Module 6: Medical Ethics/Doctor in Society

Objectives:

  1. Given a document from a specific period of time, students will be able to extract and accurately summarize the basic ethical ideology.
  2. Given the Hippocratic Oath, writings of Galen, or other texts reflecting cultural norms and a text describing medical practice, students will be able to interrogate the differences and similarities between ideal practice and reality.
  3. Given a contemporary situation, students will be able to apply knowledge of ancient ethics and dilemmas to the condition of the contemporary world without fallacy.

Deontology

James Longrigg, section on “Hippocratic deontology” from Greek Medicine: From the Heroic to the Hellenistic Age, A Source Book  (This reading is 5 pages long.  It begins with the Oath. The second and third readings deal with cooperation of the patient and the attendants. The fourth text, from the Aphorisms, warns doctors about treating hidden cancers. The natural and learned qualities that a good doctor should possess are listed in the fifth and sixth texts.  How a doctor enters the home and his bedside manner are described in passage seven.  Passage eight instructs doctors how to have a respectful and honorable relationship with a patient.  It would be interesting to compare these texts with modern instructions regarding bedside manner. Here is an article that follows the evolution of bedside manner beginning with Hippocrates.)

Professionalization, Rivalry, Competitive Display, Rhetoric

Pliny NH 29.1-29 (This selection of Book 29 is 10 pages.  It is a quick read and could be an interesting way for students to encounter the negative side of medical practice.  It is also helpful to see the “Roman” take on a “Greek art.”  Pliny’s assessment of the medical art is anything but kind.  He regularly points out that we place our lives in their incapable hands without question.  He begins with a brief history of the discipline (1-6).  Then he gives accounts of famous physicians who amassed great amounts of wealth and power (7-12), with specific mentions of Thessalus, Crinas, Charmis, and Archagathus, the “Executioner.”  Pliny quotes Cato the Elder’s words of warning to his son, Marcus, about physicians (14), and points out that Cato prolonged his life with recipes for remedies.  This shows that “It was not medicine that our forefathers condemned, but the medical profession…” (16).  He blames Roman luxury for a lack of personal health (19-20).  He, then, returns to the image of physicians as scoundrels who work against good, Roman values (21-22).  The strange practices and remedies prescribed by physicians are further evidence that they are incompetent.  Pliny mentions theriac as a “showy parade of the art” (25), followed by more strange, harmful treatments.  The text can seem to ramble jumping from topic to topic, nonetheless, it is entertaining and can help students identify some the ethical problems facing the medical field at this time.

Owsei Temkin, “The Hippocratic Practitioner” in Hippocrates in a World of Pagans and Christians (This chapter is 18 pages.  This article is very easy to read and a more measured approach to the state of medical ethics in antiquity than Pliny.  This article also mentions deontology and the Hippocratic Oath, so it looks both backward and forward.  Temkin also includes several quotes from On the Physician which is an important text for this module and walks the reader through Decorum.  The rhetorical skills needed as a physician are also discussed, which can call back to Gleason’s “Shock and Awe” in terms of looking at the physician as a performer.  Temkin then looks at Precepts regarding its message of philanthropy.  This would be an especially interesting reading for Pre-Med students, who should be thinking about what type of physician they want to be and what values will they uphold in their practice.)

Pharmacology

Longrigg section on “Pharmacology” from Greek Medicine: From the Heroic to the Hellenistic Age, A Source Book (This section is 11 pages long.  It begins with “The Medical Use of Plants in Homer,” which includes passages on the treatment of wounds in the Iliad and passages from the Odyssey on plants used as magical drugs.  In “Hippocratic Pharmacology,” there are accounts of the use of Hellebore, Mandrake, and various drugs to treat dropsy of the womb.  In “Pharmacology of the 4th Century,” the most interesting passages are from Theophrastus.  These selections address the dangers in collecting some plants as well as the effects of Mandrake and Hellebore.  “Alexandrian Pharmacology” only discusses accounts of Herophilus’ opinion of drugs and relevant Elizabethan superstitions.  The synopsis at the end is useful, but not necessary.  It may be best for the instructor to mine it for relevant information and relate it in class.)

