medical ethics medical ethics medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. these values include the respect for autonomy, non-maleficence, beneficence, and justice. such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. it is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. however, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation. medical ethics is particularly relevant in decisions regarding involuntary treatment and involuntary commitment. for the 1803 textbook, see medical ethics (book). for the journal, see journal of medical ethics. part of a series onmedical ethics values primum non nocere informed consent beneficence confidentiality autonomy conflicts capacity involuntary treatment duty to warn duty to protect frameworks advance healthcare directive surrogate decision-maker related concepts medical profession medical law bioethics critiques medical sociology there are several codes of conduct. the hippocratic oath discusses basic principles for medical professionals. this document dates back to the fifth century bce. both the declaration of helsinki (1964) and the nuremberg code (1947) are two well-known and well respected documents contributing to medical ethics. other important markings in the history of medical ethics include roe v. wade in 1973 and the development of hemodialysis in the 1960s. more recently, new techniques for gene editing aiming at treating, preventing and curing diseases utilizing gene editing, are raising important moral questions about their applications in medicine and treatments as well as societal impacts on future generations, yet remain controversial due to their association with eugenics. as this field continues to develop and change throughout history, the focus remains on fair, balanced, and moral thinking across all cultural and religious backgrounds around the world. the field of medical ethics encompasses both practical application in clinical settings and scholarly work in philosophy, history, and sociology. medical ethics encompasses beneficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. in addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying the importance of autonomy. this leads to an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings. history a 12th-century byzantine manuscript of the hippocratic oath ama code of medical ethicsthe term medical ethics first dates back to 1803, when english author and physician thomas percival published a document describing the requirements and expectations of medical professionals within medical facilities. the code of ethics was then adapted in 1847, relying heavily on percival's words. over the years in 1903, 1912, and 1947, revisions have been made to the original document. the practice of medical ethics is widely accepted and practiced throughout the world. historically, western medical ethics may be traced to guidelines on the duty of physicians in antiquity, such as the hippocratic oath, and early christian teachings. the first code of medical ethics, formula comitis archiatrorum, was published in the 5th century, during the reign of the ostrogothic christian king theodoric the great. in the medieval and early modern period, the field is indebted to islamic scholarship such as ishaq ibn ali al-ruhawi (who wrote the conduct of a physician, the first book dedicated to medical ethics), avicenna's canon of medicine and muhammad ibn zakariya ar-razi (known as rhazes in the west), jewish thinkers such as maimonides, roman catholic scholastic thinkers such as thomas aquinas, and the case-oriented analysis (casuistry) of catholic moral theology. these intellectual traditions continue in catholic, islamic and jewish medical ethics. by the 18th and 19th centuries, medical ethics emerged as a more self-conscious discourse. in england, thomas percival, a physician and author, crafted the first modern code of medical ethics. he drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, in which he coined the expressions "medical ethics" and "medical jurisprudence". however, there are some who see percival's guidelines that relate to physician consultations as being excessively protective of the home physician's reputation. jeffrey berlant is one such critic who considers percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. in addition, since the mid 19th century up to the 20th century, physician-patient relationships that once were more familiar became less prominent and less intimate, sometimes leading to malpractice, which resulted in less public trust and a shift in decision-making power from the paternalistic physician model to today's emphasis on patient autonomy and self-determination. in 1815, the apothecaries act was passed by the parliament of the united kingdom. it introduced compulsory apprenticeship and formal qualifications for the apothecaries of the day under the license of the society of apothecaries. this was the beginning of regulation of the medical profession in the uk. in 1847, the american medical association adopted its first code of ethics, with this being based in large part upon percival's work. while the secularized field borrowed largely from catholic medical ethics, in the 20th century a distinctively liberal protestant approach was articulated by thinkers such as joseph fletcher. in the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics. well-known medical ethics cases include: albert kligman's dermatology experiments deep sleep therapy doctors' trial greenberg v. miami children's hospital research institute henrietta lacks chester m. southam's cancer injection study human radiation experiments jesse gelsinger moore v. regents of the university of california surgical removal of body parts to try to improve mental health medical experimentation on black americans milgram experiment radioactive iodine experiments the monster study plutonium injections the david reimer case the stanford prison experiment tuskegee syphilis experiment willowbrook state school yanomami blood sample collection darkness in el dorado since the 1970s, the growing influence of ethics in contemporary medicine can be seen in the increasing use of institutional review boards to evaluate experiments on human subjects, the establishment of