In previous centuries humans had little choice when it came to medical treatments. There was a paternalistic attitude and the individual was expected to put their faith in those who were experts. Times have changed and these days there are the autonomy of the individual has become an important ethical principle in medicine. Not only is it now unethical to treat the individual against their will, but it is also expected that they should provide informed consent for any treatment.
The Hippocratic Oath is taken by physicians and other health care professionals. It involves these individuals swearing that they will behave ethically and honestly when dealing with those they are trying to help. This declaration has been in existence since the times of ancient Greece. It is attributed to ancient physician Hippocrates who lived from 460 BC to 370 BC. The modern version of the Hippocratic Oath was created by Doctor Louis Lasagna in 1964 and it stipulates:
> I swear to fulfill, to the best of my ability and judgment, this covenant:
* I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
* I will apply, for the benefit of the sick, all measures (that) are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
* I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
* I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
* I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
* I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
* I will prevent disease whenever I can, for prevention is preferable to cure.
* I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
* If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
One of the most important elements of the Hippocratic Oath is above all do no harm.
The medical treatment of addiction is not a new development, but it has become increasingly emphasized in recent years. There is now even a medical specialty that focuses purely on addiction. The reason for the increased interest by medical profession is the evidence that addiction causes changes to the brain. It is now viewed as a chronic disease related to reward and motivation and it is caused by faulty circuitry in the brain. The ways in which medicine is now involved in the treatment of addiction includes:
* Development of pharmaceutical drugs that can help the individual overcome their addiction. These can work by blocking the desirable effects of mind altering substance or by reducing cravings for the drug.
* There have also been medications developed that can help alleviate the symptoms of withdrawal.
* New theories of addiction are leading to increased understanding of what is causing the problem.
* Medical supervision ensures that people pass safely through the addiction withdrawal process. Such supervision saves lives.
* Medical treatments for addiction are evidence based. This means that an approach will only be adopted if it has proven effective through rigorous testing.
* More attention is being given to relapse prevention strategies. This means that people not only stop the substance abuse but stay stopped.
The fact that health care professionals are now frequently involved in addiction treatment means that there can be issues involving the Hippocratic Oath such as:
* The most important expectation under this oath is the obligation to do no harm. This means only recommending treatments where the benefits are likely to far outweigh any negative aspects.
* Health care professionals need to make use of the most current scientific research so they can suggest the best possible treatments. This means a commitment to evidence based treatment rather than personal preferences.
* Physicians and other health care professionals are obliged to use warmth and sympathy when dealing with these individuals. Any attempt to dehumanize the addict will be breaking the Hippocratic Oath.
* It is against the Hippocratic Oath to view addicts as hopeless cases. There is ample evidence that addicts can and do turn their life around.
* If the physician does not have sufficient knowledge to deal with the individual’s problems they should refer this person on to another professional who can help.
* The health care professional needs to always work in the best interest of their patients/clients.
* The oath obliges the physician to treat the person and not just their symptoms of addiction.
As well as the Hippocratic Oath the health care professional also has other ethical and legal obligations when dealing with people requiring addiction treatment including:
* The individual needs to give informed consent for any treatment. The only exception to this is when consent is implicit or the person is incapable of providing informed consent.
* Client confidentiality is vital when dealing with those individuals who are battling with addiction. This person trusts the health care professionals with deeply private information and if these confidences were to become public knowledge it could cause them harm or embarrassment.
* Honesty is another expectation between a health care professionals and clients. This can be particularly important when dealing with addicts, as they will be on high alert for any signs of dishonesty, and if they find it they will lose faith in the health care professional.
* Clients have a right to be treated with dignity and respect. Even if these individuals made poor choices in the past this does not justify treating them shabbily.
* The individual’s autonomy needs to be respected at all times. This means that they are fully involved in all decisions related to their recovery from addiction.
* The person needs to be treated justly. This means that they are given appropriate attention and have equal access to resources as other clients – in other words there should be no playing of favorites.
* Not only are health care professionals expected to avoid doing harm, but there is also an obligation for them to do good – this is usually referred to as beneficence.
The Hippocratic Oath makes no mention of informed consent. Instead it suggests a more paternalistic approach where the doctor knows best, and it is not necessary to involve the patient in the decision making process. This type of approach made more sense in the past when there was less choice in regards to available treatments and there was less emphasis on the autonomy of the individual.
During the twentieth century there was an increasing expectation that people should be involved in the decision making process regarding their own health. This demand for informed consent was influenced by events during World War II when Nazi doctors performed experiments on humans against their will. The civil rights movement of the 1960s further emphasized the right of this type of autonomy.
Although informed consent is not specifically mentioned in the Hippocratic Oath medical professionals are now legally and ethically obliged to obtain it. In order for consent to be informed it needs to contain the following elements:
* The individual needs to have a reasonable understanding of the treatment that is being proposed.
* The person for who the treatment is proposed needs to be assessed for their ability to understand what is involved. Providing information is useless if the recipient is unable to comprehend what is being said.
* After the information has been given there needs to be some type of assessment to ensure that the individual has understood.
* It is important that the person is provided with details of other reasonable alternatives to the proposed treatment.
* There should be no coercion used to get the individual to agree to the treatment.
Up until the 1970s it was quite common for addicts to be involuntary sent to institutions for treatment. This could occur if family members were able to convince a physician that such confinement was necessary to help the addict. This led to many individuals being unfairly put into institutions – they could get lost inside the system for years and come out of it far worse than when they went in. The rise of the civil rights movement during the sixties was able to highlight how such actions were unethical. It is now much harder to admit any individual to a rehab against their will. It can only happen if the individual is an imminent danger to themselves or other people.