The Foundation of Ethical Theory in the Clinic

William Osler has had a very profound and lasting effect on American medical education and medical practice. He set the pattern, still followed today, for the clinical training of medical students at the patient’s bedside and in the clinical laboratory. In such settings Osler was able to demonstrate to his pupils the principles, ethics, and standards of medical practice that he espoused and thought fundamental to the profession of medicine. His monumental text book, The Principles and Practice of Medicine, first published in 1892, transformed the medical profession and remained a standard text for more than four decades (Leon 1995, p. 13). Renowned medical historians, such as Pedro Laín Entralgo, Henry Sigerist, and Richard Shyrock, recognize him as the greatest clinician that North America has ever produced.

Osler, who had observed bedside teaching in his post-graduate studies, recognized that this method had much to offer in the instruction of medical students. Opportunity to introduce this method of teaching into the medical school curriculum came in 1888 when he was called to serve as Professor of Medicine and Physician-in-Chief at the newly established Johns Hopkins Medical School and Hospital. Bedside teaching proved to be very successful especially in demonstrating to students the standards and ethics of medical practice that he espoused.

Osler’s teaching method was immediately adopted by many of the university medical schools in the United States, including Harvard, Columbia, the University of Pennsylvania, and Stanford, all of whom appreciated the success of the Hopkins medical educational experiment. Graduates of the Hopkins Medical School quickly became a major source of faculty in medical schools in the United States. Many of Osler’s immediate pupils became outstanding clinicians and leaders in American academic medicine and served as faculty members at Hopkins or in established or newly founded schools. Osler’s disciples taught students in the wards the “art” of medicine according to his principles, ethics, and standards. The second and third generation faculty members, who were trained by Osler’s immediate pupils, continue to this day to teach the “art” by employing this method of teaching. Consequently, the practice of medicine in the United States continues to be influenced by the ethics held by Osler. To find the theories behind Osler’s teaching, we must look at Osler’s background, education, and writings.

The Religio Medici: Background For Osler’S Medical Ethics

Osler received a very solid traditional classical education at the small, excellent Anglican secondary school in Weston, Ontario run by the Reverend James Johnson, with whom Osler developed a life long friendship. Johnson’s avocation was natural science. He first aroused Osler’s interest in nature and science. Osler was taught Scripture well at Weston. He committed much of the Bible to memory and often quoted it in his speeches. He also studied both Greek and Latin, and was exposed to the writings of Plato, Aristotle, Cicero, and other classical authors, particularly the stoics.

While a student at Weston, Osler first came to know Sir Thomas Browne’s remarkable text Religio Medici (The Religion of the Physician), which was to become a lifelong favorite. In his first address as the new Regius Professor of Medicine at Oxford in 1905, which was given to the Guy’s Hospital Physical Society, he vigorously recommended the Religio Medici to the students.

The Religio is a deeply reflective personal inquiry into the paradoxical nature of one man as a microcosm of all men (Browne 1940, pp. 40, 53–54, 61–62). Browne participated in the Baconian program for the advancement of knowledge and the rise of “science.” As a defense of the physician’s faith, the Religio shows how neatly the scientist and the Christian united in the single figure of the inspired reader of God’s two books, nature and Scripture, can defend an attitude that is both scientific and yet reverent. The central theme in the first and much longer part of the Religio is the relation between faith and reason. The second part of the Religio is about charity: Man’s love of God and his neighbors, commanded as...