hospital ethics committees, the expansion of the role of clinician ethicists, and the integration of ethics into many medical school curricula. covid-19 in december 2019, the virus covid-19 emerged as a threat to worldwide public health and, over the following years, ignited novel inquiry into modern-age medical ethics. for example, since the first discovery of covid-19 in wuhan, china and subsequent global spread by mid-2020, calls for the adoption of open science principles dominated research communities. some academics believed that open science principles — like constant communication between research groups, rapid translation of study results into public policy, and transparency of scientific processes to the public — represented the only solutions to halt the impact of the virus. others, however, cautioned that these interventions may lead to side-stepping safety in favor of speed, wasteful use of research capital, and creation of public confusion. drawbacks of these practices include resource-wasting and public confusion surrounding the use of hydroxychloroquine and azithromycin as treatment for covid-19 — a combination which was later shown to have no impact on covid-19 survivorship and carried notable cardiotoxic side-effects — as well as a type of vaccine hesitancy specifically due to the speed at which covid-19 vaccines were created and made publicly available. however, open science also allowed for the rapid implementation of life-saving public interventions like wearing masks and social distancing, the rapid development of multiple vaccines and monoclonal antibodies that have significantly lowered transmission and death rates, and increased public awareness about the severity of the pandemic as well as explanation of daily protective actions against covid-19 infection, like hand washing. other notable areas of medicine impacted by covid-19 ethics include: resource rationing, especially in intensive care units that did not have enough ventilators or beds to serve the influx of severely ill patients. lack of ppe for providers, putting them at increased risk of infection during patient care. heavy burden on healthcare providers and essential workers during entirety of pandemic closure of schools and increase in virtual schooling, which presented issues for families with limited internet access. magnification of disparities in health, causing the pandemic to impact bipoc and disabled communities more so than other demographics worldwide. increase in hate crimes towards asian-americans, specifically chinese-americans related to covid-19 related xenophobia. closure of businesses, offices, and restaurants resulted in increased unemployment and economic recession. vaccine hesitancy. refusal to mask or social distance, increasing transmission rates. cessation of non-essential medical procedures, delay of routine care, and conversion to telehealth as clinics and hospitals remained overwhelmed with covid-19 patients. the ethics of covid-19 spans many more areas of medicine and society than represented in this paragraph — some of these principles will likely not be discovered until the end of the pandemic which, as of september 12, 2022, is still ongoing. values a common framework used when analysing medical ethics is the "four principles" approach postulated by tom beauchamp and james childress in their textbook principles of biomedical ethics. it recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. the four principles are: respect for autonomy – the patient has the right to refuse or choose their treatment. beneficence – a practitioner should act in the best interest of the patient. non-maleficence – to not be the cause of harm. also, "utility" – to promote more good than harm. justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment. autonomy the principle of autonomy, broken down into "autos" (self) and "nomos (rule), views the rights of an individual to self-determination. this is rooted in society's respect for individuals' ability to make informed decisions about personal matters with freedom. autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient and their family rather than medical professionals. the increasing importance of autonomy can be seen as a social reaction against the "paternalistic" tradition within healthcare. some have questioned whether the backlash against historically excessive paternalism in favor of patient autonomy has inhibited the proper use of soft paternalism to the detriment of outcomes for some patients. the definition of autonomy is the ability of an individual to make a rational, uninfluenced decision. therefore, it can be said that autonomy is a general indicator of a healthy mind and body. the progression of many terminal diseases are characterized by loss of autonomy, in various manners and extents. for example, dementia, a chronic and progressive disease that attacks the brain can induce memory loss and cause a decrease in rational thinking, almost always results in the loss of autonomy. psychiatrists and clinical psychologists are often asked to evaluate a patient's capacity for making life-and-death decisions at the end of life. persons with a psychiatric condition such as delirium or clinical depression may lack capacity to make end-of-life decisions. for these persons, a request to refuse treatment may be taken in the context of their condition. unless there is a clear advance directive to the contrary, persons lacking mental capacity are treated according to their best interests. this will involve an assessment involving people who know the person best to what decisions the person would have made had they not lost capacity. persons with the mental capacity to make end-of-life decisions may refuse treatment with the understanding that it may shorten their life. psychiatrists and psychologists may be involved to support decision making. beneficence main article: beneficence (ethics) the term beneficence refers to actions that promote the well-being of others. in the medical context, this means taking actions that serve the best interests of patients and their families. however, uncertainty surrounds the precise definition of which practices do in fact help patients. james childress and tom beauchamp in principles of