Ma. Cristina S. Sombilon, M.D., Ma. Cristina S. Sombilon, M.D., F.P.S.P.F.P.S.P.

Department of Medical HumanitiesDepartment of Medical HumanitiesUERMMMC College of MedicineUERMMMC College of Medicine

a branch of philosophy

Practical science of MORALITY of human acts

Teaches us how to judge accurately the moral GOODNESS or BADNESS of any human action

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

1. BENEFICENCE – ONE OUGHT TO DO GOOD

Seek the patient’s well-beingProvide standards of due care and

risk/benefit assessment 2. NON-MALEFICENCE – DO NO HARM

Avoid unnecessary expense, consult, procedures and medications

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

3. INFORMED CONSENT Provide the patient with a COMPLETE,

ADEQUATEDISCLOSURE of his illness and OPTIONS in a language he understands for the patient to be able to make a rational and free decision

4. AUTONOMY (RESPECT FOR PERSONS)

Respect the patient’s rational decision as long as he is aware of the consequences

The patient has a right to refuse

5. JUSTICEAllocating scarce resources fairly and

according to medical needs

“life ethics” – philosophical

More encompassing than medical ethics, includes additional issues not necessarily a part of medical ethics

Medical ethics Business ethics Sexual ethics Social ethics Environmental policy and ethics

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Medical ethics is a “subset” of bioethics

Clinical or case-based approach

Used interchangeably “BIOETHICS”

“MEDICAL ETHICS”“BIOMEDICAL ETHICS”

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

MEDICAL ETHICSMEDICAL ETHICS abortion euthanasia confidentiality truth telling fair distribution of

resources informed consent research involving

human subjects

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

HIV/AIDS issues organ

transplantation genetic engineering reproductive rights

and assisted reproductive techniques

stem cell research human cloning

Corporate responsibility Rights and obligations of employees Diversity and discrimination in the

workplace Care for the environment from industry

and business Minimum wage vs. Living wage Age discrimination School discrimination

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

BUSINESS ETHICSBUSINESS ETHICS

Homosexuality and gender sensitivity issues

Prostitution Adultery

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

SEXUAL ETHICSSEXUAL ETHICS

SOCIAL ETHICSSOCIAL ETHICS Family responsibility Distribution of social resources Society’s obligation to the poor

The application of the GENERAL PRINCIPLES of ethics to the moral problems of the medical profession

CORE: ethics of a physician-patient relationship (TRUST)

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Specific RULES OF CONDUCT of physician

What the physician PROVIDES for the patient

What the physician’s DUTIES are to the patient and VICE-VERSA

TRADITIONAL MEDICAL ETHICSTRADITIONAL MEDICAL ETHICS

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Equality of health care professionals and patients

• stewardship• autonomy

Purpose of health care is TOTAL PATIENT CARE (value based ethics)

Duty to help the patient: BENEFICENCE

Duty not to harm the patient: NON-MALEFICENCE

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Coined to cover PHILOSOPHICAL, LITERARY, HUMANISTIC approaches to problems in medicine

Ethics is an area of study in philosophy and philosophy is a part of the humanities

Contemporary use of the term includes LITERATURE, POETRY, FILM, MUSIC to increase appreciation for the HUMANISTIC, INTERPERSONAL, and EMPATHETIC aspects of medicine

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

THE HEARTOF

MEDICINE

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

When and where was bioethics born?

ANCIENT HISTORY HIPPOCRATIC OATH – first code of medical ethics

“first do no harm”

A promise to respect a patient’s personal dignity and privacy

A promise to use medical knowledge FOR THE GOOD OF THE PATIENT

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

The oath and prayer of MAIMOINIDES (c. 1200)Rabbi Moshe Ben Maimon, a Jewish

philosopher

a meditative piece which implores physicians to look at the sick with respect and dignity

OATH“The eternal providence has appointed me to watch

over the life and health of Thy creatures. May the love for my art actuate me at all times: may neither avarice nor miserliness; nor thirst for glory or for a great reputation engage my mind... ”

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

OATH OF MAIMOINIDES

“May I never see in the patient anything but a fellow creature in pain.”

“...God, thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto Thy calling.”

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

PERCIVAL’S CODE (1794) – first code of medical ethics adopted by a professional group of physicians.

