Revisiting the evolution of the Hippocratic Oath in obstetrics and gynecology

Hippocrates, an influential figure in ancient Greek medicine, is best known for his lasting contribution, the Hippocratic Oath, which includes a significant message about obstetrics and gynecology. Given the Oath's status as a widely regarded ethical code for medical practice, it requires critical evaluation. The message of the Oath, as it related to obstetrics and gynecology, is expressed in ancient Greek by the phrase "οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω" which translates directly to "I will not give to any woman a harming pessary." The words fetus and abortion were not present in the original Greek text of the Oath. Yet, this message of the Hippocratic Oath has been interpreted often as a prohibition against abortion. In this article, we present a critical linguistic and historical analysis and argue against the notion that the Hippocratic Oath was prohibiting abortion. We provide evidence that the words "foetum" (fetus) and "abortu" (abortion) were inserted in the Latin translations of the Oath, which then carried on in subsequent English versions. The addition of the words "fetus" and "abortion" in the Latin translations significantly altered the Oath's original meaning. Unfortunately, these alterations in the translation of the Hippocratic Oath have been accepted over the years because of cultural, religious, and social reasons. We assert that because the original Hippocratic Oath did not contain language related to abortion, it should not be construed as prohibiting it. The interpretation of the Oath should be based on precise and rigorous translation and speculative interpretations should be avoided.

A Catholic Perspective on COVID-19

It took nearly two thousand years for society to recognize the Hippocratic insistence that "the doctor knows best"1 was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.2.

Social media use and paediatric practice: Hippocratic help, hype or harm?

Social media is increasingly a part of our personal and professional life and is here to stay. Here, I reflect on issues surrounding the use of social media (SMU) in the digital health context by clinicians in Australian paediatric health care. I aim to briefly highlight some inherent multifactorial and contextual ethical considerations which mainly relate to professionalism; including boundaries, obligations to patients and families within the therapeutic alliance, and balancing the help, hype and harm of SMU in clinical practice. I conclude that digital health and SMU are ubiquitous, and can be beneficial if used circumspectly with Hippocratic principles that have been updated for the modern era and are grounded in ancient moral codes. Unfettered SMU however, without adherence to ethical and legal guidelines is problematic, and may expose patients, families and clinicians to significant risk of harm and moral vulnerability. Justifiable, explicit, consistent and regularly reviewed boundaries, both professional and personal, are ethically advisable. These should reflect, and adapt to, the rapidly evolving nature of social media as imprudent digital health and SMU without proportionate limits, may undermine still relevant Hippocratic tenets, and the primacy of doing no harm.

On My Oath

Most osteopathic medical students will take an oath adopted in 1954 by the American Osteopathic Association. We examine this oath to explore its ethical content by focusing on two specific lines. We conclude that the oath would benefit from scrupulous revision to promote patient-centered care.

Advocating for neurodata privacy and neurotechnology regulation

The ability to record and alter brain activity by using implantable and nonimplantable neural devices, while poised to have significant scientific and clinical benefits, also raises complex ethical concerns. In this Perspective, we raise awareness of the ability of artificial intelligence algorithms and data-aggregation tools to decode and analyze data containing highly sensitive information, jeopardizing personal neuroprivacy. Voids in existing regulatory frameworks, in fact, allow unrestricted decoding and commerce of neurodata. We advocate for the implementation of proposed ethical and human rights guidelines, alongside technical options such as data encryption, differential privacy and federated learning to ensure the protection of neurodata privacy. We further encourage regulatory bodies to consider taking a position of responsibility by categorizing all brain-derived data as sensitive health data and apply existing medical regulations to all data gathered via pre-registered neural devices. Lastly, we propose that a technocratic oath may instill a deontology for neurotechnology practitioners akin to what the Hippocratic oath represents in medicine. A conscientious societal position that thoroughly rejects the misuse of neurodata would provide the moral compass for the future development of the neurotechnology field.

