Are laws and regulations the problem or the solution in addressing ethical problems in medicine? What would be an alternative?
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The concept of ethics in the field of health care is considered to originate with the ancient Greek figure Hippocrates, who was the first in recorded history to articulate a set of principles guiding ethics in the practice of medicine. Known to this day as “the Hippocratic Oath,” these principles provide the moral foundation for the medical practice thousands of later after they were drafted. The most widely-known of these principles – paraphrased as “first, do no harm – presaged the development of the study of ethics in medicine, which exists independent of any legal statutes or regulations.
Laws very frequently arise out of a perceived need to compel compliance with the spirit inherent in ethical guidelines. Because many fields of endeavor – medicine, law, accounting – attract so many individuals, and because there is good and bad, responsible and irresponsible in any given group of people, reliance on voluntary ethical guidelines to prevent abuse cannot be assured. In the area of health care, where lax attitudes or unethical conduct can have very serious repercussions, the risk to the public from that minority of medical practitioners who fail to adhere to ethical guidelines demands government intervention in the form of laws and regulations intended to enforce what should be natural. A paper produced for the University of Washington School of Medicine on ethics in medicine summarizes the relationship of ethics to law succinctly:
“Ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order. Ethics and law thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote:
‘Conscience is the guardian in the individual of the rules which the community has evolved for its own preservation.’ William Somerset Maugham”
The United States Code – the volumes of laws created by Congress and the Executive Branch over the course of the nation’s history – can fill a room. It has been derisively pointed out that the original Ten Commandments filled two tablets. The commandments that provide the legal framework for the United States today is comprised of hundreds of volumes. The reasons for this development are many, but one of them lies in the basic reality that people cannot always be counted on to do the right thing, and the public welfare demands laws legally-enforceable to protect it.
The American Medical Association, building on the principles set forth in the 5th Century B.C., maintains Code of Medical Ethics. Number One on that list of principles states “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” [www.ama-assn.org/ama/pub/physicians-resources/medical-ethics.page?]
The process by which an individual becomes a certified medical practitioner is extremely arduous and protracted. It is difficult to imagine anyone subjecting him- or herself to that process who was not innately inclined toward the spirit of the Hippocratic Oath and the AMA’s Code of Medical Ethics. Doctors and nurses, however, are human. They make mistakes, and sometimes they cross ethical boundaries. Members of the public victimized, intentionally or not, by those medical practitioners who cross the line need legal protections.
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