A Short History of Medical Ethics - Softcover

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.
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