Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making

326 Pages·2003·12.51 MB·English

by  David Rothman

166214_DeGruyter 6/25/03 8:39 PM Page 1
A V O L U M E I N
SOCIAL INSTITUTIONS AND SOCIAL CHANGE
S T RANGERS
An Aldine de Gruyter Series of Texts and Monographs
SERIES EDITOR: James D. Wright, University of Central Florida
a t t h e
Strangers at the Bedside
A History of How Law and Bioethics
Transformed Medical Decision Making
David J. Rothman B E D S I D E
This study of the transformation of the relationship between doctors and patients
from the mid-Sixties to the mid-Seventies has acquired the status of a minor
classic. In this paperback edition the author has added an afterword on patient
autonomy that encompasses some more recent changes in the practice of medicine
and the evolving field loosely, but inexactly, characterized as bioethics. He has left
intact his portrayal of the earlier, epochal changes that are the subject of the book.
From reviews of the first edition:
“Well-researched, well-written, wide-ranging, and thoughtful.”
— New England Journal of Medicine
“There is not a better overview anywhere of the key events in the development of
modern bioethics. . . . An exciting intellectual history.”
— Contemporary Sociology
“A thoughtful, wise reading of history important to the medical profession.”
— Journal of the American Medical Association
O F R E L A T E D I N T E R E S T
Entitlement Politics: Medicare and Medicaid, 1995–2001
David G. Smith
Medical Careers and Feminist Agendas:
American, Scandinavian, and Russian Women Physicians
Elianne Riska
Managing to Care: Case Management and Service System Reform
Ann P. Dill
The Elusive Quest: Accountability in Hospitals
Carolyn L. Wiener
A History of How
Law and Bioethics Transformed
ISBN 0-202-30725-5 Medical Decision Making
ALDINE DE GRUYTER
200 Saw Mill River Road
Hawthorne, NY 10532
www.degruyter.com/aldine D A V I D J . R O T H M A N
STRANGERS at the BEDSIDE R O T H M A N
STRANGERS
AT THE BEDSIDE
SOCIAL INSTITUTIONS AND SOCIAL CHANGE
An Aldine de Gruyter Series of Texts and Monographs
SERIES EDITOR
James D. Wright, University of South Florida
Rand D. Conger and Glen H. Elder, Jr., Families in Troubled Times: Adapting to Change
in Rural America
Joel A. Devine and James D. Wright, The Greatest of Evils: Urban Poverty and the
American Underclass
Ann E. P. Dill, Managing to Care: Case Management and Service System Reform
G. William Domhoff, State Autonomy or Class Dominance: Case Studies on Policy
Making in America
Paula S. England, Comparable Worth: Theories and Evidence
Paula S. England, Theory on Gender/Feminism on Theory
Robert G. Evans, Morris L. Barer, and Theodore R. Marmor, Why Are Some People
Healthy and Others Not? The Determinants of Health of Population
George Farkas, Human Capital or Cultural Capital? Ethnicity and Poverty Groups in an
Urban School District
Joseph Galaskiewicz and Wolfgang Bielefeld, Nonprofit Organizations in an Age of
Uncertainty: A Study in Organizational Change
Davita Silfen Glasberg and Dan Skidmore, Corporate Welfare Policy and the Welfare State:
Bank Deregulation and the Savings and Loan Bailout
Ronald F. Inglehart, Neil Nevitte, and Miguel Basañez, The North American Trajectory:
Cultural, Economic, and Political Ties among the United States, Canada, and Mexico
Gary Kleck, Targeting Guns: Firearms and Their Control
James R. Kluegel, David S. Mason, and Bernd Wegener (eds.), Social Justice and Political
Change: Public Opinion in Capitalist and Post-Communist States
Theodore R. Marmor, The Politics of Medicare (Second Edition)
Clark McPhail, The Myth of a Madding Crowd
John Mirowsky and Catherine E. Ross, Social Causes of Psychological Distress (Second
Edition)
John Mirowsky and Catherine E. Ross, Education, Social Status, and Health
Thomas S. Moore, The Disposable Work Force: Worker Displacement and Employment
Instability in America
James T. Richardson, Joel Best, and David G. Bromley (eds.), The Satanism Scare
Alice S. Rossi and Peter H. Rossi, Of Human Bonding: Parent-Child Relations across the
Life Course
Peter H. Rossi and Richard A. Berk, Just Punishments: Federal Guidelines and Public
