Statement of the Problem
Disease has been one of humanity’s greatest enemies. Medicine simpliciter is the science and art of diagnosing, treating, and preventing disease and injury. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings.1 Our understanding of prehistoric medical practice is from the study of ancient pictograms that show medical practice procedures, as well as the surgical tools uncovered from anthropological sites of ancient societies. Several systems of medicine, based primarily on magic folk remedies and elementary surgery existed in diverse societies before the coming to the more advanced Greek medicine about the 6th Century BC.2 Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease typically through medication or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, prostheses, biologics, ionizing radiation and others.3 The goal of medicine is to help people live longer, happier and more active lives with less suffering and disability.
Since the beginnings of the Bioethics movement, a plurality of ethical theories have been used as a foundation for medical ethics. One approach just beginning to be examined is the grounding of medical ethics in a philosophy of the physician-patient encounter.4 On this view the phenomena of being ill, being healed and promising to heal are taken as the staring points for ethical reflection. An ethics based in the clinical encounter promises to be more closely related to the concrete experiences of doctor and patient than the application of pre-existing ethical theories.5
Ethics is the application of values and moral rules to human activities. Health care providers are expected to not only have the skills and knowledge relevant to their field but also with the ethical and legal expectations that arise out of the standard practices.6 Ethics is a branch of philosophy; it is not a set of visceral sensations arising somewhere in the solar plexus and suffusing the frontal lobes with “good” or “bad” feelings.7 Ethics is a formal, rational, systematic examination of the rightness and wrongness of human actions. It comes into existence only when a moral system becomes problematic and is challenged. Ethics was born when Socrates began to raise those perplexing questions which so vexed his contemporaries that they offered him the cup of hemlock.8 He passed onto the next world as a consequence with his irritating questions still unanswered. It is when the claims of morality put forward in any given time are made problematic subjects for critical inquiry that ethics begins. And if you examine the history of medical morality, you will find that most of it is the history of moral statements without very much in the way of formal philosophical justification.
Medical ethics has been founded on the framework of four moral principles of autonomy, beneficence, nonmaleficence, and justice.9 The first of these principles, autonomy, is the respect for the patient’s right to self-governance, choice in care, and the right to accept or refuse treatment. Beneficence is the obligation to prevent or remove harm while also promoting good by contributing to the welfare and acting in the best interest of the patient. Nonmaleficence implies the obligation of physicians not to inflict harm or adverse effects on the patient from inappropriate or absent care (This principle involves consideration of risks versus benefits from particular procedures). The last ethical principle, justice means distributing benefits, risks, and costs fairly, equitably, and appropriately, and treating patients with similar cases in a similar manner.10, 11
Why is that of concern? For one thing, the 2,500-year-old image which emerges from the Hippocratic corpus and which still has wide uncritical acceptance today, is the very image being most seriously questioned in our democratic, pluralistic society in which more and more people are being educated about matters of bodily and mental health. That image is of the physician as a benign, benevolent, all-knowing authoritarian figure who decides what is best for his patients. That conception served humanity well in a time that was simpler and when medical decisions did not involve, as they do increasingly today, a host of new questions of values and morality it more easily fulfilled expectations in a society in which there were very few educated people who would say, “Just a moment—I would like to understand what is happening! I want to have a say in what you are going to do.”
Today the traditional image is being fractured. It is being challenged and drastically revised in some of the more recently proposed professional codes. That great canon of medical morality, the Hippocratic Oath is being honored more in the breach than in the observance. Each one of its prescriptions has been questioned by some physicians and violated by others. Thus, it is almost impossible today to define a common set of medical moral principles to which all physicians subscribe. A further point is that we have competing interpretations of the physician–patient interaction to contend with. The first, as I have said, was a paternalistic one, the Hippocratic notion of the benign, all-knowing physician. The second is based on the philosophy of John Locke: the idea of two autonomous individuals entering a contract for service. Then a third model is the commercial one being eagerly propounded by some of my colleagues today. In this model, medical knowledge is held to be a proprietary possession of the physician. He makes it available, as the baker would make bread available, when he pleases, in what manner he pleases, for those who can purchase it if they please. If they don’t like the bread they can go on to another baker.
Another viewpoint is that there is no real difference between the medical transaction and the transaction between you and your auto mechanic, discussing the health of your automobile—whether he should or should not operate on the carburetor. This analogy may seem fanciful, but it is seriously and boldly argued. Other models—the hieratic, holistic, psychosociobiologic, and biological models— all have an effect upon some facet or facets of the physician–patient relationship. Each, when applied logically and completely, results in a different kind of ethics and practice and a different educational schema.
It seems self-evidently important whether you think the physician–patient relationship is a contractual relationship between two autonomous individuals, whether you think one individual has proprietary right over the knowledge he has and can purvey it for a price on his own terms, or whether you prefer some other model. A philosophical understanding of that relationship therefore becomes the first step in any reconstruction of medical morality. The obligations of physician as physician, the first step in medical morality, must depend on what we think of the healing relationship.
Statement of Purpose
The purpose of this essay is to appraise medical ethics in Nigeria.
The thesis of the essay is to ground medical ethics in the concrete realities of being ill and being healed.
This method to be adopted in this essay will be conceptual clarification, analytical and historical.
Scope and Limitation
This research shall cover the ethical dimension of medical and dental practitioners’ council of Nigeria
Sources of Material
The materials to be used for the essay shall be gotten from journal, articles, historical records, textbooks, conference proceeding, newspapers and magazines as well as materials sourced from internet. Olabisi Onabanjo University Library and E-library will also be visited for materials.
Chapter One: Conceptualizing Ethics and Medical Ethics
Chapter Two: Code of Medical Ethics in Nigeria
Chapter Three: Appraisal of Medical Ethics in Nigeria.
Summary and Conclusion