United Nations Issues Principles of Medical Ethics

The U.N. Principles of Medical Ethics attempted to prevent torture and transformed isolated national ethical codes into an internationally unified instrument for humane treatment.

Summary of Event

The story of human civilization is the meandering story of the invincible will of the human race to assert its natural right to live with dignity. The dynamics of the struggle to survive and to thrive have provided the protagonist of the story, the human race, with a vibrant resilience otherwise called the will to survive. The dynamics between a tradition of torture and the history of the evolution of medical ethics, a body of codes of professional conduct developed by individuals and groups within the medical profession and voluntarily practiced by them in word and spirit, demonstrates how the human will to survive has worked its way toward an increasingly fuller and more coherent realization of the right to live with dignity. Principles of Medical Ethics, U.N.
United Nations;medical ethics
Medical ethics;international standards
[kw]United Nations Issues Principles of Medical Ethics (Dec. 18, 1982)
[kw]Principles of Medical Ethics, United Nations Issues (Dec. 18, 1982)
[kw]Medical Ethics, United Nations Issues Principles of (Dec. 18, 1982)
[kw]Ethics, United Nations Issues Principles of Medical (Dec. 18, 1982)
Principles of Medical Ethics, U.N.
United Nations;medical ethics
Medical ethics;international standards
[g]North America;Dec. 18, 1982: United Nations Issues Principles of Medical Ethics[05010]
[g]United States;Dec. 18, 1982: United Nations Issues Principles of Medical Ethics[05010]
[c]Diplomacy and international relations;Dec. 18, 1982: United Nations Issues Principles of Medical Ethics[05010]
[c]United Nations;Dec. 18, 1982: United Nations Issues Principles of Medical Ethics[05010]
[c]Health and medicine;Dec. 18, 1982: United Nations Issues Principles of Medical Ethics[05010]
Percival, Thomas
Rush, Benjamin

In ancient Babylon, the set of laws known as Hammurabi’s Code Hammurabi’s Code[Hammurabis Code] included the earliest of the ethical guidelines for medical practitioners; the code protected the natural rights of human beings in the crude spirit of “an eye for an eye and a tooth for a tooth,” a spirit that condemns the inhuman and cruel inhumanity only to introduce a remedy as bad as the disease. According to Hammurabi’s Code, for example, a surgeon who destroys his patient’s eye in an operation must lose his hands much the same way as a builder whose faulty construction of a house results in the death of the householder’s child must lose his own child. The code does not mention prisoners, given that prisons are a relatively recent reformatory social institution, replacing the original harsher punitive measures of death, mutilation, banishment, transportation, flogging, and branding. The prevailing cruelty of the Babylonian society of King Hammurabi’s day generated a cruel code of ethics.

Hippocrates, the renowned physician of the fifth century b.c.e., has been called the “father of medicine.” He responded to the prevailing institutionalized cruelty of his age in a different manner from Hammurabi, giving the human will a different mode of survival and a new way of asserting its right to live with dignity. His code counsels physicians to use their skill and learning on their patients with kindness. One of the ways the physician can choose to be kind is to make sure that he or she does no harm to the patient in cases in which the patient cannot possibly be helped. The code captures this injunction in its phrase “above all, do no harm.” Further, the Hippocratic oath Hippocratic oath strongly urges physicians to keep under complete control their possible amorous proclivities toward patients. It also admonishes physicians to keep secret any knowledge that they gain concerning their patients “which ought not to be spread abroad.” Above all, the oath calls on physicians to apply these tenets with an uncompromising professional egalitarianism to all, “be they free or slave.” The Hippocratic oath’s professionalism in the conduct of physicians and care of their patients promotes not only the physical health but also the autonomy of the patient, thus combating the inhumanity of the forces of cruelty and leading the human will to triumph over the social institutions of evil.

The code’s unfailing devotion to the propagation of the quintessential existential rights of humans, especially in its enunciations of the interrelationship between the doctor and the patient, made the Hellenistic Hippocratic oath the overarching proclamation in the body of literature on medical ethics. The early Christians modified it only to eliminate its invocation to pagan deities, which they replaced with the Christian God the Father and Jesus Christ. Medieval Arabs admired the oath in its Arabic translations by Avicenna and Averroës, although they found the pagan ideals of the Greek philosopher-physician in conflict with their Islamic theology. They found the oath flexible enough, however, for them to incorporate Islamic ethics without changing the oath in spirit. Medieval Jews followed suit. The humanism of the Renaissance, with its new enthusiasm for Greek and Latin works, showed a deep appreciation for the oath.

Benjamin Rush, an eighteenth century American physician, drew heavily on the works of Hippocrates for his extensive lectures on medical ethics. His contemporary, Thomas Percival, based his 1803 Code of Medical Ethics on a mixture of Hellenistic background and Christian morality, extending the same humanistic temperament to his brief observations on new issues of medical ethics emerging as a result of advances in medical research. Percival’s code formed the core of the medical ethics discussed at the first meeting of the American Medical Association in 1847. In spite of its revisions in 1903, 1912, 1947, and 1980, the American Medical Association’s medical code retained the fundamentals of the Hippocratic oath as adapted and interpreted by Percival.

The political events of the mid-twentieth century heralded a new evil and threat to medical well-being and health, the evil of institutionalized torture of political prisoners. Dictatorial regimes in South Asia, Africa, and Latin America used the traditional repertoire of torture methods but also added to it the sophisticated insights the medical profession could offer. These nations were not the only transgressors; torture was practiced nearly worldwide to varying degrees.

