Medical Ethics in the Ancient World (review)

In this stimulating volume, philosopher Paul Carrick traces key issues in modern medical ethics back to ancient Greece and Rome, exploring the historical context for Greek medicine in general and the Hippocratic oath in particular. At first blush, even a classical scholar might think that a book on medical ethics in antiquity must be slender indeed, restricted perhaps to the oath and to scattered injunctions, mostly on medical etiquette, found in the Hippocratic and later medical treatises. But Carrick adroitly develops his subject by considering the place of early physicians in society; the scientific, philosophical, and religious milieus in which they worked; and a broad range of ancient attitudes toward abortion and voluntary euthanasia.

Carrick starts with the social and scientific setting of Hippocratic medicine, pointing out that most Greek physicians were low-status craftsmen who plied their trade without license and with little fear of legal liability. They hence were free to respond to the scientific and moral trends of the day. Their theories of health and disease, including humoral theory, were related to pre-Socratic philosophy, and they worked in a world where philosophical and religious attitudes toward death varied greatly, from notions of oblivion to differing forms of immortality, so that there is "no warrant for the mistaken view that the Greeks possessed anything like a single, basic outlook on death and dying" (p. 65).

The Hippocratic oath, whose date and origins remain obscure, probably represents a minor and vaguely Pythagorean reform movement among Greek physicians. In fact, the oath's famous prohibitions against abortion and voluntary euthanasia, Carrick argues, flew in the face of widespread medical practice. Infanticide was common in the ancient world and, except among the Pythagoreans, abortion was accepted too. Evidence for the practice of voluntary euthanasia is mixed, but prior to the advent of Christianity, there was widespread recognition that in dire circumstances, such as a painful mortal illness, one might reasonably choose to die rather than to live. Ancient physicians seem to have practiced medicine as they wished, with little interference from civic or religious authorities, and typically would have used abortion and voluntary euthanasia when and how they deemed those practices appropriate.

If much of this terrain seems familiar, that is because it is. Medical Ethics in the Ancient World is an updated version of Medical Ethics in Antiquity, by the same author, published seventeen years ago as part of the Philosophy and Medicine series from Kluwer Academic Publishers. H. Tristram Engelhardt Jr. and Kevin W. Wildes, who worked on that series, are co-editors of the Clinical Medical Ethics Series of which this forms a part. Carrick, a philosophy professor at Gettysburg College and consultant for Pinnacle Health Hospitals, has kept pace with contemporary debates in medical ethics. Indeed, he excels at posing topical questions and answering them with little disservice to the ancient material. At the same time, he is not a classicist; he therefore tends to underestimate the trickiness of dealing with the ancient sources, and he fails to draw on expert opinion about the texts he quotes. Classical scholars and philosophers, on the one hand, may come away disappointed, especially with Carrick's narrow emphasis on writings by Plato, Aristotle, and Seneca. On the other hand, medical ethicists seeking a historical perspective on abortion and euthanasia should certainly read this book. Amid heated controversy on issues of life and death, a cool reminder of our pluralistic and humane ancient heritage is always welcome.