On the Heart of the Hippocratic Corpus: its meaning, context and purpose

Though the Hippocratic text On the Heart has garnered significant attention in the twentieth and twenty-first centuries from classicists, physicians and historians of medicine alike, no commentary on this important work currently exists. There remain, however, central questions of interpretation concerning a number of important points: in particular, how the author understands the structure and functioning of the heart.The significance of this text for the history of cardiovascular medicine can be found first in its position as being radically advanced in its portrayal of the inner structure of the heart when compared with any other Hippocratic text. At the same time, the text falls dramatically short of the discoveries of the Alexandrian researchers who studied during the Hellenistic period-that is, around the same period as this text's likely composition. In addition, this work contains the first extant description of the valves of the heart, and its detailed descriptions of a cuspid valve and the chordae tendineae have led several scholars to imagine that this text even contains evidence of either a systematic dissection of an animal heart or-what seems impossible outside of Alexandria, Egypt at that time-evidence of the dissection of a human heart.This article intends to provide a full commentary on the text by consolidating, and in some cases correcting, previous interpretive attempts to understand an often referenced, and at times misinterpreted, ancient medical treatise.

The ethical dilemmas of risky decisions

Even in a pandemic there seem to be inherent conflicts of interest between the individual and societal consequences of remedial actions and strategies. Actions taken in the sole interests of patients, as required by the Hippocratic oath, can have broadly inconvenient economic implications for the State. ("Average" benefits for a population can impose individual inconveniences for the vulnerable.). Understandably these decisions are not normally made explicitly and transparently by governments. This leads to seemingly illogical and inhumane strategies which are not understood and hence mistrusted and often ignored by the public. Vaccination sentiments on social media are often an unwanted symptom of this dilemma. This article outlines and discusses a number of examples of such situations with a focus on ethical aspects. It concludes that each case must be considered individually as to the issues that need to be weighed in these difficult decisions; and that there are no clear and universally acceptable ethical solutions. What can be learned from the COVID-19 crisis is that short term utilitarianism has consequences that in the eyes of the population are unacceptable. This lesson seems equally valid for cost benefit evaluations regarding other risks, such as from hazardous industries, flood defenses, and air transport. Decisionmakers and politicians can learn that persuasion only goes so far. In the end the people appear to prioritize in terms of deontology.

Knowledge, Attitude and Practice of Medical Ethics among Doctors and Nurses in Pokhara Valley, Nepal

Background Medical ethics is defined as the ethical obligations of medical professionals towards their patients, colleagues, and society. The inadequacy and non-uniformity of this topic has been associated with rising cases of professional misconduct and medical negligence all over the world. Objective To assess and compare the status of knowledge, attitude and practice of medical ethics among medical doctors and nurses in three major hospitals of Pokhara valley. Method This was a cross-sectional study conducted from 15th Mar 2018 to 13th Apr 2018; in which 124 doctors and 103 nurses were asked to fill up medical ethics related questionnaire. The data was entered in SPSS file and the association of variables was determined by Chi-square and statistical significance was considered if the p-value < 0.05. Result The study showed that 56.5%, 8.1%, and 13.7% of doctors were aware of the Hippocratic oath, Nuremberg Code, and Helsinki declaration respectively compared to only 1% of nurses. There was a significant difference in opinions on various questions related to medical ethics with p-value < 0.05 in 12 out of 22 questions. Only a few (12.1% doctors vs. 25.2% nurses) stood in support of the physicianassisted dying. Conclusion The study showed that there was inadequate as well as a non-uniform level of knowledge of three major codes of medical ethics and principles related to it which resulted in significant disparity in the attitude and practice of medical ethics among doctors and nurses in Pokhara valley.

A Hippocratic Oath for Mathematicians? Mapping the Landscape of Ethics in Mathematics

While the consequences of mathematically-based software, algorithms and strategies have become ever wider and better appreciated, ethical reflection on mathematics has remained primitive. We review the somewhat disconnected suggestions of commentators in recent decades with a view to piecing together a coherent approach to ethics in mathematics. Calls for a Hippocratic Oath for mathematicians are examined and it is concluded that while lessons can be learned from the medical profession, the relation of mathematicians to those affected by their work is significantly different. There is something to be learned also from the codes of conduct of cognate but professionalised quantitative disciplines such as engineering and accountancy, as well as from legal principles bearing on professional work. We conclude with recommendations that professional societies in mathematics should sponsor an (international) code of ethics, institutional mission statements for mathematicians and syllabuses of ethics courses for incorporation into mathematics degrees.

