Wednesday, December 17, 2008

History and ethics

An article in this month's issue of Academic Medicine (2008, 83:1162-1164) addresses the place of history of medicine classes in the medical curriculum and makes the argument that the study of history is a vital component of the education of young physicians. (Abstract free)

The piece by Daniel K. Sokol, "Should We Amputate Medical History?", is described in the abstract as a "cri de coeur"--and indeed it is, with the author suggesting cuts to his own area of specialty, medical ethics, to make room for history of medicine in class.
This proposal is not as drastic as it sounds, for I have suggested that medical history can contain a strong ethical flavor. My own interest in medical ethics sprung from the formal study of medical history. I wanted tools to assess the moral rightness or wrongness of past practices. Medical history can fulfill a similar function as medical ethics ...
One example given by Sokol is of Semmelweis: "Indeed one cannot fail to be inspired by the astuteness of Ignaz Semmelweis, who in the mid-19th century discovered that unhygienic medical students were responsible for the high mortality rates in the maternity clinic and implemented hand washing before deliveries..."

Is the ethical lesson here that the physician should strive to improve patient care? Or is it that Semmelweis was subsequently hounded out of medicine by his contemporaries and left to die in an insane asylum? Either or both, it is a story well worth remembering.

In a similar vein, the life of Charles Thomas Jackson could profitably be used as a case study in medical ethics. A new biography of Jackson, available on this week's new book shelf at the OHSU Main Library, has been called "the first complete defense of this neglected scientist," "one of the most remarkable and maligned figures in the history of American science and medicine." A master at claiming prior discovery, Jackson promoted himself as developer of surgical anesthesia, inventor of the telegraph, and discoverer of copper deposits at Lake Superior. Like Semmelweis, the conflicts he engendered left Jackson mentally unhinged, and he died in an asylum in 1873.

The actions of men like Semmelweis and Jackson, and the reactions of their colleagues, provide cautionary tales for physicians young and old, in any era, who might seek to advance the principles and practice of medicine. Physician, read about thyself!

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