Laying medicine open: Understanding major turning points in the history of medical ethics

Journal/Book: Kennedy Inst Ethics J. 1999; 9: Journals Publishing Division, 2715 North Charles St, Baltimore, MD 21218-4319, USA. Johns Hopkins Univ Press. 7-23.

Abstract: At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.

Note: Article McCullough LB, Baylor Coll Med, Ctr Med Eth & Hlth Policy, Houston,TX 77030 USA

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