HISTORY, SCOPE,

AND BENEFITS OF
STUDYING HEALTH
AND BIOETHICS
3 hrs
Arizaldo E. Castro
Lecturer on Health and Bioethics

History of Ethics
For as long as people have been living together in groups, the moral regulation of
behavior has been necessary to the group's well-being.
Although the morals were formalized and made into arbitrary standards of conduct,
they developed, sometimes irrationally, after religious taboos were violated, or out of
chance behavior that became habit and then custom, or from laws imposed by chiefs
to prevent disharmony in their tribes.
Even the great ancient Egyptian and Sumerian civilizations developed no
systematized ethics; maxims and precepts set down by secular leaders, such as
Ptahhotep, mingled with a strict religion that affected the behavior of every Egyptian.
In ancient China the maxims of Confucius were accepted as a moral code.
The Greek philosophers, beginning about the 6th century BC, theorized intensively
about moral behavior, which led to the further development of philosophical ethics.

Early Greek Ethics

Pythagoras (6th century BC)
developed one of the earliest moral philosophies from the Greek
mystery religion Orphism
Intellectual nature > sensual nature
Best Life = Mental Life
Simplicity in speech, dress, and food

The Sophists (5th century BC) Skeptics of Moral Absolutes

divided into several schools of thought
the Sophist Protagoras taught that human judgment is subjective, and that one's perception is
valid only for oneself
the Sophist Gorgias went to the extreme of arguing that nothing exists; that if anything does
exist, human beings could not know it; and that if they did know it, they could not
communicate that knowledge
the Sophist Thrasymachus, believed that might makes right
Socrates (late 5th century BC and early 4th century BC)
opposed the Sophists
virtue is knowledge; people will be virtuous if they know what virtue is; and vice, or evil, is the
result of ignorance
education can make people moral

 in his Dialogues, he maintains that human virtue lies in the fitness of a person to
perform that person's proper function in the world
explained that the human soul has three elementsintellect, will, and emotion each of which possesses a specific virtue in the good person and performs a
specific role
the virtue of intellect is wisdom, or knowledge of the ends of life; that of the will is
courage, the capacity to act; and that of the emotions is temperance, or self-control
the ultimate virtue, justice, is the harmonious relation of all the others, each part of
the soul doing its appropriate task and keeping its proper place
maintained that the intellect should be sovereign, the will second, and the emotions
subject to intellect and will

 the just person, whose life is ordered in this way, is therefore the good person.
gave rise to four schools of thought build by his immediate disciples: the Cynics, the Cyrenaics, the
Megarians, and the Platonists
the Cynics, notably the philosopher Antisthenes, maintained that the essence of virtue, the only
good, is self-control and that it is capable of being taught
described pleasure as an evil, if accepted as a guide to conduct
considered all pride a vice, including pride in appearance or cleanliness

the Cyrenaics, notably Aristippus of Cyrene, were hedonists, postulating pleasure as the chief good
(as long as it does not dominate one's life), that no one kind of pleasure is superior to another, and
that it is measurable only in degree and duration
the Megarians, Euclid's followers, posited that although good may be called wisdom, God, or reason,
it is one, and that good is the final secret of the universe, which can be revealed only through
logical inquiry
the Platonist, believed that good is an essential element of reality; evil does not exist in itself but is,
rather, an imperfect reflection of the real, which is good

Aristotle (late 4th century BC)

Plato's pupil, regarded happiness as the aim of life
in his principal work on ethics, the Nicomachean Ethics, he defined
happiness as activity that accords with the specific nature of humanity
pleasure accompanies such activity but is not its chief aim
happiness results from the unique human attribute of reason,
functioning harmoniously with human faculties

 held that virtues are essentially good habits, and that to attain happiness a person must
develop two kinds of habits: those of mental activity, such as knowledge, which lead to
the highest human activity, contemplation; and those of practical action and emotion,
such as courage
moral virtues are habits of action that conform to the golden mean, the principle of
moderation, and they must be flexible because of differences among people and
conditioning factors
for example, the amount one should eat depends on one's size, age, and occupation
defines the mean as being between the two extremes of excess and insufficiency; thus,
generosity is the mean between prodigality and stinginess
the intellectual and the moral virtues are merely means toward the attainment of
happiness, which results from the full realization of human potential

History of Bioethics
Hippocrates (4th century BC)
Greek physician, associated with more than 70 works pertaining to
medicine; however, modern scholars are not certain how many of
these works can be attributed to Hippocrates himself, as some may
have been written by his followers
one work that is generally credited to Hippocrates contains one of the
first statements on medical ethics
in Epidemics I, in the midst of instructions on how to diagnose
various illnesses, he offers the following, As to diseases, make a
habit of two thingsto help and not to harm

 themostfamousethical workalthough the exact origin of the text is

unknownis the Hippocratic Oath
in eight paragraphs, those swearing the oath pledge to keep
[patients] from harm and injustice.
the oath also requires physicians to give their loyalty and support
to their fellow physicians, promise to apply dietetic measures for
the benefit of the sick, refuse to provide abortion or euthanasia,
and swear not to make improper sexual advances against any
members of the household
the oath still symbolizes a physicians duties and obligations.

