Tuesday, August 11, 2009

Ethics in Medicine and Biomedicine - The Singapore Story (Part 1)

Historically and traditionally, there has always been a very strong sense of ethics in the medical profession. We look back frequently at the Hippocratic traditions, but in reality the professional codes that governed the practice of healers are evident even in the early civilizations in Mesopotamia and Egypt.

Nonetheless, the immense influence that the Hippocratic Oath had on our ideas of professional conduct cannot be easily discounted. This was subsequently morphed at the 1948 Geneva Declaration by the World Medical Association into the Physician's Oath. But it wasn't until 1995 that we tweaked that to become our very own Physician's Pledge - one that newly graduating doctors in Singapore are now required to take. The Singapore Medical Council didn't publish their Ethical Code and Ethical Guidelines until 2002.

Prior to 1997/8, medical ethics existed in a loose unstructured environment that was heavily influenced by the Helsinki Declaration (1964) and the Physician's Oath (Geneva, 1948).

The major impetus to firming up the ethics environment can be traced to the growing pressures to comply with international expectations with respect to clinical trials and human experimentation. In 1996, the International Conference on Harmonization (US, Europe & Japan) adopted a set of 'Good Clinical Practice' guidelines with respect to the 'Technical Requirements for Registration of Pharmaceuticals for Human Use. (This is a bit of a misnomer as it is not really about clinical practice but more about good clinical research practice.) In response to this, Singapore published and implemented its own GCP compliance program in 1997, and which was revised in 1998.

This is therefore an important milestone for us in 1997/8, because it was through the implementation of GCP in Singapore that ethics committees were formally constituted in the major restructured hospitals in Singapore. Prior to this, everything was pretty ad hoc. Hospitals were required in 1997 to comply with the “Ethical Guidelines on Research Involving Human Subjects” (NMEC Guidelines) issued by the National Medical Ethics Committee (NMEC).

But we should be clear that the driver for these developments was not so much to improve medical care, but more the pressure to get engaged in clinical research and human experimentation.

More about this later.

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