Vous êtes sur la page 1sur 49


What is Ethics?
What is medical science?

How are medical science and

ethics related?
Why Ethics Become Important?

Nowadays, conflicts of interests

between the government and
medical institutions, between
medical institutions and medical
personnel, between physicians and
patients are getting more and more
serious and complex.
High technologies not only brought
us hopes of cure but have also
created a heavy economic burden.
The ethical dilemmas of high
technology medicine-brain death,
organ transplantation, and concerns
about quality of life-have become
increasingly prominent.
A new and more specific code of
ethics must be developed to meet
the demands of social development
and medical service.
This new code integrates the
traditional medical ethics with
modern principles and values.
Section 1: Morality, Ethics
Section 2: Professional
ethics, medical ethics,
bioethics, clinical ethics
Section 3: The History of
Medical Ethics
Section 1: Morality, Ethics
1.What is Morality
2.What is Ethics?
3.Ethics and Morality
4.to distinguish between Ethics and Law
5.to distinguish between Ethics and Policy
1.What is Morality
The science of human duty; the
rules of human conduct.
The function of morality is "to
combat the deleterious consequences of
human sympathies" (Beauchamp).
Its aim is "to contribute to
betterment -- or at least non-deterioration
-- of the human predicament" (Warnock).
"Ethics aims at discovering what are
those other properties belonging to all
things which are good" (Moore).
2.What is Ethics?
Ethics are standards of conduct (or
social norms) that prescribe behavior.
Ethics as a field of study is a
normative discipline whose main
goals are prescriptive and evaluative
rather than descriptive and
explanatory. So Ethicists are different
from social scientists.
Ethicists (or moral philosophers)
study standards of conduct.
But standards of conduct do not
describe our actual behavior, since
people often violate widely
accepted standards.
For Example, most people accept the idea
that one ought to tell the truth, yet many
people lie all of the time. Even though
people lie all of the time, we indicate our
endorsement of honesty as a standard of
conduct by defending honesty in public, by
teaching our children/students to be
honesty, and by expressing our
disapproval of lying.
In thinking about standards of conduct, it
will be useful to distinguish between
ethics and morality.
Morality consists of a societys most
general standards. These standards apply
to all people in society regardless of their
professional or institutional roles.
Moral standards include those rules that
most people learn in childhood, e.g. dont
lie, cheat, steal, harm other people, etc.
Many ethicists maintain that moral duties
and obligations override other ones: so,
if I have a moral duty not to lie, then I
should not lie even if my employment
requires me to lie.
3.Ethics and Morality
So that we can see, moral standards
distinguish between right and wrong, good
and bad, virtue and vice, justice and
Ethics are not general standards of
conduct but the standards of a particular
profession, occupation, institution, or
group within society. The word ethics,
when used in this way, usually serves as a
modifier for another word, e.g. business
ethics, medical ethics, sports ethics,
military ethics, etc.
They are all professional ethics.
4.to distinguish between
Ethics and Law
(1) some actions that are illegal may not be
unethical. (kill)
(2) some actions that are unethical may not be
illegal. (secret)
(3) laws can be unethical or immoral. (Nazis)
(4) we use different kinds of mechanisms to
express, teach, inculcate, and enforce laws and
Laws are often expressed in highly technical and
complex jargon, and we often need specially
trained people---lawyers and judges---to
interpret them. Ethics and morals tend to be
less technical and complex.
(5) we use the coercive power of government to
enforce laws. People who break certain laws can
be fined, imprisoned, or executed. People who
violate ethical or moral standards do not face
these kind of punishments unless their action
also violate laws. We often punish people who
disobey moral or ethical obligations by simply
expressing our disapproval or by
condemning the behavior.
5.to distinguish between
Ethics and Policy
Political standards focus on the conduct of
groups or social institutions, whereas ethical and
moral standards focus on the conduct of
Political standards take a macro-perspective on
human affairs; ethical and moral standards adopt
a micro-perspective.
However, the distinction between ethics and
politics is not absolute since many actions,
institutions, and situations can be evaluated from
an ethical or political point of view.
Section 2: Professional
ethics, medical ethics,
bioethics, clinical ethics
1.Professional Ethics
Professional ethics are standards of
conduct that apply to people who occupy a
professional occupation or role.
A person who enters a profession acquires ethical
obligations because society trusts them to
provide valuable goods and services that cannot
be provided unless their conduct conforms to
certain standards.
Professionals who fail to live up to their ethical
obligations betray this trust.
Professional ethics studied by ethicists include
medical ethics.
2.Medical ethics
The expressions professional ethics
and medical ethics were coined by
Thomas Percival.
Medical ethics is a special kind of
ethics only as it relates to a
particular realm of facts and
concerns and not because it
embodies or appeals to some special
moral principles or methodology.
It is applied ethics. It consists of the
same moral principles and rules that
we would appeal to ,and argue for, in
ordinary circumstances.
It is just that in medical ethics these
familiar moral rules are being applied
to situations peculiar to the medical
Bioethics could be defined as the
study of ethical issues and decision-
making associated with the use of
living organisms
Bioethics includes both medical
ethics and environmental ethics.
Bioethics is learning how to balance
different benefits, risks and duties.
4.Clinical ethics