Soft Skills Are Hard Skills—A Historical Perspective

The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today’s physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called “soft skills”, whose acquisition is presented in literature as a quite recent addition to medical studies. Moreover, the historical investigation of deontological texts dating from the mid-nineteenth century back to the Hippocratic Oath shows that medicine has always discussed the need to integrate technical expertise in medicine with specific personal and relationship-based skills. Debates have often circled around whether these “soft skills” could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body.

A Revised Hippocratic Oath for The Era of Digital Health (Preprint)

Physicians have been taking the Hippocratic Oath for centuries. The Oath contains a set of ethical rules designed to guide physicians through their profession; it articulates a set of true north principles that govern the practice of medicine. The Hippocratic Oath has undergone several revisions, most notably in 1948 by the World Medical Association. However, in an era of rapid change in medicine, we believe it is time to update the Oath with modest but meaningful additions so that it optimally reflects 21st century health care. The rise of digital health has dramatically changed the practice of medicine in a way that could not have been easily predicted at the time Hippocrates outlined his ethical principles of medicine. Digital health is a broad term that encompasses use of digital devices and platforms, including electronic health records, patient-provider portals, mobile health apps, wearable biosensors, artificial intelligence, social media platforms, and medical extended reality, to improve the process and outcomes of health care delivery. These technologies have driven a cultural transformation in the delivery of care. We offer modest suggestions to help prompt discussion and contemplation about the current Oath and its relevancy to our changing times. Our suggestions are not meant to be a definitive set of final recommendations. Rather, we propose new text that bodies such as the World Medical Association might consider integrating into an updated Oath, just as previous changes were adopted to ensure the Oath remains relevant and impactful for all physicians and their patients.

[Spirituality and care in the Muslim tradition]

Spirituality in health care in the sense of the Muslim tradition requires inspiration from The Medicine of the Prophet, written by Jalâl ad-Din as-Suyûtî in the 15th century. A work in line with the principles of the Hippocratic oath. It consists in restoring, preserving or promoting health in all its elements, physical and mental, individual and social.

Hippocratic Oath and current medical oaths

The so-called Hippocratic Oath is based on a standardized form of oath in the ancient world and is undoubtedly the most famous, most discussed and most commented part of the Corpus Hippocraticum, collection of medical writings whose authorship is traditionally attributed to the legendary physician Hippocrates. The study will first introduce the nature of this brief text and the various theories about the origins of the Oath, as well as the evidence for its earliest use. The second part of the study focuses on the history of medical oaths in Czechoslovakia since 1918, especially on the changes in the text of the oaths after 1948 (mainly on the basis of so far unpublished documents from the archives), and presents the form of current medical oaths in the Czech Republic, with reference to the formulations of the Hippocratic Oath itself; an overview table lists both the Czech and Latin versions of the current medical oaths.

The Hippocratic Oath: Analysis and Contemporary Meaning

The Hippocratic oath is traditionally taken by medical school graduates at the time of their graduation, either in its original form or in a modern variation. It is considered the earliest expression of medical ethics, establishing principles of ethics that remain of paramount significance today. However, it was written in antiquity, whereas medicine has been constantly evolving. This article reviews, analyzes, and interprets each section of the oath to determine to what extent it remains relevant to contemporary medicine. [Orthopedics. 2021;44(5):264-272.].

Does COVID-19 Vaccination Warrant the Classical Principle "ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic.

