Doctors and ethics : the earlier historical setting of professional ethics

311 Pages·1993·27.159 MB·English

by  Andrew Wear, Johanna Geyer-Kordesch, Roger French

DOCTORS AND ETHICS:
THE EARLIER HISTORICAL SETTING
OF PROFESSIONAL ETHICS
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THE WELLCOME INSTITUTE SERIES
IN THE HISTORY OF MEDICINE
Forthcoming Tides
French Medical Culture in the Nineteenth Century
Edited by A. La Berge and M. Feingold
The History of Health and the Modern State
Edited by Dorothy Porter
The History of Medical Education in Britain
Edited by V. Nutton and Roy Porter
Medicine in the Enlightenment
Edited by Roy Porter
Academic inquiries regarding the series should be addressed to
the editors W. F. Bynum and Roy Porter at the
Wellcome Institute for the History of Medicine,
183 Euston Road, London NWl 2BE, UK
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DOCTORS AND ETHICS:
THE EARLIER HISTORICAL SETTING
OF PROFESSIONAL ETHICS
Edited by
Andrew 'Wear, johanna Geyer-Kordesch and Roger French
Amsterdam- Atlanta, GA 1993
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First published in 1993
by Editions Rodopi B. V., Amsterdam-Atlanta, GA 1993.
© 1993 A. Wear, J. Geyer-Kordesch and R. French
Design and Typesetting Christine Lavery, the Wellcome Trust.
Printed and bound in the Netherlands by Editions Rodopi B. V.,
Amsterdam - Atlanta, GA 1993.
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by an electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the
Wellcome Institute for the History of Medicine.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 90-5183-553-1
CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG
Doctors
Doctors and Ethics: The Earlier Historical Setting of Professional
Ethics -Amsterdam - Atlanta, GA Rodopi. - ill.
(Clio Medica 24/The Wellcome Institute Series in the
History of Medicine)
Front cover: Physicians attending a patient.
Woodcut from Pliny, Aureum opus et sublime, Pavia 1516.
Wellcome Institute Library, London
Met index lit. opg.
ISBN 90-5183-553-1 geb.
Trefw.: geneeskunde; geschiedenis/gezondheidszorg;
ethiek: geschiedenis.
©Editions Rodopi B. V. Amsterdam-Atlanta, GA 1993
Printed in The Netherlands
IV
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Contents
Acknowledgements VI
Notes on Contributors Vll
Introduction
1. Beyond the Hippocratic Oath
Vivian Nutton 10
2. Medical Ethics in Transition in the Latin Medicine of the
Thirteenth and Fourteenth Centuries: New Perspectives on
the Physician-Patient Relationship and the Doctor's Fee
Luis Garda-Ballester 38
3. The Medical Ethics of Gabriele de Zerbi
Roger French 72
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Medical Ethics in Early Modern England
Andrew Wear 98
5. Conflicting Duties: Plague and the Obligations of Early
Modern Physicians Towards Patients and Commonwealth
in England and The Netherlands
Ole Peter Grell 131
6. Ethics in the Eighteenth Century: Hoffmann in Halle
Roger French 153
7. Infanticide and Medico-legal Ethics in Eighteenth
Century Prussia
johanna Geyer-Kordesch 181
8. The Ethical Discourse on Animal Experimentation,
1650-1900
Andreas-Holger Maehle 203
9. Thomas Gisborne: Physicians, Christians and Gentlemen
Roy Porter 252
10. Does a Certificate of Lunacy Affect a Patient's Ethical
Status? Psychiatric Paternalism and its Critics in
Victorian England
Michael J Clark 274
Index 294
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Acknowledgements
We would like to thank the Wellcome Trust for generously funding
the conference at Corpus Christi College, Cambridge that gave rise
to this book. The Wellcome Unit for the History of Medicine at
Cambridge provided invaluable administrative help in organising
the conference.
We would also like to thank Jenni Crisp of the Wellcome
Institute for helping to prepare the text and Dr Kim Cross and her
colleague Christine Lavery at The Wellcome Trust for their
technical skill and expertise in getting this work to the press.
