Medical ethics examines the moral issues that arise in medicine. It has a long history dating back to ancient times when diseases were viewed as supernatural. Over time, medicine became more scientific and data-driven. In Ethiopia, modern medicine was introduced in the 16th century and hospitals were established starting in the early 20th century. There are several frameworks for analyzing medical ethics issues, including utilitarianism which focuses on producing the greatest benefit for the greatest number, deontology which emphasizes moral duties and rules, and virtue ethics which focuses on good character.

1. Medical Ethics
Dr.Beka A.

2. Introduction to medical ethics
oo History of Medicine?
oHistory of Medicine In Ethiopia?
oWhat is medical ethics?
oWhy study medical ethics?
oMedical ethics, medical professionalism, human rights and law

3. History of Medicine
• Humans did not at first regard death and disease as natural phenomena.
Common maladies, such as colds or constipation, were accepted as part of
existence and dealt with by means of such herbal remedies as were
available
• Serious and disabling diseases, however, were placed in a very different
category. These were of supernatural origin. They might be the result of a
spell cast upon the victim by some enemy, visitation by a malevolent
demon, or the work of an offended god who had either projected some
object—a dart, a stone, a worm—into the body of the victim or had
abstracted something, usually the soul of the patient.
• One curious method of providing the disease with means of escape from
the body was by making a hole, 2.5 to 5 cm across, in the skull of the
victim—the practice of trepanning, or trephining

4. History of Medicine
• The magicians and religion had a major role in prehistoric medicine
• Greek historian Herodotus stated that every Babylonian was an
amateur physician
• . The first physician to emerge is Imhotep, chief minister to King
Djoser in the 3rd millennium BCE, who designed one of the
earliest pyramids
• Hippocrates (born 460 BC) is widely credited as being the father of
modern medicine. One of his huge contributions in advancing the
field was the insight into the fact that diseases could have natural
(rather than supernatural) causes. Also of enormous significance was
his oath of conduct for physicians which is still used worldwide today.

5. History of Medicine
• 2600 BC Imhotep is a famous doctor and the first physician mentioned in recorded
history. After his death he is worshiped as a god.
• 1792–1750 BC The Code of Hammurabi is written, establishing laws governing the
practice of medicine.
• 1500 BC The Ebers Papyrus is the first known medical book.
• 500 BC Alcamaeon of Croton in Italy says that a body is healthy as long as it has the right
balance of hot and cold, wet and dry. If the balance is upset, the body falls ill.
• 460–370 BC Hippocrates lives. He stresses careful observation and the importance of
nutrition.
• 384–322 BC Aristotle lives. He says the body is made up of 4 humors or liquids: phlegm,
blood, yellow bile, and black bile.
• 130–200 AD Roman doctor Galen lives. Over following centuries, his writings become
very influential.
• 12th and 13th centuries Schools of medicine are founded in Europe.

6. History of Medicine
• In the 13th century, barber-surgeons begin to work in towns. The church runs the only
hospitals.
• 1543 Andreas Vesalius publishes The Fabric of the Human Body.
• 1628 William Harvey publishes his discovery of how the blood circulates in the body.
• 1796 Edward Jenner invents vaccination against smallpox.
• 1816 Rene Laennec invents the stethoscope.
• 1847 Chloroform is used as an anesthetic by James Simpson.
• 1865 Joseph Lister develops antiseptic surgery.
• 1870 The Medical Practice Act is passed. Licensure of physicians becomes a state
function.
• 1876 The American Association of Medical Colleges is founded.
• 1880 Louis Pasteur invents a cure for chicken cholera, the first vaccine. (Debré 2000)

7. History of Medicine
• 1895 Wilhelm Conrad Röntgen X-rays are discovered.
• 1910 The Abraham Flexner report on medical education is published.
• 1928 Penicillin is discovered by Scottish scientist Alexander Fleming, and it is established
that the drug can be used in medicine.
• 1931 The electron microscope is invented. 1943 Willem Johan Kolff invents the first
artificial kidney (dialysis) machine.
• 1951 Epidemiology studies identify cigarette smoking as a cause of lung cancer. Sir
Richard Doll is the first to make this link.
• 1953 Jonas Salk announces he has developed a vaccine for polio. (Koprowski 1960) 1953
The structure of DNA is determined.
• 1967 The first heart transplant is performed by Christiaan Barnard. (Barnard 2011)
• 1971 MRI scanning is invented.
• 2019 Covid 19 caused a pandemic

8. Modern medicine In Ethiopia
Ethiopia adopted modern medicine in the 16th century, and every emperor
after that embraced medicine and health.
In 1886, Western medicine was introduced by Swedish medical staff and
more Western countries were investing time and resources in countries like
Ethiopia.
The first hospital in Ethiopia was built in 1909 by the Russian Red Cross in
Addis Ababa. By 1936, Ethiopia had eleven hospitals, two leprosaria,and a
serological for vaccine production.
The Italian-Ethiopian War (1936-1941) slowed progress of their health
system, overburdened their current system, and communicable diseases
spread more rapidly. After their liberation in 1941, hospitals and clinics were
gradually added and the country was able to strengthen its overall
infrastructure.

