History of Ethics and Medicine

          A Short History of Ethics and Medicine 

          – Dr. James F. Drane

          Two ancient strands of thought shape Western Culture and therefore shape the thinking, lives, and work of western people. In broadest terms, Western Culture is a fusion of two traditions, the Greek and the Hebrew.

          At the center of ancient Greek culture was the importance of reason. The Greeks stressed the pursuit of knowledge; a careful analysis of nature and human nature. Alexander the Great, for example, was asked by Aristotle to send back bits and pieces of nature from all over the world. These were studied and assigned a place within the rational categories of genus and species. What defined Greek culture were philosophy and science. Aristotle, the greatest of Greek philosophers, was also a scientist.  

          The center and core of Hebrew culture was monotheistic belief. The unique characteristic of human beings in this tradition was an ability to communicate with God. The emphasis in Hebrew culture was on God’s role in history and on the moral requirements of human beings, related to God. The focus of Hebrew culture was on ethics and morality, on character and virtue.

          These two broad influences have been in dialogue throughout Western history. One or the other may become dominant at certain times, but ordinarily the two background influences remain either in debate or in dialogue. Most academic persons today understand themselves as defined mainly by the Greek influence, by reason and science. But, the religious influence remains very much with us. The current debate in the U.S. about evolution and intelligent design is just one of many examples of the continuing interrelation between these two broad background influences.

          Today, the two major cultural influences are frequently at odds with one another. The religious perspective today is sometimes irrational (i.e., creationism). But religion by definition is not opposed to reason. And certainly ethics and morality, so characteristic of the Hebrew tradition, are not opposed to reason and science. This is especially true in the area of medicine. The James F. Drane Bioethics Institute is designed not just to provide a context for research in ethics and medicine, but to encourage a continuing dialogue between life sciences and ethics both in the U.S. and in Latin America.

          There was a time in the medieval age, when the Hebrew emphasis was brought together with the Greek perspective; a synthesis of religion and reason in thinkers like St. Thomas Aquinas. Historically, reason and revelation were kept in dialogue within the university. The synthesis of both influences continues in the life and work of many intellectuals today who insist upon being both rational and religious, scientific and ethical.

          Religion and ethics can remain in relationship with science and medicine. It is in the contemporary university setting that this relationship is most likely to be fostered.

          The medieval synthesis of reason and religion broke down in the 15th and 16th centuries with the Protestant Reformation’s focus on faith alone and with a scientific revolution that gradually moved toward a science-alone perspective. During the 17th and 18th centuries, Western Culture went through the Enlightenment period in which the Greek emphasis on reason and science became dominant, and religion was either rejected or marginalized.  During the Enlightenment there was a belief in reason alone as the path to all truth. Faith remained, but it was a faith in science. Science was believed to be the one way to understand.

          Even during the Enlightenment however, religion and moral concerns, (the Hebrew influence) did not disappear. Romanticism rejected science’s claim to be the only way of understanding. Mysticism flourished during this period along with individualism, symbolism, and poetry. We see a 19th century critique of the science-alone belief in the work of thinkers like Nietzche and Dostoyeski. During the 20th century, debate continued between the most extreme versions of the two major traditions; the advocates of science alone and the advocates of revelation alone. In the 21st century, the relationship between science and religion, reason and morality, has become an overwhelming concern. Every advance in science raises new issues about ultimate meaning and ethical limits. Fundamentalist religions, however, reject and oppose basic scientific truths.

          The scientific revolution had its major impact on medicine in the latter half of the 19th century. In the mid-1800s, the medieval university model was modernized in Germany. The educational system was expanded into many different disciplines, all of which attempted to apply a scientific approach: sociology, political science, history, biology, physics, astronomy, medicine, etc. Every new discipline was studied scientifically and linked to scientific research. Every university professor was expected to do more than teach. The different departments each had a laboratory where hard science was taught and scientific research was conducted.

