Healthcare Ethics have come to regulate decisions in Healthcare Services (Patient Care), Clinical Research and Public Health. The National Health Policy must provide Principles and Guidelines for Healthcare Ethics to foster trust between the Patients and the Healthcare Providers which result in better Patient Care, which promote Patient’s trust and confidence in the Healthcare System, and which ensures that Healthcare Professionals are protected and not persecuted. To deal with uncertainties of Healthcare, it is mandated that Healthcare Providers be provided a place of work which is safe and secure so that Providers can make difficult decisions about the Patient’s Health. 

Ethics are moral principles, which lead to a code of voluntary conduct based on the deduced moral obligations for social behaviour in the society. Ethics promote social order and regulate social interactions. Ethics enable harmonious living in the Society. 

Ethics have always been derived from Philosophy of the Human Reasoning. Ethics vary across countries based on their cultures, religions, and individual preferences, but are always aimed to provide clear understanding of “Right and Acceptable”  social behaviour. 

Ethics are more informal and less specific than Laws. Ethics are neither legally binding nor enforced by law but are enforced through social values and can cause loss of reputation or trust of individuals, group of persons and organisations . 

Ethics are enforced by adopting them as Regulations. Ethical Regulations can be codified as Laws and Ethical Standards. Ethical Standards and Regulations are notified, generally, for Professionals in Healthcare, Engineering, Law, Accountancy and Journalism. 

Violation of notified Ethical Regulations leads to Legal Penalties, such as Fines, Imprisonment, etc. 

Ethics are important in Healthcare because Healthcare deals with matters of Life & Death.  

Healthcare Ethics help to make compassionate, fair, and effective decisions for patient’s treatment. It enables Healthcare Providers to address very difficult situations and gain patient’s (& their families) Trust without reservation. 

Healthcare Ethics also help to protect the Healthcare Providers by establishing that the Providers have performed as most of them would have done, in similar situations, irrespective of the outcome of care. 

Healthcare Ethics have been established in all Civilisations when the role of Physician was being defined. It focussed on the fact that Physicians must be accountable for their actions. Healthcare Ethics directed them to take such care of their patients that Healthcare should not harm the Patients. Healthcare should always be directed towards Longevity. 

Overtime, development of Medical Knowledge, Professional Education, Establishment of Hospitals, etc., necessitated establishment of a code of Ethics that guided Physicians’ Professional Conduct and regulated provision of Healthcare. This concept of a Code of Ethics has remained ever since in Healthcare Services and is operative in present times also. 

Healthcare Ethics, in the Vedic Times, specified compassion on part of the providers. Physicians were expected to practice with integrity and skill, prioritise patient welfare, maintain confidentiality and achieve a balance between body, mind, and spirit, emphasizing the interconnectedness of physical, mental, and spiritual well-being of a person. These Ethics tasked the Physicians with a social responsibility to care for the sick and contribute to the well-being of the community and abhor working just for personal gains. Physicians were expected to follow a strict code of conduct and behaviour. They were directed to follow the dictate “Not for self, not for the fulfilment of any earthly desire or gain, but solely for the good of suffering, should you treat your patients”.  

In Vedic times, Physicians were revered as Literal Gods and held an honoured place in the society as respect for their ability to preserve life, and thus recognising their knowledge of healing and alleviating suffering. It was propagated that Physicians do no wrong. It was directed that Physicians will not be harmed even when they err (even intentionally) while delivering Healthcare because they do it for reducing the pain or the grief of death. The society was tasked to respect, protect and compensate the Physicians so that both the Royality and General Populace can benefit. The Vedas had acknowledged the role of divine intervention and limitations of human knowledge. They propagated Spiritual and Mental well-being alongside Physical Health. Since Physicians cannot provide comprehensive treatments by themselves, Vedic Healthcare Ethics had directed the Physicians to treat only those patients who voluntary sought their services.  

Derived from these are the similar Healthcare Ethics in Buddhist Medicine. Buddhism also tasked the Physicians with an additional social responsibility to provide palliative care in “end-of-life situations”, alleviate patients suffering and supporting their families, through the dying process while maintaining their dignity. 

Tibetan Medicine also has similar Ethical Guidelines. The “Explanatory Tantra” of the “Four Treatises” of Tibetan medicine, (known as Sowa Rigpa), specifies compassion, commitment to Healing, Kindness, Confidentiality, and Continuous Learning, as the requirements for being a Physician, or a Physician Monk.  