9. Modern medicine In Ethiopia
The Public Health Laboratory and Research Institute was opened
followed by a Public Health Proclamation; this proclamation created a
legal foundation for health programs. Shortly after, in 1948, the
Ministry of Public Health was created. Public Health administration
was transferred from the Ministry of the Interior to the newly created
Ministry of Public Health. In 1954, the Gondar Public Health College
and Training Center was opened with help from WHO, UNICEF and
USAID. This improved health greatly by training health officers,
community nurses, and sanitarians to staff the health centers. The first
Faculty of Medicine was opened at the University of Addis Ababa in
1965.
Ethiopian Medical Association was established in 1962 it the oldest
professional association in the country

10. Modern medicine In Ethiopia
The first Ethiopian medical doctor was Hakim Workineh also called Charles
Martin who was born in 1865 in Gondar. Hakim Workneh obtained his
medical degree from Lahore Medical College in 1882. He served Ethiopia as a
medical officer during the Adwa war against the invading Italian army.
Dr. Widad Kidane Mariam was born to an Ethiopian émigré family in
Palestine during the Italian occupation of her country of origin.
She studied medicine at the American University of Beirut and became the
“first female” medical practitioner and top most physician administrator in
charge of medical services division in the Ministry of Health in 1960s-1970s.
Haramaya University started Teaching Medicine in 2008 G.C the University
has trained more than 1000 medical Doctors and more the 50 specialists in
Different fields. Currently it has six residency programs with 3 subspecialty
fellowship

11. Why Do you want to be a Doctor?

12. What is Medical Ethics
• Ethics’ or ‘moral philosophy’ is the study of morals in human conduct.
Like all branches of philosophy, it deals with the critical evaluation of
assumptions and arguments. Within the field of philosophy
• ‘Medical ethics’ is the study of morals in the medical arena
• The explicit teaching of ethics aims to help to foster an ability to make
rational, moral decisions – rather than to simply do things as they
have been done before.
• students and indeed qualified doctors often find it disheartening that
medical ethics asks questions more often than it provides answers.
But this arguments should be Valid and Justifable

14. Ethical Theories
• Ethical theories attempt to provide an over-arching theoretical
framework for addressing the problem of how human beings should
behave with one another in the world.
• There are three key theories which have historically dominated
medical ethics teaching: Utilitarianism, Deontology and Virtue Ethic

15. Utilitarianism
• Utilitarianism is founded on the work of Jeremy Bentham (1748–
1832) and John Stuart Mill (1806– 1873). It is based on a single
principle of what is good: the principle of utility. The morally correct
decision or course of action is often summed up as that which
promotes ‘the greatest good for the greatest number’. The principle
of good holds that we ought to produce the maximum amount of
good

16. The advantages of utilitarianism
• it fits with two strong intuitions, i.e. morality is about promotion of
well-being and we should maximize well-being
• it is a single principle that tries to deal with appropriateness of other
principles, such as a principle of always telling the truth or of always
acting to prevent suffering
• it incorporates a principle of equality: each person’s happiness is
equal
• it can be extended to the animal kingdom: some utilitarians have
argued that the capacity to suffer (and feel pain) means our treatment
of animals also ought to be subject to moral scrutiny

17. The disadvantages of utilitarianism
• there are problems dealing with intuitively immoral actions: is it right to kill
one patient in order to harvest their organs and perhaps save five lives?
• utilitarianism demands too much: in always asking us to do the best action,
everyone is expected to be both heroic and saintly. For example, it could be
argued that ‘maximizing utility’ demands that not only should we donate
blood and bone marrow as often as we can, but also that we may well be
morally obliged to donate one of our kidneys as well
• the equality principle is overly impersonal in demanding that we treat the
well-being of our friends and family as equivalent to that of strangers
• in principle, a small increase in pleasure for the majority will override a
vast degree of pain for a minority.

18. Deontology
• Deontology covers those theories that emphasize moral duties and
rules, rather than consequences (from the Greek deon, meaning
‘duty’). Perhaps the best known deontological principles are those set
down in the Ten Commandments.
• Deontology is associated with Immanuel Kant (1724–1804). He
believed that morality was not dependent on how much happiness
resulted from particular actions

19. The advantages of Kantian deontology
• it has a simplicity of structure: moral rules must pass the ‘categorical
imperative’
• it places a special responsibility upon individuals for their actions
• it addresses factors other than consequences, such as motives,
which intuitively seem important in moral decision-making
• it allows a certain degree of choice; if more than one option is
morally acceptable, then the individual can choose which to carry out
(unlike utilitarianism where the best option must be selected).

