Disrupted Dialogue Medical Ethics and the Collapse of Physician-Humanist Communication (1770-1980)

by Veatch, Robert M.

• ISBN13: 9780195169768
• ISBN10: 019516976X
• Format: Hardcover
• Copyright: 2004-09-16
• Publisher: Oxford University Press

Summary

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had beenisolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both fields were richer for it. This volume begins with the 18thcentury Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, atmeetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changesin the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronicdisease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how itwas repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue.

Table of Contents

Part I Scotland
1. Medical Ethics in The Scottish Enlightenment,	3	(18)
Background of The Scottish Enlightenment,	4	(1)
Camaraderie Between Medicine and the Humanities,	5	(16)
John Gregory: The Beginnings of Anglo-American Professional Medical Ethics,	7	(10)
GREGORY'S BACKGROUND,	8	(1)
GREGORY'S RELATION TO SCOTTISH COMMON-SENSE MORAL PHILOSOPHY,	9	(6)
LACK OF INTEREST IN THE ETHICS OF HIPPOCRATES AND GALEN,	15	(2)
Other Scottish Enlightenment Figures with Medicine and Humanities Links,	17	(4)
SIR JOHN PRINGLE,	17	(1)
WILLIAM CULLEN,	17	(1)
JAMES GREGORY,	18	(1)
DUGALD STEWART,	19	(2)
2. The Beginnings of Medicine as an Isolated Science,	21	(24)
Isolation of the Physician,	21	(10)
Alexander Monro, Primus,	22	(6)
THE SIMPLE ANALYSIS,	23	(1)
THE COMPLEX ACCOUNT,	23	(5)
The Faculty of 1826,	28	(3)
WILLIAM PULTENEY ALISON,	29	(1)
OTHER FACULTY TESTIMONY,	30	(1)
Emergence of Hippocratic-Type Oaths at Graduation,	31	(4)
The Aberdeen Oath,	32	(1)
The Edinburgh Oath,	33	(2)
Why the Isolation?	35	(10)
Young Age of Entry Into College or Medical School,	35	(2)
AGE OF ENTERING COLLEGE,	36	(1)
MEDICAL STUDENTS,	36	(1)
Changing Social Class and More Practical Interests of Medical Students,	37	(4)
SOCIAL CLASS SHIFT,	37	(1)
POORER PREPARATION OF STUDENTS,	38	(1)
THE PROBLEM OF "STRANGERS,"	39	(1)
COMPETITION WITII INFERIOR MEDICAL SCHOOLS,	40	(1)
A FACULTY CONTENT WITH A MORE PRAGMATIC AND TECHNICAL CURRICULUM TO MEET THE COMPETITION,	40	(1)
Scientific Data Overload,	41	(4)
Part II England
3. Eighteenth-Century England's Integration of Medicine and the Humanities,	45	(26)
John Wesley,	46	(7)
Wesley as Humanist Intellectual,	46	(1)
Wesley as a Serious Student of Medicine,	47	(1)
Wesley's Feuds with Orthodox Medical Practitioners,	47	(5)
PRIMITIVE PITY SICK,	49	(1)
HAWES,	49	(2)
ELECTRICITY,	51	(1)
Wesley's Contact with Gregory, Monro, and Hamilton,	52	(1)
Gisborne.	53	(3)
Thomas Percival,	56	(15)
A Man of the Enlightenment,	56	(7)
PERCIVAL'S EARLY EDUCATION,	57	(1)
PERCIVAL'S MEDICAL EDUCATION,	58	(2)
PERCIVAL'S EARLY ESSAYS: MEDICAL AND PHILOSOPHICAL,	60	(1)
PERCIVAL'S HUMANITIES WRITING ADDRESSED TO HIS CHILDREN,	61	(1)
PERCIVAL'S ROLE IN PHILOSOPHICAL. SOCIETIES,	62	(1)
Percival's Medical Ethics,	63	(22)
OCCASION OF THE WRITING,	63	(1)
CONVERSATION WITH THE SCOTTISH PHILOSOPHERS,	64	(1)
PERCIVAL AND ENGLISH PHILOSOPHY AND THEOLOGY,	65	(1)
PERCIVAL WRITING IN THE TRADITION OF LITERATURE ON THE DUTIES OF OFFICE,	65	(2)
PERCIVAL AND TRUTH: MEDIATING THE ETHICAL CONTROVERSY,	67	(1)
PERCIVAL AND SOCIAL CONSEQUENTIALISM,	67	(2)
PERCIVAL AND HIPPOCRATES,	69	(2)
4. Isolation of the English Physician,	71	(12)