Principles of Hippocratic Medicine from the Perspective of Modern Medicine

In this paper authors described some of the principles and theses of Hippocratic medicine. They emphasized that regardless existing controversial opinions as to whether Hippocrates stated some theses or not, and controversial views on some of his principles, he is often called the "father" of medicine, who laid the foundations in medicine as a science. Hippocrates gave recommendations on the doctor's behavior towards the patient, which is relevant up today. His holistic approach to medicine is becoming more and more relevant in the modern medicine. The application of the Hippocratic Oath today depends on the legislation of individual states, related to how legal solutions in some states are pro or contra to it. Authors opened and discussed his attitudes that mental illnesses are a sign of a diseased brain, his consideration the food as medicine and that the disease came from the intestines. Also issue of prognosis of the disease was opened and discussed as well as and Hippocrates's consideration of work and physical activity as the most appropriate medicine. Furthermore, authors considered importance of Hippocratic medicine related to Creative psychopharmacotherapy based on therapeutic communication and the creative satisfaction of needs in the therapeutic relationship with patients and in the recovery itself. Finally, an example of creatively use of the principle of Hippocratic medicine: "work as the most appropriate medicine" in therapeutic communication with patients through an ecological approach called "Ecopsychiatry", under the slogan presented in the media to the general public: "Cleansing nature improves your mental health" was described.

Against Scientism: Corrupted Science and the Fight for Medicine's Soul

This article maintains that via the current form of evidence-based medicine, scientism (a pseudo-religious belief in science that is itself not scientific) has been allowed to encroach into medicine. By setting out the philosophical limits of what it is science can do, the effects of this encroachment are discussed in terms of upsetting the balance between the necessarily conflicting art AND science of medicine. In this context, one effect of the Covid-19 pandemic might be to act as a timely reminder - as if it was needed - of the importance of the Hippocratic Oath, which is and always has been the soul of medicine.

[If help with suicide knocks on the door of medicine.]

Most codes of ethics states that physician-assisted suicide is prohibited, mainly because it is "fundamentally incompatible with the physician's role as healer". It would also be difficult to control, and would pose serious societal risks. Physician-assisted suicide is contrary to the Hippocratic Oath, when it states that no doctors will give deadly medicine to anyone if asked, nor will suggest any such counsel. The push towards a change of legislation, in a permissive sense, and some acquittal judgments have led the top of professional orders to decide that, under certain conditions, disciplinary sanctions should not be imposed on doctors who facilitate a patient's death (6th February 2020). This scenario poses a challenge to the medical profession. The request for death must be evaluated in the framework of a "shared planning of care".

Hippocratic Oath and Heart Failure Journey: An Update on Therapies

The innovation that has taken place in medicine, combined with state-of-the-art technological developments, provides therapeutic options for patients in conditions that were previously considered incurable. This promotion at the same time presents us with new ethical challenges. In this article, we review the journey through life of an advanced heart failure patient, covering a variety of potential clinical and ethics subjects in the field of heart failure treatment. We review the ethical principles of the Hippocratic Oath against the background of the realities of practicing medicine and of the enormous advances in therapeutics.

The Hippocratic Oath and the Declaration of Geneva: legitimisation attempts of professional conduct

The Hippocratic Oath and the Declaration of Geneva of the World Medical Association are compared in terms of content and origin. Their relevance for current medical practice is investigated. The status which is ascribed to these documents will be shown and the status which they can reasonably claim to have will be explored. Arguments in favor of the Hippocratic Oath that rely on historical stability or historical origin are being examined. It is demonstrated that they get caught up in paradoxes. Should doctors swear the Hippocratic Oath or the Declaration of Geneva? The Hippocratic Oath is a remarkable historic document, which contains important elements still relevant for medical ethics today. Its interpretation as a timeless, still valid medical code is unfounded. The historical arguments, that should justify its validity, are untenable. The Declaration of Geneva, and not the Hippocratic Oath, can legitimately claim to come close to representing the most important principles of professional medical conduct in today's globalised world.

Enduring Oaths

In this image, 3 figures-Hippocrates, a plague doctor, and a modern physician-represent continuity of ethical standards in ancient, medieval, and contemporary medical communities.