20. The disadvantages of Kantianism
• it depends on freedom of will and rationality: are we perfectly free
and rational?
• it seems to be absolutist in nature: the imperative ‘do not lie’ is
intractable – it means ‘do not lie ... EVER’, even if it prevents great harm
from occurring
• the moral rules can seem quite abstract and unable to deal with the
complexities of real-life ethical dilemmas
• two duties (imperatives) may conflict, so what happens then?

21. Virtue theory
• Virtue theory does not focus on either moral rules or consequences;
rather, it concentrates on character and motivation
• It originates in the philosophical writings of the ancient Greeks.
Socrates (469–399 BC) asked, ‘How should a man live, in order to
achieve eudaimonia (happiness or flourishing)?’ His answer was that
the good life was the one lived in accordance with areˆte (virtue).
Ancient virtues included wisdom, justice, courage, moderation and
piety.

22. The advantages of the virtue theory
• It is more personal than either utilitarianism or Kantianism: it
supports those actions done out of benevolence, friendship, honesty
and love in and of themselves, rather than because they are
‘maximizing positive value’ or are carried out in accordance with ‘moral
duty’
• It is more adaptive to the particular context of a dilemma, rather than
being bound by rules or applying a ‘calculation’ to a dilemma

23. The disadvantages of the virtue theory
• A list of virtues is insufficient to justify why we should promote them
• It is unhelpful in resolving moral conflicts
• There is no universally agreed-upon list of virtues to promote. Some
writers, however, have attempted to come up with a set of medical
virtue

24. Values-based medicine
• Values-based medicine Consideration for individual values,
particularly those of the patient, can be difficult within the context of
modern health care, where complex and conflicting values are often
in play. This is particularly so when a patient’s values seem to be at
odds with evidence-based practice or widely shared ethical principles,
or when a health professional’s personal values may affect the care
provided

26. FOUR Ethical Principles
• Autonomy
• Beneficence
• Non-maleficence
• Justice

27. Respect for autonomy
Autonomy literally means ‘self-rule’. In essence, it refers to an ability:
(1) to reason and think about one’s own choices;
(2) to decide how to act and
(3) to act on that decision, all without hindrance from other people.
Autonomy is more than simply being free to do what one wants to do

28. Beneficence and non-maleficence
Beneficence is the principle of doing ‘good’. In the medical context, this
generally means improving the welfare of patients.
Non-maleficence involves ‘not harming patients’.
It is associated with the Latin phrase primum non nocere or ‘above all,
do no harm’.

29. Justice
The principle of justice within the medical context refers to the
allocation or distribution of resources among the population.
Basically, this principle demands the fair treatment of ‘equals’ within
the healthcare system

30. Why Do we need Medical Ethics
Medicine as a field of study has done great things for the advancement
of human life from treating simple infections to doing complex
surgeries to treat diseases previous dammed untreatable.
On the Flip Side there were also some Doctors how did horrible
research on human being such as:
THE TUSKEGEE SYPHILIS STUDY
MK ULTRA
NAZI MEDICAL EXPERIMENTS
SEPARATING TRIPLETS

31. MEDICAL ETHICS, MEDICAL PROFESSIONALISM,
HUMAN RIGHTS AND LAW
• Ethics has been an integral part of medicine at least since the time of
Hippocrates, the fifth century B.C.E. (before the Christian era) Greek
physician who is regarded as a founder of medical ethics. From
Hippocrates came the concept of medicine as a profession, whereby
physicians make a public promise that they will place the interests of
their patients above their own interests.

32. MEDICAL ETHICS, MEDICAL PROFESSIONALISM,
HUMAN RIGHTS AND LAW
• In recent times medical ethics has been greatly influenced by
developments in human rights. In a pluralistic and multicultural
world, with many different moral traditions, the major international
human rights agreements can provide a foundation for medical ethics
that is acceptable across national and cultural boundaries.
• Moreover, physicians frequently have to deal with medical problems
resulting from violations of human rights, such as forced migration
and torture. And they are greatly affected by the debate over
whether healthcare is a human right, since the answer to this
question in any particular country determines to a large extent who
has access to medical care. This Manual will give careful consideration
to human rights issues as they affect medical practice

33. MEDICAL ETHICS, MEDICAL PROFESSIONALISM,
HUMAN RIGHTS AND LAW
• Medical ethics is also closely related to law. In most countries there
are laws that specify how physicians are required to deal with ethical
issues in patient care and research. In addition, the medical licensing
and regulatory officials in each country can and do punish physicians
for ethical violations. But ethics and law are not identical. Quite often
ethics prescribes higher standards of behaviour than does the law,
and occasionally ethics requires that physicians disobey laws that
demand unethical behavior. Moreover, laws differ significantly from
one country to another while ethics is applicable across national
boundaries. For these reasons, the focus of this Manual is on ethics
rather than law.