VI
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Notes on Contributors
Michael J. Clark is a former Research Fellow of the Department of
History, Universiry of Lancaster and the Centre de Recherche en
Histoire des Sciences et des Techniques, La Villette, Paris. He has
published a number of articles on aspects of the history of psychiatry
in the nineteenth and twentieth centuries, and is currently working
on an outline history of English forensic medicine during the past
150 years. Since 1990 he has managed the Wellcome Trust's
collections of medical and medical-historical films and videos.
Roger French taught History and Philosophy of Science in the
universities of Leicester and Aberdeen, after a D.Phil in Oxford, and
since 1975 has been Director of the Wellcome Unit for the History
of Medicine in Cambridge, where he is the Universiry Lecturer in
the History of Medicine. He has published on a range of topics
from Greek texts to nineteenth century reform in medicine. He is
General Editor of a series of books on science in antiquity with
Routledge and part editor of a series on history of medicine with
Cambridge University Press. Current research interests include
William Harvey and medieval natural philosophy.
Luis Garcia-Ballester, MD, Ph.D., is a member of the CSIC (Unit
of the History of Science), Barcelona, and professor of the History
of Medicine. He is now working on the social and intellectual
history of medicine in medieval and renaissance medicine. He is co
editor (with J.A. Paniagua and M.R. McVaugh) of the critical
edition of the medical corpus of Arnau de Vilanova.
Johanna Geyer-Kordesch is Director of the Wellcome Unit for the
History of Medicine, University of Gla5gow, Scotland. Her area of
expertise is eighteenth-century European Medicine,. She was general
secretary to the Cambridge Medical Ethics Forum 1989-92. She is
continuing work on forensic and medical case histories both in
regard to witchcraft and infanticide. Currently she is also interested
in case histories as life narratives and their relation to periodical
writings and literary forms in the Enlightenment.
Vll
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Notes on Contributors
Ole Peter Grell is a Carlsberg Fellow at the Wellcome Unit for the
History of Medicine at the University of Cambridge. He has
published several articles on religion and medicine and has recently
co-edited the volume, Medicine and the Reformation (Routledge,
1993). He is at present completing a study of the Bartholin circle
and the Danish Medical Renaissance.
Andreas-Holger Maehle, born 1957 in Siegen, Germany, studied
medicine at the University of Bonn (Dr. med. 1983) and worked
then as a Research Fellow at the Institute for the History of
Medicine of the University of Gottingen (Dr. med. habil. 1990).
He is now a Lecturer in the History of Medicine at this Institute.
Since 1991 he has been working as a Wellcome Research Fellow at
the Wellcome Institute for the History of Medicine in London. His
publications include johann Jakob Wepfer (1620-1695) als
Toxikologe (Aarau: Sauerlander, 1987) and Kritik und Verteidigung
des Tierversuchs: Die Anfiinge der Diskussion in 11. und 18.
jahrhundert (Stuttgart: F. Steiner, 1992).
Vrvian Nutton. is a professor in the Academic Unit at the Wellcome
Institute for the History of Medicine, London. His interests cover
the classical tradition of medicine from the Greeks to the
seventeenth century. Among his books are: Galen: On Prognosis
(I 979); From Democedes to Harvey: Studies in the History ofM edicine
(1988); and Essays on the History ofTherapeutics (1991).
Roy Porter is professor of the Social History of Medicine at the
Wellcome Institute for the History of Medicine. He is currendy
working on the history of hysteria. Recent books include Mind Forg'd
Manacles. Madness in England from the Restoration to the Regency
(Athlone, 1987); A Social History of Madness (Weidenfeld and
Nicolson, 1987); In Sickness and in Health. The British Experience,
1650-1850 (Fourth Estate, 1988); Patient's Progress (Polity, 1989)
these last two co-authored with Dorothy Porter; and Health for Sale.
Quackery in England 1660-1850 (Manchester University Press).
