What Are Medical Ethics?

Medical ethics is a discipline that uses general ethics principles to solve medical ethical issues and medical ethical phenomena in medical practice and medical development. It is an important part of medicine and a branch of ethics. Medical ethics is a science that studies the moral issues of human-to-human, human-to-social, and human-to-natural relations in the field of medicine by using theories and methods of ethics.

Medical ethics

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Medical ethics

The Hippocrates Oath in the fourth century BC is the earliest literature on medical ethics. The gist is that doctors should take measures that are beneficial to patients based on their "abilities and judgments" and keep patients secret.

Two ethics codes adopted by the World Medical Federation, the 1948

(1) Modal ethics school. It is advocated that the ethical code should be determined according to the modality, emphasize the flexibility of ethics, and oppose the fixed ethical code.

(2) Traditional ethics school. Advocate adherence to traditional medical ethical principles and religious ethical principles.

(3) Youth moral school or analytical school. It opposes both the rough utilitarianism of the Modal Ethics school and the rigid theological moralism of the Traditional Ethics school. It advocates that ethical issues should be analyzed carefully.

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In medical ethics ^[1]

The main research contents of medical ethics are: the basic principles, norms, functions and development laws of medical ethics; the relationship between medical staff and patients (doctor-patient relationship); the relationship between medical staff (inter-medical relationship); health department Relationship with society.

The concept of health and disease. This plays an important role in defining the scope of medical care and the obligations of medical staff. If the concept of health is broader, the scope of health care will be greater, and the responsibilities of medical staff will be more. The definition of health by the World Health Organization includes physical, mental and social integrity. Many people think that this definition is too broad, which will make the scope of medical care too large and the burden on society. The narrower definition of health includes only physical and mental well-being, or is limited to physical well-being. Another definition of health prescribes health as being free of disease, whereby medical coverage is limited to eliminating and controlling disease. Regarding disease, there is a dispute between the definition of naturalism and the definition of normism. The definition of naturalism emphasizes that disease is a departure from the natural function of the organizational structure of a species and has nothing to do with value. The normative definition emphasizes that disease is a departure from social norms and is value-related. Whether masturbation, homosexuality and other diseases are related to social norms and values.

Doctor-patient relationship. Doctor-patient relationship involves many basic issues of medical ethics, the most important of which are the rights of patients and the obligations of doctors. Various ethical models of doctor-patient relationship have been proposed. Traditional medical ethics emphasizes that everything the medical staff does must be beneficial to the patient, regardless of the patient's wishes. This is a paternalistic model. Later in the West, with the development of the civil rights movement, more emphasis was placed on respecting the opinions of patients, which was an autonomous model. Someone is trying to unify the two. In addition, the contract model modeled after the commodity exchange relationship treats both doctors and patients as equal partners in the commodity exchange, and the interests of both parties are protected by law. However, the trust nature of the doctor-patient relationship goes beyond the commodity exchange relationship and cannot be a contract model. Inclusive, and there is a de facto inequality between the doctor and the patient in their possession of medical knowledge. There are three criteria for the moral evaluation of the behavior of medical personnel: whether it violates laws and administrative regulations; whether it meets recognized ethical principles and moral rules; and whether it is a noble person. Patients have the right to basic medical care, self-determination, informed consent, and privacy.

Reproductive technology. Reproductive technologies such as artificial insemination, in vitro fertilization, and surrogate motherhood provide humans with unnatural methods of reproduction, causing a series of conceptual, ethical, and legal issues. Reproductive technology makes people separate love, sexual intercourse from reproduction and fertility. Will this weaken the family s sacred bond? Will introducing zygotes involving third parties into the marriage relationship through artificial insemination destroy the foundation of the family? What is the legal status of children born from donor sperm insemination? Should donor services be checked, restricted, confidential, and commercialized? What is the ethical and legal status of embryos in IVF? Should research on human embryos be controlled? Should surrogate mothers be legally banned? In artificial reproductive technology, a child may have both parents who provide genetic material and developmental environment, as well as parents who raised him. So who are his parents who have ethical and legal obligations and rights? Should sex be banned before giving birth? Discussion of these issues often requires corresponding decisions in policy and law.

