Principles of Bioethics
Ethical Dilemmas in Biology & Medicine
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Are there any basic principles which discussions of bioethics or medical ethics should ideally start with? The field of bioethics is, after all, very wide ranging - it encompasses just about every ethical issue involving medicine and biology. Without some basic and unifying principles, it would be difficult to imagine considering this a single field of study at all.
Perhaps the most fundamental principle of all medical ethics is the idea that for anyone who presumes to be involved in the treatment of disease or illness, their primary and overriding duty is to their patient. All of these concepts should be understood in very broad rather than narrow ways.
Those involved in treatment are not merely physicians who are standing at a person's bedside; they also include all medical researchers and scientists who have anything to do with not only the direct treatment, but also basic investigation into the nature of illnesses. Disease, in turn, should be understood as any medical condition for which a person seeks not only treatment, but also advice.
Finally, the concept of "patient" should not refer solely to a person who is receiving immediate treatment, but also anyone for whom a treatment is being prepared or researched. This is potentially everyone in society - and if the duty of doctors and researchers is not to them, then to whom could it possibly be?
There are a variety of ways in which this basic principle can be expressed. One of the oldest comes from Hippocrates, an early Greek physician. Many believe that his Hippocratic Oath mandates that doctors "first do no harm," but that doesn't actually appear in the oath (although it does seem to be present in other writings of his). Instead, he wrote "I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."
A significant portion of the Oath actually deals with a physician's duty to other physicians, but the principle of working first and foremost to benefit the sick, to keep patients from harm, and to keep them from injustice remains an important aspect of bioethics even today.
Although Hippocrates is among the most famous of early physicians, he was not the only one to formulate a code of conduct. Chinese physician Gong Tingxian created ten maxims for physicians and ten for patients. The very first of the maxims directed at doctors is that they should "adopt a disposition of humaneness: this is a justified demand. They should make a very special effort to assist the people and to pefform far-reaching good deeds."
A bit more interesting are the maxims directed at patients. In the field of medical ethics, the responsibilities of doctors is justifiably emphasized, but those of patients tends to be neglected. Tingxian wrote that patients should "choose 'enlightened physicians' and thereby receive help in their ailment. They have to be careful, because life and death follow each other closely."
Although the technology and knowledge behind medical practice has changed dramatically over the past millennia, what has not changed is the fundamental fact that it involves human beings helping other human beings who are hurt or sick. What we should learn from these ancient writings is that the first and most important principle of all bioethics is to help other humans. Actions taken must always have that goal in mind - not profit, personal fame, or anything else that is self-serving. The patient's interests must always come first.
The second fundamental principle, one which is probably not well recognized, is that those who need help must seek out caregivers who do their duty to put the patient's interest first. They must find "enlightened" physicians who know what they are doing and have taken on this profession not for fame or fortune, but because they sincerely believe in helping others. It would be wise if we today were to re-emphasize that patients also carry an ethical duty to themselves and their well-being.
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