Edward Percival and the Beginnings of Isolation,	71	(1)
Emergence of Hippocrates,	72	(1)
Michael Ryan,	72	(2)
Alfred S. Taylor,	74	(1)
Jukes de Styrap,	75	(2)
Nineteenth- and Twentieth-Century Activity of the British Medical Association,	77	(1)
The Basis for the English Isolation,	78	(5)
Part III The United States, Canada, and New Zealand
5. Physician-Humanist Interaction in the Eighteenth Century in the United States,	83	(13)
Cotton Mather,	84	(1)
Benjamin Rush,	85	(8)
Nurturing an Enlightenment Man,	85	(1)
The Edinburgh Connection,	86	(2)
Philadelphia Enlightenment Man,	88	(1)
The Empirical Science of Morality,	88	(3)
Contribution to Medical Ethics,	91	(2)
SELECTED WRITINGS OF BENJAMIN RUSH AND INTRODUCTORY LECTURES,	91	(1)
LACK OF INTEREST IN HIPPOCRATIC ETHICS,	91	(2)
Samuel Bard,	93	(3)
The Edinburgh Connection,	93	(1)
Bard's New York Medical Practice,	93	(1)
Duties of a Physician,	93	(3)
6. The Scientizing of Medicine in the United States,	96	(26)
Nathaniel Chapman,	96	(6)
The Right Roots,	96	(4)
THE PHILADELPHIA ELITE, 96 THE RUSH CONNECTION,	97	(1)
PORT FOLIO AND THE TUESDAY CLUB,	97	(1)
THE EDINBURGH CONNECTION,	98	(1)
FROM THE PHILADELPHIA CLUBS TO AMERICAN PHILOSOPHICAL SOCIETY PRESIDENT,	98	(2)
Chapman as Scientific Era Physician (in the Monro Model),	100	(3)
PROFESSOR WITH INTERESTS LIMITED TO MUNDANE MEDICINE,	100	(1)
SYMPATHY: WHAT HAS IT COME To? (CHAPMAN'S MEDICALIZING OF SYMPATHY),	100	(2)
THE AMERICAN MEDICAL ASSOCIATION'S FIRST PRESIDENT,	102	(1)
John Redmon Coxe,	102	(1)
Early History of Organized Medicine's Ethics,	103	(12)
Boston,	103	(5)
BOSTON MEDICAL POLICE,	103	(1)
CONTROVERSY OVER LINKS TO EARLIER WORKS,	104	(1)
BACKGROUND OF THE COMMITTEE,	105	(2)
ROLE OF JOHN WARE,	107	(1)
Medical Society of the State of New York,	108	(2)
Philadelphia,	110	(4)
Baltimore and Washington, D.C.,	114	(1)
American Medical Association Code of 1847,	115	(7)
Isaac Hays,	115	(4)
HAYS'S ROLE IN THE AMERICAN MEDICAL ASSOCIATION CODE,	115	(3)
HAYS'S OTHER PUBLICATIONS AND INTERESTS,	118	(1)
John Bell,	119	(8)
BELL'S INTRODUCTION TO THE AMERICAN MEDICAL ASSOCIATION CODE,	119	(1)
BELL'S PHILOSOPHICAL SOURCES,	120	(1)
BELL'S OTHER PUBLICATIONS AND INTERESTS,	121	(1)
7. Some Physicians Who Almost Confront the Humanities,	122	(23)
Worthington Hooker,	123	(2)
Alfred Stillé,	125	(1)
Austin Flint, Lewis S. Pilcher, and the New York Society,	125	(2)
William Osier,	127	(8)
A Lifetime Coming Close to the Humanities,	128	(1)
Osier's Lifelong Interest in Classical Figures,	129	(1)
Osier's Relative Lack of Interest in Modern Philosophy and Ethics,	130	(1)
Osier's Interest in Theologians,	131	(1)
Osier's Interest in Physician-Humanists,	132	(1)
SIR THOMAS BROWNE (1605-1682),	132	(1)
JOHN LOCKE (1632-1704),	132	(1)
THOMAS LINACRE (1460-1524),	133	(1)
SERVETUS (1511-1553),	133	(1)
Osler and Hippocrates,	133	(2)
LECTURES ON THE HISTORY OF MEDICINE,	134	(1)
OSLER AND THE HIPPOCRATIC OATH,	134	(1)
Richard Cabot,	135	(6)
Cabot's Interest in Religion, Ethics, and Medicine,	136	(1)
Cabot's Interest in Truth Telling,	136	(4)
EARLY TREATMENT OF TRUTH TELLING,	137	(1)
LATER TRUTH-TELLING WRITINGS,	138	(2)
Cabot's Interest in the Hippocratic Oath,	140	(1)
Revisions of the American Medical Association's Principles,	141	(1)
Reasons for Isolation in the United States,	142	(3)
8. Diverging Traditions: Professional and Religious Medical Ethics of the Nineteenth Century,	145	(10)