          It was the joining of hard laboratory science with medicine that created what we refer to today as Modern Medicine. Modern Medicine is German Medicine. It is slightly more than 100 years old in the United States. Abraham Flexner brought it to the U.S. from Germany and implanted it at John Hopkins in about 1912-13. In Modern Medicine, hard scientific reasoning reigns—indeed it defines reality.      

          Before modern medicine, Hippocratic medicine was practiced for more than two millennia under the influence of a medical ethics that enjoyed the strong support of Judaism, Christianity and Islam. Hippocratic medical ethics originated from the ethical principles of doing good for patients (beneficence), not doing harm (non-maleficence), not taking human life, not violating patients sexually, keeping patient information secret, etc. Once modern scientific medicine was established, the traditional Hippocratic ethic was joined with new ethical components in the form of concrete rules and practical norms. Modern scientific medicine was founded on research with human subjects and the moral rules and norms were meant to guarantee that patients and subjects were not violated, used, or treated as things.

          During the Nazi period the traditional philanthropic commitment (love of the patient) was set aside, and a eugenic metaphor (improvement of the race) was put in its place. Modern scientific medicine began with a horrendous ethical failure, the Holocaust. This failure resulted from an attempt to remove literally and figuratively the Hebrew influence from science and medicine. The discipline of Bioethics was created as one of many responses to this tragedy. Bioethics quickly expanded throughout the world because of the importance of its objective; to protect the most vulnerable human beings from a recurrence of the earlier ethical failure. The ethical failures of the Holocaust can neither be ignored nor forgotten without trampling on the dead bodies of millions of innocent persons.

          After World War II, Modern Scientific Medicine ceased being described as German Medicine. It became American Medicine because the U.S. government invested enormous amounts of money in medical science. A whole new city outside of Washington, DC, was created for scientific research in medicine, the NIH. New medicines and technologies, new treatments and interventions were generated in a continuing stream. Each new scientific development created new ethical questions. In the post-war period, additional ethical rules and regulations were put again into place; the Nuremberg Code, the Department of Health and Human Services Rules and Regulations, the FDA Regulations, the WHO Regulations, the Helsinki Declaration, the Belmont Report, etc. These ethical rules and regulations continue to be updated periodically.

          The new rules and regulations, however, were not totally successful. It was assumed that American scientists would not violate human subjects or mistreat medical patients. “Only Nazi doctors and researchers did such things.” Then Henry Beecher, in the NE JOM published a list of 23 research violations, which were shockingly similar to what had happened in Nazi, Germany. During this period of the 1960s, the new discipline of Bioethics was established.

          The lesson of both the Nazi and the American ethical failures is too important to be ignored. For all persons involved in the field of medicine, it is necessary to pay attention to the relationship between science and ethics. The lessons of history for university professors and medical professionals are clear: watch what you are doing; watch what is going on around you; watch your background assumptions; watch the broad cultural context in which you are doing your work and living your lives; pay attention to ethical rules and regulations.

          University faculty and medical professionals are believers in science. They have to be. But do they remember the past? Are they aware of the assumptions that they bring to their work? Do they keep the Greek and the Hebrew background insights in view? Is their science always in dialogue with a reality that is not revealed by science, i.e., their ethical responsibilities, the principles of beneficence, non-maleficence, the rules and regulations for doing scientific research and practicing scientific medicine? Are they looking at the broader picture? Do reason and science, ethics and morality have a place in their lives? Do both the Greek perspective and the Hebrew perspective continue to influence them?

          Edinboro University has been a center for bioethics since the beginning of the discipline in 1969. Dr. James F. Drane began work in bioethics at Edinboro University that year, after returning from a trip around the world researching public policies in different cultures on ethical issues in medicine. Since then, he has worked to promote bioethics in the U.S. and Latin America. The James F. Drane Bioethics Institute is designed to continue his work in bioethics at Edinboro University and throughout Latin America and the Caribbean. In 2002, Dr. Drane was named a founder of the discipline of Bioethics at the International Bioethics Conference in Brasilia, Brazil.