Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict

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NOTES Preface and Acknowledgments 1. Jones, ‘‘Concept of Natural Theology in the Gifford Lectures’’; Jones, Earnest Enquirers after Truth; Jaki, Lord Gifford and His Lectures; Witham, Measure of God. 2. Gifford, ‘‘Trust, Disposition and Settlement,’’ 74. 3. Ibid., 72. Introduction: The Hippocratic Problem 1. AMA, CEJA, Code of Medical Ethics (2010), xiii. 2. See ‘‘Hippocratic Oath,’’ under ‘‘A-Z of Common Queries and Useful Websites,’’ British Medical Association, www.bma.org.uk/patients_public/AZusefulsites.jspHippo cratic%20Oath, accessed January 5, 2012. 3. Adams, ‘‘Expert: Conrad Murray Violated Hippocratic Oath When Treating Michael Jackson,’’ Crime Examiner, www.examiner.com/crime-in-national/expert-con rad-murray-violated-hippocratic-oath-when-treating-michael-jackson, accessed January 5, 2012. 4. ‘‘Jackson Family Statement from Brain Panish,’’ JanetJackson.com, December 1, 2011. www.janetjackson.com/story/news/jackson-family-statement-from-brian-panish, accessed January 5, 2012. 5. Pat Patrick, ‘‘Judge Pastor Sentenced Conrad Murray to Four Years Imprisonment ,’’ Chicago Community Life Examiner, November 29, 2011, www.examiner.com/com munity-life-in-chicago/judge-pastor-sentenced-conrad-murray-to-four-years-imprisonment, accessed January 5, 2012. 6. Miles, Hippocratic Oath and the Ethics of Medicine, vii. 7. Jonsen, Siegler, and Winslade, Clinical Ethics, 10, 174. 8. Frankel, Lorry R., Amnon Goldworth, Mary V. Rorty, and William A. Silverman, eds. Ethical Dilemmas in Pediatrics: Cases and Commentaries. New York: Cambridge University Press, 2005, 1. 9. AMA, Code of Medical Ethics (1848), 15–16. 10. Ibid., 16. 203 204  Notes Chapter 1: The Hippocratic Oath and the Ethic of Hippocratism 1. Jones, Doctor’s Oath, 2. 2. Edelstein, ‘‘Hippocratic Oath,’’ 55. 3. Ibid. I will generally use the Edelstein translation of the Oath unless otherwise noted. For other translations, see Jones, Doctor’s Oath; and von Staden, ‘‘‘In a Pure and Holy Way.’’’ The translations are, of course, the work of the translators, so variations in tone, nuance, and meaning are inevitable. Even the Greek versions available represent a wide range of manuscripts, the earliest and most reliable of which date from no earlier than the tenth century of the common era, some 1,500 years after the supposed original writing. For a good summary of the problems and variations in the manuscript texts, see Jones, Doctor’s Oath. Jones hints at Pythagorean connections for the Oath prior to the work of Edelstein (45). 4. Matthai, ‘‘Tractatus de philosophia medici sive,’’ 108. 5. Carrick, Medical Ethics in Antiquity, 162–63; Kudlien, ‘‘Medical Ethics and Popular Ethics,’’ 104, 107ff; von Staden, ‘‘‘In a Pure and Holy Way’’’; and Prioreschi, ‘‘Hippocratic Oath.’’ Kudlien refers to the ‘‘pan-pythagorizing trend’’ of eighteenth-century medicine. 6. Edelstein, ‘‘Hippocratic Oath,’’ 6. 7. Ibid. 8. Meyer, ‘‘Truth and the Physician.’’ 9. The claim here is not that benefit must be assessed based on the personal preferences of the patient. That is one, but only one, alternative. The good for the patient may rest on some objective teleology such as seen in Christian natural law theory. Thus, Allen Verhey misunderstands the nature of the problem. See Verhey, ‘‘The Doctor’s Oath,’’ 155–56, where he accuses me of reducing patient benefit to private personal preferences external to the practice of medicine. He is correct that the good for the patient must be external to the practice of medicine but wrong in assuming that the external standard for the good for the patient must reduce to personal preferences. The external source may be a more objective theory of the good such as that reflected in traditional Christian teleological natural law theory. What is problematic in the Hippocratic paternalistic formulation is that the good is necessarily known best by the physician’s judgment. In Christian natural law theory, for example, it is far more plausible that theological experts in natural law theory would be considered the authoritative standard than some individual medical practitioner. Other objective theories of the good might turn to other external standards for assessing the patient’s good. For further discussion of this problem, see Veatch, ‘‘Impossibility of a Morality Internal to Medicine.’’ 10. I first developed this formulation of these three characteristics of the Hippocratic Oath in Veatch, ‘‘The Hippocratic Ethic: Consequentialism, Individualism and Paternalism .’’ 11. Edelstein, ‘‘Hippocratic Oath,’’ 6. 12. An alternative interpretation of the Hippocratic text reads this section as prohibiting physician participation in homicide, that is, garden-variety murder through the use Notes  205 of poison, a subject about which the...