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Perspectives in Biology and Medicine 43.3 (2000) 308-324
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Care of the Medical Ethos, with Some Comments on Research: Reflections After the Holocaust
Jeremiah A. Barondess *
Symposium: Medical Research Ethics at the Millennium: What Have We Learned?
Traditional views of the core values of medicine were profoundly and violently disrupted during the l930s and l940s, as the medical profession in Germany lent itself to the perceptions and priorities of the Third Reich. The history of German biomedicine in the Nazi years presses us to examine our own central assumptions, the perceived verities on which modern medicine proceed. The questions are profound, and although they include research ethics, they exist in a larger context.
The Western medical ethos has been composed of an interlocking set of views about the physician, the patient, and the medical enterprise itself. The doctor's role has been framed as centered on helping, on support, on the primacy of beneficence, as medical ethicists have come to call it; primum non nocere has been a central tenet, taken from the Hippocratic writings. In the 15th century the still-powerful expression "to cure sometimes; to relieve often; to comfort always"  was so widely accepted that it is carved into the bases on which statues of medical luminaries rest--for example, that of Edward Livingston Trudeau at Saranac. Further, we have seen physicians as engaged in a highly moral enterprise containing echoes of its ancient origins. At the temple to Asklepios on the Acropolis, for example, there is an inscription that reads: "These are the duties of a physician . . . he would be like god, savior equally of slaves, of paupers, of rich men, of princes, and to all a brother, such help would he give" . The demands our culture continues to make of the physician--for integrity, sacrifice and compassion--thus have their roots in the mythic traditions of ancient Greece . We have continued to transmit these views in our faculties of medicine, in our universities and in our academies. In 1769, Samuel Bard, a prominent New York physician, addressed the first graduates in medicine of King's College, later Columbia University, and said: "be not alarmed if I set out with telling you that your labours must [End Page 308] have no end. No less than life, and its greatest blessing, health, are to be the objects of your attention; and would you acquit yourselves to your own consciences you must spend your days in assiduous inquiries after the means of rendering those of others long and happy" .
With relation to the patient, Western societies have endowed the sick with special worth, a concept powerfully articulated in the Middle Ages by the Knights Hospitallers of Saint John of Jerusalem. The Knights Hospitallers were founded at the end of the 11th century to provide hostels for pilgrims to the Holy Land and to care for the sick among them. As Jonsen has noted, the Knights established along the route from Eastern Europe to Palestine institutions that were the precursors of the modern hospital . To the end of their reign, at the fall of Malta to the Turks in the mid-16th century, the Knights were devoted to hospital work, which remained the essence of their community. Every brother, at his induction into the Knights, recited the vow found in the earliest rule of the order: "The brethren of the Hospital should serve our Lords, the sick, with zeal and devotion, as if they were serfs to their Lords." Centuries later their leaders were still proclaiming, "We make a promise which no other people make, promising to be the serf and slave of our Lords, the sick" . The special worth of the sick has continued as a powerful underlying theme in medicine since that time; the concept of service to them has been so powerful that in our own time it has been invoked as a general characteristic of professions, as when Justice Brandeis noted as a central orientation of a profession that it is...