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The Cambridge World History of Medical Ethics
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Book description

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The book reconceptualises the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical ethics and the state, which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi 'medical ethics', and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names.


'I'm pleased to have this volume on my bookshelf; and when a student comes in wondering about what health practitioners in the ninth- to fourteenth-century Middle East thought about psychosomatic aspects of disease, I will know just where to look.'

Kirstin Borgerson Source: Isis

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  • View abstract
    This chapter aims to construct a history of medical ethics whose structure would eschew essentialism, presentism, traditionalism, and Eurocentrism and that would, as much as current scholarship will permit, be responsive to the subordinate as well as the dominant voices with cultures. The standard history of medical ethics would thereafter emphasize oaths, codes, rules, principles, and other formalizations of medical self-regulation, underlining that they were founded on ancient traditions that are continuous and influential to the present day. To appreciate the influence of the traditionalist archetype on our understanding of the history of medical ethics, one should compare the construction of histories of science with the construction of histories of medical ethics. Ethics in medicine focuses on primary sources and constructs its history around such enduring issues as abortion, euthanasia, triage, eugenics and the cost-effectiveness of medical procedures.
  • 2 - Bioethics and History
    pp 16-20
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    This chapter sketches one historian's view of the relationship between medical history and bioethics. Some of the most exciting work in medical history today focuses on the changing cultural construction or framing of disease. Feminist historians and historians of mental illness pioneered such studies, but many others now argue that history reveals the value-laden nature of all disease categories. Practitioners' histories of bioethics promote and display the maturation of the field as an autonomous, self-defining, self-reflective discipline, whereas nonpractitioners emphasize that the discipline was shaped by larger social forces and that it often ironically depended on medical power. Modern bioethicists use history to demonstrate the newness of their approach to medical ethics in contrast with the long tradition of doctor-dominated medical ethics before 1960. Even more fundamental than the internal-external distinction is the difference between past and present goals for studying the history of medical ethics.
    pp 21-98
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    This chapter chronicles the history and historiography of medical ethics through the end of the twentieth century, using a few noteworthy events in world and medical history as chronological signposts. Following Roy Porter, the chronology opens circa 4000 BCE: the dates of the earliest known urban centers. The dates, events, persons, and texts cited in the chronology are, for the most part, those mentioned in the book. The earliest medical entry is circa 650 BCE, a description of epilepsy in a Babylonian text; the Hippocratic corpus, several centuries younger, constitute the first texts cited. The chronology ends in 2000, closing with an act prohibiting cloning and a book by Albert Jonsen, on the history of medical ethics. For reasons of economy, and because of the difficulty of putting the present into historical perspective, the chapter restricted entries in the person's column to those who are deceased.
  • View abstract
    Birth and death, in turn, frame the life cycle and pose the fundamental religious questions of human meaning and destiny. As human life has its phases and moments of vulnerability (birth, illness, old age, and dying), religions have also used their authority to protect the vulnerable through an ethics of care, if not inviolable sanctity ascribed to life itself. There are different views on the number of stages in the Hindu life cycle, some late accounts numbering forty. The ethics of transplantation has involved three major issues: defining the moment of death, the nature of the body, and the scope for exploitation. Defining the moment of death has been an issue for transplantation because one has to remove the organs or tissue quickly to maintain the condition of the organ or tissue for transplantation but not so quickly that one might cause death to the donor.
  • 4 - Medical Ethics through the Life Cycle in Buddhist India
    pp 113-125
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    Buddhism by and large left reproductive and family matters to other religions, focusing instead on liberation as the ultimate telos of life. As a result, for Buddhists, each phase of life is characterized by suffering, especially the last phase of old age and dying. The life cycle for Buddhists is being profoundly affected by the development of modern, medical technologies. The impact of Western medicine on Asian countries has escalated in the last half of the twentieth century. There has been transfer not only of the new reproductive technologies and transplantation technologies but also of the ethical and legal issues they have raised. This in turn has sparked discussions of religious, cultural, and regional identities. Much of the Buddhist debate has developed because Buddhism now has a broad movement called socially engaged Buddhism, which is attentive to general ethical issues and has attracted a number of Westerners.
