The birth of an ethics charter for pain medicine.

In Webster's New International Dictionary, Second Edition, 1953, " ethics " is defined as " the science of moral duty; more broadly the science of the ideal human character and the ideal ends of human action. " From a more pragmatic point of view, ethics in the medical world and, more specifically , in pain medicine, is, by and large, a road-map that allows us to keep practicing in the face of an increasingly complex—and often confusing and contradictory—environment without losing our way and ending in bedlam, jail, or forced retirement. Ethics has always been part of medicine. Through human history, morality has been an integral part of any medical decision. However, in the last 50 years, the field of medical ethics has been formally established and is now an essential part of the teaching and practice of medicine. Some sort of guidelines or laws for practicing morally acceptable medicine have existed for at least 4,000 years, through, for instance, the Code of Hammurabi in Babylonia (1727 b. c .), the Book of Toth in ancient Egypt, and, of course, the Hippo-cratic Oath (about 400 b. c .), which focused primarily on the perception of physicians' behavior. While the Hippocratic Oath survived until modern times as a principle of moral behavior in medicine, the Nuremberg military tribunal of World War II raised modern concerns about the ethical treatment of human subjects for research under Nazi Germany and led to the Nuremberg Code of 1947. This was followed by the initial Declaration of Helsinki (1964) from the World Medical Association , which has since been revised and updated several times. In the United States, the Belmont Report, published in 1978, was a major step in instituting medical ethics, setting forth the national policy on ethics in human-subject research. It was soon followed by a flurry of federal regulations, which have continued unabated. The multiplication of medical interventions associated with an explosion of new technologies in the second half of the twentieth century has created complex and sometimes puzzling clinical situations. This increasing complexity has served to solidify the need for medical ethics as a permanent part of modern medicine. As old references to traditional moral authority crumbled, medical ethics soon became indispensable in grappling with ethical issues in clinical practice. More recently, pain medicine asserted itself as a new specialty. Key ethical issues specific to this field were raised. Soon, the …