Birth control. Contraception, abortion, and sterilization are also technologies that separate love, sexual intercourse, and reproductive fertility, and are therefore opposed by religious or non-religious authorities. On the other hand, it is an open question whether compulsory sterilization should be implemented for people with severe mental retardation and severe mental patients. If it is considered that ethics can justify birth control technology, then there is another question of how to defend: Is it because the person has the right to make self-determination on reproductive issues, or because marriage and childbirth are privacy issues that others and society have no right to interfere ? The discussion of abortion raises another question: whether the fetus is human, and when the human begins. People start at the time of fertilization, from fetal movement, from the emergence of brain waves, from the fact that they can survive outside the body? As long as there are 23 pairs of chromosomes, is it a person, or must a person be self-conscious and have some social relationship with others? In some countries, abortion is not allowed after the fetus has entered a viable period, but is abortion allowed for some reason? In the case of late abortion, how to deal with the conflict of values or interests of the fetus, mother, family, society, and medical staff is a problem that has been difficult for medical staff.

genetics and eugenics. Prenatal diagnosis, genetic testing, genetic screening, genetic counseling, gene therapy, genetic engineering and other technologies are conducive to the early detection of hereditary diseases, but these technologies have caused whether such inspections and screening can be enforced and whether they should be severely restricted. Ethical issues such as marriage and childbirth of patients with genetic diseases, whether genetic information should be kept secret, whether genetic counseling services should be free of charge, and how the benefits and losses of these technologies should be weighed. Using genetics to reduce the number of patients with genetic diseases and improve the quality of the population, how can it be distinguished from the so-called eugenic movement advocated by Nazi Germany in terms of purpose and method?

Death and euthanasia. Thanks to the development and application of life-sustaining technology, medical staff can enable irreversibly comatose brain-dead patients and people with persistent vegetative states to continue to maintain their biological lives, but they will permanently lose their consciousness and motor capacity. This makes it necessary to reconsider the concept of death and to redefine death. Many countries have legally recognized the concept of brain death. But the concept of brain death is the concept of whole brain death. The hotly debated question is: Is the person with a persistent vegetative state in which the cerebral cortex has died but the brain stem is still alive? On the other hand, can a child without a brain be considered a human? The death here is the death of man, so the concept of death is closely related to the concept of what a person is. If brain dead, vegetative, and anencephaly are considered to have died, it is not within the scope of euthanasia to leave them untreated or take measures to end their lives. The ethics of euthanasia is one of the most actively discussed and debated in medical ethics. Voluntary passive euthanasia, that is, the withdrawal or treatment of a terminally ill patient, is recognized by the laws of many countries, and incompetent patients can also make their decisions. However, there are still different opinions on whether artificial water supply and feeding are included in the treatment that can be omitted or withdrawn. The big difference is the problem of active euthanasia, which is mainly because there are still different opinions on whether there is a nature difference between the initiative to end the patient's life and the passive action that does not give or withdraw treatment. In the case of active euthanasia, it is difficult to determine whether the cause of death was disease, or action, and whether the person taking the action was out of goodwill or malice. Euthanasia also involves the treatment of severely disabled newborns, ie, the criteria on which decisions should be made and who should make them. Opposition to euthanasia can be seen from both a moral and a consequence perspective. For example, if euthanasia is to kill innocent people, euthanasia may have a negative effect on the moral responsibility of medical personnel and the development of medicine.

Allocation of medical and health resources and health policies. Resource allocation includes macro resource allocation and micro resource allocation. Macro-allocation of medical and health resources refers to how much of the total resources available to the country should be allocated to health care, and how resources allocated to health care are allocated between various sectors of the health care, such as how much cancer research should be divided, and preventive medicine should be divided. How much, how much high-tech medicine should be divided. Macro distribution must also address the following questions: Should the government be responsible for medical and health services, or leave the medical industry to the market, and if the government should be responsible, how much budget should be used for medical and health care. How to make the most effective use of the budget allocated to health care, such as whether the budget should focus on kidney dialysis, organ transplants, intensive care or rescue, or disease prevention; which diseases should be prioritized for resource allocation; and to change individuals Behavioral patterns and lifestyles (such as smoking), how much resources the government should invest; etc. The micro-allocation of resources refers to the principles on which medical staff and medical administrative units allocate health resources to patients, and how to allocate them is fair and reasonable. When it comes to scarce resources, which patients have priority access to resources (if two patients need a kidney transplant, but only one kidney is available for transplant). In order to make micro-distribution, first of all, rules and procedures need to be established to determine who can get this resource, that is, preliminary screening based on indications, age, possibility and hope of successful treatment, life expectancy and quality of life, which are mainly medical standards ; Then there are rules and procedures from which it is ultimately decided who gets this resource. This set of rules and procedures often refers to social standards: the status and role of the patient, past achievements, potential contributions, etc. But social standards are more controversial.

The most controversial issue in health policy is whether a country should socialize health care, such as whether it should implement public health care or medical insurance, or commercialize health care, or adopt a mixed eclectic approach (such as the basic needs of health care). The state is responsible, while high-tech medicine is purchased by patients themselves.

The salient features of medical ethics are: practicality, inheritance, and timeliness. ^[2]