Aspects of Informed Consent in Medical Practice in the Eastern Mediterranean Region During the 17th and 18th Centuries

Abstract

Informed consent is a question of central importance in contemporary medical ethics, and clinical practice is inconceivable without considering the issues it raises. Although it is often vigorously argued that consent, informed or otherwise, is a recent phenomenon and that no sources testify to its existence before the 20th century, it is difficult to accept that a process for regulating the common and fundamental parameters in the relationship between doctor and patient and the planning of treatment had not concerned previous eras. A review of the Registers of the Islamic Court of Candia (Heraklion) in Crete, a series of records that touches on, among other things, matters of medical interest, reveals that the concept of informed consent was not only known during a period that stretched from the mid-17th to the early 19th century, but it was concerned with the same principles that prevail or have been a point of contention today. An extension of this study into other periods may thus provide contemporary researchers with material and information valuable in the discussion of today's bioethical issues.

Patients’ perceived purpose of clinical informed consent: Mill’s individual autonomy model is preferred

“…Further, Islam does promote a sort of rational autonomy conceived as the ability to rationally determine what is in one’s best interest and as having the motivation to live accordingly [39]. It is of note that documentation of the use of formal informed consent for surgery in the Islamic/Arabic culture dates back at least to the 17th century [11,12]. …”

“…In the West, informed consent for surgery arose in the early 20th century as courts moved to protect patients from battery and negligence; the modern legal precedent for “simple” consent was written in 1914, whereas “informed” consent was first articulated in 1957 [3,6,10]. Interestingly, a forerunner of informed consent was documented in the Eastern Mediterranean region at least since the mid-17th century in the Registers of the Islamic Court of Candia (Heraklion) in Crete [11] and Tripoli-Syria [12]. The current medical practice law in Saudi Arabia is not dissimilar to the corresponding Western laws.…”

Information disclosure in clinical informed consent: “reasonable” patient’s perception of norm in high-context communication culture

“…Consent for surgery arose in the early 20th century as US courts moved to protect patients from battery and negligence and “informed” consent was first articulated in 1957, when a court called for disclosure of risks to enable patient’s decision-making [10,11]. Interestingly, a forerunner of informed consent was documented in the Eastern Mediterranean region at least since the mid-17th century [12,13]. The current medical practice law in Saudi Arabia is not dissimilar to the corresponding Western and international regulations [14].…”

Cerrahi kliniklerdeki sağlık çalışanlarının aydınlatılmış onam hakkındaki görüşleriyle uygulamaları örtüşüyor mu?

“…Bununla birlikte tıbbi işlem öncesi bireyin aydınlatılmış onamının olmaması ya da uygun bir şekilde alınamaması klinik uygulamalarda önemli etik ve hukuk sorunların ortaya çıkmasına neden olmaktadır [1]. Aydınlatılmış onam, hastanın karar vermeye yeterli ve gönüllü olmasını, bilginin açıklanmasını ve anlaşılır olmasını zorunlu kılmaktadır [2,3]. Bununla birlikte bilgilendirmenin hasta tarafından anlaşıldığından da sağlık profesyonelleri emin olmalıdır.…”