Bioethics Discussion Blog: When Should Doctors Retire?

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Monday, May 18, 2009

When Should Doctors Retire?

My visitors may have varying opinions regarding the answer to the question "When Should Doctors Retire?". If so, please write your opinions here. However, here is the opinion from a physician, Thomas Percival, who lived throughout the latter half of the 18th Century and published a notable book of medical ethics a year before he died in 1804. What follows is a quotation from Chapter 2 Section XXXII from that book "Medical Ethics".


The commencement of that period of senescence, when it becomes incumbent on a physician to decline the offices of his profession, it is not easy to ascertain; and the decision on so nice a point must be left to the moral discretion of the individual. For, one grown old in the useful and honourable exercise of the healing art, may continue to enjoy, and justly to enjoy, the unabated confidence of the public. And whilst exempt, in a considerable degree, from the privations and infirmities of age, he is under indispensable obliga¬tions to apply his knowledge and experience, in the most efficient way, to the benefit of mankind.

For the possession of powers is a clear indication of the will of our Creator, concerning their practical direction. But in the ordinary course of nature, the bodily and mental vigour must be expected to decay progressively, though perhaps slowly, after the meridian of life is past. As age advances, therefore, a physician should, from time to time, scrutinize impartially, the state of his faculties; that he may determine, bona fide, the precise degree in which he is qualified to execute the active and multifarious offices of his profession. And whenever he becomes conscious that his memory presents to him, with faintness, those analogies, on which medical reasoning and the treatment of diseases are founded; that diffidence of the measures to be pursued perplexes his judgment; that, from a deficiency in the acuteness of his senses, he finds himself less able to distinguish signs, or to prognosticate events; he should at once resolve, though others perceive not the changes which have taken place, to sacrifice every consideration of fame or fortune, and to retire from the engagements of business. To the surgeon under similar circumstances, this rule of conduct is still more necessary. For the energy of the understanding often subsists much longer than the quickness of eye-sight, delicacy of touch, and steadiness of hand, which arc essential to the skilful performance of operations. Let both the physician and surgeon never forget, that their professions are public trusts, properly rendered lucrative whilst they fulfil them; but which they are bound, by honour and probity, to relinquish, as soon as they find themselves unequal to their adequate and faithful execution.


Here is the story of Thomas Percival as described in Wikipedia. Please go to this link to Wikipedia to access the links to the references. ..Maurice.


Thomas Percival (1740-1804) was an English physician best known for crafting perhaps the first modern code of medical ethics. He drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, in which he reportedly coined the expression "medical ethics"[1].
He was born at Warrington at Lancashire. He lost both his parents when he was three years old, so his older sister was responsible for his early education. Once he was old enough, he was placed in a private academy in his home town. He also spent time in a free grammar-school. In 1757, he was enrolled as the first student at Warrington Academy. After achieving a good reputation in classical and theological studies, he transferred to Edinburgh in 1761. He became a fellow to the Royal Society in 1765, through a recommendation by his friend and patron Lord Willoughby de Parham, and achieved his M.D. degree the same year.[2]
Percival is also known for his early work in Occupational health. He led a group of doctors to supervise textile mills, their report influenced Robert Peel's to introduce the Health and Morals of Apprentices Act of 1802. The legislation stipulated that children could work only 12 hours per day, walls had to be washed, and visitors had to be admitted to factories so that they could make health-related suggestions.[3][4]
Percival's Medical Ethics served as a key source for American Medical Association (AMA) code, adopted in 1847. Though hyperbolic in its recognition of Percival, the AMA itself states:
The most significant contribution to Western medical ethical history subsequent to Hippocrates was made by Thomas Percival, an English physician, philosopher, and writer. In 1803, he published his Code of Medical Ethics. His personality, his interest in sociological matters, and his close association with the Manchester Infirmary led to the preparation of a scheme of professional conduct relative to hospitals and other charities from which he drafted the code that bears his name. [5]
As one expert writes, "The Percivalian code asserted the moral authority and independence of physicians in service to others, affirmed the profession's responsibility to care for the sick, and emphasized individual honor."[6]

References
1. ^ Codes of Ethics: Some History, Center for the Study of Ethics in the Professions at IIT
2. ^ Thomas, Percival (Digitized Oct 17, 2006). Percival's Medical ethics. Published 1849 John Churchill. http://books.google.com/books?id=yVUEAAAAQAAJ&printsec=frontcover&dq=medical+ethics+thomas+percival&as_brr=1#PPP4,M1.
3. ^ Dr Thomas Percival and the Beginnings of Industrial Legislation
4. ^ Environmental History Timeline (1795)
5. ^ Short history of medical ethics, AMA web site
6. ^ Bioethics - Codes, Oaths, Guidelines and Position Statements, Dal Libraries

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