians, or more thorough and specific as is the code of conduct for nurses. Modern medical codes and oaths are patterned after the Hippocratic Oath and contain the same basic concepts: to work for the good of one's patients; to cause them no harm; to honor the profession of medicine and protect it from corruption; to give no drugs or perform no operation that would cause harm to the patient; and to keep medical information confidential.Whether the code is an ancient or a contemporary version, it gives the health care professional a high standard of conduct for which to strive.

Viewpoints

Historical background

The earliest statement of ethical standards for physicians is the so-called Hippocratic Oath, attributed to the "father of medicine" in the fifth century b.c. In the West, both Judaism and Christianity gave extensive consideration to the importance of the physician's moral character as well as his clinical duties to patients. In Judaism, medical ethics is rooted in the study of specific case histories interpreted in the light of Jewish law. In medieval Christianity, ethical reflection took the form of an emphasis on duty, moral obligation, and right action. In both faiths, the relationship between the medical professional and the patient was regarded as a covenant or sacred bond of trust rather than an economic transaction or a business contract.

Since the eighteenth century, several developments have led to increased concern about the ethical standards of the health professions. These changes include:

• A philosophical emphasis on individual freedom and personal rights rather than on obligations to family or society.
• Advances in scientific knowledge and technology that raise new questions about the nature of human personhood, life, and death.
• Recognition of the vulnerability of the health professions to abuse by government authority. Specific examples include medical experiments on concentration camp inmates in Nazi Germany and the abuse of psychiatry in Stalinist Russia.
• The increased role of economic considerations in health care decisions on the individual as well as the communal level.
• The loss of a universal moral framework accepted by all or most people. Although there are a number of religious and philosophical perspectives on ethical questions that many people accept, none of these perspectives is accepted by everyone.

Present models for making ethical decisions in medicine

Models are outlines or patterns that can be used in ethical decision-making to help the care provider organize his or her thoughts and bring in all relevant considerations. One widely used model for decision-making in medicine holds that any ethical decision must consider four factors:

• Medical indications. These include the diagnosis and treatment of the patient's condition.
• Patient preferences. This factor assumes that health professionals should respect the patient's wishes, and wherever possible provide care that does not violate them.
• Quality of life. This factor is to be evaluated from the patient's point of view, not the medical professional's perspective.
• The wider context. This factor includes all the other features that may be involved in a specific decision, such as the family's feelings, legal considerations, socioeconomic issues, religious practices, and others.

Another model that is sometimes used in clinical practice proposes three rules to be followed in ethical decision-making:

• Impartiality. This rule requires the health professional to place himor herself in the patient's position and ask whether they would be willing to have the action performed if they were the patient.
• Universality. This rule asks whether the health professional would be willing to apply the same solution to the patient's situation in all similar cases.
• Justifiability. This rule asks the health professional to consider whether he or she could defend the decision to other people or discuss it in public.

Other considerations

Although there are many medical codes and guidelines within individual medical associations, some observers have proposed a universal code of ethics binding on all health care professions. It has been suggested that a universal code of ethics would unify the medical community and restore society's trust in its professional care givers.

Another dimension of ethical decision-making in medicine that has received greater attention in recent years is the role of empathy and compassion. The ethical codes that govern health professionals do not specify these characteristics in health care providers, but both care givers and patients increasingly recognize that ethical integrity can be cold and lifeless without emotional rapport. Human beings have feelings as well as capacities for intellectual reflection and analysis. Empathy and compassion help to build trust between care giver and patient, improve communication, and often contribute to healing.

Professional implications

One implication for health professionals is the importance of studying ethical issues during one's professional education. Many medical, dental, and nursing

KEY TERMS

Empathy —The ability to identify with the feelings or thoughts of another person.

Ethics —A system or set of moral principles; also, the study of values relating to human conduct.

Hippocratic Oath —The ethical oath attributed to Hippocrates that is used as a standard for care by physicians worldwide.

Non-normative ethics —An approach to ethics that emphasizes analysis of moral decisions without making judgments of right or wrong.

Normative ethics —An approach to ethics that attempts to define right and wrong and distinguish between them.

Rapport —A relation between two people that is harmonious and sympathetic.

schools now include courses in their curricula that deal with such topics as moral decision-making, definitions of life and death, the ethical complexities of professional-patient relationships, and the moral safeguards of medical research.

A second implication is recognizing the necessity of interdisciplinary conversation and cooperation. Health professionals can benefit from the insights of scholars in the social sciences, philosophy, theology, law, and history. At the same time, health professionals have much to offer to scholars in other fields gained from their clinical experience.

Resources

BOOKS

Brody, Baruch A., et al. Medical Ethics: Codes, Opinions, and Statements. New York: BNA Books, 2000. This book is a collection of the ethical statements and positions of the twenty-six leading medical societies in the United States.

Jonsen, Albert R. A Short History of Medical Ethics. New York: Oxford University Press, 2000.

PERIODICALS

Hughes, James J., and Damien Keown. "Buddhism and Medical Ethics: A Bibliographic Introduction." Journal of Buddhist Ethics 7 (2000): 1-12.

Levine, Carol. "Hands on/hands off: Why health care professionals depend on families but keep them at arm's length." Journal of Law, Medicine, and Ethics (Spring, 2000).

Smith, Richard. "Education and debate: Shared ethical principles for everybody in health care: A working draft from the Tavistock Group." British Medical Journal 318 (January 23, 1999): 248-251.

ORGANIZATIONS

American Medical Association, Council on Ethical and Judicial Affairs. 535 North Dearborn St., Chicago, IL60610. (312) 645-5000.

Canadian Medical Association. 1867 Alta Vista Drive, Ottawa ON K1G 3Y6. (613) 731-8610×2307 or (888) 855-2555. Fax (613) 236-8864. cmamsc@cma.ca.

Society for Academic Emergency Medicine. 901 North Washington Avenue, Lansing, MI 48906-5137. (517) 485-5484. Fax: (517) 485-0801. saem@saem.org.

OTHER

Canadian Medical Association. Code of Ethics of the Canadian Medical Association. Policy statement approved by the CMA Board of Directors, October 15,1996.

Peggy Elaine Browning