Before Bioethics: A History of American Medical Ethics from the Colonial Period to the Bioethics Revolution

489 Pages·2013·2.94 MB·English

by  Robert Baker

BEFORE BIOETHICS
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B E F OR E B IOE T H IC S
A H I ST O RY O F A M E R IC A N
M E D IC A L E T H IC S F R OM T H E
C O L O N IA L P E R IO D T O T H E
B IO E T H IC S R EVO LU T IO N
ROBERT BAKER
1
3

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Library of Congress Cataloging-in-Publication Data
Baker, Robert, 1937– author
Before bioethics : a history of American medical ethics from the
colonial period to the bioethics revolution/Robert Baker.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–977411–1 (hardcover : alk. paper)
I. Title.
[DNLM: 1. Ethics, Medical—history—United States. 2. History, 18th Century—United States.
3. History, 19th Century—United States. 4. History, 20th Century—United States. W 50]
174.2—dc23
2013001404
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
To my wife
Arlene
Without her patience and support, this project
would never have been completed.
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TABLE OF CONTENTS
Preface i x
ONE Introduction: On Medicine, Ethics, and Morality 1
T WO Midwives’ Oaths of Fidelity and Diligence 19
THREE Th e Medical Ethics of Gentlemanly Honor 36
FOUR Th e Lecturers: Samuel Bard and Benjamin Rush 62
FIVE Oaths and Codes of Medical Police and Ethics, 1806–1846 94
SIX A National Code of Medical Ethics 131
SEVEN Professional Medical Ethics, 1848–1875: Abortion, Inquisition,
and Exclusion 168
EIGHT Th e Anti-Code Revolt: Laissez-Faire Medical
Ethics, 1876–1979 199
NINE American Research Ethics, 1800–1946 232
TEN Explaining the Birth of Bioethics, 1947–1999 274
Notes 319
Bibliography 383
Index 431
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PREFACE
History is philosophy teaching by examples.
Attributed to Th ucydides (c. 460–400 bce )
Prefaces are places where authors directly address their readers to explain why
they wrote the book that follows, to justify the author’s presumption in asking
readers to spend time reading the book, and to thank those who helped in the
writing of the book. Th is book began decades ago as a very diff erent project. A
joint NEH-NSF program, Ethics and Values in Science and Technology (EVIST),
awarded me a grant to explore the moral methodologies of intensive care units
(ICUs). At the time, I thought that emerging medical technologies in ICUs created
what the philosopher Ludwig Wittgenstein characterized as “a form of life.” My
theory was that a novel technology-driven ethics had been created to suit a special
form of moral life arising from ICU technology. So I spent eighteen months living
in ICUs, interviewing clinicians, patients, and families, attempting to discern the
evolution of moral notions and decision-making methodologies integral in the
form of life evolving around critical care technologies.
Few things are more disheartening to the life of the mind than having a recal-
citrant fact undermine a favored theory. I came across such a fact in a 1794 book,
Medical Jurisprudence, by British physician Th omas Percival. On page aft er page,
Percival described the same decision-making process that I thought had evolved
in twentieth-century ICUs. Evidently, ICU clinicians had not created a new form
of life; they were adopting older forms to novel circumstances. Reviewing my data,
it appeared that ICUs had experimented with a variety of approaches in coping
with how and whether to discontinue apparently futile life support and that the
real issue was how some particular approach came to be valorized and legitimated
as morally appropriate—and, as I argue in this book, that is something that occurs
outside of critical care units.
So I discarded the fi rst version of this book, returned to teaching philoso-
phy, to launching a hybrid online/onsite graduate program that made graduate
training in clinical ethics consultation and research ethics accessible for working