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.
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.
In ancient Babylon, the set of laws known as Hammurabi’s Code
Hippocrates, the renowned physician of the fifth century
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,
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,
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.
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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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