AMERICAN MEDICAL ASSOCIATION (AMA) – first code of ethics was adopted in 1847 in Philadelphia

Duties and obligations of physicians to their patients and vice-versa

Duties of physicians to society and medicine itself

Revised and updated over time

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

MODERN DAY BIOETHICS Emerged from the atrocities and

scandals in human experimentation

Horrific experiments performed on prisoners by doctors in Nazi concentration camps

NUREMBURG MILITARY TRIBUNAL TRIALS (Nov. 14, 1945 – Oct. 1, 1946)

NUREMBURG CODE – influenced the direction of research ethics and policy

NUREMBURG CODE Code of ethics on human

experimentation

Ten point statement delimiting permissible medical experimentation on human subjects

First line emphasizes that VOLUNTARY CONSENT of human subject is absolutely essential in any experiment

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

MODERN DAY BIOETHICS A new discipline which tries to reconcile the

discrepancies between the 2400 year old Hippocratic Code with today’s medico-moral issues

FROM AN ETHICAL POINT OF VIEW, MEDICINE IS

THE VICTIM OF ITS OWN SUCCESS

Today in medicine, the CRITERION OF WHAT IS GOOD (ethical or moral) is being replaced by WHAT IS USEFUL (Utilitarianism)

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

1966 article by Dr. Henry Beecher, Harvard Univ., in the New England Journal of Medicine (NEJM)

Several unethical and experimental research programs in clinical research in the U.S.

Used unknowing human subjects exposed to extreme health risks

“moral basis” or purpose is to advance scientific knowledge

Other well publicized events in health care and research questioned the norms of medical ethics

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

WILLOWBROOK STUDY/EXPERIMENT

Infecting mentally retarded school children of the Willowbrook State School in New York with HEPATITIS

To study the course of the disease

Consent to the study became a “prerequisite” for enrolment

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

TUSKEGEE EXPERIMENT

1930s U.S. Government study

400 Black American men with SYPHILIS were signed up to observe the course of the disease

1949- discovery of a cure PENICILLIN

Treatment was DELIBERATELY WITHELD from the subjects in order to observe the progress of the disease and its complications until death

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

TUSKEGEE EXPERIMENT

“bad blood”

Patients lived with the disease until their death, some in the 1970s

U.S. Gov’t. reparations and recognition of these men did little to regain the trust of the public in human experimentation

Only in the last term of Pres. W. Clinton was a FORMAL APOLOGY to the families of the Tuskegee victims given

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

MODERN DAY BIOETHICS CANDIDATES

1962: LIFE magazine article by Shana Alexander on the Seattle Artificial Kidney Program

1967: Dr.Christiaan Barnard, South Africa, first successful heart transplant

1973: Roe vs. Wade – U.S. Supreme Court decision on abortion

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

1974: exposure of Tuskegee Syphilis study

1974: The National Commission for the Protection of Human Subjects in Biomedical and Behavioural Research

1976: Quinlan case – U.S. Supreme Court decision on end-of-life

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

1978: Drs. Patrick Steptoe and Robert Edwards – first test tube baby (IVF) and embryo transplant baby Louise Brown

1980s – present: HIV/AIDS

1991: the Patient Self-determination Act (advanced directives, living will, ethics committees)

MODERN DAY BIOETHICS RECENT EVENTS

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

1996: Dolly, the first cloned sheep; stem cell technology

2002: legalization of euthanasia in the Netherlands, emergence of Right to Die advocates and movement, Oregon Death with Dignity Act

2007: Terri Schiavo – end of life case, termination of feeding

BIOETHICS AS A FIELD MORE DEFINED

Bioethics institutes 1969 Hastings Center 1971 Kennedy Institute for Ethics (Georgetown

Univ.)

1977 Tom Beauchamp and James Childress The Principles of Biomedical Ethics (a synthesis of

approaches and methods in biomedical decision making)

1995 – 2001 National Bioethics Advisory Committee; President’s Council on Bioethics

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

HOSPITAL ETHICS COMMITTEESS

ETHICS REVIEW BOARD

Ma. Cristina S. Sombilon, MD, FPSP || Depatment of Medical Humanities UERMMMC

THE FUTURE OF BIOETHICS

Brain mapping and highly precise imagine technology – neuroethical issues to determine personality traits and disease and behavior predisposition: accessing a person’s memories for legal or forensic purposes