  • 5 - Medical Ethics through the Life Cycle in China
    pp 126-131
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    This chapter provides an account of Chinese perspectives on ethical issues through the life cycle, and focuses on those at the beginning and end of life. Materials presented in the chapter demonstrate that this is certainly not the case with medical ethics in China. The current dominant and official line on such subjects as abortion, fetal life, truth telling about terminal illness, and euthanasia does not necessarily accord with historical values and practices. The chapter reviews Chinese perspectives on ethical issues at the two ends of human life provides further evidence on the diversity, richness, flux, changeability, historical complexity, openness for new possibilities, and contradictory elements of Chinese medical morality. The contemporary dominant Chinese views on abortion, eugenics, and euthanasia seem to support the commonly accepted view that individual human life is less respected in Chinese culture than in the West.
  • 6 - Medical Ethics through the Life Cycle in Japan
    pp 132-136
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    Traditional medical ethics in Japan has faced grave changes challenged by the development of modern biomedical technologies such as organ transplantation. The Japanese life cycle is becoming more similar than different to the situation in the medically advanced countries of the world. The understanding of the life cycle has been vanishing as the Japanese have applied modern biomedical technologies more frequently in well-equipped hospital settings. The unique Japanese sociocultural elements of each life cycle of Sho, Ro, Byo, Shi have been generally converging toward either birth/life or death by disregarding the stages of Ro and Byo, very often particularly by having artificial interventions at both the beginning and end of life. Some traditional elements of the involvement of family members in the process of Sho, Ro, Byo, Shi continue in a variety of ways, as reflected in the newly established framework of the Law for the Care of the Elderly.
  • 7 - Medical Ethics through the Life Cycle in Europe and the Americas
    pp 137-162
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    For four centuries, Europe and the Americas have experimented with the medicalization of the life cycle: conception, childbirth, sexual maturation, aging, and dying. Enlightenment ideals motivated this experiment and, judged in terms of these ideals, many aspects must be considered a success. By the end of the twentieth century mother and child were much more likely to survive childbirth in good health than in any prior period. Much of the pain of delivery had been muted, and the aura and fear of death that once attended childbirth had been dissipated. By focusing reductively on natural causal explanations of health and disease the medical gaze was blind to religious and cultural meanings depriving Europeans and Americans of much that had once made life cycle events significant. The medicalization of birth allowed men to colonize a female and feminine domain.
  • 8 - Medical Ethics through the Life Cycle in the Islamic Middle east
    pp 163-172
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    It is obvious that the Islamic view of humanity and the articles of faith influence the understanding and experience of different phases of life in the biography of a Muslim. The content of such concepts as the beginning of life, childhood, illness, growing old, and death is constructed out of the faith and interpreted accordingly. This chapter discusses the interpretations of these stages of life that can be derived from Islamic sources and some medically relevant moral obligations that arise from them. Even if one can proceed on the basis of a general basic approach to all phases of life, differing opinions about the appropriate and ethically tenable attitudes in these areas of life are to be found in different legal schools. This is an inter-Islamic reality that is to be traced back to the nature and structure of conventional decision making.
  • View abstract
    One of the distinguishing features of Hinduism has been its penchant for both analysis and synthesis. The development of specialized knowledge in the classical period contributed to empirical medicine based on analysis. Despite an emphasis on observation, description, categorization, and experimentation, efforts were made to keep the new approach within a general religious framework and to recognize the fact that body, psychology, and behavior (including ethics) must work together with the environment to maintain harmony, prevent disease, or restore health. This integrative approach also prevented a deep split between philosophy and religion or between religion and ethics. In the medieval period, it led to grand synthetic treatises of the Indian schools of medicine, new syntheses with religion, and attempts to integrate the Islamic systems of medicine. By the modern period, the synthetic spirit was at work once again trying to integrate Western medicine.
