HISTORY OF HEALTH CARE ETHICS

The term “bioethics” was first introduced by the American physician, Van Rensselaer Potter, in 1971 in his book, Bioethics: Bridge to the Future. In this book, Potter used the term to emphasize the importance of developing new biological knowledge in combination with an understanding of human values. The study of health care ethics arises out of attempts to address the ethical issues caused by developments in the biological sciences and their application to medical practice.

Medical ethics, or the study of physician morality, has a much longer history and in Western history can be said to have developed its lasting foundation in the era of Hippocrates (b:460, d:377?). The Hippocratic Oath, which may actually have been previously constructed by Pythagoras, lays down the foundations for the virtuous physician.

The oath has four distinct parts consisting of:

• The actual oath.

• A covenant outlining the duties of medical students to their teachers and their obligations regarding the transmission of medical knowledge to others.

• The ethical code involving, among other things, prohibitions against giving poisons, performing abortions, having sexual relations with patients and revealing to others details of a patient's private life.

• A prayer expressing hope for reward upon keeping the oath.

This oath, influenced by Platonic, Aristotelian and Stoic philosophy represented the ideal of the time. Noticeably absent was the concept of patient autonomy. A physician of the time was expected to have developed both technical skills and the skill of phronesis, which consisted of recognizing the right thing to do in a particular situation.