Why Medical Ethics?

The recent proliferation in our medical schools and universities of “departments of medical ethics,” was a sure sign that the medical establishment had decided to redefine and mould medical ethics after its own ideas; and to move away from many centuries of ethics that had always spoken to physicians and nurses with a clear, universal and humane voice.

Every age regards itself as inheritor of a unique set of moral and ethical problems not confronting a previous age! The need for ethics however, is an implicit recognition that there is evil and wickedness present in human affairs (or a “wrong” way of doing things) and that we must choose the righteous and the good over the evil. The manifestation of evil (or the unethical) may have changed, but the heart of the problem does indeed reside in the human being, where evil originates. As the prophet Jeremiah pointed out more than 2,000 years ago, “the heart is desperately wicked above all things; who can know it?”

In medicine for example, the present era might regard the ethical issues surrounding euthanasia as being unique to modern medicine. This is certainly not true and the questions of human suffering, man’s mortality and whether to alter the timing of life’s demise, has consumed physicians and philosophers for millennia.  As a surgeon, I might even argue that in the mid 1800s, the absence of anesthesia for major surgery was an enormous and unique ethical challenge which we do not face today!

What has changed progressively in the last 100 years however, is the loss of an anchor to the soul of medical ethics. Adrift and battered on the stormy sea of human frailty, the ship of medical ethics seeks shelter in “departments” of medical ethics and bioethics in our medical schools, but these hostile harbours are soon consumed by the storm themselves or else do no more than turn the ship around and send it back into an even stormier sea.

The moral and ethical consensus and anchor of societies depended on a relationship to a higher Power, a higher wisdom and a higher understanding than their own. Thus it was to ancient Israel, to the Christian nations, to Islam, to Hinduism and to every major religion and nation. The skeptic and the atheist may not have believed in God, but usually did believe in the moral/ethical code that defined the societies he or she lived in. 

The twentieth century and the age of materialism has filled our material lives with abundance but has deprived us of the abundant life. No longer moored and anchored to the higher Power and Source of our moral and ethical codes, an obsession with our mortal lives has evicted eternal values and replaced them with the postmodern idea of defining our own “truths.” This in turn, has given rise to the proliferation of ethics and bioethics departments in our universities - although it should stand to ordinary reason that goodness and learning bear no relationship to each other!

The original Hippocratic Oath begins, "I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.” The revised Hippocratic Oath leaves out the Greek Gods, but still retains, “above all, I must not play God.”

The great Jewish physician and philosopher Moses Maimonides (1135-1204) was also regarded as a Rabbi and his physician’s oath is in fact called a physician’s prayer. It begins, “The eternal Providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.”

During the golden age of Islamic medicine and science, Europe was considered to be in a “dark age.” One of the brilliant Arab physicians of that era, Ishaq bin Ali Al-Ruhawi  lived in the ninth century and wrote his own book and code of medical ethics. His book of “Practical Ethics of the Physician (Adab al-ṭabīb)” begins: “The first thing in which a physician must believe is that every created being has a sole Creator who is Omnipotent, Wise and can perform all deeds wilfully. The second article of the physician’s faith is to have true love for Allah the Sublime and to be devoted to Him with all his reason, soul, and free will. The third article of faith which a physician must possess is that Allah sent His messengers to mankind in order to teach them what is good and beneficial since the intellect alone is not sufficient.”

The central medical ethic of “above all, do no harm” (primum non nocere) is commonly attributed to Hippocrates, but in fact belongs to the work of the intrepid English physician Thomas Sydenham(1624-1689), who laid the foundations of modern, clinical medicine and is considered the “father of English medicine.” His advice to medical students and his textbook of medicine were regarded as England’s own version of the Hippocratic corpus (hence Sydenham’s other title as the “English Hippocrates”). Sydenham’s advice to medical students begins: “Whoever applies himself to medicine should seriously weigh the following considerations:

First, that he will one day have to render an account to the supreme Judge of the lives of sick persons committed to his care.

Next, whatever skill or knowledge he may, by divine favour, become possessed of, should be devoted above all things to the glory of God and the welfare of the human race.