Traditional Chinese Medical Ethics had philosophised that “Medicine is applied Humaneness”. Humaneness was, to be kind, empathic, compassionate, considerate towards others – both the Humans and the Animals, and a willingness to alleviate their suffering. These Ethics also specified standards for Physician’s Morality and for Practicing Medicine. Confucius, who was a celebrated Chinese Philosopher, had formulated the Chinese Medical Ethics in his time. He had emphasized benevolence, respect for life, and the importance of family in Healthcare Decisions. He had specified that Physicians must consult with patient’s families to ensure that treatment plans align with the patient’s values and the family’s needs. He had deliberated on the role of Physician and Family, in providing the “End-of-life Care” (Passive Euthanasia). He had prohibited Active Euthanasia. He also specified the presence of a Companion, when the Physician was examining and treating a woman. All these have been integrated in Medical Ethics as practised now. 

\In ancient Greece, illness was attributed to divine punishments which required magical remedies like prayers, offerings, and incantations. Over time, use of herbal remedies was also included, and this initiated empirical observations of human body and various life processes of Birth and Death. This promoted rational thinking, emphasizing natural causes and treatments, while still acknowledging the influence of divine powers. Role of diet, exercise, massage, and personal hygiene in healing came to be recognised and practiced, at this time.  

When the Greek Medicine moved from mystical to logical reasoning, it realised that practicing Medicine was an Art, most important of all Arts,  that is closely related to the Natural Science and Practical Wisdom, a concept that seems to be valid even today. It was then postulated that the Physician deals with the Human Life and not merely with the condition of the Human Body and it necessarily requires a level of trust between the Physician and the Patient for providing holistic treatment. It is widely accepted that Asclepius, (son of Apollo, God of healing) laid the  foundations for study of anatomy, physiology and psychology, in order to find the sources of diseases, and to promote health status of Humans and Human Society. He founded the philosophy of Medical Thinking and established the Methodic School of Medicine, which focused on understanding the Health and Health Status of Humans and Animals. He theorised diseases into acute and chronic ones. He used to perform elective non-emergency Tracheostomy. His contribution to development of Scientific Medicine was recognised after his death, when he was worshipped as Greco-Roman God of Medicine. 

Then Pythagorean, the Mathematician, proposed “Principles and Practices for wellbeing of Humans”. He promoted the Holistic view of Health, which considered the physical, emotional and spiritual well-being, together, as a whole. He hypothesized that the Human body functions best when its various organs and inner elements are in proper proportion and in a state of balance. Conversely, when these are in disharmony, the body is in Disease State. He advocated leading a disciplined life to maintain good health and pure soul and avoiding excesses in all aspects of life including eating, drinking, and material possessions to maintain balance and harmony. Pythagorean philosophy, is credited with developing one of the first rational theory of Health and Disease. He also specified Physicians duty of Justice, Secrecy, respect for Teachers and solidarity with peers, as Medical Ethics, to be followed by Physicians. 

Later Hippocrates, universally recognized as the father of Modern Medicine, established the Clinical and Ethical basics of Medical Practice. Hippocratic medicine was influenced by the Pythagorean philosophy. He had formulated the “Humoral Theory of Health”, whereby the four body humours, (blood, phlegm, yellow bile, and black bile), needed to be kept in balance. Their imbalance caused Illness which may require reduction in the body of a humor through Bloodletting or Purging. He had recognised the importance of community living and companionship to lead a Healthy life, based on Epicurus’s theory of pleasure.  

Epicurus considered absence of pain, both physical & mental, is the key to a Healthy life. He had postulated that simple pleasures, when pursued in moderation, can lead to a tranquil & fulfilling life. 

Hippocrates also established the Code of Ethics for the Physicians in ancient Greece. This code, now known as the “Hippocratic Oath,” was to keep the physicians accountable. The modern version of this Oath is used in most of the  Medical Colleges in the world and forms the basis for current Medical Ethics Regulations. He emphasised that “First, do no harm” is most important Ethic (core principle) in Healthcare Delivery. 

In more recent years, Florence Nightingale has influenced Healthcare Services during and after the Crimean War, when pasteurization, antibiotics, and antiseptics had not yet been discovered. She advocated provision of Fresh Air Ventilation; Sunlight; Personal Cleanliness, Cleanliness of the area, Bed and Bedding; Clean Water and Warming as essential for Human Health and Quick Healing. 

Florence Nightingale had emphasised “The very first requirement in a hospital is that it should do the sick no harm”. This has become the Foundational Principle for modern nursing and patient safety practices. (Notes on Hospitals, 1863)