From the Ethics of Hippocrates to the Deontology of Scientific Research & Writing

The moral principles that control or influence a person’s  behaviour or the conducting of an activity is what  we call Ethics.¹  In  the  western  world the basis of ethics has more or less been shaped by the Christian  laws of the  Old and  New Testament.  In Medical practice  Hippocrates with the  Hippocratic Oath,  is  the  one  who  provided  physicians  with regulations  and  “algorithms”  of deontology  more than 2000 years ago.

In the  original version of the  oath,  the  physician swore by a number  of healing gods (by Apollo, Asclepius,   Hygieia  and   Panacea),   to   uphold   a number of professional ethical standards.  The Hippocratic oath ensures the respect of students towards   those   who  teach   medicine  as  well  as respect among colleagues and towards patients.2

With the Hippocratic Oath doctors swear to share knowledge,  provide  only helpful  remedies,  cause no harm or hurt and protect  patients  from hurt or injustice, lead a flawless personal as well as professional  life setting  a  good  example,  refrain from sexual misconduct towards  patients,  exercise gender equality and equality of men (either free or slaves),  and  finally exercise  medical confidentiality.2,3

The Hippocratic Oath is perhaps  the most widely known of Greek medical texts. It first appeared at around 400 BC.3 Over the centuries it has been reviewed  and rewritten  often  in order  to suit the values of different cultures influenced by Greek medicine or to fit with changes in modern  medical practice. In 1948 it was revised and adopted by the World Medical Association and is still used  in the graduation  ceremonies  of medical schools around the world.4,5  Why? Because it is a code of professional  ethics  and  deontology  and  provides the  guidelines  for  medical  conduct  towards patients,  teachers  and among colleagues. It is noteworthy that declarations  worldwide are based upon  the  content   of  the  Oath.  2500  years  ago, being the first to use observation  of the body as a basis for medical knowledge,  Hippocrates  led the way to medical research and scientific thought.

Today   medical   researchers  around   the   globe make new knowledge available through  publishing their research.  Apart from presenting  research, sharing and promoting knowledge, if one thinks of why scientists publish today, notions such as remaining  alert,  sharing  ideas,  expressing  an opinion, rising discussion, upgrading a scientific branch, reporting  a case, claiming originality of an idea, applying for a promotion or maintaining a position,  reputation  and  gaining  income,  might come to mind.

Whatever the motivation for writing, scientists should  abide  by  bioethics`  regulations  and legislation available shaping the ethics and deontology of research, writing and publishing of scientific work. So according to legislation and regulations  available  worldwide,  a publication should be characterized  by scientific originality and research  results reported should be clear and reliable. Scientific research  should be based  upon data  whose  liability can  be  easily audited  and  it should lead to new knowledge aiming to improve public health. Appropriate infrastructure and accurate  design of a study is a prerequisite. Volunteers when involved should participate  after informed  consent  has  been  obtained  and anonymity   should   be   kept   for   protection    of personal  data.  Minimizing the  risk of participants/ patients  and researchers as well as ethical use of experimental   animals  (replacement,  reduction  of pain and anxiety, refinement)  is imperative.6

Laws and regulations that apply to biomedical research are observed by Ethics` Committees worldwide   that   look  into  the   deontology   of  a research project. Ethics Committees function according to and refer to relevant laws and regulations  in place concerning research.  Integrity of research and reporting according to ethical standards  is a prerequisite  for manuscripts  to  be submitted  for publication.7  Construction of data or observations that never occurred (fabrication), changing or omitting research  results to support  a hypothesis or claim (falsification), representing the work of others as one`s own work (plagiarism) and conflict of interest  are examples  of misconduct  in research,   writing  and  publishing  scientific  work, that can be successfully prevented.8

In the history of medical research ethics, the Nuremberg Code can be considered as a milestone, because   it  has  served  as  an  “ethical  map”,  an outline, and the  principles that  warrant  the  rights and wellbeing of the  subjects  in medical research nowadays have been drawn from. In August 1947, in Nuremberg,  Germany  the  American  judges  of the   “Doctors’  Trial”   (a  trial  during  which  Nazi doctors  were  convicted  for  conducting  inhuman and lethal experiments using human subjects in the concentration camps), composed the Nuremberg Code. The Nuremberg Code stresses  the voluntary consent    of   human    subjects    participating    in research  as a prerequisite, as well as their right to withdraw from the experiment at any time if felt so by them. According to the Nuremberg Code an experiment   should  aim  at  and  anticipate  results that  are  for  the  benefit  of  society.  Experiments that  could possibly cause death  or disabling injury should not take place and all aspects should be considered  to ensure  the protection  and safety of the  experimental   subjects.  Unnecessary  physical and mental  suffering and injury are unacceptable. Also experiments  should be conducted  only by qualified scientists,  that  are  prepared at  all times to end the experiment  if it is likely to cause injury,

disability or death to the subject.6  Although the Nuremberg  Code was one of the  first attempts to state  the principles that should involve human experimentation, it had relatively little effect on practice,  because  of its historical link to the  Nazi war crimes.9