Some politicized medical and health care professionals volunteered to assist in torture, Torture;medical ethics with various motives, and many others were coerced into using their skill. Medical practitioners acted to “rejuvenate” the tortured, so that torture could be prolonged until the tortured person “confessed,” and advised torturers on how to inflict pain and damage while leaving the least possible evidence of torture, making the burden of proof almost impossible to meet for humanitarian agencies working on behalf of the rights of the tortured. Some even signed false documents attributing natural causes to deaths resulting from torture. In some countries, psychiatrists were used to interpret political dissidence as “delusions,” commit the “deluded individuals” to psychiatric hospitals, and administer drugs for the person’s “treatment.” Psychiatry;abuses

This retrogression of the rights of humans to an autonomous selfhood became a matter of concern to the World Medical Association, an association of national medical associations. In its 1975 Declaration of Tokyo, Declaration of Tokyo (1975) the World Medical Association World Medical Association expressed the collective conscience of medical professionals and called on colleagues not to use their medical knowledge against the natural laws of humanity and to desist from providing “any premises, instruments, substances, or knowledge to facilitate the practice of torture or other forms of cruel, inhuman, or degrading treatment or to diminish the ability of the victim to resist such treatment.”

The United Nations broadened the scope of the Declaration of Tokyo after elaborate consultations with the World Health Organization (WHO), the World Medical Association, and the Council for International Organizations of Medical Sciences, an international nongovernmental scientific organization jointly established by WHO and the United Nations Educational, Scientific, and Cultural Organization (UNESCO). Finally, it consolidated all suggestions into the Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners Against Torture, which was formally adopted by its General Assembly’s thirty-seventh session on December 18, 1982.


The six principles contained in the U.N. document concerning medical ethics are rather unlike their predecessors in that they target a specific group of people (prisoners) and address the ethical problems related to a particular category of social pathology (torture). For example, the second principle specifically denounces the practice, active or passive, by health personnel, particularly physicians, of torture or other cruel, inhuman, or degrading treatment or punishment. The principles are also like their predecessors, as they are the intramural directives of medical professionals without the extramural legal authority of law.

The principles offer extensive moral support local, national, and international, of professionals and of the laity for those medical personnel who are coerced into the abuse of medical ethics under the threats of torture or inhuman and degrading acts either from their employers or from their national dictators. Further, presence of such international moral support was hoped to be an effective deterrent to those in the medical profession who may have been tempted to volunteer for the transgression of their professional ethics.

An authoritarian regime cannot afford to exist without ties to the world outside, which is becoming progressively interdependent for economic, technological, scientific, and many other reasons. In such an increasingly interconnected world, consciousness-raising can be stronger than the power of legal implementation. Realizing this, the United Nations has publicized the document extensively. In the resolution to which the principles are attached, the General Assembly calls on all governments to give the resolution and the principles the widest possible distribution, in particular among medical and paramedical associations and institutions of detention or imprisonment. It also requests that intergovernmental and nongovernmental agencies, especially WHO, do the same. Such acts of consciousness-raising attempt to make the U.N. Principles of Medical Ethics a more efficacious force than they may appear.

Consciousness-raising within the medical profession has led to more soul-searching at the national, continental, and local levels, resulting in the formation of smaller groups espousing the same cause. These local, national, and even international groups may not succeed in preventing dictators from trampling on human rights, but they do shine light on the moral darkness so created by dictatorships. The U.N. resolution on medical ethics is a part of such light. Principles of Medical Ethics, U.N.
United Nations;medical ethics
Medical ethics;international standards

Further Reading

  • American Medical Association. Code of Medical Ethics: Current Opinions with Annotations, 2002-2003. Chicago: American Medical Association, 2002. Replaces previous editions. Treats all aspects of medical ethics, such as social policy issues, confidentiality, and advertising.
  • British Medical Association. The Medical Profession and Human Rights: Handbook for a Changing Agenda. New York: Palgrave, 2001. Thorough, well-researched account of the role of doctors and medical professionals in acts of abuse, torture, and human rights violations. Bibliography and index.
  • Burns, Chester R., ed. Legacies in Ethics and Medicine. New York: Science History Publications, 1977. A collection of essays designed for use in the classroom by teachers of history, philosophy, and religion. Explores the problems of medical ethics in relation to ethics in general, religion, and secularism.
  • Gordon, Neve, and Ruchama Marton, eds. Torture: Human Rights, Medical Ethics and the Case of Israel. Highlands, N.J.: Zed Books, 1995. An examination of the reported torture of Palestinian prisoners and the role of medical ethics codes in stopping it. Includes appendixes and index.
  • McLean, Sheila. Old Law, New Medicine: Medical Ethics and Human Rights. New York: New York University Press, 1999. Scholarly examination of the implications of medical policies on human rights. Includes bibliographical references and index.

  • Philosophy and Practice of Medical Ethics. 3d impression. London: British Medical Association, 1986. Published in 1984 as The Handbook of Medical Ethics, a self-help type of manual for doctors to work out, on their own, medical ethical questions, both contemporary and future. “Ethical Codes and Statements” is a useful compilation of documents on medical ethics.
  • United Nations. General Assembly. Council for International Organizations of Medical Ethics. Principles of Medical Ethics Relevant to the Protection of Prisoners Against Torture. Geneva: CIOMS, 1983. A synopsis in English, French, Russian, Chinese, and Arabic of the U.N. General Assembly’s resolution of December 18, 1982.

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