Oath Taking at U.S. and Canadian Medical School Ceremonies: Historical Perspectives, Current Practices, and Future Considerations

The widespread use of oaths at medical commencements is a recent phenomenon of the late 20th century. While many are referred to as "Hippocratic," surveys have found that most oaths are modern, and the use of unique oaths has been rising. Oaths taken upon entry to medical school are even more recent, and their content has not been reported. The authors surveyed all Association of American Medical Colleges-member schools in the United States and Canada in 2015 and analyzed oath texts. Of 111 (70.2%) responses, full texts were submitted for 80 commencement and 72 white coat oaths. Previous studies have shown that while oaths before World War II were commonly variations on the original Hippocratic text and subsequently more often variations on the Geneva or Lasagna oath, now more than half of commencement ceremonies use an oath unique to that school or written by that class. With a wider range of oath texts, content elements are less uniformly shared, so that only three elements (respecting confidentiality, avoiding harm, and upholding the profession's integrity) are present in as many as 80% of oaths. There is less uniformity in the content of oaths upon entry to medical school. Consistently all of these oaths represent the relationship between individual physicians and individual patients, and only a minority express obligations to teach, advocate, prevent disease, or advance knowledge. They do not reflect obligations to ensure that systems operate safely, for example. None of the obligations in these oaths are unique to physicians.

Context, culture and beyond: medical oaths in a globalising world

The authors argue oath taking to be an expression of context specific social processes and that seemingly universal concepts might be conceived variably.

Medical oath: use and relevance of the Declaration of Geneva. A survey of member organizations of the World Medical Association (WMA)

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association (WMA) in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations (NMA): The Declaration of Geneva is only rarely used as an oath text despite the fact that physicians' oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva.

The Use and Relevance of the Hippocratic Oath in 2015-a Survey of US Medical Schools

INTRODUCTION

We determined the extent and context in which the Hippocratic or other oaths are administered at accredited medical schools in the United States.

METHODS

An online survey was used to gather data about oath ceremonies at every allopathic medical school in the US.

RESULTS

Sixty-seven of 141 contacted medical schools (48%) had medical students recite an oath. Fifty-nine (88% of responding institutions) had students swear an oath more than once during medical training and 30 (45%) used more than one oath. Responses show that 29 (43%) schools used the classic Hippocratic Oath or a modified version of it, 29 (43%) used oaths authored by students and/or faculty, and 28 (42%) used some other oath. All reporting institutions (67, 100%) incorporated an oath into a White Coat Ceremony (62, 92%), a ceremonial event where medical students are given short white coats to be worn during clinical rotations, or Commencement (62, 93%).

DISCUSSION

Oaths play a significant role in medical school ceremonies with an unknown impact on shaping the medical ethics of student physicians. Although sections of the Hippocratic Oath may seem outdated, its principles remain vastly applicable to the ethical practice of modern medicine. On the contrary, we argue that many features of the oath are more applicable than ever before to the modern clinician. We believe that the Hippocratic Oath ought to remain a vital part of today's medical education and clinical practice.

American Doctors at the Nuremberg Medical Trial

Three Hippocratic physicians played critical roles in the prosecution of 23 Nazi doctors charged with murder and torture for conducting lethal medical experiments on concentration camp prisoners. Two of the physicians, Leopold Alexander and Andrew C. Ivy, were Americans, and the other, Werner Leibbrandt, was German. At the 70th anniversary of the Doctors' Trial it is fitting to recall the three's influences and contributions to the formulation of strict research ethics rules, known as the Nuremberg Code. Their contributions help us better understand why they insisted on strict research rules and yet ultimately were unable to apply these rules to their own research. Exploring their contributions at Nuremberg may help us appreciate the continuing difficulty physician-researchers have with accepting public regulation of research.