Andrew Wear is a lecturer in the History of Medicine at the
Wellcome Institute. He has research interests in early modern
medicine and in colonial and empire medicine. .
VIII
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Introduction
This book is not so much a search for definitive answers to the
question of how history can inform present-day medical ethics but
is more an attempt to begin such a history. It shows that ~.history of
medical ethics does in fact exist and that medical ethics were a
constant part of the history of medicine in the period between those
often-cited 'origins' of medical ethics, the Hippocratic Oath and
Thomas Percival's Medical Ethics of 1803. This book tackles the gap
on the subject that exists between these two works.
A number of themes emerge from these studies. The first shows
that the perception of what was 'ethical' changed greatly in the
past. At different periods and in different groups, practices like
infanticide and abortion and the doctor's refusal to take hopeless
cases were ethically unproblematic. At other times they met with the
severest of censure.
Also of significance is the great complexiry of interpretation.
Hippocratic ethics have been seen as an expression of the loftiest
moral philosophy, but it is also possible to view them as professional
rules of thumb designed to protect one group of physicians against
competition from another. Moreover, in the medical market-place
one group might usefully evolve a system of ethics that appeared to
benefit the patient at the expense of the doctor thus giving a
competitive edge to that group of practitioners. Apart from ;he
influences of market forces, it is clear that the practising physician
derived his ethics from his religion and also from his education (for
moral philosophy was a central part of the course in arts of the
medieval and Renaissance universiry). In other cases an ethic was
imposed on him by the state or his professional body: it is not
always easy to separate these sources.
In this way we can recognise, although not always isolate, some
of the sources of medical ethics. These chapters reveal these sources.
Within medicine, in one example, it was claimed that the most
ethical form of practice was that derived from the most learned and
hence most advanced medicine. Sources outside medicine offered,
in other examples, the framework for the ethical treatment of the
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Introduction
insane and for the medical use of animals. Other chapters discuss
cases where different ethical systems met and clashed. Taken
together the chapters show that in contrast to present codified
guidelines more weight rested on the doctor as an individual in
deciding ethical issues. He was faced with less regulation than the
modern doctor, less technology, fewer administrators and no ethical
committees. What was central to medical ethics in the period before
the present century was the personal conduct, behaviour, manners
and knowledge of the practitioner.
Our book begins with Greek medical ethics. As with much else,
one must look to the ancients in order to trace the beginnings of
Western meclical ethics or medical deontology. The text that
connects present-day medical ethics to the classical period is the
Hippocratic Oath. However, as Vivian Nutton notes in his chapter,
'Beyond the Hippocratic Oath', it was only in the Renaissance that
the Oath achieved the authoritative and normative status which to
day it is assumed it had from the beginning. There were many
classical texts other than the Oath which dealt with medical ethics.
It is thus possible to envisage a code of medical ethics being drawn
up before the Renaissance without having recourse to the Oath.
In his discussion of these texts Nutton emphasizes that it was the
medical practitioners themselves who laid down ethical norms. Not
only was the medical market-place a competitive one, but the State
was absent from it. Greek medical ethics did not come from State
regulation of medicine, nor, as was the case in some later instances
in our volume, did they reflect the needs of the State or of civil
society. In the situation of an open unregulated medical market
place with competing groups of practitioners who produced ethical
rules for themselves, uniformity in these rules could not be
expected. Moreover, between the fifth century BC when the first
Hippocratic treatises were produced and the death of Galen around
AD 200 there were changes in the religious and philosophical
influences that helped to shape medical ethics and, of course, the
social worlds of the practitioners. N utton discusses these changes
and a significant point that emerges is how morality and technical
competence came to be closely associated. It was felt that the
morally good doctor must practise to the best of his ability. In the
absence of licensing or of diplomas morality was, in a sense, a sign
to the patient of medical competence. Galen, who after Hippocrates
came to be the authority in medicine for' the Middle Ages and the
Renaissance, integrated Hippocratic rules of bedside conduct into
medical practice by pointing out that they made the practitioner a
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