European Principles for Medical Ethics
Giorgio
Berchicci
Ethical problems have always had a great interest to the public at large, and
this has increased even more so with recent discoveries such as DNA sequence
transcription (that has opened new perspectives in the battle against the most
dangerous diseases), stem cells (offering potential cures), and the beginning of
single gene interpretation, opening a new era in Predictive Medicine.
Major
Interest in this subject commenced following the Nuremberg trial, when (as is
well know) it was revealed that atrocious experiments were made on the inmates
of concentration camps without any informed consent, resulting in the Nuremberg
Code, which was universally accepted. Respect for Human Dignity had achieved an
absolute value, and the necessity to obtain Informed Consent from people
submitted to clinical and pharmacological experiments was also underlined by the
Helsinki code (1964 ).
Neverthless, despite both the Nuremberg and Helsinki declarations, many doctors
continued without obtaining informed consent from their patients.
In
order to correct this and other serious abuses, a commission was organized in
the USA in the 70’s that elaborated the Belmont rapport ( 1974).
During the same period, in contributing to the Kennedy Institute research
project on Bioethics, Warren Reich, President of the Encyclopedia of Bioethics
(1978), emphasised the work of two philosophers, Tom L Beauchamp and James F
Childress, who individualize some “ in-between principles” to help scientists in
biomedical research.
Thanks to their work, the first four ethical principles for medicine were
established:
1. Autonomy
2. Beneficialty
3. Non-malevolence
4. Justice or equity
In
1970 was born also the name of this new discipline, studying the relationship
between patients and doctors: firstly, an article entitled “Bioethics. The
science of survival”
and, the following year, the famous book, written by Van Renssealer Potter,
“Bioethics. A bridge to future”
which stressed the writer’s hope “to confront in a new way the problem of the
survival of humanity in a context difficult in a time of technological
improvement”. In other words, Van Renssealer Potter wanted that Bioethics could
be an “individual science”, to defend man against man”.
The
autonomy principle is linked to a citizen’s personal freedom. This principle
underlines the idea that a patient must be considered as a individual person,
who has the right to take upon himself the responsibility for decisions about
his own health, and that doctors must respect all those decisions that he has
made.
The
second and third principles express the requirement on doctors to work for the
patient’s best interests and good health: in the Hippocratic Oath, “do no harm”
was the fundamental principle, and still today, despite all the advanced
technological progress, it remains the most important principle in medical
practice.
Finally, the justice principle introduces a new dimension into medicine context
- overall (and not only in those Countries that have a National Health System)
that there should be a just distribution of advantages and burdens within the
access criteria to that NHS in order to satisfy the right to health protection
present in many Constitutional Laws.
Following this short reconstruction of the first four ethical principles, UEMS
should ask itself if it is possible to develop other principles in this new era
of change in medicine and society, to reply to new dilemmas presented by new
technologies, “to introduce a new pathway for values opposite a deeply changed
reality”,
to offer to collegues some new principles for future years.
Thus
it is suggested to introduce three other principles that, in our opinion, can
help patients and doctors in their relationships:
1. Privacy
2. Conflict of interest
3. CPD
On
Privacy, we can say that it’s a fundamental right of all citizens, recognized
also by EU in a specific law adopted in all European States - this has a large
ethical value. All the articles of this law must be respected by Specialists, to
preserve patients from some unacceptable problems that may arise. It must be
remembered that the Privacy principle is linked to that on Autonomy, both
emanating from the Law of “Habeus Corpus” of 1672 in England.
Regarding Conflict of Interest, there are many excellent articles in the
literature. It’s not only “A set of conditions in which professional judgement
concerning a primary interest (such as a patient’s welfare or the validity of
research) tends to be unduly influenced by a secondary interest (such as
financial gain)”,
but also where personal advantage may occur, such as in the relation between
some influential medicine names and the pharmaceutical industries,
and, overall, the objectivity of interpretation of results.
As is
well know, today the battle is played out through the media, where it is
difficult for practitioners to decide whether the information is entirely
correct, or used to imply conclusions that may be wrong or, in a subtle manner,
to induce to thinking in the same manner as the industry... For these reasons,
we believe that Doctors must keep always their independence judgement, and
U.E.M.S. can offer them the instruments to do so (such as G.I.N.)
This
is also a good reason for the third principle, CPD, because we know that the
only way for specialists to care for their patients, is to be always prepared
and up-to-date in their own specialty, but also in all aspects of medicine in
general. UEMS has strenuously applied itself to spread even more CME, it being
the only European Medical Organisation to have created a specific organism to
elaborate and harmonize the CME/CPD “ Culture ” in all the European Union
Countries.
It’s
for these reasons that, in UEMS Strategy paper, Sections should undertake
research; It is not sufficient just to complete graduate and post –graduate
studies in order to care for patients. We need overall to apply research
results, to give to patients the very best treatment and care in a particular
field of medicine. Only by the continual application of the latest developments
in medicine can we help our profession and patient health. European examinations
may be a very good way for young specialists to check their expertise. Medical
education must be adjusted to overcome dogmatic and reductive concepts in the
field of medicine, but must give attention to develop knowledge, behaviour and
competence to permit a specialist to interpret and confront different clinical
situations.