  • 10 - The Discourses of Buddhist Medical Ethics
    pp 185-194
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    This chapter examines the place of ethics within the general Buddhist world view (a soteriological orientation). There are differences within Buddhist ethics based on Buddhism's three major traditions, Theravāada, Mahāyāna, and Vajrayāna, and how they view the relation between religion and medicine. In addition, there are differences in modern scholarship based on whether Buddhist ethics is viewed as limited to the means or intrinsic to both the means and the goal. Analogies with medicine were common: illness is the normal condition of the body within samsyāra, the Buddha is the great physician, Buddhist teachings are the medicine, and enlightenment is the absence of illness. The antinomian passages of Mahāyāna and Vajrayāna are interpreted literally by those scholars who view ethics as but instrumental. This has led to some modern scholars interpreting them within the Western framework of utilitarianism or situational ethics.
  • 11 - The Discourses of Confucian Medical Ethics
    pp 195-201
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    Most scholars seem to believe that the Daoist contribution to original Chinese medicine is more prominent than Confucianism; however, it is not controversial that the Confucian teachings of ren have shaped the basic tone of Chinese medical ethics. Ren constitutes the basic virtue of human individuals and sets down the fundamental Confucian principle of human society. Confucianism can be understood as a personal health care system, even if it cannot be reduced to a personal health care system. Confucians have seen medicine as the art of ren; however, they have seen politics as the governing of ren. The Confucian physicians took medicine as an enterprise of ren, namely, the art of ren. Medicine is their way of making the Confucian life, rather than simply treating diseases as technicians. The good life for Confucians is the life of cultivating the virtues for taking care of the family and the whole world.
  • 12 - The Discourses of Early Christian Medical Ethics
    pp 202-210
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    This chapter describes the discourses of early Christian medical ethics, and demonstrates that the New Testament presents a primarily naturalistic understanding of sickness that was not inimical to naturalistic healing and medical practice (without which it would be fatuous to speak of early Christian medical ethics). It also describes the most fundamental principles of New Testament ethics. The chapter discusses the patristic era by articulating some basic principles that provided the theological and moral framework of the Church Fathers' medical ethics. It considers the question, regularly raised in secondary literature, of whether the Church Fathers ever rejected the use of medicine and physicians on theological grounds. The chapter deals with these propedeutic but essential matters, and addresses various aspects of patristic medical ethics under the rubrics of compassion, philanthropy, and etiquette and the sanctity of life.
  • 13 - The Discourses of Orthodox Christian Medical Ethics
    pp 211-217
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    Orthodox Christianity understands the moral life to be a whole, a way of life within which one can enter into union with God. Orthodox Christian morality and medical ethics are modes of reorienting persons away from themselves toward God and their fellow man. Neither medical ethics nor bioethics is a univocal term. Orthodox Christianity through its morality, medical ethics, and theology provide a stark example of such differences. As an introduction to the depth of these differences, one considers the Orthodox Christian historiography of Christian morality and medical ethics. Orthodox Christianity contrasts with both Roman Catholicism and most Protestant faiths in rejecting a notion of moral dogmatic progress. Orthodox Christian reflections on medical ethics are one element of the Church's attempt to set aside the alienating character of time, which appears to isolate the past from present, which seems to separate one from the living Fathers of the first centuries.