Aspetti deontologici e giuridici della Responsabilità professionale del chirurgo in Italia. Evoluzione storica a partire dal '900

È pleonastico ricordare che ogni individuo raziocinante delle essere responsabile delle sue azioni: deve agire con la coscienza degli scopi che si propone evitando possibili conseguenze negative dei suoi atti. In ambito medico questo tipo di responsabilità è codificata con le norme della "deontologia". Per secoli l'arte terapeutica è stata praticata da individui dotati di una particolare vocazione ed una particolare cultura acquisita da Maestri dell'arte ancor prima che dalla propria esperienza, con nozioni di erboristeria e di elementari conoscenze anatomiche e di fisiologia, circondati da un'aura sacerdotale e da un rispetto derivante dal timore e dall'ammirazione per il coraggio e auspicabilmente dai successi, e facendo riferimento nell'occidente mediterraneo alle regole operative fissate nel Giuramento di Ippocrate, di significato tra il sacro ed il deontologico. Lo sviluppo delle tecniche anestesiologiche a partire dalla seconda metà dell'800 ha determinato l'ampliamento delle iniziative chirurgiche di tipo elettivo, a fianco con gli storici interventi in emergenza per la cura di lesioni traumatiche, ancor prima delle acquisizioni riguardanti le infezioni. Con l'espansione del campo di azione della chirurgia, le possibili complicanze ed i possibili insuccessi hanno fatto da contrappeso ai sentimenti di rispetto e di fiducia nei confronti dei chirurghi, giungendo a far assimilare in tali casi la loro opera quale causa all'origine di danni, provocati rientrando quindi nella categoria dei reati sottoposti alla Legge penale. Così, al termine deontologico di "responsabilità" valido per ogni iniziativa ed ogni professione, per i medici è venuto ad associarsi la qualifica di "professionale", con un significato di presunta colpevolezza. Da una parte le regole deontologiche si sono ampliate, ed hanno coinvolto direttamente il paziente nella fase decisionale delle terapie chirurgiche, formalizzate programmaticamente in moderni codici deontologici ed operativamente nel documento del "consenso informato". Per altro verso le leggi innovative del Codice Civile definito nel 1942, che al posto delle pene del codice penale introduceva il criterio della risarcibilità economica del danno in caso di riconosciuta "responsabilità professionale", ha determinato il coinvolgimento di altre figura professionali, e cioè di avvocati e di medici legali, oltre che delle organizzazioni assicurative, con detrimento alla serenità nell'espletamento delle professioni sanitarie e con l'insorgenza per reazione della cosidetta "medicina difensiva". La concretezza di queste problematiche hanno richiesto l'interessamento attivo della Giurisprudenza con una serie di sentenze, ed una formulazione di decreti e nuove leggi parlamentari, ancora in pieno assestamento nel corso del 2017, lasciano in qualche modo ancora irrisolti alcuni nodi.

[Communicate Medical Errors or Hide Them? In Relation to the Henry Marsh's Memoirs]

″Do no harm″ is the work of Henry Marsh, an English neurosurgeon who, in the epilogue of his professional career at the National Health Service, remembers not only his professional successes but also his failures. This is the starting point to propose a system of notification of medical errors in Spain that allows to comply with the hippocratic key principle that gives title to the book: ″primum non nocere″. With this objective, our proposal is, in first place, to analyze the extent to which there is a conflict of loyalties in the professional performance of any doctor (institution vs. patient) that conditions the possibility of communicating the errors that may occur, concluding that there are normative counterweights to comply with this principle: to inform the patient respecting other rights in conflict. The balance between the right to be informed and the right to defend oneself against further actions of responsibility has the faithful of that imaginary balance in the canonical idea that to learn from error the starting point is to recognize it, and the second to analyze why it occurred. Only from learning can the error be avoided and, thus, improved the quality of care assistance. In our analysis of the Spanish system of adverse effects communication (SiNASP), we conclude that it does not meet the standards we set ourselves, and not only from an ethical and legal analysis, but also taking as reference the systems with the same Objective in our European environment - including the references of treaties and international agreements in this area. The final conclusion to which we arrive as the culmination of all the previous reflection is that for a system of communication of errors to actually function, it has to be obligatory and anonymous for the informant, transparent and conclusive for the informed and, above all, reflexive and didactic for the institution, so that it fulfils with the duty to inform and it also avoids that the error is repeated.

Duty of care has never been more relevant

The recent attack on Westminster Bridge in London sparked an immediate response from the emergency services who tried to save the lives of the many people who had been mowed down by a single perpetrator. The emergency teams should be commended for their work during such an extreme and difficult situation.