Fictional Doctors and the Evolution of Medical Ethics in the United States, 1875-1900

^Fictional Doctors and the Evolution of Medical Ethics in the United States, 1875-1900 Chester R. Burns Medical ethics, some would claim, is primarily a subject for health care professionals, and for philosophers and theologians who devote careers to the problems of ethics in general. Physicians, nurses, and others fashion their ethical values as health care professionals, and scholars in the reflective disciplines, such as philosophy and theology, provide critical assistance with such creative tasks. Is there, some might then ask, a role for the literary imagination in the evolution of medical ethics? As demonstrated in other essays of this volume, there are various answers to this question. In this essay, I wish only to claim that a study of fictional doctors can be instructive in understanding the social history of medical ethics in the United States. I focus on the last quarter of the nineteenth century because of the significant changes in medical ethics that began to appear during that time. Most discussions of medical ethics in the United States during the last half of the nineteenth century involved the contents and merits of a code adopted in 1847. Some eighty physicians had assembled in New York Qty in May of 1846 to consider the formation of a national medical society for general practitioners.1 These doctors established two committees , one on medical education and the other on medical ethics. Naming themselves the American Medical Association (AMA), this group held its first official meeting in Philadelphia in June of 1847, and unanimously adopted the report of its committee on medical ethics. This report, without John Bell's introduction, became the code of professional ethics championed unchanged by AMA physicians for fifty-six years.2 This code was the culmination of extensive interest in ethical values among American doctors during the first half of the nineteenth century. Literature and Medicine 7 (1988) 39-55 © 1988 by The Johns Hopkins University Press 40 FICTIONAL DOCTORS AND MEDICAL ETHICS Major codifications, relying heavily on British and Continental legacies, occurred in Boston, New York City, Baltimore, and Philadelphia between 1808 and 1843.3 Rephrasing and rearranging various paragraphs of these earlier codes produced the one that was adopted by the AMA in 1847. In 1874, the Judicial Council of the AMA proclaimed that all of this code's precepts were still valid, a situation acknowledged by some American newspapers. In the September 8, 1875, issue of the Galveston Daily News, for example, a reporter summarized the major precepts of this code that had been adopted almost three decades earlier. The writer recounted the code's theme of mutual obligations between physicians and patients. Physicians, for example, should display confidentiality in all transactions with patients . Patients, on the other hand, should communicate all details of their illness unashamedly and completely. Numerous other obligations for doctors and patients were included in the summary. The author emphasized that these criteria for right and wrong were recognized as "binding by all respectable physicians in the United States."4 But were they recognized as valid and "binding" by respectable citizens in the United States who were not physicians? Did the AMA code of 1847, reaffirmed in 1874, actually shape the ideals of American citizens about good and bad doctors? Conclusive answers to these questions are elusive, but evidence for partial answers can be found in newspapers, popular magazines, and novels written by Americans during the last half of the nineteenth century. This essay will be limited to an analysis of evidence from seven novels crafted by seven American authors between 1875 and 1900.5 Five of the seven authors were nationally prominent during their lifetimes: William Dean Howells, George Washington Cable, Sarah Orne Jewett, Edward Eggleston, and Robert Herrick.6 Elizabeth Stuart Phelps and Clara Burnham were recognized as important regional authors. Although these novelists did not mention the AMA code by name, they did deal directly with some of its major precepts, especially the ones about consultations. Some of the novelists addressed ethical questions, such as male-female relationships, that were ignored by the code. All revealed their images of doctors as moral therapists, thereby contributing significantly to public discourse about medical ethics. Consultations Rules about consultations...