Marta Lucia Perez

Beneficence, Justice, and Lifelong Learning Expressed in Medical Oaths.

Introduction: The principles of justice, beneficence, and nonmaleficence are prescriptions of the Hippocratic Oath. To fulfill them, physicians are obligated morally to lifelong learning; yet, there is little evidence that the relationship of beneficence to lifelong learning or to continuing medical education (CME) is expressed in medical oaths. Methods: We analyzed 48 medical oaths written from the first century Ce through the present day, searching for a commitment to lifelong learning and for specification of a relationship to the principle of beneficence. Thirteen ancient and medieval and 35 modern and contemporary oaths were inventoried for source, such as corresponding to a medical school. They were sorted by those that mention the commitment toward lifelong learning and to determine their relationship with the principle of beneficence. Results: Of the 48 medical oaths analyzed, only 20 manifest the commitment to lifelong learning. However, most of the oaths that contain this commitment do not pertain to medical schools, with the exception of the Declaration of Geneva. Of this group, 16 also indicate the principle of beneficence. Of these 16, only 3 establish a link between both. One medical oath indicated this commitment, and none of them analyzed the relation with the principle of beneficence. Discussion: The commitment toward CME should not be absent in the present medical oaths. It is a duty and right of all physicians, and in turn, society should recognize this obligation in order to offer opportunities for the achievement of the principle of beneficence that will result in better health care.

Compromiso de retribución justa en los juramentos médicos

BACKGROUND: to determine if Medical Oaths from different times include the statement of the physician to request from patients a fair retribution for his/her medical services. METHODS: Fifty Medical Oaths found in articles and publications were analyzed. In accordance with their corresponding dates, the Oaths were grouped as ancient /medieval (12), and modern/contemporary (38). RESULTS: Of the fifty, only three specifically included the statement of fair retribution. Two of the three were medieval and belonged to the School of Medicine of Montpellier. The other text was modern (Amato Lusitanos Oath). Four writings showed statements regarding medical assistance to the poor. Eleven pledges indirectly stated that no earnings from other activities and/or relations were obtained. CONCLUSIONS: Ancient oaths emphasize fair retribution, no discrimination in medical assistance based on payment possibilities, and gain of honest earnings. Modern oaths generally do not include these topics and very few mention that the medical profession should not be exercised merely for material purposes. Despite the above, physicians should respect the limits of their obligations and should be committed to assist without discriminating, particularly without taking into consideration their patients financial possibilities. Therefore their fees should not be excessive for the services rendered.

Discriminación en la atención médica: Una mirada a través de los juramentos médicos

Background: All humans have the right to receive a thorough medical attention, and should not be discriminated. Aims: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. Materials and Methods: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. Results: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. Conclusions: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care (Rev Med Chile 2003; 131: 799-807)

References to Bioethics in Argentina

The present survey of Argentinean bioethics institutions is not exhaustive but illustrates its present development in the country. Thus, it mentions the main academic institutions (study, research, and teaching centers), assistance or welfare institutions (ethics committees, commissions, and boards), and public policy institutions (legislation and jurisprudence). It also mentions a few national publications on bioethics and web sites maintained by institutions and organizations.