Views Compared
Joseph F. Sheley and James D. Wright, In the Line of Fire: Youths, Guns, and Violence in
Urban America
David G. Smith, Entitlement Politics: Medicare and Medicaid, 1995–2001
Linda J. Waite et al. (eds.) The Ties That Bind: Perspectives on Marriage and Cohabitation
Les G. Whitbeck and Dan R. Hoyt, Nowhere to Grow: Homeless and Runaway
Adolescents and Their Families
James D. Wright, Address Unknown: The Homeless in America
James D. Wright and Peter H. Rossi, Armed and Considered Dangerous: A Survey of
Felons and Their Firearms (Expanded Edition)
Mary Zey, Banking on Fraud: Drexel, Junk Bonds, and Buyouts
STRANGERS
AT THE BEDSIDE
A History of How Law and
Bioethics Transformed Medical
Decision Making
DAVID J. ROTHMAN
Aldine de Gruyter
New York
About the Author
David J. Rothman is Bernard Schoenberg Professor of Social Medicine and Director
of the Center for the Study of Society and Medicine at the Columbia College of
Physicians and Surgeons, and Professor of History at Columbia University. Among
his numerous books are The Discovery of The Asylum and Conscience and Convenience
(both Aldine, 2002).
Copyright © 1991, 2003 by David J. Rothman
First published by Basic Books, New York
Second paperback edition
Published 2003 by Walter de Gruyter, Inc., New York
All rights reserved. No part of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopy, recording, or any informa-
tion storage or retrieval system, without permission in writing from the publisher.
ALDINE DE GRUYTER
A division of Walter de Gruyter, Inc.
200 Saw Mill River Road
Hawthorne, New York 10532
This publication is printed on acid free paper I
Library of Congress Cataloging-in-Publication Data
Rothman, David J.
Strangers at the bedside : a history of how law and bioethics
transformed medical decision making / David J. Rothman.
p. cm. — (Social institutions and social change)
Includes bibliographical references and index.
ISBN 0-202-30725-5 (pbk. alk. paper)
1. Medicine—United States—Decision making—History. 2.
Medicine—Research—United States—Decision making—History. 3. Medical
ethics—United States—History. I. Title. II. Series.
R723.5.R67 2003
610.69′6′0973—dc21
2003011853
Manufactured in the United States of America
10 9 8 7 6 5 4 3 2 1
To J.R.
For Doing Good
This Page Intentionally Left Blank
Contents
Acknowledgments
Introduction: Making the Invisible Visible
1. The Nobility of the Material
2. Research at War
3. The Guilded Age of Research
4. The Doctor as Whistle-Blower
5. New Rules for the Laboratory
6. Bedside Ethics
7. The Doctor as Stranger
8. Life Through Death
9. Commissioning Ethics
10. No One to Trust
11 . New Rules for the Bedside
Epilogue: The Price of Success
Afrenvord
Appendix A
Notes
Index
vii
This Page Intentionally Left Blank
A C K N O W L E D G M E N T S
N the course of research and writing, I received significant assis-
It ance from a number of individuals, and I am pleased to be able
to acknowledge their contributions. I was fortunate enough to have
exceptional guides to the world of medicine, and although they will
dissent from some of the things said here, my debt to them is great.
All on the faculty of the Columbia College of Physicians and Sur-
geons, they are: Henrik Bendixen, John Driscoll, Norman Kahn, Mi-
chael Katz, Edgar Leifer, Jay Meltzer, Harold Neu, and Keith
Reemtsma. The two people most responsible for my joining the faculty,
Thomas Morris and Donald Tapley, taught me all that they could about
navigating in strange waters.
A grant from the National Endowment for the Humanities freed me
from other responsibilities, and Daniel Jones (program officer for grant
RO-21349-06) was particularly helpful. The Samuel and May Rudin
Foundation provided matching funds as part of its ongoing support of
the program at the Center for the Study of Society and Medicine.
Neither foundation is responsible for the views expressed here, which,
of course, means that in no way did they attempt to influence the
direction or course of the research.
I have benefited, as have so many other researchers, from the knowl-
edgeable staff of the National Archives, the National Institutes of