A Short History of Medical Ethics

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9780195134551: A Short History of Medical Ethics
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A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and the medical profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medical ethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian 7nd Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition.

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About the Author:

Albert Jonsen, Ph.D. is Professor Emeritus of Ethics in Medicine, School of Medicine, University of Washington.

From The New England Journal of Medicine:

Albert Jonsen, a distinguished theoretician and practitioner of bioethics, has written what is essentially a prehistory of the field. He begins with the Greek and Roman period (from the fifth century b.c.e. to the third century c.e.), moves on to medieval medicine, embarks on a quick tour of medical ethics in India and China, returns to European medical ethics, and then concludes with developments in America. For most of this 2500-year period, medical ethics consisted of physicians' defining the proper conduct for their profession. Jonsen classifies most of this conduct as decorum: demeanor such as politeness and respectfulness that was thought to reflect inner virtue. Other kinds of behavior advocated over the centuries included what Jonsen calls deontology: actions dictated by moral rules, such as refusal to take a life or perform an abortion. Occasionally, the discussions of moral conduct focused on what he calls "politic ethics," the relationship of physicians to the surrounding community, which determined, for example, whether a doctor should flee or stay with his patients during an epidemic of plague.

In the course of exploring the concepts of deontology, decorum, and politic ethics, Jonsen makes interesting observations that challenge prevailing assumptions about ethics. In his discussion of the Hippocratic corpus, he comments on the widely quoted injunction to "do no harm," which may have been a reaction to the tendency to subject patients to the rigors of medicine even though they had no chance of recovering. Jonsen argues that the exhortation against taking on desperate cases, far from endorsing the abandonment of dying patients, was in fact a judicious caution against futile therapy. Jonsen also observes that Eastern and Western cultures shared similar ethical precepts, in contrast to the modern view that medical ethics is culture-specific. At least in the long prehistory of bioethics, he suggests, there may have been a "universal moral atmosphere that surrounds the work of caring for the sick and pervades that work."

Despite its brevity, A Short History of Medical Ethics may be most useful as a reference work. It is full of pithy descriptions of pivotal works. Jonsen devotes several pages to the British physician, Thomas Percival, who introduced the term "medical ethics" in 1803. Percival wrote mainly about decorum but began to view the conduct of physicians in the broad context of the whole society. Jonsen also summarizes the views of the respected American physician Richard Cabot (1868-1939), who helped establish the discipline of medical social work and retooled himself as a moral philosopher. Jonsen sees Cabot's contribution to ethics as the recognition that the physician's primary moral duty was to master scientific medicine and to apply this knowledge to the care of patients.

A Short History of Medical Ethics is a scholarly prologue to the evolving world of contemporary bioethics. In the penultimate chapter, Jonsen takes the reader on a whirlwind tour of some of the seminal events that shaped the new discipline, among them the Nuremberg Tribunal of 1947, with its condemnation of experimentation without the consent of the subjects; the introduction of hemodialysis in 1960 and the adoption of "social worth criteria" for the allocation of resources by the Seattle Artificial Kidney Center; and in 1973, Roe v. Wade, the case in which the U.S. Supreme Court affirmed that the constitutional right to privacy prevents state laws from restricting the right of a woman to obtain an abortion during the first trimester of pregnancy. Today's bioethics is enriched by a conceptual framework that goes beyond decorum and deontology and that takes the patient's perspective as its starting point. Modern bioethics reformulates the fundamental moral problem as a problem for society, rather than merely one of professional self-regulation. I would add to Jonsen's list of the ways in which today's bioethics has transcended its predecessors the use of empirical data to help answer questions. The old question of whether patients should be told the truth about their conditions, for instance, can be answered in part by studying the types of information patients want and by examining the consequences of their having information. Not surprisingly, A Short History of Medical Ethics is at least as useful for what it tells us about earlier societies as it is for what it tells us about bioethics.

Muriel R. Gillick, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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