The purpose of the academy is to
promote education in biothics, especially in medical ethics on a national,
nonprofit basis through events like symposia, congresses, workshops, seminars.
Furthermore, the academy intends to initiate research projects and spread
subject-specific publications in the area of bioethics and medical ethics.
The academy is committed to the interdisciplinary and interreligious discourse
on topics of bioethics and medical ethics. The academy also integrates
people who do not belong to any particular organised religion.
paper: the formulation of modern global medical ethics
Schapowal, guest editor: Ethik in der Medizin 10, Suppl. 1/1998: 155-159)
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
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:
- 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.
- 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.
- 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.
- 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:
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.
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.
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
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WHO home page address: www.who.int
Andreas G. Schapowal MD
Swiss Academy of Medicine and Ethics
Hochwangstr. 3, 7302 Landquart, Switzerland