Healthcare is an inherently moral profession. It is motivated by moral virtues such as altruism, respect for others, honesty, fairness, and compassion in a way that few other practices are. The morality of healthcare stems from the interpersonal relationship between patient and practitioner, one which is predicated on the vulnerability of patients and the corresponding authority of practitioners. It is this imbalance of power, under the most humbling of circumstances, that ascribes to healthcare its moral character and compels the practitioner to act ethically.
The understanding of healthcare as a moral practice is hardly a novel notion. Ancient Greek physicians viewed medicine as a moral enterprise with an inherently human component. The widely known Hippocratic Oath has remained an enduring model for an ethical practice of medicine, clearly stipulating the moral responsibilities and ethical obligations of practitioners. Muslim scholars also understood moral virtue to be inseparable from healthcare practice. In the 9th and 10th centuries, Abu Baker Al-Razi and Ishaq Ibn Ali Al-Ruhawi published some of the earliest texts exclusively pertaining to ethics and medicine. These volumes proved vital to the shaping of a contemporary moral medical practice and have contributed to the development of an Islamic bioethics discipline.
Despite its intrinsic morality, the history of medical practice is regrettably fraught with instances of unethical behavior. The Nazi experiments at Nuremberg during the second world ware, the 40-year Tuskegee Syphilis study, and the Stanford Prison experiment are well-known examples of unethical medical research on human participants. Similarly, troubling racist and inhumane origins contributed to the development of some modern medical disciplines such as gynecology and psychiatry. Even today, long-held discriminatory and biased beliefs influence medical practice particularly regarding pain management, physiological and racial differences, healthcare disparities, and cross-cultural competence.
In response to increasing awareness of medicine’s moral fallibility, the discipline of bioethics emerged in its modern iteration in the late 1960s. Its first goal was to ensure and promote ethical medical practice and research. Its second, was to contemplate and respond to novel moral dilemmas resulting from newfound healthcare advancements. Innovative medical technologies- such as genomic medicine, assisted reproduction, developments in organ transplantation and life support modalities, telemedicine, and social media – created new moral challenges for practitioners and patients alike. The mindful practitioner was bound to ask herself: Am I acting ethically? Am I fulfilling my moral duty toward my patients, my practice, and myself? Answers to these pressing issues were sometimes not so readily apparent. The discipline of bioethics was tasked with considering and suggesting answers to these oft fraught questions.
There is growing recognition that women’s healthcare needs have been historically and systematically dismissed and minimized by practitioners. Bioethics plays an essential role in identifying these challenges and limitations, in raising practitioner awareness, and in advocating for all patient populations
In Saudi Arabia, palpable changes in social norms, new advances in medical technology, and imminent transformations in the country’s healthcare system have similarly resulted in new questions and novel ethical dilemmas. At the same time, progressive legislative and regulatory changes warranted continuous examination of healthcare’s moral imperatives. Saudi bioethics, a quickly expanding discipline, proved integral in supporting practitioners and patients as they navigated newly granted rights and responsibilities in healthcare.
Women’s healthcare rights were, and remain, an important focus of bioethics’ attention. In recent years, the Saudi Ministry of Health has spearheaded several campaigns underscoring the fundamental rights of women in medical decision-making. This included the right of a competent, adult woman with decision-making capacity to independently consent to all and any interventions including those of a reproductive nature such as prenatal genetic screening or diagnosis, caesarean sections, pain management, episiotomies, termination, contraception, or others. Likewise, the Council of Senior Scholars’ fatwa permitting oocyte cryopreservation for unmarried cancer patients undergoing gonadotoxic therapies expanded reproductive choices for women. Finally, legislative changes in custodial arrangements have empowered more women with the authority to make medical decisions for their minor children.
These momentous regulations lay the foundation for much bioethical work. Bioethicists must support and advance the rights of women through these protections and ensure that established regulations and policies are implemented in support of patients. Bioethicists must also strive to alert practitioners to the social and cultural challenges that make it more difficult for women patients to access the healthcare they require. For example, there is growing recognition that women’s healthcare needs have been historically and systematically dismissed and minimized by practitioners. Bioethics plays an essential role in identifying these challenges and limitations, in raising practitioner awareness, and in advocating for all patient populations.
As healthcare continues to advance and change, new ethical dilemmas are bound to appear. Bioethics must strive to become a partner to the practitioner, an ally to the patient, and an advocate for the moral practice of medicine.
Dr. Ruaim Muaygil (MD, PhD, HEC-C) is an assistant professor of healthcare ethics at the College of Medicine, King Saud University, and a clinical ethics consultant at King Saud University Medical City in Riyadh, Saudi Arabia. She is a member of multiple national bioethics initiatives including at the Saudi Health Council, the Saudi Council for Health Specialities, and the Public Health Authority.
The opinions expressed are those of the author and may not reflect the editorial policy or an official position held by TRENDS.