Medical Ethics

“THE OATH OF HIPPOCRATES I swear by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation --to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.”

“Then, again, one must divide the full ureter, and demonstrate how the urine spurts out of it, like blood in the operation of vene-section; and after this one cuts through the other also, and both being thus divided, one bandages up the animal externally. Then when enough time seems to have elapsed, one takes off the bandages; the bladder will now be found empty, and the whole region between the intestines and the peritoneum full of urine, as if the animal were suffering from dropsy. Now, if anyone will but test this for himself on an animal, I think he will strongly condemn the rashness of Asclepiades, and if he also learns the reason why nothing regurgitates from the bladder into the ureters, I think he will be persuaded by this also of the forethought and art shown by Nature in relation to animals.” Galen, “On the Natural Faculties”

“Caspar Bauhin and John Riolan,¹ most learned men and skillful anatomists, inform us that from their observations, that if we carefully watch the movements of the heart in the vivisection of an animal, we shall perceive four motions distinct in time and in place, two of which are proper to the auricles, two to the ventricles. With all deference to such authority I say that there are four motions distinct in point of place, but not of time; for the two auricles move together, and so also do the two ventricles, in such wise that though the places be four, the times are only two. And this occurs in the following manner:” William Harvey, “On the Motion of the Heart and Blood in Animals” Chapter IV.

“But I think it right to describe what I have observed of an opposite character: the heart of an eel, of several fishes, and even of some (of the higher) animals taken out of the body, pulsates without auricles; nay, if it be cut in pieces the several parts may still be seen contracting and relaxing; so that in these creatures the body of the heart may be seen pulsating and palpitating, after the cessation of all motion in the auricle.” William Harvey

“My Lord Marshal Montejan remained Lieutenant-General for the King in Piedmont, having ten or twelve thousand men in garrison in the different cities and castles, who were often fighting among themselves with swords and other weapons, even with arquebuses. And if there were four wounded, I always had three of them; and if there were question of cutting off an arm or a leg, or of trepanning, or of reducing a fracture or a dislocation, I accomplished it all.” Ambrose Pare, “Diverse Journeys”

“There was a culverin-shot passed through the tent of H. de Rohan, which hit a gentleman leg who was of his household. I had to finish the cutting off of it, which I did without applying the hot irons.” Ambrose Pare, “Diverse Journeys”

“I thought, having finished my mission, to return to the King; but M. le Marechal begged me to stop at La Fere with him, to dress a very great number of wounded who had retreated there after the battle, and he would write to the King to explain why I stopped; which I did. Their wounds were very putrid, and full of worms, with gangrene, and corruption; and I had to make free play with the knife to cut off what was corrupt, which was not done without amputation of arms and legs, and also sundry trepannings.” Ambrose Pare, “Diverse Journeys”

Anti-Social Personality Disorder is

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest

Laws change and norms change. Some study or other once showed that if an Irishman were to encounter a red light at night with no one around he would drive through it about 100% of the time. An American would do it about half the time and a German would always stop. These are social norms at one degree or another of the law.

2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

Barnum and Bailey are obviously guilty as well as all Carnies. Of course Carnies don’t Con their own kind. Conning people from outside your own tribe is normal and considered praiseworthy in many cultures.

3. impulsivity or failure to plan ahead

Courage is a virtue. You can either be courageous by planning ahead and overcoming your fears or just being reckless. Traditional military wisdom and leadership maxims discuss these two personality types with one leader preferring one and another leader preferring the other, but the first type seems to be the rarer of the two. This trait might have been seen as the mark of a good soldier 300 years ago.

4. irritability and aggressiveness, as indicated by repeated physical fights or assaults

In the movie Robin Hood starring Errol Flynn, he attacks Friar Tuck just to see what he was made of. In context of history Americans live in a violence deprived society. This makes violence when it does happen seem more traumatic as it is more unusual but humans evolved to live in a much more violent environment. The above traits are adaptations to that environment. A hundred or so years ago this would have been seen as a badge of decent manhood and not as a fault.

5. reckless disregard for safety of self or others

This depends on the context. Depending on the culture either could be regarded as a virtue and source of pride.

