The issue of medical ethics acquired an increased significance in Britain during the 19th century. The medical profession faced immense reforms, and the prominence of medicine within the scope of public policy necessitated the emergence of ethical and medico-legal issues. The 19th century saw the medical ethics take a codified form for the first time. The period between the 16th and the 18th century was significant because many medical colleges such as the Royal College of Physicians were from during this time. However, the school played an insignificant role in imposing ethical principles upon the medical profession. Also, it is vital to appreciate the fact that both the Royal College of Physicians and Surgeons had jurisdiction over London hence the country lacked a centralized medical regulation that could serve the nation in its entirety. Therefore, it is vital to note that the 19th century was a critical time in the medical history of Britain as it saw the development of medical ethics which played a significant role in the modernization of medicine.
As stated earlier, before the 19th century, Britain did not have any centralized medical regulation in most parts of the nation. The 19th century saw the actual writing down of the medical ethics and their publication. Examples include the 1803 Thomas Percival’s Medical Ethics and secondly, ‘’A Code of Institutes and Precepts Adapted to the Professional Conduct of Physicians and Surgeons’’ (Koch, 2012). Two factors played a critical role in the codification of the medical ethics. First, was the intellectual, and secondly the socioeconomic factors. Regarding the intellectual reasons, Evangelicalism, moral philosophy, and Scottish Enlightenment all concentrated on the position of man in their duty to the society. John Gregory for instance, who served as a professor of medicine, published what was known as the ‘'Observations on the Duties of a Physician'' in 1770. Another personality, Rev. Thomas Gisborne also made publications on several materials that covered on the obligations of a physician and their role in the society. Therefore, it is imperative to note that Percival drew much from these two individuals when developing his Medical Ethics.
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The second factor that necessitated the development of medical ethics in Britain included the socioeconomic aspects. Bynum (2013) asserted that the 19th century witnessed tremendous social changes in the area of the industrial revolution which posed enormous challenges to medical practitioners. The emergence of the urban communities prompted medical needs, but the problem was that there was lack of traditions of professional service. Some of the issues posed by industrialization included poor sanitation, overcrowding, and factory workplace issues. During the laissez-faire, free market economy philosophy, medical practitioners were tempted to apply entrepreneurial mindsets which required them to operate in accordance with the law of ‘’let the buyer beware.’’ It is also critical to note that during this time, new medical facilities were coming up that served the welfare of the poor including charity dispensaries and hospitals. Therefore there was a growing need to develop codes of practice which would govern the duties of doctors in these new establishments.
Thomas Percival was born in 1745 and studied medicine in Edinburgh. He became a renowned practitioner at Manchester and one of the leading persons in the development of the ‘'Literary and Philosophical Society.'' For instance, in 1972, he played a critical role in solving an inter-professional feud that erupted in a hospital in Manchester which emanated due to nepotistic appointments (Beauchamp, 2016). Therefore, his Medical Ethics resulting from his deep thoughts over that inappropriate row that threatened to bring chaos in a medical facility. Thus, his work was contextually designed to solve the problems experienced at that particular time. Percival set out precepts that defined the general duties and responsibilities that the physician had to his patients, the society at large, and the greater calling. He also addressed several issues and difficulties that doctors faced in the commercial society. One of the most important factors prioritized by Percival was to create harmony among doctors and between various grades of professions. He addressed matters to deal with hierarchy giving out stipulations of joint consultation. He was also critical about the issue of doctors competing against each other and instead advocated for the spirit of comradeship.
