Die Akademie bezweckt die Bildungsförderung im Bereich der Bioethik, speziell der Medizinethik auf überregionaler, gemeinnütziger Basis durch Veranstaltungen wie Symposien, Kongresse, Workshops, Seminare. Ferner bezweckt sie die Initiierung von Forschungsprojekten und die Verbreitung fachspezifischer Publikationen auf dem Gebiete der Bioethik und Medizinethik. Die Akademie ist dem interdisziplinären und interreligiösen Diskurs über Themen der Bioethik und Medizinethik verpflichtet. Die Akademie bindet auch Personen mit ein, die sich keiner Religion verpflichtet fühlen.

Thesenpapier zur Formulierung einer zeitgemässen, globalen ärztlichen Ethik
(Niedersächsisches Ärzteblatt 1/1998: 16 – 19)

Thesis paper: the formulation of modern global medical ethics
(A. Schapowal, Gastherausgeber: Ethik in der Medizin Band 10, Suppl. 1/1998: 155-159)

Essai pour la formulation d´une étique médicale globale
(Abstract Book des 1. Symposiums Medizin und Ethik 1998)


A. Schapowal: What is ethics?
EAACI Newsletter 2: 6 - 8 (2001)

Definition of ethics

Ethics is the branch of philosophy concerned with the study of those concepts we use to evaluate human activities, in particular the concepts of goodness and obligation.
Philosophical schools can be devided into schools that regard ethical language as being descriptive, and those that regard it as being prescriptive. Descriptive theories of ethics seek to define the meaning of good either in terms of nonmoral characteristics (naturalism), in terms of metaphysical constructions, or in terms of moral notions that are considered to have a special and peculiar character of their own. Important amongst the prescriptive theories is the view that ethical language is used to appeal not to the intellect but to the emotions, showing that a person´s moral feelings
arouse and are designed to arouse similar feelings in others. Other prescriptive theories are those that define ethical terms as carrying mandatory force, enjoined by some kind of authority, divine or otherwise. A special case was Immanuel Kant´s theory of the categorical imperative, according to which the prescriptive force of moral action hinges on the criterion of whether the principle involved could become a universal maxim. So far there is no global consensus in philosophy for a definition of "good".
In my opinion, in identifying the meaning of a human action, the intention is decisive. From this viewpoint we are able to distinguish in moral philosophy between good – bad, right – wrong,
helpful – harmful, wholesome – unwholesome.

A global ethics for a global community

At the beginning of the 21st century we realize that the world has grown smaller and the world´s people have become almost one community interdependent in large multinational groups, in global economy, industry, trade with worldwide communications eliminating nearly every ancient barrier of distance, language and race. We also share the same grave problems: overpopulation, dwindling natural resources, environmental pollution threatening our air, water, food, elimination life forms minute by minute.
There is a common ethical basis of all world religions in which believers of different religions and also non-believers or agnostics can agree: respect of nature and humanity. No matter whether we believe in the sayings of Confucius, the discourses of Buddha, the Torah, the Sermon on the Mount or any other religion or pseudo-religion, we as human beings all desire happiness and do not want suffering. Furthermore each of us has an equal right to persue these goals. In Europe this was reflected in the philosophical discussions prior and during the French revolution and expressed in the
Declaration of human rights in 1789, renewed worldwide in the General Declaration of Human Rights of the United Nations.

The definition of health

The World Health Organization (WHO) defines health in its preamble as "a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." In January 1998 the WHO Executive Board adopted a resolution requesting that this definition of health be changed to "Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity." The WHO General Assembly has still to agree to extend the definition of health to the spiritual level.

Globalisation of health ethics

Moral commitments to protect individual health go back thousands of years to ancient Hindu Samihita medical ethics, the Japanese Rhi-Shu code of medicine and the Greek Hippocratic Oath. In Hippocratic medicine the therapeutic relationship was grounded on the moral principle of philanthropia: "where there is love of man (philantropia), there is the love of the art of healing (philotechnia)". The link between religious beliefs and medical ethics also has wellestablished historical roots. For instance, Buddhist scriptures frequently referred to the Buddha as the "Great
Physician". In the bible, Christus Medicus acts very much in the same way. Contemporary bioethics are based on the Ethical Guidelines of the World Medical Association, examples of which are the Declaration of Geneva and the Declaration of Helsinki.
Presuming that it is every medical doctor's task and aim to maintain, improve or restore his patients´ health using all possible efforts, this new definition of health has many implications for the education, ethics and daily practice of doctors no matter in which field or country they are working:

  1. The physical level
    Our universities and medical schools offer a high standard of medical education. The medical student's obligation is to study hard and gain as much knowledge of the human body and its functions as well as of pathogenesis and salutogenesis as possible. The qualified doctor has a duty is to consider himself an eternal student, and must ensure that by reading scientific journals and attending scientific meetings and postgraduate courses he maintains a high standard of
    the increasingly subtle body of knowledge at least in his field of specialization.

  2. The mental level
    Doctors must know about the mind and its functions as well as about the interdependent relationship between the body and the mind. This is every doctor's obligation. Leaving the mental level to the psychiatrist would be a very poor and limited understanding of the human being in general and the patient's needs in particular.

