Advocacy and community: the social roles of physicians in the last 1000 years. Part I

Over the last 1000 years, the practice of medicine in the Western world has been shaped by extraordinary transformations -- in the organizational structures of healthcare delivery, the changing concepts of disease and illness, and the ethical and social issues posed to a growing and diversified profession. Some critical aspects that characterize contemporary Western medicine -- as professionally defined, highly organized and regulated, and scientifically and technologically based -- have emerged only within the last 200 years. For most of its history, medicine was practiced without these distinctions -- but precursors to many current tensions can be traced back to Hippocratic times. In the last millennium, medicine developed in tandem with emerging political ideologies and social structures, and the roles of physicians evolved to respond to the needs of individual patients, the profession, and society at large. As medicine became increasingly effective, it was harnessed into the political objectives of promoting social cohesion and productivity. Professional regulation and social mechanisms for the equitable distribution of healthcare became significant considerations for the profession and society. In this brief 3-part history, we will trace the major organizational, conceptual, and political changes that, together, by the year 2000, created a profession with responsibilities of advocacy for individual patients in concert with attention to the needs and demands of all the individuals in the larger community.

Physician-assisted suicide: where to draw the line?

In brief compass, I will touch on three of the central ethical and public policy issues that divide those who are opposed to physician-assisted dying from those who are supportive of this practice. These are: (1) the moral distinction (if any) between actively hastening death and passively allowing to die; (2) how to interpret the Hippocratic tradition in medicine with respect to physician-assisted death; and (3) whether physician-assisted suicide can be effectively regulated. I shall summarize the arguments pro and con with respect to each issue, and also indicate my own position.

[Medical oath and the notion of human dignity]

Considering the recent commemoration of the 50th anniversary of the Proclamation of Human Rights, the author attempts to establish a parallel between the notion of human dignity as we read in the Hippocratic Oath, and the prevailing concept within the societies that either preceded, were contemporary or succeeded it. With that goal in mind, three ancient civilizations are focussed--Egypt, Mesopotamia and Greece--showing the differences in behaviour towards the human being, far different from the perspective of the Oath. The new view of human dignity and its due respect, in any circumstance, was only completely understood with the appearance and acceptance of Christianity. The author then draws attention to what may be viewed as the main feature of this century, as it approaches its end: the urge to lead the international community to accept, in a clear way, what Hippocrates defined in Medicine--the dignity of the human person, regardless of race, religion, sex or social class.

Involuntary psychiatric interventions: a breach of the Hippocratic oath?

In this article the author argues that involuntary psychiatric interventions are inherently dangerous and potentially harmful to their subjects, thus challenging the Hippocratic ethical principle of "first do no harm." Damages arising from coercion in common clinical situations are analyzed, as well as the motives of psychiatrists for persistently promoting an expansion of involuntary interventions. Alternative strategies to coercion are explored.

Ethics in surgery: historical perspective

Ethics codes and guidelines date back to the origins of medicine in virtually all civilizations. Developed by the medical practitioners of each era and culture, oaths, prayers, and codes bound new physicians to the profession through agreement with the principles of conduct toward patients, colleagues, and society. Although less famous than the Hippocratic oath, the medical fraternities of ancient India, seventh-century China, and early Hebrew society each had medical oaths or codes that medical apprentices swore to on professional initiation. The Hippocratic oath, which graduating medical students swear to at more than 60% of US medical schools, is perhaps the most enduring medical oath of Western civilization. Other oaths commonly sworn to by new physicians include the Declaration of Geneva (a secular, updated form of the Hippocratic oath formulated by the World Medical Association, Ferney-Voltaire, France) and the Prayer of Moses Maimondes, developed by the 18th-century Jewish physician Marcus Herz.