A History of Medical Professionalism and Ethics and Some Questions

As a segue from the previous posting about the medical professionalism issue of Dr. Vlasak’s speech and also as a followup on a number of previous postings on “physicians wearing two hats” and other professionalism issues and along with current concerns about the treatment or torture of military prisoners, I have posted below a very good brief summary of the history of medical professionalism and ethics which was recently written to a bioethics listserv. The author, from whom I have permission to reproduce his writing here, is Robert Baker, PhD, Chair, Alden March Bioethics Institute
Professor of Bioethics, Graduate College of Union University and
Professor of Philosophy, Union College. Read the history and then maybe you could comment on what points in medical professionalism you would emphasize in terms of physician public advocacy or simultaneously wearing another occupational hat if you were writing a code of ethics for doctors. ..Maurice.

The modern concept of a professional is absent from eighteenth century English (e.g. is not to be found in Dr. Samuel Johnson's Dictionary 1755 and later eds.) emerging in the early nineteenth century initially in Percival's Medical Ethics (1803). In that book Percival looks back to Cicero and Stoic philosophy (the source of an early effort to create a notion of professionalism by the Greek physician Scribonius Largus, fl. 14-54 CE ) to offer the concept of an occupational role, that of physicians and/or surgeons, whose obligations--because they entail duties of service to others--transcend that of mere employee, and whose prerogatives are justified by an implicit social contract which makes their position a "public trust" (Percival's words). Percival's innovative conception was ignored by physicians and surgeons everywhere--except for a few receptive young men in America. These men would ultimately draft a code of medical ethics for the AMA in 1847. By means of the code and the AMA the concept of being a professional (and the correlative notion of unprofessional conduct) gradually displaced the older conception of the physician as gentleman bound by precepts of gentlemanly honor. American conceptions of professionalism and professional ethics--with it presumptions of competence formally bound by medical ethics-- did not definitively displace older concept of honor until the end of WWII (a post-Holocaust/post-Nuremberg phenomenon).

To teach professionalism, in my view, is to teach both how and why the concept was constructed, as well as the nature and limitations of its construction--it is to teach the lived experience of medicine, the history of its response and failures to respond to a variety of challenges.

More specifically, it is not self-evident that physicians shouldn't act as patriots, and use their medical knowledge to aid their countryman and to thwart its enemies.

Hippocrates VITAE --a life of Hippocrates written some time after his death--states clearly that Hippocrates refused to treat Persians suffering from a plague because they were the enemies of the Greeks. Benjamin Rush (1745-1813) lectured to his students using this example to argue that physicians must be patriots.

(See: Jouanna, Jacques. Hipporcrate Translated as Hippocrates by M. B. DeBevoise (Baltimore, MD: Johns Hopkins University Press, 1999; Temkin, Owsei. Hippocrates in a World of Pagans and Christians. (Baltimore, MD: Johns Hopkins University Press, 1991).


The notion that physicians are above the battle and should treat the wounded from all sides emerges from military medicine. It becomes wedded to professionalism only after the formation of the World Medical Association in 1947 and is a post-Holocaust phenomenon. Hence the importance of teaching not only the Nuremberg trials--but the international codes of medical ethics, oaths and declarations that derive from them.

As physicians became involved in military conflicts in the second half of the twentieth century-- British physicians' treatment of IRA hunger strikers, the revelations of physician complicity at the South African Truth and Reconciliation Hearings (http://shr.aaas.org/trc-med/default.htm ), etc.,--medical societies began to rethink the obligations of physicians.

What sort of medical care/information should they supply in these contexts? Should they force feed prisoners? Do they have a professional obligation to protest torture? To reveal what they see? etc.