|
|
|
|
|
|
the circumstances: (text by Robert Baker; context below):
In 1792, a festering dispute, exacerbated by a pamphlet war, erupted into a work stoppage by surgeons that coincided with the outbreak of an epidemic. Hospital trustees were outraged that desperate patients were being turned away from the hospital because of a dispute between surgeons. They called upon Percival to lead a committee to draft rules to prevent any recurrence of this fiasco. The committee drafted the needed regulations, which were promptly implemented. Then, two years later, for reasons unknown to us (most of Percival's personal papers were destroyed during the bombing of Manchester in World War 11, Percival published Medical Jurisprudence or a Code of Ethics and Institutes' Adapted to the Professions of Physic and Surgery. Nine years later he issued the revised pamphlet as a book, Medical Ethics.
PHYSICIANS ... should minister to the sick with due impressions of the importance of their office ... They should study, also, in their deportment, so to unite tenderness with firmness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect, and confidence.
American Medical Association, 1847: First Code of Medical Ethics, quoting Thomas Percival (1740-1804); reprinted in Ethics in Medicine, Historical Perspectives and Contemporary Concerns, ed. Reiser et.al. (M.I.T. Press, 1977) p.29.
Codes of Ethics: Some History Robert Baker, Philosophy, Union College,
http://www.iit.edu/departments/csep/perspective/persp_v19_fall99_2.html
From accountants to zookeepers, professionals of all sorts seem to have a code of ethics these days. It was not always so. Until about 1800, ethics, especially professional ethics, was about character, honor and dishonor, virtue and vice. Ethics had nothing to do with formal codes of conduct. A true professional, being a gentleman, needed no written instruction in how to behave. [...]
The need to guard personal honor zealously may have helped to preserve professional standards among solo practitioners, but it also tended to undermine the largescale cooperation that characterizes modern professional institutions (law and medical schools, law firms and medical hospitals, and so forth). For professionalism to assume its modern form, some alternative conception of "professional morality" was required.
Thomas Percival seems to have been the first person to appreciate this point - and thus the first to propose writing a code of professional ethics. A practicing physician, a leader of the Manchester Philosophical Society, an anti-slavery activist, and a world- author of moral parables for children (such as A Father's Instructions to His Children, 1775), Percival came to doubt the ethics of character only reluctantly, after a spectacular breakdown in professional morality at his own hospital, the Manchester Infirmary.
In 1792, a festering dispute, exacerbated by a pamphlet war, erupted into a work stoppage by surgeons that coincided with the outbreak of an epidemic. Hospital trustees were outraged that desperate patients were being turned away from the hospital because of a dispute between surgeons. They called upon Percival to lead a committee to draft rules to prevent any recurrence of this fiasco. The committee drafted the needed regulations, which were promptly implemented. Then, two years later, for reasons unknown to us (most of Percival's personal papers were destroyed during the bombing of Manchester in World War 11, Percival published Medical Jurisprudence or a Code of Ethics and Institutes' Adapted to the Professions of Physic and Surgery. Nine years later he issued the revised pamphlet as a book, Medical Ethics.
Percival's code of ethics was unlike anything published before. It banished the first person singular, the language of oath, subjectivity, and idiosyncrasy, replacing it with the second and third person plural. Standards of conduct were formulated in numbered "duties". The duties, some quite detailed, were justified by the medical profession's core collective responsibility to care for the sick. As is typically the case with professional ethics, in affirming this core responsibility, Percival also asserted the moral authority and independence of medical professionals, especially, their authority over the hospital trustees who were their nominal employers.
Percival knew from personal experience that the lay trustees of eighteenth -century hospitals, rather like the trustees of some twentiethcentury managed care organizations, were not always trustworthy guardians of the profession's fiduciary responsibility to serve "the ease, the health, and the lives of those committed to their charge." Trustees were sometimes tempted to overcrowd words or use "drugs of inferior quality". Noting that such cost- strategies were typically counterproductive, Percival stated that, even if they were not, physicians and surgeons had a professional obligation "not [to) suffer themselves to be restrained by parsimonious considerations from prescribing .... drugs [since] .... no economy of a fatal tendency ought to be admitted into institutions founded on the principles of purest beneficence".
Percival's code of ethics thus gave medical professionals a moral mandate to appraise the conduct, not only of fellow professionals, but of their nominal superiors and employers, hospital administrators, managers, and trustees.
Percival drafted the first code of professional ethics in response to a particular crisis arising from the mismatch between the personalized ethics of individual honor and the requirements for standardization inherent in a modern institution, the hospital. Modern professions adopted his innovation, codes of ethics, because they needed its fundamental elements: a) common standards (to support extensive cooperative endeavors); b) the minimization of the interpersonal strife that the emphasis on individual honor encourages; and c) a framework of Weals that permits professionals to assert their independence of their nominal employers in the name of service to others.
xxxx» cont
This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 1990
