Development of Ethical Codes

The first ethical code dates back to the time of the Greek physician Hippocrates, and the influence of the Hippocratic traditions and writers of his time is still reflected today in modern versions of ethical codes. Traditional medical codes of ethics emphasize the physician’s (1) duties in the individual patient-physician relationship, including the obligation of confidentiality; (2) authority and duty of beneficence (i.e., acting for the patient’s good); and (3) obligations to each other.³ In return for the power and prestige granted to the professions, a code of ethics is the promise to society to uphold certain values and standards in the practice of the profession. They typically are powerful ethical statements, but they are not legal mandates. However, codes cannot easily be dismissed if there is a formal structure for self-regulation. Because state boards typically have the authority to suspend or terminate a professional’s right to practice, the fact that more attention is being given to ethical behavior strengthens the relation between ethical codes and enforcement. Codes can also be recognized in a court of law under a provision called judicial notice. This term acknowledges that while a code is not a legal mandate, the court can apply as doctrine of evidence the existence of a particular fact commonly known by persons of average intelligence. In other words, common knowledge can be considered in a legal court case.

Ideally, codes should create a relationship among members of a profession that are similar to the ties in a family, obviating the need for enforcement outside the group. Professionals’ obligations to each other, to patients, and to society should be similar to the strong obligations and emotional feelings that attend belonging to a family, with the behavior of members being monitored by the membership.

The elements of most codes sound very moral in tone, and this is a legacy from the previous centuries. Early codes were rooted in etiquette more than ethics and were concerned that practitioners be gentlemen of a high-toned moral character. Oaths were taken in very solemn circumstances and warned against “giving poisons” and never to do the sick persons “harm or injustice.” During the Renaissance, writers extolled the physicians to adhere to the intent of the oaths bringing benefit to the sick and avoiding harm, influenced greatly by the religious scholars of the day and what was referred to as divine guidance. In one text of the time, a listing of the sins of physicians addressed what was obviously in violation of expectations of these individuals ranging of abandoning the sick to treating patients while drunk.⁵ The health care professionals of today can see the principle roots of our current codes in the ills of this era.

Even hundreds of years ago, people understood that there is power and the potential for exploitation when educated professionals are trusted with the health, legal rights or the safety of the country. The clinician of today must have a strong grasp of the ethical responsibilities as individuals who are trusted with the health of others. Health care professionals have a special responsibility to the patients they treat because of their knowledge and the resultant dependency of the patient on that knowledge and subsequent actions.

A code of ethics also is a set of commandments and, as such, has two principle functions.

• First, it provides an enforceable standard of minimally decent conduct for those who fall below that standard.

• Second, it indicates in general terms some of the ethical considerations a professional must consider when deciding on conduct.

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A code of ethics can and does serve as a tool in the function of self-regulation, an important part of professionalism.

The use of professional codes in health care has some limitations. Not every situation can be addressed in an ethical code or fully explained in an accompanying interpretation. Some philosophers have noted that most codes stress the obligations of health care professionals rather than describe the rights of those receiving health care services.⁶ The current use of a patient’s bill of rights in health care settings is an attempt to address this discrepancy.