10 1 Ethics

General Medicine 2021/2022

Emilia Feodorovici
Alexandru Ghimpu
Hannah Erles

#What are Ethics?

  1. Ethics in general?
  2. What is health care ethics?
  3. Why a Code of Ethics?
  4. The 4 principles of medical ethics.
  5. Confidentiality
  6. Impartiality
  7. History of Medical ethics.
  8. Case examples from medical problems.

What are Ethics?
Ethics are defined as the study of standards of conduct and moral judgment, the system or code of morals of a particular person, religion, group or profession.

What is Health Care Ethics?

Health care ethics is a subchapter of general ethics. Its a moral compass for everyone who works in healthcare institutions and organizations. The well-being of the patients should always be in the focus. Medical ethics is a ideal which is under continuous change. What is correct today could be totally false in 40 years. There is also a difference beteeen doctor ethics and nursing ethics.


Its a set of moral principles, beliefs and values that are used as a Guide for making Choices in medical care. The core of health care ethics is our sense of right and wrong and our own beliefs about rights we possess and duties we owe others. Health care workes who do not follow the principles can face ligations by their patients and clients and could even be suspended from medical practice.
The choices we take may not always be the right, good, fair and just. So medical ethics assists a medical worker to take the most suitable action. At this time medical ethics are even more important because of the covid-19 pandemic which has caused a lot of mortality and morbidity world wide.

4 principles of ethical conduct in medicine

Medical ethicists Tom I. Beauchamp and James F. Childress developed four basic principles of medical action at Georgetown University that have become established in medical ethics and are also referred to as the 'Georgetown Mantra'. The four principles of ethical conduct in medicine are described as follows:

- Patient's right to self-determination (respect for autonomy)
- Principle of non-maleficence
- Patient welfare (beneficence)
- (Social) justice

Why a Code of Ethics?
The International Medical Interpreters Association’s Code of Ethics, the first such code published for medical interpreters, was designed to provide an ethical compass for both interpreters. It has been translated into 11 languages and in some countries remains the only ethical code specific to medical interpreters. The IMIA Code of Ethics applies to IMIA members and non-member medical interpreters alike. IMIA members are required to abide by the code in order to maintain their good standing. Non-compliance can result in disciplinary action by the Ethics Committee or termination of membership. For clients of medical interpreting services, the Code offers professional quality assurance.

Patient Autonomy

On the point of view of medical ethics, the patient is an autonomic, self-determining being, which has the right to decide what happens to him. The doctor not only has the duty to respect the patient's freedom and choice rights, he should also ensure that the patient is informed in detail and sufficiently about the disease, the possible treatments and their consequences so that he can actively participate in the therapy decision and the course of therapy.

Principle of damage prevention and action for the benefit of the patient

If the doctor wants to follow these two principles, he comes into a dilemma situation. On the one hand, he must not harm his patients, on the other hand, he must heal them. For example, in the case of chemotherapy or radiation in tumor patients, the risks and side effects must be weighed against the benefits of the therapy. Some chemotherapy drugs lead to heart or kidney damage, for example.
Therefore, patients are examined particularly thoroughly in the course of therapy in order to keep the risk of organ damage as low as possible. It is important that this follow-up examination must not ignore the first principle, patient autonomy. Communication and exchange with the patient are therefore central.


Especially in times of scarce resources, it is a difficult task to distribute them fairly. The principle applies: the same cases must be treated equally. This means that two patients with the same disease must be treated equally, i.e. receive the same examinations and the same therapy as far as they are necessary. Organ transplantation should be mentioned as an important and decisive area at this point. Here, special care must be taken to distribute the available organs according to the principle of justice. Unfortunately, there are fewer transferable organs today than are requested by patients or recipients. In Germany, as well as in some other European countries, the allocation of organs is regulated by a central institution, "Eurotransplant" (4). For each organ to be transplanted, certain rules and guidelines are laid down according to which the organs are allocated in order to ensure a fair and medically meaningful distribution.


In health care settings, preserving the anonymity and privacy of patient information is crucial. Ensuring confidentiality responds to patients’ core need for privacy, prevents discrimination and ethical dilemmas, and is mandated by federal laws.
Critical patient information should only be shared with appropriate medical staff and used for medical purposes. If possible, it should be kept in patient charts and not be removed from the institution. Medical interpreters have different levels of access to patient information depending on their working status and responsibilities.
In addition to not disclosing patient information to medical staff, medical interpreters should refrain from disclosing information shared by a patient in a session with one provider to another provider in another session with that same patient.