  3. The social level
    In the third world, addressing the basic health needs of a country´s poorest citizens is the first step towards reducing the level of poverty. Tuberculosis, malaria and HIV remain the most pressing global challenges in the context of diseases that cause poverty. How can medical doctors, businesses, governments and international organizations join together to attack the diseases that continue to afflict the poor and that prevent greater socio-economic development?
    In the developed countries, with the arrival of genetic screening, gene technology and telemedicine, healthcare practices are set to change considerably in the next few years. What real advances can we expect from new methods and treatments? Will new healthcare systems further empower patients or diminish their influence?
    Social commitment should be an integral component of the medical profession. Social responsibility ranges from such goals as commitment to a fair health system in one's own country to the involvement in the improvement of working conditions, to questions of global distribution of health resources and the commitment for a healthy environment suitable
    for human beings, animals and plants.
    In WHO there is a movement towards globalisation of public health ethics. Doing good in public health would include investment in global research, surveillance, and development aimed at protecting all from infectious diseases, and controls on exports of products hazardous to health, in particular tobacco, hazardous wastes, contaminated food products, hazardous chemicals, illegal drugs, and weapons.

  4. The spiritual level
    Spirituality seeks the ultimate truth beyond our superficial material world. In different cultures and nations mankind has devised various religions with their different anthropologies. All religions can agree on global ethics. Global medical ethics can be accepted as well by doctors who do not feel affiliated to any religion. In ancient times the medical doctor was also a priest. For example, prior to Chinese occupation, Tibetans had first to pass the examination as a lama, which required at least six years of study in a monastery, and then undertake a six-year course to become a medical doctor.Good medical and good scientific judgement requires much more than scientific and medical knowledge, analytical and surgical skills. It also needs every doctor´s and scientist´s integrity, which comes with courage and character on the right
    ethical basis. To try to implement the right medical ethics in each single medical student, ethics should be part of the medical curricula at all universities worldwide.

Three features are needed to be a good doctor or scientist committed to improving the state of health:

  1. Altruism
    The mental faults of ignorance, hatred and greed should be erased from one's mind. The medical doctor should be happy and thankful for the opportunity to help and serve other beings, which makes his profession one of the most precious of all.

  2. Wisdom
    To seek the best possible knowledge of medicine and to develop a peaceful and altruistic mind is the right basis to maintain or restore health in patients. This includes a clear understanding of the basis of suffering, death and life after death. An important quality in this context is mindfulness, being aware of the consequences of our decisions and actions.

  3. Compassion
    Loving kindness should be the basis of a doctor's behaviour. The motivation should not be to become well-known, respected, famous, rich or whatever other wordly values could be achieved, but exclusively to help others as best as possible. The ongoing discussion in western countries of the salary of medical doctors is counterproductive. Working continously for the well-being of others will bring much more benefit to one's own spiritual continuum than anything
    else. By not giving priority to selfish and monetary aspects, doctors will recover lost ground in their patients esteem and make a very good first step towards a health care system affordable for the global interdependent society.

Further reading:

Bankowski, Z., J. H. Bryant (eds): Poverty, vulnerability, and the value of human life. Council for International Organizations of Medical Sciences (CIOMS), Geneva (1995)

Bankowski, Z., J. H. Bryant, J. Gallagher (eds): Ethics, equity and health for all. CIOMS, Geneva (1997)

Beachump, T. L., Childress J. F.: Principles of biomedical ethics, 4th edn. Oxford University Press, New York (1994)

Bettcher, D., D. Yach: The globalisation of public health ethics? Journal of International Studies 27/3: pp. 469 – 496 (1998)

Brundtland, G. H.: Health – The key to human development. Campus, Frankfurt/New York (2000)

Cohen-Almagor, R. (ed): Medical ethics at the dawn of the 21st century. Annals of the New York Academy of Sciences, Vol. 913 (2000)

Khayat, M. H.: Health – an Islamic perspective. The right path to health – Health education through religion Nr. 4. World Health Organization, Alexandria (1997)

Council for International Organizations of Medicial Sciences: International Guidelines for biomedical research involving human subjects. CIOMS, Geneva (1993)

Küng, H.: A Global ethics – The Declaration of the Parliament of the World´ Religions. Continuum, New York (1995)

Schapowal, A. (ed): Medizin und Ethik. Ethik in der Medizin Band 10, Suppl. 1 (1998)

Steinberg, A.: Jewish medical ethics. In: Brody, B. A. et al (eds): Bioethics Yearbook, vol. 1. Theological developments in bioethics 1988 – 1990. Kluwer Academic, Dordrecht-Boston-London, pp 271 – 279 (1991)

Steinberg, A.: A Jewish perspective on the four principles. In: Gillon, R. (ed): Principles of health care ethics. Wiley, New York, pp 65 – 73 (1994)

Swiss Academy of Medicine and Ethics home page address: www.medizin-ethik.ch

Velasquez, G., Boulet, P.: Globalization and Access to Drugs: Implications of the WTO/TRIPs Agreement. WHO Geneva (1997)

WHO home page address: www.who.int

Andreas G. Schapowal MD
Swiss Academy of Medicine and Ethics
Hochwangstr. 3, 7302 Landquart, Switzerland
E-mail: mail@medizin-ethik.ch