Maqbool H. Jafarey  ( Bahria Complex No.1, Queens Road, Karachi. )

Ethics is a branch of philosophy which relates to the moral issues and morality in general. Medical ethics is specifically concerned with moral principles in relation to patient care, clinical, investigational as well as experimental. One of the earliest known codes of behaviour for medical practitioners is the Hippocratic oath, probably written around 500 B.C. It covers a variety of principles as to how to conduct the medical practice given the ability orjudgement for the benefit of the patients, lays down how the science of medicine is to be passed on and to whom, how not to give a harmful medicine or induce an abortion, how to pass on the treatment to those qualified in the art of surgery, how not to divulge the secrets of the patients and how to conduct oneself by giving due respect to the teachers. Over the centuries, however, with the growth in medi­cine in many dimensions, Hippocratic oath became inade­quate and more recently an opinion has been voiced that Hippocratic oath has become an anachronism¹. International code of Ethics was adapted by the General Assembly at the World Medical Association (WMA) at Geneva in 1948. This was further amended by World Medical Assembly in 1968 and subsequently in 1983. In 1975, WMA adapted guidelines for doctors concerning torture or other inhuman or degrading methods of treatment or punishment. This is known as Declaration of Tokyo, recognising the importance of huinair rights, hitherto acknowledged but not clearly spelt out. The common thread that runs through all the codes of ethics is based on 4 cardinal principles i.e., autonomy, beneficence, non- male ficence and justice. These principles are also strongly embedded in the teachings of Islam. The heavenly books namely the Quran, the Bible and the Talmud all are moral doctrines by the Almighty to the mankind. Most of the other moral codes are derived or greatly influenced by these divine books. The Holy Qurano fcourse, excels them all. The Prophet of Islam (PBUH) practiced and preached these moral codes. The Holy Quran and Sunnah arc both insepara­ble, mandatory for muslims and eternal sources of ethics for the mankind. In a Muslim society, there is a prevailing belief that God has a remedy for every illness. The guiding rule is the Islamic dictum “Wherever welfare is found, there exists the status of God²”. At times there is gross violation of the ethical principles in day to day medical practice as the financial motives become the prime consideration. These practices include surgical and diagnostic procedures, gratification from various sources. including pharma industry, self-promotion, medical certifi­cates, enticing the patients from each other or from public hospitals to private consultations, to name a few. Biomedical issues are relatively new to the area of ethics. With the recent advancement in therapeutics and biotechnology, more and more topics get added to the list. While the Western countries evaluate the issues in the light of their values, Islamic teachings may put a totally different light on it. One such issue is Euthanasia. Fischer³ has observed that when therapy becomes futile and the suffering of the patient does not justify any anticipated benefit or the patient is in a persistent vegetative state, even a nutritional support by an unnatural route may ethically be denied. This view is perhaps representative of the trend of the opinion on this issue in the West. In fact practical steps are being taken to implement this view. Recently, Australia’s Northern Territory became the first jurisdiction in the world to allow doctors to take the lives Of terminally ill patients who wish to die⁴. In the light of teachings of Islam giving or taking away life is not within the domain of a human being as Quran speaks⁵. “And the life which He gives therewith to an earth that is dead”. The Holy Book has aptly highlighted the authority of Allah in the matters of life and death at many places. “It is He who created death and life⁶” and “It is He who created you to die⁷”. There are several other issues, however, in which the consensus or large body of opinion is still waiting to evolve in the Islamic world. These issues include contraception, test tube babies, genetic engineering/surgery etc. Theologians and scholars would no doubt sweat it out in due course, as they have done so po sitively for life-saving issues like cadaveric organ donation. There has never been a greater need to emphasize the importance of Ethics in Medicine as it is today. The moral values seem to have declined considerably, in the face of increasingly materialistic world. The irony is that the teaching of ethics in our medical schools has correspondingly declined or vanished. The established principles of ethics and codes of good medical practice have become more and more strained. The end result is that the followers of Islam have not been able to stick to dictates of ethics, so heavily emphasized by Islam and thus have succumbed to the temptations. The race to become afiluent through shortcuts of efforts and time have compounded the ills of the society. Can anybody stem the tide?

1. Ors. Y. The Hippocratic oath An anachronism? World Health Forum, 1994; 15:57.58.
2. Islamic Code ofMedical Ethics, I.O.I.M., Kuwait, 1981.
3. Fischer, D. S. Observations on ethical problems and terminal care. Yale J. Biol. Med., 1992;65(2): 1105-20.
4. ‘Kinder, Gentler, Death’?Tirne, June 12, 1995.
5. The Holy Quran. Surah Al-Baqar:20.2,164.
6. The Holy Quran. Surah Al-Mulk: 67;2.
7. The Holy Quran. Surah Ai-Hajj. :22;66.