Dr Hidayathulla Shaikh Lecturer, College Of Dentistry, Majmaah University.

objectives At the end of lecture students should be able to To discuss ancient ethical codes To discuss Hippocratic oath.

The system of medical ethics has a long tradition that can be traced back to ancient times. Each and every empire / Dynasty had their own ethical principles concerned with the field of medicine.

Egyptian Medicine Ehtical rules dates back to 2700 BCE, Rigid rules were laid down as to experimental treatment. There was no culpability in failure to cure as long as the standards text book were followed. Severe penalties were, however, threatened for those who ignore the instructions,

Babylonian Medicine The code of Hammurabi (1900 BCE) was followed and it is the first known legal code. It contained an element of medical ethics. A system of payment based on results and the ability to pay on the status of the patient. There were penalties for negligent failure, some of which were draconian (harsh & severe) to an extent. If the physician succeeds, he gets paid. If he fails, at worst he loses his hands.

Indian Medicine The oath of the Hindu physician, also known as the vaidya's oath, was an oath taken by Hindu physicians. It is dated from the 15th century BCE the vaidya's oath entreats physicians not to harm their patients and be solely devoted to their care, even if this put their lives in danger. 1) You must put behind your desire, anger, greed, folly, pride, egotism, jealousy, harshness, falsehood, sloth and improper conduct. You should be with short-cut nails, ritually clean and clad in the orange garment, you must be pledged to truth, and full of reverence. 2) If, however, you behave perfectly, while I profess false views, I shall be guilty of sin and my knowledge shall bear me no fruit.

3) (after having finished your studies) with your medicaments you shall assist Brahmins, venerable persons, poor people, women, ascetics, pious people seeking your assistance, widows and orphans and any one you meet on your errands, as if they were your own relatives. This will be right conduct.

Greek Medicine A code of intra professional conduct evolved, the dawn of what has become known as medical etiquette. The famous Hippocratic oath (4 th BCE) is even followed today and he is also considered the father of medicine.

Hippocratic oath I swear by Apollo the physician and Aesculapius, and Hygeia, and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation-- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; To look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee.

I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

Judo – Christian influence The Oath of Asaph, also known as the Oath of Asaph and Yohanan, is a code of conduct for Hebrew physicians. It may have been written in the 6th century CE, which would make its presumed author, Asaph Judaeus, the oldest known Hebrew medical writer. It resembles the Hippocratic Oath

Arab Medicine Practice and Saying (Traditions) of Prophet Muhammad (PBUH) on hygiene, sanitation and treatment of diseases by medicine are called Tibb-al-Nabvi (Medicine of the Prophet or Prophetic Medicine) by Muslims all over the world. Many Traditions (Arabic, Ahadith ) on specific ailments and their remedies have been grouped together under the Chapter called Kitab-al-Tibb (Book of Medicine) of well- known collections of Ahadith by Bukhari, Muslim, Abu Dawud, Tirmidhi etc.

All these Traditions, which number about four hundred, constitute the Prophetic Medicine, and can be found together in classic books of Ibn al-Qayyim Aljouzi (8th century Hegira) Abu Nu’aim (5th century Hegira). Abu Abd-Allah al-Dhahbi (8th century Hegira), Abu Bakar Ibn al-Sani (4th century Hegira). Most of these original Arabic treatises have been recently translated in English and other languages. Prophet Muhammad (pbuh) laid foundation of social order in which every Muslim, for that matter every human being, was advised to maintain healthy life physically, psychologically and spiritually. Indifferences to any aspects of life was discouraged by the Prophet.

The Islamic Authorities placed a lot of value in medicine. Baghdad had a hospital by AD 850 and doctors had to pass medical examinations by AD 931 in order to practice. Hospitals were later developed throughout the Islamic world, with the most famous being those in Damascus and Cairo.

Oath of Maimonides 12 th cy. CE Ming Dynasty (China) 14 th cy. CE Seventeen Rules of Enjun (Japanese Buddhist Physicians) 16 th cy. CE) The rules are similar to the Hippocratic Oath.

Beaumont's Code (United States) 1833: experimental treatments when all else fails. Get voluntary, informed consent. Stop experiment at subject’s request. American Medical Association (AMA) Code of Medical Ethics 1847 Walter Reed (United States) 1898: Introduces written consent “contracts”. Allows healthy human subjects in medical experiments. Berlin Code, or Prussian Code (Germany) 1900: No medical experiments when subject not competent to give informed consent, in the absence of unambiguous consent, or when information not properly explained to subject. Reich Circular (Germany) 1932 Concerned with consent and well-being of the subjects.

To be continued…..