Clinical Ethics for Obstetric Sonography

Morality and Ethics Defined

Ethics is a systematic reflection on and analysis of morality. Morality concerns right and wrong conduct (what we ought or ought not to do) and good and bad character (the kinds of persons we should become and the virtues we should cultivate in doing so). Morality reflects duties and values. Freedom and autonomy are integral to morality because they allow people to express values. All aspects of morality, duties, values, and rights are important in the clinical ethics of sonography practice.

In a pluralistic, multicultural society such as the United States, moral beliefs and behaviors vary widely. People learn morality through personal experiences, family traditions, and normative behavior within communities, ethnic and racial groups, or geographic regions. Religions disagree about conduct and character, and religious ethics provides an inadequate foundation for professional ethics in a culturally diverse society. National identity and history also contribute to beliefs, as do the laws of the states and the federal government. These many sources of moral beliefs can sometimes cause conflict. Health care providers with good intentions may disagree among themselves or with patients on moral directions. When these disagreements are discussed and analyzed, a collaborative and ethical resolution of the conflict can be achieved. This type of discussion, reflection, and discourse on morality constitutes ethics.

Whereas morality has to do with protecting cherished values, ethics is a discipline of study that seeks to articulate clear, consistent, coherent, and practical guidelines for conduct and character. Ethics tries to answer the key question, “What is good?” To be applicable to a medical context such as sonography, ethics must transcend moral pluralism by offering an approach with minimal ties to any substantive prior belief about moral conduct and character. This is what philosophical ethics attempts to do because it requires only a commitment to the results of rational discourse in which all substantive commitments about what morality is are open to question. Every such substantive moral claim requires intellectual justification in the form of rigorous ethical analysis and argument. Therefore, philosophical ethics properly serves as the foundation for medical ethics, especially in an international context.

History of Medical Ethics

Medical ethics has evolved since the beginning of civilization when health care knowledge was shared orally, and healers exemplified a community’s moral code. Prince Hammurabi of Babylon recorded the responsibilities of health care providers in 1727 BCE, and early Hindu writers at about the same time cautioned healers to treat patients with respect, gentleness, and dignity. Fundamental principles of Western medical ethics were first recorded in ancient Greece in about the 5th century BCE. Hippocrates cautioned his students, “Primum non nocere,” which famously means, “First, do no harm.” In ethics, this is known as the ethical principle of nonmaleficence . Hippocrates’ teachings emphasize choosing treatment based on the knowledge that would best benefit patients, treating patients as one would treat family members, upholding confidentiality, and practicing personal piety.

Ethical norms, elements, and principles were refined through the centuries. Thomas Percival (1740–1805) wrote a treatise that substantially changed medical ethics. Previously, a patient was someone who paid for treatment, but Percival redefined patient as anyone needing care. He also foresaw a team approach in health care and public health. Percival emphasized patient care provided by all professionals and ordered competitive or professional interests as secondary to the patient's needs.

Modern medical ethics was codified after the Nuremberg trials, which judged the atrocities done in medical experimentation by Nazi doctors. The judges in the Nuremberg trial issued a verdict that included a section on permissible human experimentation. That section, which became known as the Nuremberg code, was incorporated into regulatory policy in the United States. The same protections were adopted internationally and published within the Helsinki report in 1964. The Nuremberg code emphasized individual rights and autonomy and has become a key element of modern ethics.

Basic principles of medical ethics have been incorporated into research regulations, professional codes, and clinical practices worldwide. The ethical codes of various professional groups may differ slightly in definition and emphasis, but the basic principles of autonomy, justice, beneficence, nonmaleficence, integrity, and respect for persons are universal.

The Code of Ethics for the Profession of Diagnostic Medical Sonography has been adopted and is maintained by the SDMS.