Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication (1770-1980) (review)

As one of the founders of bioethics, Robert Veatch has participated in an “intense conversation . . . between humanists and physicians interested in ethics” (p. vii). This dialogue began in the 1960s, gained momentum after 1971 (when the neologism “bioethics” first found its way into print), and continues today. Veatch initially believed that the “isolated professional physician ethics in the English-speaking world” that preceded this dialogue was normal; after “exploring further back in the history of medical ethics, [however, he] discovered that, in another time and in another place, physicians and humanists . . . were also actively engaged with one another” (p. vii). The other time was 1770 to 1800; the other place was Britain. Veatch’s discovery of an earlier dialogue prompts the question that frames his monograph: Why was the dialogue between physicians and philosophers/humanists that began in the eighteenth century disrupted for almost two centuries? To parse the question more broadly, why do physicians engage in intense dialogues with philosophers and humanists about the morality of medicine and its practices in some eras but not in others?


The monograph opens with an analysis of the dialogue between physicians and humanists during the Scottish and English Enlightenments (1770–1800). Drawing on an extensive review of the libraries and the works cited by pivotal figures in Anglo-American medicine, Veatch argues that whereas John Gregory and Thomas Percival read philosophers and humanists, the three generations of the Monro medical dynasty, and Percival’s son, Edward, did not. Differences in medical education, he argues, account for the differences in their receptivity to philosophy and to the humanities. Broadly educated physicians, like Gregory and Percival, could draw their ethics from a wealth of resources, whereas those narrowly educated in science and medical practice, like the Monros, had to draw their sense of morality from resources internal to the medical tradition—namely, oaths, codes, and the writings of other physicians. A narrow medical education thus led to an internalist conception of medical morality, isolated from and unresponsive to the ethical concerns of the wider culture. Ultimately, however, the insularity of internalist medical ethics rendered it so nonresponsive to the needs of society that physicians were forced to engage in a dialogue with philosophers and humanists who were in touch with cultural values. These dialogues created a new medical ethics that reconfigures ideals of medicine within the context of the wider culture.


Veatch’s provocative and perceptive analysis raises many questions. One wonders why his inventory of dialogues ignores public health medicine, omitting such “dialogues” as the one between the philosopher Jeremy Bentham, the public health reformer Sir Edmund Chadwick, and utilitarian physicians like Southwood Smith. One also has to wonder whether Veatch’s tight focus on biography and education obscures the role of political, socioeconomic, and institutional forces as change agents. Moreover, his claim that internalist medical ethics—the ethics of oaths and codes—merely parrots the past without being responsive to the present, cuts against the grain of recent scholarship on the Hippocratic tradition¹ and the American Medical Association’s Code of Ethics.² These studies indicate that seemingly conservative appeals to the past often valorize radical changes responsive to the perceived needs of the present and the future.


Disrupted Dialogue offers an intriguing new perspective on isolation and innovation in the history of Anglo-American medical ethics. It also presents a wealth of valuable new biographical and bibliographic information on the major and minor figures that shaped this history. It deserves a careful reading by anyone seriously interested in the history of modern medical ethics.