Religious Traditions in Medical Ethics,	145	(3)
Roman Catholic Medical Morality,	148	(1)
Comparing the Ethics of Organized Medicine and the Catholic Church,	149	(4)
Medico-Moral Methodologies,	149	(1)
Normative Ethical Issues,	150	(5)
ABORTION,	151	(1)
RISKY SURGERY,	151	(1)
SEXUAL ETHICS,	151	(1)
TERMINAL ILLNESS DISCLOSURE,	152	(1)
SOCIAL ETHICS OF MEDICINE,	152	(1)
A Concluding Puzzle,	153	(2)
9. Medical Ethics in New Zealand and Nova Scotia: Test Cases,	155
New Zealand: A Nineteenth Century Scottish Case,	155	(8)
Founding of the Medical School,	156	(1)
THE FOUR ORIGINAL PROFESSORS,	156	(1)
DUNCAN MACGREGOR: PHYSICIAN-MORAL PHILOSOPHER,	156	(1)
Emergence of the Monro-type Anatomist Physicians,	157	(1)
The Search for Medical Ethics in the Early Years,	158	(1)
Emergence of Modified Hippocratism,	158	(3)
The Basis of New Zealand Isolation,	161	(2)
Nova Scotia: Another Nineteenth Century Scottish Case,	163	(11)
Thomas McCulloch: Nova Scotia's Liberal Intellectual Giant,	163	(2)
Dalhousie Medical School and the Business of Medical Science,	165	(4)
Part IV The Reconvergence of Physicians and Humanists
10. The End of Isolation: Hints of Reconvergence,	169	(46)
Anticipating Reintegration: Mid-Century Hints of Something to Come,	174	(7)
Medical Scientists Stepping out of the Clinic,	175	(2)
CHAUNCEY LEAKE	175	(1)
OTTO GUTTENTAG,	175	(1)
HENRY BEECHER,	176	(1)
Humanists and Social Scientists Stepping into the Clinic,	177	(4)
DANIEL JENKINS,	178	(1)
WILLARD SPERRY,	178	(2)
JOSEPH FLETCHER,	180	(1)
The Excitement of The 1960's,	181	(11)
Dialysis: The God Squad,	182	(1)
Transplantation: Handling Scarce Resources,	183	(2)
PROCURING ORGANS,	183	(2)
THE DEFINITION OF DEATH, l	l84
Abortion, Birth Control, and Population,	185	(2)
Genetics and Reproductive Technologies,	187	(2)
Physician Humanities Education,	189	(3)
PENN STATE HUMANITIES DEPARTMENT,	189	(1)
STONY BROOK,	190	(1)
11. The New Enlightenment: The 1970's,	191	(17)
Emergence of Interdisciplinary Centers and Teaching Programs,	192	(3)
Institute of Society, Ethics and the Life Sciences,	193	(1)
Kennedy Institute of Ethics,	194	(1)
Secular Medical School Teaching Programs,	195	(3)
Harvard,	196	(1)
Galveston,	196	(1)
Tennessee,	196	(1)
Society for Health and Human Values,	197	(1)
Interdisciplinary Commissions,	198	(1)
The National Commission,	198	(1)
Other 1970's Commissions,	199	(1)
British Reconvergence,	199	(2)
Society for the Study of Medical Ethics,	199	(1)
Dictionary of Medical Ethics,	200	(1)
The Impact of Renewing the Dialogue,	201	(3)
Why the Reconvergence?	204	(9)
The Change to Chronic Illness and Half-way Technologies,	204	(3)
The Social Rights Movement,	207	(1)
Dissonance Between Physician Ethics and Other Ethics,	208	(5)
BENEFITS VS. RIGHTS AND DUTIES,	208	(2)
INDIVIDUAL VS. SOCIAL,	210	(1)
AUTHORITARIAN VS. EGALITARIAN,	211	(1)
ETHICS OF RULES AND ETHICS OF CASES,	211	(2)
Conclusion,	213	(2)
Afterword: The 1980's and Beyond,	215	(1)
Major Developments in Bioethics,	216	(7)
The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research,	217	(1)
Medical School Developments,	217	(2)
The New Face of Organized Medicine,	219	(1)
The Bioethics Program at the National Institutes of Health,	219	(1)
The Council for International Organizations of Medical Sciences Ethics Effort,	220	(1)
The Intenational Association of Bioethics,	220	(1)
Conclusion.	221	(2)
Notes,	223	(46)
Bibliography,	269	(30)
Index,	299