In June1964 the World Medical Association (WMA) at its 18th  assembly in Helsinki, Finland, adopted the  Declaration  of Helsinki which is a statement of ethical principles for medical research involving human  subjects,  including research  on identifiable human material and data. Although the Declaration  of Helsinki is not  a legal document  it has served as a guide for local law making. The Declaration  of Helsinki is a  respected institution and  one   of  the   most  influential  documents   in research   ethics, having  withstood   a  number   of revisions since its conception in 1964. Its basic principles include respect  for human  life, the right for self-determination and informed consent, the researchers` duty being the patients benefit, and putting patients` health first.10

In Greece Ethics and Deontology Committees for research in Universities and Research Institutes are responsible  for ensuring that  clinical research  is conducted  to the highest standards  of human research ethics and abides by legislation and bioethics`   regulations   concerning   scientific research.  Clinical trials on drugs or other therapies, epidemiological studies, behavioral studies in humans,  studies  concerning  groups  such  as children, prisoners or people with a psychiatric condition, studies in groups with special gender or cultural characteristics,  studies  concerning  the human embryo, research on vertebrate animals, research  on rare species (animalsCc or plants) and research on genetically modified organisms and microorganisms must abide by the various laws, directives  and  conventions  available,  as  for example  the  European Convention on Human Rights and  Biomedicine (Oviedo Convention),  law 2472/1997 on the protection  of individuals with regard to the processing of personal data, UNESCO Universal Declaration  on the Human Genome and Human Rights , UN Convention on Biological Diversity, directive 2001/20/EC.

Moreover  the  Hellenic National  Bioethics and Technoethics Commission is an independent advisory body created  during the pandemic, with a role to review and consult on complicated matters  that are otherwise difficult to address.11

Reading the Hippocratic Oath and having in mind the various modern time laws and conventions, one realizes that the ethical values applied to research and scientific publishing today, are actually summarized and contained in the following three quotes from the Hippocratic Oath:

“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous…”

“Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret…”

“With purity and with holiness I will pass my life and practice my Art…” 3

The first quote refers to causing no harm and promoting health, the second to confidentiality and the third to exemplary professional life. Going through laws, conventions and declarations regulating scientific research and publishing, it is evident that 2500 years later, these Hippocratic values are present in modern texts, remaining worldwide and timeless and Hippocrates himself, through the Hippocratic Oath, still represents the humane and ethical aspects of the medical profession.

References

1.  Oxford Advanced Learner’s Dictionary, 7th    Edition; Sally Wehmeier, Colin McIntosh, Joanna Turnbull.
2.  Laskaratos History of Medicine. Vol I Paschalidis Medical Publications, Athens 2003; 179-180.

3. Britannica,      The     Editors      of      Encyclopaedia. “Hippocratic oath”. Encyclopedia Britannica, 5 Sep. 2022, www.britannica.com/topic/Hippocratic-oath.
4. World Medical Association.Decl-of-Geneva-
   v1948.www.wma.net/wp- content/uploads/2018/07/Decl-of-Geneva-v1948-1.pdf
5. Isaacs, D., The Hippocratic Oath. Journal of
   Paediatrics and Child Health, 2011, 47: 321-321.
6. Shuster E. PhD. Fifty Years Later: The Significance of the Nuremberg Code. N Engl J Med 1997  Nov 13; 337:1436-1440
7. International Committee of Medical Journal Editors. Recommendations.
   https://www.icmje.org/recommendations/
8. Charles Gross. Scientific misconduct. Annual
   Review of Psychology. 2016; 67:693-711.
9. Goodyear MD, Krleza-Jeric K, Lemmens T. The
   Declaration of Helsinki. BMJ. 2007 Sep 29;335(7621):624
10. World Medical Association. Ethics Unit. Declaration of Helsinki 2022. www.wma.net/e/ethicsunit/helsinki.htm
    Hellenic Republic National Commission for bioethics and Technoethics. Legislation. Biomedicine.
    https://bioethics.gr/en/nomothesia-56