History of Ethics

Ethics started with the beginning of humanity.  No doubt, Adam’s teachings included all ethical principles of our days. The first, on earth, human crime was a big breech to those teachings that warrants punishment and cursing of the killer brother. Since then, any human community included ethical principles that tell everyone what to do and what not to do.

In Ancient Egypt, the concept of medical ethics was established by “Amen-Hu-Tep” who was a very talented physician as well as a prominent engineer of the Fifth Dynasty, who built the Sakara Pyramid and who was worshipped as a God afterwards. There are many Papyri that describes that medical conduct should be following the “Ma’at” which was the patron of truth, justice, and universal harmony. It was thought that the pharaoh's job was to uphold Maat. When a pharaoh died, Ma’at was lost and the world was flung into chaos, only the coronation of a new pharaoh could restore Ma’at.

More than 2000 years later, The Well Known Hippocrates of Cos (a tiny island in the Mediterranean) appeared (~460 to ~375 B.C.).  His Oath is still stated in most medical schools all over the world by those who are starting their medical career. It starts with the famous doctrine ‘First do no harm” and included many ethical principles that govern the medical practice. Some extracted paragraphs from it include “I Swear by Apollo the physician and Aesculapius....., 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 …. I will not give to a woman a peccary to produce abortion … Whatever, .. I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, ..”

Six centuries later, the Roman Empire had already taken over the Greco- Hellenic civilization. There, appeared Galen (131–201 A.D.). He wrote many books describing diseases and prognoses as well as modifications to the Hippocratic views in medicine.

With the introduction of Islam, a vast work of translation into Arabic was taken care of by the Muslims of all the historical books, thus the teachings of Galen were preserved to the modern world. It was only two centuries later when Sheikh “Al-Tabari” (838- 870 A.D.) wrote his book “ Firdaus Al-Hikma” = “The Wisdom Heaven”, which was a very important document dealing with medical ethics. It described the role of the physician towards his patients, community, colleagues and assistants as well as the personal characteristics of physicians. Also, his contemporary, “Al-Razi” (864-925 A.D.) mentioned ethical conduct in his medical books. Those ethical principles were deeply rooted from the Islamic teachings of human rights, morality and justice.

Ishaak Ibn Ali Al-Rahawessy, also wrote a very important document in the Tenth century called “Physician Ethics Adaab Al-Tabib” which was first to explicitly mention the patients rights. It advocates that any physician should have high morals standards. These books, as well as others, were translated to Latin in the Renascence Era.

In modern history, the research ethics was branched from the medical ethics, owing to the extensive research done in the 20th century. Ethical guidelines were usually created in response to an ethical lapse or a scandal.

The Nuremberg Code of ethics was stated after the World War II was over and trials of Nazi doctors took place in the city of Nuremberg, 1947, same year when the human rights declaration was signed in Geneva. The Nazi doctors conducted inhuman research on concentration camps inmates that represented a shock to the world.

The document included 10 guidelines governing the ethical conduct of research.

In 1964, the World Medical Association (WMA) issued the “Declaration of Helsinki” It provided guidance for physicians and participants in medical research. Many updates were introduced in 1975, 1983, 1989, 1996, 2000 and lastly 2008.

An ethical scandal in USA known as the Tuskegee Syphilis study was discovered in the 1970’s. Tuskegee is a small village in Alabama inhabited by African Americans with high prevalence of Syphilis. A study was started in the 1930’s to follow up the disease. During the World War II, Fleming discovered the Penicillin which was its treatment. Enrolled subjects were not summoned to Army in order not to give them their established treatment. This took 40 years to be discovered. Thus, in 1974, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was established.

In 1978, it submitted The Belmont Report that sets the fundamental ethical principles:
 • Respect for persons
 • Beneficence
 • Justice

With the advance in research involving humans, the Council for International Organizations of Medical Science (CIOMS), an international, non-governmental, non-profit organization was established jointly by WHO and UNESCO in 1949.  The membership of CIOMS in 2003 included 48 international member organizations, and 18 national members.

In 1993, CIOMS issued the “International Ethical Guidelines for Biomedical Research Involving Human Subjects”. With latest version published in 2002 and included 21 guidelines.

The Islamic Organization for Medical Sciences (IOMS), published the Islamic Code of Medical Ethics in 1981. In the IOMS Cairo Conference, Dec. 2004, International Ethical Guidelines– an Islamic Perspective– CIOMS and IOMS was published to develop the Islamic Charter of Medical and Health Ethics– Basis of Muslim Ethics as a potential for evolving understanding between Contemporary Bioethics and Muslim Ethics.