The Importance of Besim Omer (Akalin)'s 1906 Article "Doktorlar Ve Avukatlar" (Doctors and Advocates) from the Point of View of the Principles of Medical Ethics

- Prof. Dr. Aysegul Demirhan Erdemir
Uludag University, Faculty of Medicine, Director of Department of Medical Ethics and History of Medicine, Bursa, Turkey.
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Email: ademirer@yahoo.com

Eubios Journal of Asian and International Bioethics 14 (2004), 134-5.


The most important principles of the medical ethics are beneficence, non-maleficence, informed consent, autonomy, justice. We know we can add some principles such as privacy, confidentiality, fidelity, veracity to them. A physician should behave according to these principles while they treat their patient. These principles were also moral virtues of a physician in the past, and their importance has been pointed out in books on medical ethics. Some famous past Turkish physicians also stressed these subjects in their books and we see the importance of the principles of medical ethics in an article by Prof. Dr. Besim Omer Akalõn Pasha called Doktorlar ve Avukatlar (Doctors and Advocates in English) published in 1906. This article is 6 pages long, and I present some points here.
Dr. Akalõn (1863-1940) is a famous Turkish physician. He was born in Istanbul in 1863. He graduated from the school of military medicine in Istanbul in 1885. He went to France for obstetrics specialty. Dr. Akalõn became the director of an obstetrics clinic and midwivery school. After 1909, he continued to the same duty in Haydarpasha medical school. He retired after 1933 University reform and opened the examining room. Dr. Besim Omer Pasha, who was the founder of modern obstetrics and pediatrics in Turkey, wrote 61 books (14). Moreover, he helped the development of some societies on health. He was known as a popular author of health topics. Dr.Akalõn also became the founder president of the Turkish Society on History of Medicine (15).
"Afiyet" means Small or Fresh Articles about Health. He wrote encyclopedic books of 4 volumes called Nevsali Afiyet. The moral virtues of a physician are written in this article. Dr. Akalõn stresses that physicianship is the most sacred profession. According to this famous author, some ethical principles such as beneficence, nonmaleficence, justice, veracity are very important from the point of view of medical ethics. Moreover, the physician is a self-sacrificing person for their patients. This is his (her) most important characteristic. A self-sacrificing physician always thinks to be beneficial for his (her) patient. The term beneficence connotes acts of mercy, kindness and charity. Sometimes, altruism, love and humanity are also known forms of beneficence. Namely, beneficence means an action done for the benefit of others. If a physician takes notice to other ethical rules, we can see him as a self-sacrificing person. Moreover, according to Besim …mer Pasha, the physician at the scene of an accident is obligated to do more than the advocate or student to aid the injured in accordance with the need for the skills of the medical profession. We can also see this condition in the physician's medical acts. Dr. Akalõn also pointed out the medical act of a physician. We can mention the ethical rules about the medical act. We know that the medical act is present in the responsibility of a doctor, also today.
The Medical Act is formed as a result of the practice of a doctor on his patients. Therefore, some practices should be proper to ethical rules from the point of view of medical responsibility. Dr.Akalõn also stresses these rules in his article. According to Akalõn, physicians should be more conscientious than other professionals in medical practice. That is, while he is performing his profession, a physician acts according to their conscience and opinion. Moreover, the physician pays attention to the medical rules from the point of view of the medical act. Two behaviours of the physician are necessary:
1) A physician doesn't avoid medical intervention for his patient. If he avoids the medical intervention because of his negligence and inexperience in medical practice, he is responsible from the point of view of the medical act. So, he behaves according to the principle of beneficence.
2) A physician doesn't not have behaviour with intention in the medical practices. Because, these kinds of practices are made with the aim of benefit and they are contrary to ethical rules such as nonmaleficence, beneficence etc.
The physician's responsibility to his patients has the highest priority. When we assume responsibility for the health of our patients, all other responsibilities should be placed in the background. First of all we should see the patient as a person. We should take into consideration his fears, anxieties, goals, responsibilities and his socio-economic position. Dr. Akalõn stresses all the conditions in his article. Akalõn also stressed the duties of a physician in his article. These duties are also known in the medical ethics of today, including:
"The physician treats each patient respectfully and equally, no matter what their social status, wealth, age, sex, religion, political beliefs etc.
Moreover, the physician takes into consideration the psychological position of his patient. The physician has psychological knowledge about his patient.
Furthermore, he tries to charge from his patients as little as possible. Thus, he should write cheaper but equally effective drugs for his poor patients.
So, a physician behaves according to the principle of nonmaleficence.
He tries to talk to the patient in a simple, clear and concise language. So, his patient can decide about his disease .This is the principle of autonomy. He should avoid unnecessary pessimism or optimism about clinical diagnosis. Thus, a physician should give necessary care to his patient. Even he can not save the patient's life, at least, the physician could try to decrease or stop the patient's pain and misery. Moreover, a physician should give hope to his patient. If he believes that bad news about the prognosis of the disease does not worsen his patient's condition, he should tell the truth openly diagnosis in order to take proper precautions for the patient."
However, all these characteristics of a physician are his ideal properties. Physicians are expected to put their patients' interests before their own. According to Akalõn, physicians often damaged their own health by treating victims and other infections patients. But, we can not see this understanding in the other professions. For example, Dr. Akalõn compares physicians with advocates. According to Akalõn, when advocates get advocacy fee from their clients, they can sue. But, physicians can also treat their patients without fee. Especially, many physicians don't get a visitation fee from poor patients. Physicians try to treat their patients in every condition. Because, health is a very valuable thing. But, advocates don't show an excess self-sacrifice for their clients. According to Besim …mer, many students choose the faculty of law instead of the faculty of medicine because of the difficulties in medicine. Advocate-ship also is necessary for humanity. Physician-ship is interested in human health and health also is the most important thing for human life. So, Dr. Akalõn stresses all these characteristics of physicians in his article and shows the differentiations between physicians and advocates. Physicians are also known as self-sacrificing persons for their patients, today.
As a result, we can say that the profession of medicine is a difficult branch and the physicians are self-sacrificing persons for their patients.

References
1. Akalõn,Besim …mer.:Doktorlar ve Avukatlar(Physicians and Advocates),Nevsali Afiyet Afiyet(Cilt.4) , Mtbaaai Ahmed _hsan, Istanbul H.1322/M.1906,s.102-106.
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13.Demirhan,E.A.: Klinik Uygulamalarda Hekim-Hasta _li_kileri(The Relations of Patient and Physician in the Clinical Practices) Klinik Etik(Ed: Demirhan Erdemir,Oguz, Elioglu, Do_an) ,Nobel Tõp Kitabevleri,Ist.2001,s.65-85.
14.Kazancõgil,A.:…lŸmŸnŸn 40.Yõlõnda Besim …mer Pa_a(1863-1940)(Besim Omer Pasha), Dirim Derg 55:237-247(1980).
15.Demirhan,E.A.: Prof.Dr.Besim …mer Akalõn 'õn TŸtŸn Adlõ Eserinin TŸrk Tõp Tarihi Aõsõndan …nemi ve Bazõ Sonular(Besim Omer Pasha ,his book ,Tobacco and History of Medicine),TŸrk DŸnyasõ Ara_tõrmalarõ Derg 103:45-52(1996).

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