MEDICAL ETHICS AND ETIQUETTE.

INTRODUCTORY REMARKS.

THE objects of this volume are to present to the reader our National Code of Medical Ethics-in other words, the code adopted by the American Medical Association, as also by the State and local societies throughout our country-to submit in connection therewith brief commentaries; and to state certain rules of professional etiquette.

A reader who has given to the subject little or no attention may be supposed to ask, "Wherefore the propriety of recognizing the principles of duty applied to medicine as constituting a distinct branch of ethical science?" "Are not the rules in ethics which would govern the practitioner of medicine the same as in other applications? There are certain fundamental truths which, of course, underlie all possible applications of ethics; but the adaptation to different conditions of human life call for separate consideration. Political ethics and social ethics are recognized different branches of ethical science. Ethics as applied to the medical profession involves adaptations which require to be considered apart from the science as a whole. In various points of view, the practice of medicine,

when contrasted with other pursuits, is peculiar. The medical practitioner does not deal with facts and laws having the exactness of those pertaining to physics. In employing means for certain ends, he can not calculate results with mathematical precision. The problems of disease embrace many and varying elements, which can not always be estimated with absolute certainty. They offer a wide scope for the exercise of judgment in the practical applications of medical knowledge. It is by no means easy in all cases for the practitioner himself to judge correctly of the results of his practice; and, for those who are not versed in the study of disease, this is an impossibility; hence, he is often blamed undeservedly, and as often, perhaps, he receives praise not strictly his due. People can not form a true judgment of the merits of a physician by the character of his work, as can be done with reference to mechanical callings, and even the sister professions of law and theology. The choice of a family doctor is in many instances determined by other circumstances than those which pertain to scientific knowledge or skill, and, as a rule, the relations between the physician and his patients are not purely professional, but involve the ties of friendship, and often affection. In no other profession or calling are extrinsic means available for competition to the same extent as in the practice of medicine, and in no other pursuit are the opportunities so great for ungenerous or unscrupulous advantages. Under these circumstances it is not to be wondered at that physicians are peculiarly sensitive respecting their professional relations and rival practitioners.

Peculiar responsibilities pertain to the practice of medicine, aside from those involved in the treatment of cases of disease. In the exercise of his profession, the physician becomes intimately acquainted with the private character of his patients. Weaknesses, faults, vices, can not be con

cealed, if not confessed. He can not escape, if he would, knowledge of family secrets. He is exposed to peculiar temptations. Other responsibilities relate to the honor and purity of the profession, the promotion of medical knowledge, the prevention of diseases, and the protection of the public health. The charitable gift of professional services to institutions and to individuals is an obligation which, with certain limitations, is inseparable from the medical profession. Important obligations arise from the opportunities afforded by the relations of physician and patient for advice and aid in overcoming injurious and immoral habits. There are duties connected with the expression of opinions concerning the nature, the probable cause, and the termination of diseases to patients and their friends, with communications respecting the diseases of patients to others, and with testimony given in courts of law. Finally, moral obligations to society are to be fulfilled by the members of the medical profession, individually and collectively, with reference to irregular practitioners, secret nostrums, and all the multitudinous forms of quackery.

The rules of conduct adapted to the peculiarities of medicine constitute medical ethics. These rules have a moral weight. Medical etiquette, on the other hand, consists of the forms to be observed in professional intercourse. These are conventional. They have not the binding force of ethical rules; nevertheless, they claim observance. The medical profession receives not a little ridicule for observing rules of etiquette, but their observance is a protection against not only embarrassment and confusion, but misapprehensions and dissensions, injurious alike to physicians and patients.

If there be ground for a distinct system of ethics applied to medicine, the rules of conduct which the system requires should be codified. A code of ethics adopted by the pro

fession represents the views held by the majority of its members, and is, therefore, binding on all. It is indispensable for the sake of reference whenever differences of opinion arise. It indicates the proper course to those whose moral perceptions may be defective. It may prove a safeguard against the bias of personal interests. It thus contributes to the purity and dignity of the medical profession. Much would be gained in the popular respect for the profession were the public better acquainted than they are with the ethical rules by which its members assume to be governed. It is, perhaps, a common impression that the objects of a code of medical ethics have exclusive reference to the interests of the medical profession. So far from this, the objects are of far more importance to the public welfare than to physicians. The truth of this statement will be apparent, without argument, to any who will take the trouble to become acquainted with the provisions of the code. The writer may add that, in preparing these articles, he has been actuated by the hope that they may do something in the way of a general diffusion of knowledge on subjects which they who are not members of the medical profession are apt to think do not in the least concern them. These remarks, having reference to the ethics of medicine, will apply measurably to the rules of professional etiquette.

Prior to 1847 the codes of medical ethics which existed in this country were instituted by State or local societies, and in many, probably in most, of the States of the Union there were none. At the convention which resulted in the organization of the American Medical Association, in 1847, a committee, of which the late Isaac Hays was chairman, were instructed to report a code of ethics. This committee reported a code which was adopted unanimously, and from that date it has been recognized as the National Code throughout the whole country. With the single exception of