  • 14 - The Discourses of Roman Catholic Medical Ethics
    pp 218-254
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    This chapter focuses on the major sources of moral definition and authority within Roman Catholicism. It extends from the early Middle Ages to the First Council of the Vatican, which convened in 1869. During most of this lengthy period, canon law and moral theology were the major sources of Roman Catholic medical ethics. Canon law consisted of private compilations of canons of councils, papal rescripts, and episcopal statutes, often inconsistent with each other. The influence of canon law on the development of Roman Catholic medical ethics has been profound, especially in three respects. The chapter describes the role of the magisterium as a source of moral definition. The Church's tradition has constantly upheld, and the magisterium has consistently proposed the moral truth of the absolute inviolability of innocent human life. Within the Church the magisterium is ordinarily exercised in teaching moral principles and precepts through catechesis and preaching.
  • 15 - The Discourses of Protestant Medical Ethics
    pp 255-263
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    Protestantism encouraged the participation of Christians in every aspect of society with the confidence that they could provide a redemptive force in a sinful world. Protestant medical ethics arose more directly from religious considerations of health and disease, as well as from biblical themes such as providence, justification, law and grace, covenant, and the place of suffering in the Christian experience. In medicine Protestant physicians and philosophers as well as theologians, laymen as well as clergy have influenced the formulation of medical ethics. From the sixteenth through the eighteenth centuries, many Protestant clergymen practiced medicine on the side. The distinctively Protestant understanding of the individual and his or her conscience alone before God, together with its insistence that a Christian's calling must be lived out in the world, have served as powerful motivating factors in the medical professions.
  • 16 - The Discourses of Jewish Medical Ethics
    pp 264-269
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    This chapter presents a small sample of the talmudic texts relating to issues in medical ethics. In general, modern Jewish bioethics has tended to proceed in the spirit of Maimonides, endorsing the enhancement of the capacity to heal. The chapter finds resistance to placing Jewish patients in institutions where the ritual dietary laws cannot be observed, numerous concerns over observing the Sabbath by both patients and staff in hospitals, insistence on details of ritual circumcision although accepting (some) medical innovations. Other issues in contemporary Jewish bioethics have a more clearly ethical dimension, often related to the valuation of humans as created in God's image. People committed to the halakhah have continued to turn to rabbinic leaders, and significant portions of the writings in modern Jewish bioethics are produced in the traditional form of responsa. The chapter draws insight for Jewish bioethics from biblical narratives and from rabbinic non-halakhic sources.
  • 17 - The Discourses of Islamic Medical Ethics
    pp 270-278
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    This chapter describes the concepts of health, disease, and illness presented in the Quran and the traditions of the Prophet Muhammad (Sunna) and the moral obligations for practitioners and patients that can be derived from them. The meaning and justification of medical skill and a number of medical-ethical principles are also discussed. The Prophet's recommendations of medical therapies or the mention of specific medicines for particular illnesses emphasize the values of bodily well-being and imply that it is necessary to maintain one's health. The chapter explores what normative content and moral implications the historical texts can have for contemporary Muslims. Despite numerous common positions on topics in medical ethics, such as the problem of abortion, euthanasia, the doctor's duty to maintain confidentiality, it does not seem appropriate to describe the medical ethics of the Islamic Middle Ages as a copy of the Hippocratic ethics.
  • View abstract
    This chapter offers an alternative to Daniel Fox's disconnection hypothesis, providing an account of the influence of philosophy on medical morality that explains the disconnection phenomenon while establishing a deeper sense of connectivity. By applying Hans-Georg Gadamer's concept of the long horizon of philosophical influence, which allows one to analyze the impact of Platonic discourse on a physician, such as Hoche, many centuries later, and by adopting I. Bernard Cohen's four-stage analysis of the dissemination of innovative ideas in science, the chapter shows, in three case studies, how concepts, such as the sympathetic physician, professional ethics, and lebensunwertesLeben, trace their origins to such philosophers as Bacon, Cicero, Hume, Locke, Nietzsche, and Plato. Arguments, concepts, and discourses, although intangible, are just as much inventions as tangible artifacts. The three cases discussed in the chapter are merely illustrative of philosophy's influence on conceptions of medical morality, for better, and for worse.
