This document provides a history of the development of bioethics and medical ethics from ancient civilizations to modern times. It describes some of the earliest ethical codes from ancient Egypt, Babylon, India, Greece, Rome, and Islamic and Jewish traditions. It then outlines the progression of medical ethics standards over time, including influential codes and guidelines developed in response to unethical human experimentation, with a focus on the atrocities that occurred in the United States in the 20th century. Key milestones discussed include the Nuremberg Code, Declaration of Helsinki, and Belmont Report.

1. History of Bioethics
Seema Daud

2. What is Ethics?
The formal study of:
–What is right and wrong.
–The study of the bases or principles for
deciding right and wrong.
–The analyses of the processes by which we
decide what is right and wrong.

3. Medical Ethics
According to the World Medical Association
• It is the study of morality, careful and systematic
reflection on, and analysis or moral decisions and
behavior.
• As a scholarly discipline, medical ethics
encompasses its practical application in clinical
settings as well as work on its history, philosophy,
theology, sociology, and anthropology.
• Ethical codes in different era were based on the
religious beliefs of the people or needs of
humanity.
Based on definition of “Medical Ethics” http://en.wikipedia.org/wiki/Medical_ethics

4. • Rigid rules were laid down as to experimental treatment.
• There was no accountability in failure to cure as long as
the standards text book were followed.
• Severe penalties were, however, threatened for those
who ignore the instructions.
Ethics in Egyptian Medicine
2700 BC
Hieroglyphic
Writing

5. • The code of Hammurabi (Babylon 1900
BC) was the first written laws in the
world (282 laws).
• King Hammurabi is one of several
influential lawgivers depicted in a
marble frieze found in the chambers
of the United States Supreme Court.
• A system of payment based on results
and the ability to pay on the status of
the patient.
• There were penalties for negligent
failure, some of which were harsh &
severe.
• If the physician succeeds, he gets paid.
If he fails, at worst he loses his hands.
Code of Hammurabi
(Louvre Museum,
Paris)

6. • Laws with regard to healing the
sick, with best diet, according to
physician’s judgment and
means;
• Taking care that patients suffer
no hurt or damage.
• No administration of poison to
anyone.
• Not giving any sort of medicine
to any pregnant woman, with a
view to destroy the child.
• Keeping sacred and secret
patient’s information within my
own breast. Hippocratic Oath
4 BC

7. • Rules about entering
patients’ homes,
respecting and honoring
them by dressing properly
and maintaining modesty.
• Having entered, the
speech, mind, intellect
and senses shall be
entirely devoted to no
other thought than that of
being helpful to the
patient and of things
concerning only him.
• The peculiar customs of
the patient's household
shall not be made public.
Oath of Initiation of
professional ethics
(Charaka Samhita)
1st Century India

8. • Oldest Hebrew medical
text, written by a Hebrew
physician from Syria
• Not to kill not any man
with the sap of a root;
• Not to dispense a potion to
a woman with child by
adultery to cause her to
miscarry;
• Not to disclose secrets
confided by the patient;
• Not to take bribes to cause
injury and to kill;
• Not to harden hearts against
the poor and the needy, but
heal them;
The Oath of Asaph in
Judaism
(3rd Century)

9. • Sources Quran & Sunnah
• Islam made it an obligation upon the sick to seek
treatment.
• Human life is sacred. The saving of one life is regarded to
be the same as saving the life of all of humanity.
• For every ailment (except old age) there is a remedy.
• Actions will be judged according to intentions.
• Rulings exist for Euthanasia, Contraception, organ
transplant and Abortion etc.
Islamic Medical Ethics
(7th Century)

10. • Haly Abbas (Ahwazi), devoted the first
chapter of his work Liber Regius
(Kamel Al Sanaah al Tibbia) to the
ethics of medicine. A physician should:
• Prudently treat his patients with food
and medicine out of good and spiritual
motives, not for the sake of gain.
• Never to prescribe or use a harmful drug
or abortifacient.
• Respect confidences and protect the
patient’s secrets.
• Be kind, compassionate, merciful and
benevolent, and give himself
unstintingly to the treatment of patients,
especially the poor.
Advice to a
Physician by
Haly Abbas
Persian physician
(10th Century AD)

