Medicine et morale dans l'antiquite (review)

A panel of nine experts in the history of Greek and Roman medicine present formal essays and discussions that took place during five days in August, 1996, on the theme of medical ethics in the ancient Mediterranean world. A tenth paper by Olivier Reverdin describes the story behind the long-delayed Frankfurt edition of Dioscorides' Materia Medica that appeared in 1598, the year that its publisher Henri Estienne and its Latin translator Jean-Antoine Sarasin both died. While none of the nine papers centers exclusively on the so-called Hippocratic Oath, its injunctions and prohibitions, as well as other deontologic pronouncements in the treatises of the Hippocratic Corpus, are repeatedly probed for their meanings, both then and now.

The first three papers (by Flashar, Vivien Nutton, and Thomas Rütten) interweave the ethical concerns of Hippocratic physicians with the preoccupations of ethicists in modern health-care systems—systems in which biomedicine has a much-enhanced capacity to transform and prolong human life. Flashar sees potential for dialogues between the itinerant physicians of the Hippocratic Epidemics and the anonymity of managed care or in the emergency room, between Hippocratics' concerns to legitimize medicine as a techne and the defensive medicine now practiced in litigious climates, and between Hippocratic manipulation of prognosis and the decisive role currently played by statistical probabilities. Appeal to pronouncements, such as "help, or do no harm" (Epid. 1.5), underscores Flashar's contention that the medical ethics that Hippocratics were crafting is likewise often distinct from the philosophical and popular norms contemporary to them. Nutton suggests that repeated calls for a return to "Hippocratic morality" in the nineteenth and twentieth centuries, accompanied by an upsurge in the numbers of graduating medical students who swear some form of Hippocratic Oath, naively presuppose that ancient medical practices are straightforward, without imprint from the society in which they were formulated, and ever capable of reinterpretation in order to cure, or at least ameliorate, present ills of the medical profession. Rütten examines in minute detail the Oath's prohibitions regarding the physician's promise not to provide deadly poison to anyone, nor an abortive pessary to a woman; along the way, Rütten shows how untenable remain Ludwig Edelstein's oft-quoted contentions that the first prohibition intends to prevent doctor-assisted suicide and that the second reflects thinking about abortions characteristic of Pythagoreans, not Hippocratic physicians.

The middle pair of papers (Charlotte Schubert and Heinrich von Staden) discusses the interjection of moral concepts into Hippocratic medical thinking, with Schubert charting the expansion of Alcmaeon of Croton's equation of health with insonomia and disease with monarchia through increased valorization in medical circles of the democratic virtues of self-awareness and autonomy. Von Staden argues that bonds between professional competence and moral qualities of the physician in all spheres of his life characterize medical morality, beginning with their early and concise expression in the Oath's ". . . in a pure and holy way, I shall argue my life and my techne," onward to fuller and more insistent articulation in Hellenistic and Roman times.

Focus shifts to the wealthy and sophisticated milieu of Rome in the next three papers (Jouanna, Jackie Pigeaud, and Philippe Mudry) and the ninth moves into the medical scene of late antiquity (Antonio Garzya). Jouanna provides an elegant summary of Galen's transformative reactions to Hippocratics' enunciations of ethical principles, including his commentary on the Oath, now partially preserved only in Arabic; beautifully underscored are the ways in which Galen combines a faithfulness to his Hippocratic sources, with a crafting of new obligations more appropriate to the Roman setting. Pigeaud sketches the philosophical grounding of medical ethics at Rome, explaining Celsus' claim that Hippocrates had long ago separated medicine from philosophy as no more than a foundation myth. Mudry investigates how the Latin of the first-century A.D. Celsus and Scribonius Largus paraphrases Hippocratic ethical pronouncements and, at...