A Short History of Medical Ethics [Hardcover]

Albert R. Jonsen (Author)

Book Description

Publication Date: January 15, 2000 | ISBN-10: 0195134559 | ISBN-13: 978-0195134551 | Edition: 1

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.

Editorial Reviews

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.

Review

"This is an important resource for a discipline just beginning to discover its historical roots." --Doodu's

"This historical analysis highlights ways in which the reflections on the role of character, moral obligations, and the relationship between the individual and the community (which stimulates contemporary bioethics) have a history that reaches deep into the past and across cultural boundaries.... An important resource for a discipline just beginning to discover its historical roots." --Choice

"Albert Jonsen, a distinguished theoretician and practitioner of bioethics, has written what is essentially a prehistory of the field....A Short History of Medical Ethics is a scholarly prologue to the evolving world of contemporary bioethics....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." -- The New England Journal of Medicine

"Concise but comprehensive, thorough yet readable, this well-written book is a stimulating compendium of the historical and cultural imperatives that serve as the infrastructure linking scientific advances to human and environmental values." --New Jersey Medicine

Students and practitioners alike will benefit from this impressive tour of the history of medical ethics.--

"Analyzing both primary and secondary sources, Jonsen's summaries are crisp digests that provide a good introduction to the literary traditions of medical ethics. Jonsen highlights the ideas of certain Hippocratic, Roman, Arabic, French, Italian, and Prussian physicians, as well as the ideas in the writings of traditional Indian and Chinese doctors. Thanks to Jonsen who has provided a new era of more sophisticated historiography in medical ethics, the storytellers and practitioners of the new millennium can strive for even better stories and more morally adequate practices." - Chester R. Burns, Medical Humanities Review, Spring 2000

"For those working in the field, "Albert R. Jonsen is almost synonymous with the word bioethics. His most recent contribution, weighing in at only 120 pages, condenses a considerable amount of information into "a brief tour of the complex story in the social and cultural contexts in which the work of healing is practiced." This book is aptly named, and those readers interested in the early beginnings of ethics and medicine will find this book a fascinating and quick read. Inclusion of the medical/ethical history from the Eastern and Western cultural perspectives, including early religious views from Christianity, Islam, Judaism, Confucianism, Buddhism, and Hinduism is noteworthy. As a historical overview of key events, this book does a fine job as a primer of ancient history." - E-streams, Vol 3, No. 9

"Albert Jonsen, whose previous work helped first to shape and later to chronicle the post-1950s emergence of bioethics, provides here a brief overview of medical ethics from ancient Greece and Asia to the 1940s, in what might be called a "prequel" to his rich 1998 eyewitness history The Birth of Bioethics. This book is a very useful source of a rich variety of specific quotations and of good capsule histories of a variety of specific topics, from the Hippocratic Oath to the medical importance of medieval casuistry. No other work can rival the scope and conciseness of this densely-packed volume. This book provides a rich selection of key writings on the qualities and principles of an ethical healer over the ages." -- Martin S. Pernick, PhD, JAMA, Nov 15, 2000 - Vol 284 No 19

"As all good narrative, this history is made lively by the competing responses to the changes that demaind new or further definitions of health and medicine. This book is to be highly recommended for those working in bioethics, for courses in bioethics, and more broadly, for those concerned with how a professional ethic is actually formed and constructively developed. In considering the study and development of other professional ethics - such as clergy ethics - this masterful text points to what is required." -- Timothy F. Sedgewick, Theological Studies

See all Editorial Reviews

Product Details

• Hardcover: 153 pages
• Publisher: Oxford University Press, USA; 1 edition (January 15, 2000)
• Language: English
• ISBN-10: 0195134559
• ISBN-13: 978-0195134551
• Product Dimensions: 9.3 x 6.2 x 0.8 inches
• Shipping Weight: 15.2 ounces
• Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #1,274,983 in Books (See Top 100 in Books)

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1 of 5 people found the following review helpful:

5.0 out of 5 stars a good book for bioethics teachers and students, October 27, 2000

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lilun (China) - See all my reviews

This review is from: A Short History of Medical Ethics (Hardcover)

Although I have just read two chapters of this book, I found that it's a good book for Chinese bioethics teachers and students.