Percival pointed out several professional enemies that would jeopardize intra-professional relations including rivalries, jealousies, and controversies. Such things he said would ultimately work to disadvantage the patients. He also touched on the issue of charging where he asserted that charging lower than what is normal would deny the practitioners a living and discourage people from pursuing medical education. Individuals like Ivan Waddington and Chauncey Leake backed Percival’s assertions and sentiments saying that they reflected medical etiquette. They further added that Percival’s ideas were meant to improve collective status, dignity, and a move to increase the monopolistic power of the medical profession. Koch (2012) further intimated that it is also vital to appreciate that Percival was majorly concerned with humanitarianism, honorable conduct, and prudence which reflected a gentlemanly behavior. He called for courtesy among medical practitioners citing that the welfare of the sick must be respected. He also called upon the physicians to comply with the requirements of the patient however worthless they were, so long as they were safe. Today, this is what is referred to as the power of autonomy in patients. Percival’s thoughts on ethics became so influential that they served as the basis for the American Medical Association’s (AMA) (EBOOKS World Medical Association Medical Ethics Manual 2nd). Others work such as ‘'Medical Science and Ethics'' of 1837 and ‘’Medical Etiquette’’ of 1839 written by William Ogilvie and Abraham Banks respectively drew much from Percival’s work.
The lack of ethical considerations in the British society during the 19th century also led to problems such as ‘’discontents, imperfections, and abuses in medicine’’ as outlined by Thomas Beddoes. It is also important to note that the emergence of medical ethics was the basis for the differentiation between honorable practice and quackery. However, in the wake of ethical considerations, the prospect of ethical dilemmas could be escaped. In enhancing quality standards, the General Medical Council was formed to admit and register only qualified practitioners in a move to lock out the quacks. The body also sought to lock out doctors who were professionally inadmissible due to their conducts such as those who had been convicted of crime or guilty of a professional conduct such as committing adultery with a patient. Therefore, the General Medical Council was an ethical body which acted as a moral inquisition for the professional. Understanding the etiology of ethics in Britain requires individuals to appreciate club regulation. The club regulation mainly resulted from social and economic changes. Earlier before, physicians worked under a system known as the ‘lay patronage' where wealthy clients determined actions. Such a system allowed the wealthy patients to control their needs and how they wanted the needs to be met.
According to Ellis (2014), the lay patronage system also demanded that the doctors showed an increased loyalty to their clients than they showed to their colleagues, therefore, jeopardizing occupational solidarity. The health facility was regarded as the ‘’medical marketplace’’ which saw practitioners such as surgeons, physicians, and apothecaries compete for patients with each other with various other healthcare professionals such as mesmerists, homoeopathists, and bone setters among others. Therefore, with such disputes and rivalries, some physicians resorted to writing professional codes of ethics in the early 19th century. The earlier conducts focused mainly on individual behavior and the call for practitioners to act like gentlemen. Thomas Percival's ethics came to streamline the profession focusing on mitigating professional conflict, improving collective autonomy, and a need for collaborative self-regulation. Therefore, Percival depicts professional concerns and not public interests.
Therefore, through the club regulation, the doctors, and medical practitioners argued that the role of determining their conduct should be left to them. Most of them felt that medical and scientific ethics should be regarded as internal affairs aimed at limiting internal conflict. As such, doctors would be able to consolidate professional expertise by creating boundaries and excluding unqualified professionals hence asserting their position as the only people capable of providing essential health services to the public. However, with the rise of doctors such as Percival, the ethics slowly evolved to cater for both the professional interest and that of the public which represents the patients.
In conclusion, the 19th century is an important period in the medical history of not only Britain but the entire world. The emergence of the medical ethics stemmed from consistent disputes and conflicts among professionals. As such, there was a growing need to develop codes of conducts that would improve how professionals collaborated, consolidated, and related to each other. Therefore, this urge saw the emergence of written medical ethics by doctors such as Thomas Percival who initially sought to mitigate the conflicts and also improve practitioners’ association with the patients. With the rise in industrialization during this period, factors such as poor sanitation, overcrowding, and factory workplace issues increased medical needs thereby prompting doctors to develop an internal system of ethics that would allow them to work efficiently.
References
Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer, Cham.
Bynum, W. F. (2013). Companion encyclopedia of the history of medicine . Routledge.
EBOOKS World Medical Association Medical Ethics Manual 2nd https://www.youtube.com/watch?v=HiDWxgLHBYs
Ellis, H. (2014). Knowledge, character, and professionalization in nineteenth-century British science. History of Education , 43 (6), 777-792.
Koch, T. (2012). Thieves of virtue: when bioethics stole medicine . MIT Press.