Adrienne Mayor, Chapter 5 in Greek Fire, Poison Arrows and Scorpion Bombs: Biological and Chemical Warfare in the Ancient World (This reading is 25 pages long, however, there are several illustrations.  This article is not a model for scholarship.  Mayor’s dates are not always accurate and he lacks citations of texts, primary and secondary, and it is not organized with a thesis at the beginning.  That said, this is a highly entertaining chapter.  He disseminates information through storytelling.  He begins with the story of the “mad honey,” recounted in Xenophon, then, Pompey’s army with the same honey, and Mithridates’ theriac.  He relates the ancient use of poisons in warfare to modern-day bioweapons. Pages 154-9 is a list of examples where food and drink were used against soldiers.  The following section (159-164) gives examples of poisoning by mandrake root.  Then, Mayor discusses those who concocted the potions, and tells the story of the Thessalian priestess of Hecate, Chrysame.  He ends with cautionary tales of what can go wrong with bioweapons.  In class, you may want to highlight some of the ethical problems that Mayor brings up in the final section of this chapter, as they are not explicitly pointed out throughout the chapter.  Mayor seems more interested in engaging the reader than in making an argument, which might be refreshing for students at the end of the semester.)

Totelin, “Mithridates’ Antidote: A Pharmacological Ghost” (This article is 19 pages.  Totelin steps away from the attempt to define the original recipe and focuses, instead, on how the Romans coopted the concoction and used it as a panacea.  He does spend some time, however, showing that there is no one recipe and no way to trace the various recipes to one source.  The discussion of who was taking these drugs and why, which begins on page 10, is very useful.  It could be used as a way to discuss modern medications and access to them.  The various recipes for Mithridatium/Theriac were published to attract members of the elite, even going so far as to write them in verse to lend prestige.  He also takes into account who was mixing and selling Mithridatium.  Doctors, unguent-makers, and drug-sellers all sold Mithridatium/Theriac, but they were doubtful using the same recipe or the same quality of ingredients.  Finally, he addresses how the physicians justified the efficacy of such a panacea.  Here, he turns to Galen.  Totelin concludes with the assertion that Mithridatium/Theriac could only have become popular in the Roman Empire, with its wealthy clients, trendsetting Emperors, and access to exotic ingredients.  I think that this is a particularly interesting point, which students can latch on to.  Drugs are not only a product of innovation and science, but also of the society.  Overall, I found this to be easy to read and interesting.  I would highly suggest it for undergraduates.)

Galen, Avoiding Distress (This is 23 pages long, but half of it is footnotes.  This text details Galen’s losses in a fire that consumed his warehouse.  He lost recipes, drugs, spices, instruments, notes, etc.  Students may be interested in the awareness that Galen has of the quality of his texts (12b ff.).  This complements the mention of textual accuracy mentioned in Totelin.  Of particular value for this module is the section “Galen’s Recipe Collection,” which begins at paragraph 31.  On page 89, paragraph 38, Galen begins to explain how he has avoided distress using philosophy.  From this point on, he discusses his moral philosophy that allows him to avoid distress.  While this is interesting, it can be cut from the reading assignment, if you want to distill the readings to medically relevant topics only.)

Oaths

Hippocratic Oath (the original and Lasangna’s modern version,) Oath of a Muslim Doctor, Vejjavatapada, Oath of Asaph, Seventeen Rules of Enjuin, and Declaration of Geneva 

These are various oaths from across time and the globe.  I would suggest choosing two or three and having students compare them.  What elements of the oath govern bedside manner, personal responsibility, specific procedures, etc?  How do these oaths reflect the values of their societies?  Do any of them align with our values today?  If so, how?  These are some questions that students should ponder when reading the oaths.