In Asia
theideaofethicalconduct is common in many early texts, including those from Ancient India
and China
believed that medical knowledge was divine or magical in origin
counterpart of the Hippocratic Oath, the Caraka Samhita, a Sanskrit text written in India roughly
2,000 years ago, urges the following commandment to physicians
Day and night, however you may be engaged, you shall strive for the relief of the patient with
all your heart and soul. You shall not desert the patient even for the sake of your life or living
similar sentiments can be found in the Chinese text Nei Jing (The Yellow Emperor's Classic of
Inner Medicine), dating from the 2nd century BC
three centuries later, the work of the Chinese physician Sun Simiao emphasized compassion and
humility, a great physician should not pay attention to status, wealth, or age.... he should meet
everyone on equal ground....

InEuropeduringtheMiddle Ages
the ethical standards of physicians were put to the test by the bubonic
plague, the highly contagious Black Death that arrived around the
mid-1300s and remained a threat for centuries
when plague broke out, physicians had a choice: They could stay and
treat the sickrisking death in the processor flee
the bubonic plague and other epidemics provide an early example of
the challenges that still exist today when doctors must decide
whether they are willing to face personal risks when caring for their
patients

Bythe18thcentury,particularly in Britain
the emphasis in medical ethics centered on proper, honorable behavior
one of the best-known works from the period is Medical Ethics; or, a Code of Institutes and
Precepts, Adapted to the Professional Conduct of Physicians and Surgeons, published in 1803
by the British physician Thomas Percival
in his 72 precepts, Percival urged a level of care and attention such that doctors would
inspire the minds of their patients with gratitude, respect, and confidence
his ethics, however, also permitted withholding the truth from a patient if the truth might
be deeply injurious to himself, to his family, and to the public
at roughly the same time American physician Benjamin Rush, a signer of the Declaration of
Independence, was promoting American medical ethics
he spoke of the virtues of generosity, honesty, piety, and service to the poor.

Bytheearly19thcentury
it seemed that such virtues were in short supply, and the public generally held physicians in North
America in low esteem
complicating the problem was the existence of a variety of faith healers and other unconventional
practitioners who flourished in an almost entirely unregulated medical marketplace
in part to remedy this situation, physicians convened in 1847 to form a national association devoted
to the improvement of standards in medical education and practice
the American Medical Association (AMA), as the group called itself, issued its own code of
ethics, stating, A physician shall be dedicated to providing competent medical service with
compassion and respect for human dignity. A physician shall recognize a responsibility to
participate in activities contributing to an improved community.
the Canadian Medical Association (CMA), established in 1867, also developed a Code of Ethics
as a guide for physicians. Today the CMA code provides over 40 guidelines about physician
responsibilities to patients, society, and the medical profession.

Inrecentyears
the field of medical ethics has struggled to keep pace with the many complex issues raised
by new technologies for creating and sustaining life
artificial-respiration devices, kidney dialysis, and other machines can keep patients alive
who previously would have succumbed to their illnesses or injuries
advances in organ transplantation have brought new hope to those afflicted with diseased
organs
new techniques have enabled prospective parents to conquer infertility
progress in molecular biology and genetics has placed scientists in control of the most basic
biochemical processes of life
with the advent of these new technologies, codes of medical ethics have become
inadequate or obsolete as new questions and issues continue to confront medical ethicists.

Defining Health
A state of complete physical, mental, and social well-being and not merely
the absence of disease or infirmity (World Health Organization 1948).
Can be discussed in three levels
Individual
Animal Health
Human Health

Population
Population Health
Public Health

Ecosystem
Ecosystem Health

The One Health concept (One

Health Sweden)

Scope and Benefits of Studying

Health and Bioethics (Clowney
1992)
Identify different kinds of moral values and distinguish them from
other sorts of values.

Notice what moral values are at stake in a variety of situations.

Clarify the reason behind moral judgments and decisions.
Make some sense out of changing and conflicting moral values.
Decide where you will stand on difficult ethical choices you face.
Understand why being ethical matters.

Aims of Science Ethics Education

(modified from Kabasenche
2014)
Raise awareness of ethical issues to be considered.
Reflection and comparison from paradigm cases.
Avoid errors of ethical reasoning.
Differentiate descriptive form normative claims.
Sharpen ethical argumentation skills.
Develop consistency of position in biomedical issues.
Importance of character traits such as integrity, persistence, and intellectual
humility.
Conception that moral disagreement does not equate to irrationality of
opposite party.

References
Kabasenche WP. 2014. (The Ethics of) Teaching Science and Ethics: A
Collaborative Proposal. JOURNAL OF MICROBIOLOGY & BIOLOGY
EDUCATION, December 2014, p. 135-138
Lerner H, Berg C. 2015. The concept of health in One Health and some
practical implications for research and education: what is One Health?
Infect Ecol Epidemiol. 2015; 5: 10.3402/iee.v5.25300.