  • View abstract
    This chapter distinguishes the roles of traditional medical healers in Africa, who mainly dealt with biological causation, from those of diviners, whose work was largely based on metaphysical aspects. It examines the wider role and social standing of the traditional healer in the community. Health in African communities is generally viewed as a fundamentally ethical question pointing to the relationships in the family and in the community, and between people and nature. Concepts of illness, disease, diagnosis, treatment, and life and death always had a cultural dimension in all societies, including African societies. Most African societies believe in the dualism of body and soul. An experienced traditional healer who then became the mentor of the newly admitted healer led the initiation ceremony. Most traditional healers underwent long periods of training and apprenticeship to acquire knowledge of medicinal herbs and other specialized medical skills.
  • 20 - The Discourses of Practitioners in India
    pp 324-334
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    This chapter attempts to ensure group control of the new physicians beginning with their apprenticeship and the taking of oaths (Hinduism) or indirect regulation by the general observance of monastic rules including the required monthly confessions (Buddhism). The discourses of practitioners describe model nurses and model patients, and who should have access to medicine. After the arrival of Islam in India, this also served to keep Islamic medicine at bay. But with colonialism and the establishment of Western medicine, the discourses of practitioners reflect a deep conflict of values at the heart of medical practice, a conflict that has played out in independent India with the call for a return to a pure Hindu medicine as an expression of Indian nationalism. Traditional medicines and their underlying principles of holism and balance are spreading to the West.
  • 21 - The Discourses of Practitioners in China
    pp 335-344
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    This chapter provides an overview of the moral discourses of medical practitioners in China from the Axial Age to the end of twentieth century, with emphasis given to the great diversity of culture and medical morality in China. With regard to the diversity of morality, healing systems and healers, an overview of the moral discourses of medical practitioners in China should address the characteristics, dissimilarities, similarities and commonalities of the moral discourses of different groups of healers who believed in specific moral systems or religions and practiced specific types of therapy. The chapter focuses on traditional China and Confucian physicians and then twentieth-century China and socialist or communist health care providers. Lack of systematic and detailed exploration in contemporary scholarship precludes a presentation of other Chinese medico-moral discourses, such as the moral discourses of itinerant healers, sorcerer-healers, and practitioners from various ethnic minorities.
  • 22 - The Discourses of Practitioners in Japan
    pp 345-351
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    Japanese medical ethics developed in the framework of a unique discourse integrating concepts of nature, the human body, and medical practice. The understanding and practice of medicine in Japan has been strongly influenced by the acceptance of medical knowledge from countries such as China, Korea, Spain, Portugal, Netherlands, Germany, Britain, France, and United States. In ancient Japan, according to its mythology, disease was understood as a punishment and/or curse of kami. The ancient Japanese believed that there were various kami (god) and evil spirits that possessed living human being and caused different types of disease. People believed that widespread epidemic diseases, famines, and political disorders were caused by traditional gods who were angry because the people had accepted Buddhism. Buddhism, Confucianism, and Taoism had enormous impact on Japanese political, cultural, social, and religious life.
  • 23 - The Discourses of Practitioners in Ancient Europe
    pp 352-358
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    The image of Hippocrates and the precepts of the Hippocratic Oath and related texts had an important influence on medical ethics in Europe and the Middle East from the ancient period onward. The relative insecurity of medicine within the social order partly accounts for the overt preoccupation with reputation, and likewise for the defensive and often polemical tone with which some Hippocratic writer's stake out the claims of their new, nonmagical medicine. Several versions of the Oath were attributed to Hippocrates in antiquity. The inclusion of numerous abortifacients in the doctor's pharmacological arsenal suggest that at least some Hippocratics also dispensed such drugs, as did numerous later Greek physicians. In other Hellenistic medical works, some of the emphases traced in the Hippocratic Corpus also emerge. Galen's valorization of truthfulness with one's patients is to some extent at odds with emphases in the postclassical Hippocratic deontological treatises.

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