Health Insurance Portability and Accountability Act (HIPAA)
Primary among these laws is the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This act protects the personal health information held by health care providers, health plans (including Medicare and Medicaid), and health care clearinghouses. HIPAA also gives patients an array of rights with respect to that information. Privacy rules allow for disclosure of personal health information when it is needed for patient care and other important purposes.


In the United States, professional distance is an important tenet for health care professionals. It allows one to remain objective and not get involved in a more personal relationship with a patient or provider, which might affect objectivity and impartiality. An interpreter’s impartiality is essential to accurate communication between patient and provider. To remain impartial, interpreters should not share personal opinions or allow personal beliefs and relationships to affect communication. Impartiality, or professional distance, does not imply lack of concern for patients and assignments but speaks to the integrity of the profession and the process.
Interpreters, who can understand both patient and provider, are in a position of power. It is important that they handle that position with professionalism. Patients may feel more at ease with an individual who speaks their language and may naturally offer a greater degree of trust to interpreters than to their health care provider. It is important to manage that trust with ethical conduct. Maintaining impartiality in a triadic encounter is a skill that needs to be learned and practiced.

In almost all cultures there are solemn self-commitments by doctors regarding their medical skills, their relationship with patients and their own profession. In Europe, where medical ethics had developed with the Hippocratic medicine based on a high level of professional awareness among doctors, the so-called Hippocratic Oath (approx. 4th century BC) is probably best known. It was reformulated in a contemporary way in the Geneva Doctors' Pledge (1948, 1968, 1983, 2017). In the European Middle Ages, medical ethics was based primarily on theological ethics, and medical ethics was determined in particular by Christian charity and mercy, with scholasticism attempting to combine the aspects of Christian theology and Aristotelian philosophy to be discussed.

Modern medical ethics from the 19th century
The founder of today's medical ethics is the English doctor Thomas Percival, who published the work Medical Ethics a year before his death in 1803 and thus also coined the term. In it he developed a first modern code of ethics, from which the first code of ethics was derived when the American Medical Association was founded in 1847 and directly adopted in many passages.

After 1945
Euthanasia programs and human experiments under National Socialism, Japanese experiments with prisoners of war, the abuse of psychiatry in the Soviet Union, certain research experiments in the USA and other painful experiences showed that medical professional ethics are not sufficient to prevent criminal abuse of medical knowledge and ambition. At the Nuremberg Doctors' Trial (1947), a Nuremberg code was drawn up, which represents the basis for carrying out necessary and ethically tenable medical experiments on humans. In 1964, the World Medical Association adopted a “Declaration on Ethical Principles for Medical Research Involving Humans” (Helsinki Declaration), which has since been updated several times (most recently in 2013) and is applied in many countries.

Finally, the challenges posed by new developments in medicine from the 1970s (e.g. prenatal diagnosis, cloning, etc.) led to an enormous differentiation in medical ethics. The use of resources in the healthcare system should also be discussed from an ethical perspective.

Ethics in medical research

Medical ethics examples

How would you react and what would you do in the position as a doctor.


How do you react when a "Jehovah's Witness" refuses a vital blood transfusion?

A Jehovah's Witness has to undergo an operation. She explains to the doctors treating her that she refuses a blood transfusion that may be necessary and gives them a document in which she appoints an authorized representative who is a member of the same religious community.

Immediately after the operation, the patient experiences serious complications. Without blood transfusions, according to the treating physician, the chances of recovery are reduced to zero. He goes to the guardianship court and asks that a guardian be appointed for the patient. The judge visits the unconscious patient in the hospital and appoints her husband as temporary supervisor. He agrees to the transfusion, also with regard to their son. The patient survives and files a constitutional complaint against the interference with her physical integrity and her right to freedom of religion.


Selection of an embryo in in vitro fertilization

The married couple Lisa and Jack Nash have been in treatment in a reproductive medicine clinic for a long time because they want a second child. A few in vitro fertilization cycles have already been unsuccessful, but the couple still doesn't want to give up.

Their daughter Molly - who was also born via artificial insemination - is six years old. A few months ago, the parents found out that Molly suffers from Fanconi anemia, a severe hereditary bone marrow disorder, and will need a bone marrow cell donation in the near future.
The Nashes now ask the reproductive doctor to select an embryo for IVF that 1. does not have the same medical condition as Molly and 2. is genetically close enough to his sister to be a potential cell donor. Stem cells from the newborn's cord blood could potentially cure terminally ill Molly.

In response to critical inquiries, the parents affirm that they would have wanted another child anyway and now only want to try to offer their Molly a chance of healing at the same time. However, if there were no possible donors among the embryos, then they would transfer any of the embryos that did not suffer from the same immunodeficiency.



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