Introduction

No other profession is so influenced by ethics as medicine. Ethics has been an inherent part of medical practice since the ancient times of Hippocrates (480 B.C.). Hippocrates, the father of medicine, was the first to introduce the essential ethical principle of the physician-patient relationship: the physician must benefit and not harm the patient. Since then, medical ethics have determined physicians’ behavior during their professional lives. Medicine requires dedication to the patient as a person and the physician should be committed to the humanistic and ethical principles of medicine for the benefit of patients and society.

In recent years, the explosive development of biotechnology and computer science has tremendously influenced medicine and our subspecialty of gastroenterology. The modern gastroenterologist is not only a clinician but also an interventionist endoscopist, diagnosing, treating, and palliating a variety of diseases that afflict the gastrointestinal tract, the liver, and the pancreas. Every year we witness the emergence of new diagnostic and therapeutic endoscopic techniques. These require formal clinical evaluation followed by a learning period for gastroenterologists before application to daily clinical practice. In the industrialized world of the 21st century, social, political, legal, economical, cultural, and religious factors all influence our practice. Ethicolegal issues are aired by the mass media in a simplistic ”right” and ”wrong” fashion which creates a climate of controversy and can lead to conflict with ethical principles. It is a dangerous time for a physician to neglect fundamental ethical principles.

Europe is a continent with a long history of civilization, culture, and tradition in medicine. It includes many of the world’s leading medical societies. Despite this, there is a lack of harmonization of medical ethics among member countries, which probably reflects differences of ethnicity, economy, religion, and culture. It was for this reason that two of the leading gastrointestinal societies, the European Society of Gastrointestinal Endoscopy (ESGE) and the European Association of Gastroenterology and Endoscopy (EAGE), took the initiative of organizing the First European Symposium on Ethics in Gastroenterology and Digestive Endoscopy. This was held on Kos, the native island of Hippocrates, Greece, in June 2002. Representatives of European endoscopy societies and members of ESGE and EAGE participated, and contributed to a European ethical consensus.

The core programme included six workshops on ethical issues in gastroenterology and digestive endoscopy. The aim of each was to elaborate consensus statements on ethics which would be applicable to Europe. Eminent European gastroenterologists, surgeons, ethicists, and gastroentrologist associates prepared and presented their topics, which were extensively discussed and presented to the general assembly of the symposium for further discussion and voting.

The paucity of published data on ethical topics in gastroenterology was a major difficulty. It was therefore difficult to categorize statements according to levels of published evidence. Despite that, when statements were presented there was lively discussion followed by voting. The consensus ethical statements of the six workshops are published in this issue of Endoscopy.

We believe that the First European Symposium on Ethics in Gastroenterology and Digestive Endoscopy was a success. We thank all the contributors for their valuable input and the Bio-medical Industry (BMI) for generous funding. It is our hope that the consensus statements of the six workshops will help European gastroenterologists as they practice their profession, and renew their interest in medical ethics. We are looking forward to the Second European Symposium on Ethics in Gastroenterology and Digestive Endoscopy, which we hope to announce soon.

A. Axon (Leeds)
P. Malfertheiner (Magdeburg)
J. Devière (Brussels)
S. Ladas (Athens)