Thirdly, he must remember that it is no mean or ignoble creature that he deals with. We may ascertain the worth of the human race since for its sake God’s only begotten Son became man and thereby ennobled the nature that he took upon him.”

Since the latter half of the twentieth century, the rise of the postmodern idea of a university with its own, constantly changing version of truth, also coincided with two related developments in medical ethics. The first, was the rapidly accelerating trend of medical schools to abandon completely the Hippocratic oath at commencement or in their graduating and “white coat” ceremonies, so that by 2015, only 43% of American medical schools required its medical students to take the Hippocratic oath. Consistent with the postmodern university of the twenty first century, medical students are also encouraged to write their own oaths for the graduating ceremony!

The other, closely related development since the 1970s was the proliferation of “medical ethicists” and “bio-ethicists” together with departments of medical ethics in our medical universities. These ethicists and their departments of medical ethics do not commonly claim any guidance from God, a higher Power or the major, world religions or historical medical ethics codes. Nor do they necessarily subscribe to transcendent truth which outlasts and outlives any particular era or period in history. Indeed, the defining characteristic of the present dispensation is claimed to be “bioethics without God.”

The postmodern idea of making mankind itself the maker of its own “truth” does not bode well for human beings, human rights and the future of Western civilization.   

The other great convulsions of the twentieth century were also preceded or accompanied by an abandoning of the historical anchors of society that moored peoples and nations to commonly held values derived from centuries of spiritual progress. 

In communist Russia and the resulting Soviet Union, an aggressive and violent form of atheism was a foundational pillar of communism. Medical ethics were also modified or ignored, in the service of the communist cause and ideal. The disturbing conditions of the Soviet concentration camps (gulags) were described in Nobel prize winning writer Alexander Solzhenitsyn’s “The Gulag Archipelago” and by survivors of the gulag system. Physicians of the gulag prison system regularly ignored and undermined serious patient symptoms and complaints and were enablers of torture and execution in the gulag. 

Solzhenitsyn describes the gulag prison doctor: “The prison doctor was the interrogator's and executioner's right-hand man. The beaten prisoner would come to on the floor only to hear the doctor's voice: "You can continue, the pulse is normal." After a prisoner's five days and nights in a punishment cell the doctor inspects the frozen, naked body and says: "You can continue." If a prisoner is beaten to death, he signs the death certificate: "Cirrhosis of the liver" or "Coronary occlusion." He gets an urgent call to a dying prisoner in a cell and he takes his time. And whoever behaves differently is not kept on in the prison.”

The “Third Reich” of Nazi Germany hated both Christianity and Judaism, but in addition, it constructed for itself a new and novel system of belief based on racial superiority, nordic paganism, occultism and eugenics. After the collapse of Nazi Germany, the Nuremberg doctors’ trial exposed to the world the open complicity of physicians with experimentation without consent, torture and execution.

Several years prior to concerns being expressed about the violation of medical ethics by physicians during the covid-19 pandemic, physicians educated by our postmodern universities had already produced another egregious violation of medical ethics in the aftermath of the 9/11 terrorist attacks. As described in multiple reports, including senate investigations, physicians were complicit and willing collaborators in the CIA torture programs and in experimentation without consent.

With postmodernism’s vice-like grip upon our universities now established and entrenched, a progressive slide to totalitarianism with its accompanying loss of medical ethics seems inevitable. That slide may already have started and only a determined pushback by the people can prevent society’s descent into the abyss. 

Any “modernized” version of the Hippocratic oath must still be based on the original Hippocratic oath, the oath of Maimonides, Ali Al-Ruhawi’s guide to medical ethics and the work of Thomas Sydenham and others who have recognized our allegiance and dependance on a higher Power and Wisdom than our own.

The quintessential and celebrated, ancient foundation of medical ethics otherwise called the “Golden Rule,” is found not in the “Communist Manifesto” or Chairman Mao’s “Little Red Book,” but in the scriptures of the world’s major religions. It informs and adorns all the classic medical oaths. “Do unto others as you would have others to do unto you.”