Morality and Ethics in Medicine: Key Codes and Cases

Introduction: Ethics and Technology in Modern Medicine

Over the last several decades, the issues of morality and ethics have been continually brought to the forefront of medicine. Part of the reason for this is the advances that have taken place in medical research, which have caused a whole host of ethical and moral dilemmas to develop. A clear example of this can be seen with the use of social networking, chatting, and email as part of modern-day medical practice. These advances have allowed physicians to communicate more effectively with patients and colleagues about a broad range of issues, including routine follow-ups with patients and discussions with other doctors about the latest procedures. In general, this was promoted as a cost-effective way to provide better healthcare services.

However, like many new breakthroughs, a number of moral and ethical issues have emerged. The most notable include: liability issues, reimbursement and time concerns, and the confidentiality of the physician-patient relationship. Liability issues arise when a patient provides instructions to a physician via email, where no established ethical or moral guidelines exist for following such instructions. Reimbursement and time concerns are also problematic, as constantly monitoring incoming emails and instant messages could interrupt the time physicians spend with patients and serve as an unwelcome distraction. Furthermore, when a doctor conducts patient follow-ups through chat or email, the physician-patient relationship and its confidentiality may be compromised, as communications could be intercepted and used to exert influence over either party.

What this demonstrates is that with nearly every medical breakthrough or technological innovation, a number of moral and ethical issues must be addressed. ("Privacy and Security," 2010) To fully understand how the rules of morality will apply to a variety of situations in the future, it is necessary to examine the factors that have influenced medical ethics and the different rules governing morality. This examination provides the greatest insights into how various moral and ethical standards can be updated to reflect the rapid changes that are occurring.

Historical Events That Shaped Medical Ethics

To fully understand how various factors have affected medical ethics requires first defining both ethics and morals. Morals refer to a person's sense of right and wrong about the various situations encountered in daily life. Ethics involves examining how various views and behaviors will influence a particular situation, with the goal of achieving the greatest amount of good. In the field of healthcare, professionals seek to focus on achieving the greatest amounts of good through their actions and judgments about various issues that may arise. Over the last several decades, a number of ethical issues have emerged in healthcare, including right-to-life issues and assisted suicide, as well as questions about when and how various ethical standards apply to different patients. (Pozgar, n.d.)

A number of events throughout the twentieth century and the early twenty-first century have shaped how medical ethics are applied. The most notable include the Tuskegee study, the Nuremberg Trials, and advances in technology and medicine.

The Tuskegee syphilis study took place from 1932 to 1972, during which researchers sought to observe the full effects of syphilis. The problem was that researchers specifically sought out individuals who were most vulnerable to the disease or were already infected, and then observed the effects over time—despite the fact that syphilis could be treated with antibiotics. All of the subjects were African-American men who were poor, uneducated, and from rural areas. The fact that these individuals were not informed about a possible cure, and the manner in which they were selected, brought the overall morals and ethics of the researchers seriously into question. Scientists were interested in observing the long-term effects of the disease but demonstrated no concern for the well-being of their subjects. (Pozgar, n.d.) This study helped shape how medical standards would be applied when conducting medical research or procedures. One could argue that the Supreme Court case Canterbury v. Spence is directly tied to the Tuskegee study, as the court ruled that physicians are required to disclose the possible risks associated with any medical procedure or study at a time when the subject or patient can make an informed determination of the risks involved. ("Canterbury v. Spence," n.d.) In the Tuskegee study, researchers clearly violated this ethical principle by failing to disclose the dangers of their research and the existence of a treatment for their subjects.

A second event that influenced medical ethics was the Nuremberg Trials. A military tribunal was conducted for 23 doctors and Nazi officials who had authorized various kinds of medical experiments in concentration camps. This was significant because it produced the first ethical standards for modern medicine—the Nuremberg Code. The Code required that voluntary consent must be obtained from a subject prior to any kind of medical research, and that the benefits of the research must outweigh any possible risks. As a result, an ethical standard was developed to guide healthcare professionals in the most morally correct way of working with patients. The Nuremberg Code then led to a number of further ethical standards, most notably the creation of the World Medical Association guidelines for doctors in 1964 and the National Research Act—a law enacted specifically to prevent the abuses that occurred during the Tuskegee study. The National Research Act established a commission to regulate and apply ethical standards to the medical industry: the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. ("Regulations and Ethical Guidelines," n.d.) (Pozgar, n.d.)

A third major influence on medical ethics has been the changes in technology and advances in medicine. During the late twentieth century and early twenty-first century, the questions of when life begins and when it ends became two of the most hotly debated ethical issues. At the heart of the debate were abortion and assisted suicide, because for the first time medical technology made it relatively straightforward for life to be ended through intervention. (Pozgar, n.d.) In the case of abortion, the Supreme Court ruled in Roe v. Wade that abortion was a legal medical procedure, though subsequent attempts were made to limit or restrict access. ("Roe v. Wade," 2010) As medical science evolved, an abortion pill was developed that women could obtain without a prescription—the so-called "morning-after pill." This development intensifies the ethical conflict over bodily autonomy and the question of when life actually begins, making these issues increasingly complicated.

Advances in medicine have also extended the ethical debate by enabling life to be prolonged far beyond what was previously possible. A person may fall into a deep coma or suffer from a debilitating condition, and modern medicine can keep such a person alive in a vegetative state for years. Many in the medical community argue that it is unethical to allow someone to continue in such a state indefinitely, while others claim that withdrawing assistance is effectively committing murder. In the case of assisted suicide, a similar argument applies: proponents do not want to see someone suffer unnecessarily from debilitating conditions such as Alzheimer's disease, while opponents argue that assisting a patient in ending their life is tantamount to manslaughter. A notable example occurred in 2006, when the Supreme Court prevented the White House from punishing doctors who assisted critically ill patients with suicide. (Pozgar, n.d.) These cases highlight the profound ethical conflicts that exist within medical ethics and demonstrate how advances in technology and medicine continue to reshape the boundaries of the ethical debate in both the medical and legal communities.

Together, all of these events have helped shape how ethical standards for medicine have evolved, clearly defining the most appropriate conduct for medical research and patient interaction in the healthcare industry. They form the backbone of the professional standards that the industry currently follows. However, as breakthroughs in medicine and technology continue to accelerate, the issues of morality and ethics are constantly evolving—becoming more ambiguous or giving rise to entirely new dilemmas.

Conclusion

Clearly, the world of healthcare ethics is constantly evolving. Part of the reason for this is improvements in technology and medicine, which together are fueling a rise in ethical situations that healthcare professionals must navigate. These advances have the potential to render various codes of ethics obsolete. However, despite these challenges, the various ethical codes have provided a standard that helps guide healthcare professionals in their daily activities. This is significant because, prior to such standards, many patients and research subjects often faced unnecessary suffering at the hands of unscrupulous healthcare officials.

To curb such abuses, a number of different ethical codes were created to protect the general public. The Nuremberg Code was the first of its kind to establish ethical guidelines for conducting medical research on a global scale. Over the course of time, as various scientific breakthroughs occurred, new sets of ethical standards were developed, with the medical establishment seeking to improve upon the guidelines established by the Nuremberg Code. As a result, laws and codes such as the National Research Act and the Helsinki Declaration were created to provide even greater moral clarity to healthcare professionals. The various advancements in technology and medicine require that these codes of ethics be continually updated to reflect the changes that are occurring. It is only through this ongoing process that high ethical standards in medicine can be effectively maintained while preventing obvious loopholes from being exploited.