MED 431 · Medical Ethics

Introduction to the course

Who decides? — and the history of medical ethics

47 slides·Lecture 1·English·1448 · 2026
Download the slides (PDF) Read Chapter 1 →
Lecture 01

Introduction to the Course

Who decides?. Medical Ethics · MED 431 · Lecture 1
1. Who decides?
Three decisions you will have to make. A woman with metastatic cancer asks you what her scan showed. Her son has begged you to say nothing.
2. Three decisions you will have to make
Slide reading: None of these is a gap in medical knowledge.
3. None of these is a gap in medical knowledge.
So what are they?. Situations where two or more legitimate values conflict, and no algorithm settles the answer
4. So what are they?
What this course will not give you. A formula that produces the correct answer to every ethical question
5. What this course will not give you
First tool.
6. First tool
Not every difficult situation is one. Some difficulties are clinical — what is the diagnosis?
7. Not every difficult situation is one
Apply it to the three cases. Take each one and test it against the four conditions
8. Apply it to the three cases
A second distinction: ethics is not law. Law sets a floor of minimally acceptable behaviour, enforced by sanction
9. A second distinction: ethics is not law
Six moments.
10. Six moments
A timeline of the six moments: Hammurabi, the Hippocratic Oath, al-Rahawi, Schloendorff 1914, the century of abuses, and the four principles of 1979.
11. Six moments, at a glance
1 · Babylon, c. 1754 BCE — the healer becomes accountable. The Code of Hammurabi sets fees for surgery — and penalties for the physician whose patient dies or is harmed
12. 1 · Babylon, c. 1754 BCE — the healer becomes accountable
2 · Cos, c. 420 BCE — the profession binds itself. Act in the patient’s best interest
13. 2 · Cos, c. 420 BCE — the profession binds itself
3 · Baghdad, 9th century — conduct becomes a discipline. Ishaq ibn Ali al-Rahawi, Adab al-Tabib — The Conduct of the Physician
14. 3 · Baghdad, 9th century — conduct becomes a discipline
Medicine before the patient had a say. For most of its history medicine was practised on patients rather than with them. The doctor decided, and frequently did not tell.
15. Medicine before the patient had a say
4 · New York, 1914 — the patient acquires a right. Mary Schloendorff consented to an examination under anaesthesia, and expressly refused any operation
16. 4 · New York, 1914 — the patient acquires a right
Slide reading: “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.” — Justice Benjamin Cardozo, 1914
17. “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.” — Justice Benjamin Cardozo, 1914
What changed in 1914. Autonomy stops being a courtesy the doctor may extend, and becomes a right the patient holds
18. What changed in 1914
5 · The century of abuses.
19. 5 · The century of abuses
Nazi human experimentation — 1939 to 1945. Hypothermia, high-altitude depressurisation, forced infection, transplantation and surgery — performed on prisoners
20. Nazi human experimentation — 1939 to 1945
Tuskegee, Alabama — 1932 to 1972. 399 Black men with syphilis, enrolled without being told what they had
21. Tuskegee, Alabama — 1932 to 1972
Guatemala — 1946 to 1948. United States Public Health Service researchers deliberately infected prisoners, soldiers and psychiatric patients with syphilis and gonorrhoea
22. Guatemala — 1946 to 1948
Willowbrook — 1956 to 1970. Children with intellectual disability at a New York state school were deliberately infected with hepatitis
23. Willowbrook — 1956 to 1970
Baltimore, 1951 — Henrietta Lacks. Her tumour cells were taken during treatment, shared, and grown worldwide as the HeLa line. She never consented, and her family was not told for twenty-five years.
24. Baltimore, 1951 — Henrietta Lacks
Two things these have in common. The subjects were people with the least power to refuse
25. Two things these have in common
The answer: Nuremberg, 1947. For the first time in international law, voluntary informed consent becomes an absolute requirement for human experimentation.
26. The answer: Nuremberg, 1947
And then the instruments that followed. Declaration of Helsinki, 1964 — the duties of the physician-researcher, revised repeatedly since
27. And then the instruments that followed
6 · 1979 — medicine acquires a common language. Beauchamp and Childress, Principles of Biomedical Ethics
28. 6 · 1979 — medicine acquires a common language
The tools those six moments produced.
29. The tools those six moments produced
The four principles. Autonomy — the right of a competent person to decide about their own body, free from coercion
30. The four principles
Where they collide. Autonomy against beneficence — the competent patient refuses what would save her
31. Where they collide
Three ways of arguing — and one more. Deontology (Kant) — some acts are right or wrong in themselves, whatever follows. “She had a right to know.”
32. Three ways of arguing — and one more
Islamic ethical theory. Theocentric — obligations derive from the Quran and Sunnah, interpreted through usul al-fiqh
33. Islamic ethical theory
Slide reading: Paternalism gave way to autonomy. Has the pendulum swung too far?
34. Paternalism gave way to autonomy. Has the pendulum swung too far?
Now work one.
35. Now work one
The case. A 62-year-old woman is admitted with jaundice. Imaging and biopsy show metastatic pancreatic cancer.
36. The case
Work it in this order. Is it a dilemma? Two defensible options, each violating something?
37. Work it in this order
How this course works.
38. How this course works
Two tracks, both examined. Medical ethics — in English, with me and guest lecturers from the College of Medicine, in person
39. Two tracks, both examined
Assessment. Electronic assignments on Blackboard — 20%
40. Assessment
What we will cover. Professionalism — as a student, then as a doctor
41. What we will cover
Your book — online, free, and the source for these slides. Applied Medical Ethics — the full edition, 18 chapters
42. Your book — online, free, and the source for these slides
Recommended textbooks. All are supplied to you as soft copies.
43. Recommended textbooks
Before every lecture — not only the next one. Every lecture in this course has a chapter behind it
44. Before every lecture — not only the next one
Which chapter goes with which week. Week 3 · Rules and regulation in study and training — Ch. 2 and Ch. 17
45. Which chapter goes with which week
And one more thing. Write to me by email, and write it properly
46. And one more thing
Slide reading: Who decides?
47. Who decides?
Next

Before every lecture

Every lecture in this course has a chapter behind it. Read the chapter before the lecture, then do the case vignettes at the end of it, and bring your answers. This lecture was Chapter 1 — What Is Medical Ethics?

The question bank has 113 scenarios with the answers explained, and the Trainee Edition is the shorter version written for the wards.