Academic journal article The Hastings Center Report

The Efficacy of Professional Ethics

Academic journal article The Hastings Center Report

The Efficacy of Professional Ethics

Article excerpt

The AMA Code of Ethics in Historical and Current Perspective

The expressions "professional ethics" and "medical ethics" were coined by Thomas Percival (1740-1804), a philosophically trained English physician famous in his own lifetime for writing moral tales for children, for championing the abolition of slavery, for founding one of the first departments of public health, and for publishing a book in the penultimate year of his life, Medical Ethics: A Code of Ethics and Institutes Adopted to the Professions of Physic and Surgery.[1] Medical Ethics was inspired by outrage. In 1792, the fever hospital of the Manchester Infirmary closed its doors to patients in the midst of an epidemic. The reason: a quarrel between staff members. After the incident, the infirmary's trustees appointed Percival to head a committee charged with drafting rules of conduct to insure that disputes would never again shut down the hospital. The committee developed a set of sensible rules, but that did not settle the matter for Percival. He appreciated that a new, collaborative form of medical practice was emerging in hospitals, and he believed that it would require a different conception of medical morality. Accordingly, he spent a decade developing a conception of "professional ethics"[2] that vests medicine's prime moral mandate, the duty of caring for the sick, in the medical profession collectively, rather than in the individual practitioners who had been the traditional focus of medical morality. Percival believed that by acting collectively, medical professionals could challenge hospital administrators who promulgated directives that failed to serve "the health and the lives of those committed to their charge."[3] And he gave voice to a notion of professional advocacy, in the sense of advocating for the interests of patients and public health in discourse either with government or the private sector.

Like most revolutionary ideas, Percival's required new ways to express them. His codes contain the earliest known use of the expression "physician in attendance," or "attending physician."[4] And they redefine the range of patient. Physicians had hitherto applied the term only to paying clientele in the middle and upper classes, differentiating "patients" from the "sick poor" whom they treated in hospitals. By using patient for all sick people, Percival extended the elaborate code of conduct employed by medical professionals in their dealings with upper and middle class patrons to the nonpaying poor.[5] To encapsulate his radically different concept of professional medical morality Percival coined the neologisms "professional ethics," distinguishing it from the narrower "medical ethics."

The Professional Medical Ethics of the American Medical Association

It is one thing to propose radical changes, and quite another to actually change the world radically. Percival's rules for pacifying hospital disputes were emulated around the world. But his revolutionary reconceptualization of medical morality--"medical ethics" and "professional ethics"--had few followers in Europe.[6] In America, however, physicians and surgeons were drawn to Percival's vision of a self-regulating profession. Commencing in 1808, just five years after the publication of Medical Ethics, the Boston Medical Society appropriated Percival's language to develop rules for self-regulation--a "Medical Police"--copying word for word some of the consensus-generating procedures that Percival had proposed. After decades of experiments by dozens of municipal, county, and state medical societies, the stage was set for the first entirely Percivalean code of professional ethics, the code adopted by the fledging American Medical Association in 1847.[7]

The AMA was designed as the embodiment of the Percivalean ideal of professional self-regulation and one of its first acts was the adoption of a code of ethics. The AMA code put patients' interests before professional interests--the code opens by asserting the physician's duty to "obey the calls of the sick. …

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