Clinical ethics is a
practical discipline that
provides a structured approach
for identifying ,analyzing, and
resolving ethical issues in
clinical medicine.
Clinical medical ethics is a practical and
applied discipline that aims to improve
patient care and patient outcomes by
focusing on reaching a right and good
decision in individual cases.
It focuses on the doctor-patient
relationship and takes account of the
ethical and legal issues that patients,
doctors, and hospitals must address to
reach good decisions for individual
Clinical ethics emphasizes that in
practicing good clinical medicine,
physicians must combine scientific
and technical abilities with ethical
concerns for the personal values of
the patients who seek their help.
The content of clinical ethics
specific issues such as truth-telling,
informed consent, end of life care,
palliative care, allocation of clinical
resources, and the ethics of medical
the study of the doctor-patient
relationship, including such issues as
honesty, competence, integrity, and
respect for persons.
Section 3: The History of
Medical Ethics
A brief history of medical
ethics in China
The value system of medical ethics in China
has a long tradition that can be traced back to
ancient times.
As in ancient Greek medicine, the
professional values of ancient Chinese medicine
arose with the development of medical
professionalism itself. In ancient China,
profession meant ones duties.
Zhou Dynasty (from 1065-771 B.C.E.)
an independent medical profession and medical
system took shape , built around four aspects: dietetic,
internal, surgery, and veterinary.

Spring and Autumn Period (770-476 B.C.E.) and the

Warring States (475-221 B.C.E.)
medicine began to divorce itself from witchcraft
(magic) and became an experience-based knowledge and a
professional skill .
In ancient China, folk physicians
didnt have fixed clinics or hospitals
but went from one place to another
practicing medicine freely.
They hadnt formal training and
werent licensed, but performed their
work by their own skills and
Ancient physicians paid great
attention to prognosis and
accumulated rich experience,
codified in ancient medical books
such as the Canon of Medicine and
Classic on Medical Problems.
By judging whether a patient was
curable or incurable, a physician
decided whether to accept the case
for treatment.
Medicine should not be offered in six
circumstances, namely, to (1) people
who have unreasonable arrogance
and indulgence, (2) people who
appreciate riches more than life, (3)
people who cannot even keep body
and soul together, (4) people who
suffer from interlocking Yin and Yang,
(5) people who are too weak to take
medicines, and (6) people who dont
believe in medicine but in sorcery.
the Han Dynasty (206 B.C.E.-220 C.E.)
Confucianism shaped the core values
of Chinese culture.
medicine is a humane art
it emphasizes on caring about
patients and on physicians self-cultivation
in virtue.
Benevolence is the core of Confucian
ethics. In Confucianism benevolence
means, to love the people.
Confucianism required
doctors to be very cautious and
responsible in the course of diagnosis
and prescription in order to avoid
mistakes that would harm patients.
The Confucian principle also calls for
respect for patients.
The principle calls for universal
love, that is,
to treat every patient equally,
regardless of social status, family
background, appearances, age, etc.
Whoever comes to seek cure
must be treated like your own
relatives regardless of their social
status, family economic conditions,
appearances, ages, races, and
mental abilities.

Simiao Sun
For Confucians, morality is grounded in
human nature, which is expressed by
Confucius as ren or humaneness,
sometime simply as benevolence.
From this origin of morality, some more
concrete moral principles spurt out, such
as the principles of ren, yi, li and zhi, or
principles of benevolence, of justice, of
propriety , and of moral consciousness.
These are major guiding principles for our
common lives.
The leading principle is the moral
mind and our concern about the
sufferings of others.
one must understand Confucianism
before one really understand what
medicine is all about.
With the introduction of Western
medicine beginning in the nineteenth
century, Chinas medical system has
changed tremendously.
A new type of medical system has
emerged and a new perspective on
professional ethics has gained
peoples attention.
This change has also brought new
requirements for doctors, who now
are responsible not only for their
patients, but also for their
hospitals and the whole society.
Meanwhile, Western theories of
medical ethics and professional
standards of medicine were
introduced into China.
never being selfish but
always ready to help
others have become the
principal values of medical
History of Medical Ethics
in the West
1Ancient Egypt: Ancient
Egyptian Medicine
The people of Ancient Egypt made
several major medical discoveries
and began treating diseases in a
physical manner alongside older
spiritual cures.
2Ancient Greek Medicine
Medical practice in Ancient Greece,
like Egypt, was based largely upon
religious beliefs.
The works of Hippocrates and his
followers led to several scientific
facts being recorded for the first time
Hippocrates theory of the Four
Humours was, for a long time, the
basis upon which to develop medical
Ancient Roman Medicine
Roman medicine was a mixture of new
theories and developments of Greek
practices. Medicine was improved through
the studies of Galen, through a desire to
maintain a fit and healthy army and
through empirical observation.
Medicine in Ancient Rome also brought
about some great developments of Public
Health facilities.
Oriental and Islamic Medicine
The Islamic Authorities placed a lot of
value in medicine.
Baghdad had a hospital by AD 850
and doctors had to pass medical
examinations by AD 931 in order to
Hospitals were later developed throughout
the Islamic world, with the most famous
being those in Damascus and Cairo.
Developments of Galen and Hippocrates
Rhazes said that it was vitally important to
observe patients and make notes of all
minor details. He was the first man to
observe and record the differences
between smallpox and measles.
Avicenna wrote the Canon of medicine .
This developed some of Galens ideas and
was used with aspiring doctors in both
Arabia and later in the West.
Medicine in Medieval and
Early Modern Europe
Medicine during the Medieval period
changed in a number of ways, often
for the worse.
Medieval Europe was a place that
placed less importance on the value
of Public Health facilities
As the church taught that God sent
illness, and that repenting would
cure all evils, many people at the
time believed that pilgrimage would
cure them. Other theories were
based upon astrology, the movement
of the sun and stars.