Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush

Philosophers of the Scottish Enlightenment dealt with many of the enduring questions of human society, and in this book Lisbeth Haakonssen examines their influence on three seminal writers on medical ethics. She successfully lays to rest the contention that the “ethics” of the period was really about “etiquette” or “professional decorum,” demonstrating that it was, instead, thoroughly grounded in moral and legal philosophy and fully deserved to be called an ethical system.

In the first chapter, “Interpreting Eighteenth-Century Medical Ethics,” Haakonssen examines the scholarship on medical ethics in the period and provides a framework for her own analysis as intellectual history. The second chapter, “John Gregory: Medical Ethics and Common Sense,” discusses Gregory’s application of Francis Bacon’s and Thomas Reid’s ideas to medicine and medical practice. In the third chapter, “Thomas Percival: The Duty of Public Office,” the author places Percival in the context of Dissenting intellectual life. She argues that though Percival was interested in adapting the traditional discussion of the physician-patient relationship to the new circumstances of hospital practice, he was not merely producing a practical guide for the hospital physician. Instead, his discussion was informed both by earlier writers—including Gregory—and by the idea of contract developed in British legal theory. In the last chapter, “Benjamin Rush: Medical Ethics for a New Republic,” she analyzes Rush’s connection to Scottish moral philosophy and his view of the physician-patient relationship.

Haakonssen is to be commended for providing the first philosophically grounded discussion of Percival’s work: no scholar will be able to maintain that he wrote on etiquette, not ethics, from now on. But the book as a whole is uneven. There is a lack of attention to detail: the footnotes in the first chapter are misnumbered, and the biographical material on all three men owes little to original research. More attention to their actual clinical experience, and their own relationships with their patients, would have been helpful. It would also have been helpful to examine more closely the assumption that hospital patients were docile and had to obey the physician’s orders. We know from surviving clinical records of early modern hospitals that patients were not nearly as compliant as writers like John Aikin assumed: Percival’s writings become more complex if viewed as prescriptive for patients as well as practitioners. Benjamin Rush’s connection with the other writers is never made clear, beyond the fact that he studied at Edinburgh. He was a fluid and facile writer who commented on almost any medical topic of interest, and though he may indeed have aspired to write a “Medical Ethics” for American conditions, the book does not demonstrate that he did so.

Medicine and Morals is nevertheless valuable in tracing the intellectual origins of some of the most important writers on medical ethics in the Enlightenment. It will be of interest to historians of medicine and ethics.