Notwithstanding popular perception that bioethics or health ethics was a 20th century development based largely on Western philosophy, concern for and social responses to, ethical issues have been extant for millennia and reflect a wide range of spiritual beliefs.
Documentation of ethical principles dates to the Code of Hammurabi — circa 2500 BC — which included provisions concerning the importance of ethical considerations to clinical practice and recognized the physician’s dual responsibility to the patient and to society. The Pharonic principle of Maat addressed the principle of ethical balance and compassionate care for the poor and sick. Hindu philosophy holds sacred the transcendent character of human life, expressed through the principles of sanctity and quality of life and the duty to preserve and guard individual and communal health. In Judaism, Tikun olam is the Judaic imperative to repair the world, reflecting the divine values of justice (tzedek) and compassion (hesed). Christianity values charity toward individuals and members of society generally and the sanctity of human life. In Islam, one of the hadiths (sayings of the Prophet Mohammad) made treatment mandatory or obligatory when a treatment was definitely available and if withholding treatment would be harmful. If one is unsure of any benefit from a treatment and any harm is feared, then it is discouraged according to Islamic principles.
Knowing that there are common values across spiritual beliefs is critical for an understanding of the role of religion in international health and specifically consideration of the emerging conceptual frameworks for health ethics that are being applied to health issues as diverse as resource allocation, clinical practice, engagement of vulnerable populations in medical research, donor investment in health, and related development policies and programs. Over the past decade, there has been a flourishing of philosophical, social, and other discourse regarding health ethics; much of this discourse has been based in new concepts of and approaches to health research, development, and public health. It has, importantly, not been dominated by North American or European thinkers — although many, including notably Dr. Paul Farmer, Dr. Nancy Kass, Dr. Alex London, Dr. Peter Singer, and others, have made invaluable contributions to the discourse.
Rather, the discourse has benefited from a rich diversity of scholars and others who have explored health ethics from a wide range of perspectives. New concepts of health ethics principles and frameworks have been proposed by bioethicists from the Democratic Republic of the Congo and South Africa, philosophers from Cameroon and India, public health physicians from Egypt, and biomedical researchers from Argentina and Venezuela. Among the conceptual frameworks that have been posited — and that have been the basis for recent discourse regarding health ethics — are the Human Development Approach to International Research, which makes explicit the linkages between medical research and the social determinants of health and global justice; the Fair Benefits Approach, which also focuses on medical research; Ethics from Below, which addresses health ethics more broadly and suggests contextualizing ethical dilemmas broadly in the social sciences, rather than focusing only on moral philosophy; a Participatory Framework for Health Ethics; and the African Meta-physical Worldview.
Awareness of these new concepts of health ethics is essential for all those engaged in ensuring that individuals and populations broadly benefit from the health rights to which they are entitled through the multiple international accords that have been promulgated since 1948. Rather than focusing somewhat narrowly on medical research — as vital as that field is, and as important are assurances that all, including adolescents, benefit equally from it — many of the new approaches consider public health, access to individual health care and to related services, and the broad socioeconomic context of health. Moreover, as they reflect a wide diversity of cultures and religions, they are not embedded only in Judeo-Christian principles, but in a broader range of spiritual and philosophical belief systems. Consideration of religious, cultural, and other values and norms beyond those prominent in the West has enabled a broader understanding of both health ethics generally and their implication for adolescent health.
To what extent should discourse regarding religion in international health be predicated primarily on Judeo-Christian beliefs and dogma? How can clinicians, policymakers, communities, donors and others address the complex intersection of religion and international health?
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