Blog2. Hippocratic Oath . . . . . First, Do No Harm!

The Hippocratic Oath is an oath taken by physicians and healthcare professionals; it is the guiding ethical code which they must conform to. Although it does not contain these specific words, the oath’s basic principle is to ‘First, Do no Harm’. That is, any practice undertaken on any human being should not cause any harm as a consequence. Psychology professionals are not required to take this oath; however Psychological practices are regulated by a code of ethics such as the Nuremburg code, which is the blueprint for today’s principles that ensure the rights of subjects in research are protected. The code merges Hippocratic ethics and the protection of human rights into one code, so that there is a clear guideline for participant protection in research. Minimizing harm to patients and research participants has been the primary goal of governmentally imposed restrictions and ethics codes, however there is little consensus on how this can always be achieved.

Problems arise with the Hippocratic Oath’s maxim of ‘First, Do no harm’, when we look at experimental processes. For many years, there has been a dilemma concerning Terminally Ill patients and drug trials. A terminally ill patient has the right to refuse treatment, but does not have the same right to demand access to investigational therapies. This issue has spurred debate from both sides of the issue; some believe that experimental drugs should be made readily available, and some argue for restrictions. The quandary here is if a patient chooses to take part in experimental trials, is it classed as harm if the trials do not work?

Advocates who believe that drugs should be available, argue that patients should have the right to experimental treatment, as it is their last hope. Terminally ill patients are often willing to try unproven treatments when standard therapies are either unavailable or have failed to work. These trials could not only improve their chances of survival, but could also aid the survival of other patients with the same illnesses. If the patient is willing, then there is no harm! Excluding them from the opportunity to take part could be seen as causing harm! They are dying anyway so why shouldn’t they be allowed access to these drugs? So, some people believe that not allowing them the chance to take part in experimental trials is contradicting the Hippocratic Oath. This view is however only one side to the argument.

Those who appose drug trials in terminally ill patients, note that only a small portion of drugs tested in clinical trials are eventually marketed, the drugs that do manage to receive approval, are of benefit to only a fraction of patients. Experimental drugs are not therapies, they are a part of research, and most of them are ineffective. Terminally ill patients are the most vulnerable population, and the only reason patients demand access to these drugs is because they think they are therapy, which they are not. How people die is as important as when they die, and these drugs may end up causing far more harm than benefit. In some cases they could reduce their, already, short life expectancy, which is then causing harm.

So which side of the argument is right? Experimental drugs should be used in the research environment, but patients need to be aware that trials and experiments are not performed for their benefit, but are done to increase knowledge. It is difficult to define ‘terminally ill’ in terms of who might be eligible to receive experimental drugs i.e. should they be given to people who have 2 weeks to live, 6 months, a year, or someone who has a chronic illness that can progress over years. It may also be difficult to draw the line at terminally ill. What about patients who are losing mobility, or eyesight? They may be going through challenges that are just as severe, and may also want access to these experimental drugs.
So, if terminally ill patients choose to partake in the use of experimental drugs, should we refuse them? Is the Hippocratic Oath justified in this case? There are two sides to the argument, so it is impossible to make a precise decision about this. It is unlikely that there will ever be a perfect balance that leaves everyone satisfied. The key is to carefully consider the balance between individual and societal benefit and to find a way that each link together. So when looking at ethics in general it is important to remember that they are not always as clear cut as they seem.



4 Responses to “Blog2. Hippocratic Oath . . . . . First, Do No Harm!”

  1. February 19, 2012 at 11:36 pm

    This is a very murky topic. It is so difficult to decide if these kind of medicines should be tested on humans and terminally ill humans at that. And I think this is where I have my major problem because recently I found out terminally ill doesn’t just mean terminally ill. There are two kinds of terminally ill patients. when applying for medical benefits they categorize terminally ill patients ( I am pretty sure it is terminally ill 1 and terminally ill 2). Terminally ill 1 is those who are going to die from their diagnosed disease in a short time (e.g. weeks/months) or terminally ill 2 who are those who could live from years but will eventually die from their diagnosed disease. This 2nd one is what bugs me because does that mean we are all considered terminally ill? we are all going to die some day and I could die before a terminally ill person and does that mean whoever has a disability or something as simple as asthma are classed as terminally ill because they could just as easily die from their condition. It isn’t unheard of people dying from an asthma attack so does that mean asthmatics should be testing these medicines because they want to help the medical society and could die any day. And is it ethically OK for scientists to test these medicines on terminally ill patients (especially those who are categorized as terminally ill 2) because they could live for years but the medicine could make them worse and lead them to a premature death. Like I said this is a very difficult topic and I don’t see how society will ever reach an answer that everyone will agree with and say is ethical.
    http://www.portlandpress.com/pp/books/online/mbwdnotes/0301.pdf <<<< this link highlights the processes taken into medical research and explains how risky it can be when testing new medicines especially on children, the elderly and pregnant women.

  2. February 21, 2012 at 8:50 pm

    We are all terminally ill; we are all ticking away, dying ever so slowly. Like it kennedy92. However, with regard to the argument of experimental drugs, it is clear that there will be conflict of interest between the companies who want to make money from a drug and the individuals suffering or prescribing for suffering wanting the drug to be significantly effective. Experimental drugs are not treatment; they are potential candidates for treatment. It seems reasonable to assume that after advice from an independent body case by case, individuals seeking more than the current treatments for whatever reason, would be able to get sound information on what they are entering into. It should not be unethical to run these drug trials, but the do no harm principle is vital to continue research in this manner.

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