11. • In Japan:
Buddhist Physicians crafted
Seventeen Rules of Enjun
(6th century)
&
• In China:
Ming Dynasty (14th century)
Ethical instruction for healers
were discovered which were
similar to Hippocratic oath

12. • Thomas Percival (1740–1804) was
an English physician and author, best
known for crafting perhaps the first
modern code of medical ethics.
• He drew up a pamphlet with the code
in 1794 and wrote an expanded
version in 1803, Medical Ethics, or a
Code of Institutes and Precepts,
Adapted to the Professional Conduct
of Physicians and Surgeons in which
he coined the expression "medical
ethics".
• He was also a pioneering campaigner
for public health measures and
factory regulation in Manchester
(Occupational Bioethics)
Percival
Code of
Medical Ethics
(UK: 1794)

13. • Bioethics is a native American product.
• Bioethics occurred as a ‘reactive response’ to
biomedicine’s technology advances and cultural
pluralism.
• International bioethics began more then a decade
after the birth of bioethics in USA.
• In the 20th century, there have been numerous
unethical & inhumane experiments performed on
human test subjects in the United States that were
often performed illegally, without the knowledge,
or informed consent of the test subjects.
• These experiments were funded by USA
government, CIA , military & private agencies.

14. Exposure of people to biological and chemical weapons
• Mustard Gas Tested on Soldiers via Involuntary Gas Chambers
• CIA sprayed: whooping cough virus on Tampa Bay; 12 people died.
• The Navy sprayed bacterial pathogens of pneumonia in San
Francisco
• The Army released millions of mosquitoes in the hope they would
spread yellow fever and dengue fever upon Savannah, GA, and Avon
Park, FL

15. The deliberate infection of people with deadly
or debilitating diseases
US Infected Guatemalans with Syphilis
and did not give them penicillin

16. Post world war II, Human Radiation
Experiments on pregnant women, men & infants
Over 4,000 secret and classified radiation experiments were
conducted by the Atomic Energy Commission (AEC) and other
government agencies involving introduction of radio-active
material to Black infants, gonads of Blacks and other ethnics and
even cereals for teenagers

17. Surgical experiments
• Throughout the 1840s, J Marion Sims, who is often referred
to as "the father of Gynecology", performed surgical
experiments on enslaved African women, without anesthesia.
• One of whom was operated on 30 times—regularly died from
infections resulting from the experiments.

18. Surgical experiments
• In 1874, Mary Rafferty, an Irish servant woman, came to Dr.
Robert Bartholow of the Good Samaritan Hospital in
Cincinnati for treatment of her cancer.
• Seeing a research opportunity, he cut open her head, and
inserted needle electrodes into her exposed brain matter.

19. Psychological & Torture experiments
CIA conducted experiments on prisoners & mentally
retarded, exposing them to:
• Pain
• Fear
• Sexual abuse

20. • Beaumont's Code (United States) 1833: experimental treatments when all
else fails. Get voluntary, informed consent. Stop experiment at subject’s
request.
• American Medical Association (AMA) Code of Medical Ethics 1847
• Walter Reed (United States) 1898: Introduces written consent “contracts”.
Allows healthy human subjects in medical experiments.
• Berlin Code, or Prussian Code (Germany) 1900: No medical experiments
when subject not competent to give informed consent, in the absence of
unambiguous consent, or when information not properly explained to
subject.
• Reich Circular (Germany) 1932 Concerned with consent and well-being of
the subjects.
• Nuremberg Code (1947) Medical research
• Declaration of Geneva, W.M.A. (1948, 1968, 1984, 1994, 2005, 2006)
• World Medical Association International Code of Medical Ethics (1949)
• Declaration of Helsinki, application to medical research (1964, rev. 1975,
1983, 1989, 1996, 2000)
• Belmont Report (1979)
• AMA Code of Medical Ethics revision (2001)