6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

This which might be defined as a lack of mature responsibility is the hallmark of servile populations throughout history. People attempting to free slaves in the modern world find getting them to accept the responsibilities of freedom more difficult than physically freeing them. Serfs, peasants, indentured servants, slaves, and gun control advocates are all normed this way.

7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Taking scalps, headhunting, torture, theft, cattle rustling, privateering, etc. ad infinitum cum nauseum have all been accomplishments to be proud of as long as you targeted someone outside your own tribe or group. Some studies of group therapy with sexual predators have shown higher rates of recidivism than among those not receiving such therapy. It is possible that such persons combined in a group normed together reinforcing their behaviors and further identifying their victims as outside their group and legitimate prey.

Different cultures norm in different ways. All of the behaviors above are normative for many cultures when it comes to dealing with outsiders, strangers, foreigners, etc. When you look at this list you realize that many traits which modern psychology maintains are disorders were adaptive and even praiseworthy in previous ages. One of the classic books in this area is Ruth Benedict’s “Patterns of Culture”.

Within any given modern Nation State there is a great deal of cultural diversity and members of these subcultures norm differently from one another. Some of these subcultures are ethnic, some are avocational, many are professional. When a subculture norms its members to a standard which is in conflict with national norms or laws, problems ensue. Virtually the entire prison population of the US qualifies for ASPD. Most of that prison population comes from subcultures in the US which have a cultural history as a servile population and all of the symptoms above could be related to the persistence of slave culture behaviors in that population group. Something like 30% of all adolescent males diagnose with ASPD but most norm to more normal standards as they become adults. Only 3% of adults diagnose ASPD. There is some profound confusion about the diagnosis of ASPD and that of psychopath.

The purpose of this discussion is to demonstrate how easy it is to confuse mental health problems with norming problems or differences in cultural norms. Professional groups form tribes with professional respect within the tribe and norm in various ways quite differently from the mainstream population of whatever nation they live in. This is especially true of Soldiers and Surgeons.

There was for millennia a traditional distinction between Doctors and Surgeons. It persists to this day in the distinction between internal medicine and surgery. It was not until a couple of centuries ago that Surgeons began to have anything like the professional respect which Doctors received. Buddhist ethics through most of the orient make the profession of butcher unclean. Surgeons and Butchers are traditionally seen as unclean fellows. They have to norm to a level of indifference to visible suffering of others to a degree that is abnormal for the society in which they live. In our modern society all Doctors learn some Surgery and norm like Surgeons. This means that when they make ethical decisions they do it based on psychological norms far different from those of average Americans.

It is common to look on anyone who norms out at more indifference to human blood than we do as pathological. As a person with surgical operating experience you are not equipped to accurately estimate how average people would interpret what you see. In addition, when humans are forced to shed the blood of other humans they adopt a few standard strategies to handle the emotional strain involved. No hypotheses of pathology is required only an assumption of different norms in their subculture.

Medical personnel and soldiers are at constant risk of crossing invisible lines of human nature because the inherent requirements of their work force them to adopt a higher level of indifference to human bloodshed than average persons are.

If you read Galen or Harvey or Aristotle in the GBWW describing experiments performed in natural philosophy or medicine you will be impressed with how far from what we commonly accept as norms in our society they are. A medical person or scientist might not be particularly disturbed by seeing a dog vivisected in a classroom, but to a normal American today it would be shocking. Reading the original works of great surgeons and anatomists of the past and reading their life histories gives a person the very real impression that medical history is largely a history of psychopaths performing inhuman acts on helpless slaves and animals. The emotional stability of some of the greatest names in medical history can be seriously questioned. One of the Hunter brothers knew his own weakness and predicted his own death from a medical condition combined with his inability to control his temper.

Doctors tend to assume a detached attitude towards these things without condemnation of the injured party. Soldiers tend to assume an emotional justification for the treatment of the enemy which includes such condemnation. Doctors will discuss the clinical procedures without ill feeling towards whatever they are dissecting or experimenting on. This is the attitude Mengele had during his work and may be termed the Mengele Method. Soldiers tend to designate the party to be injured with pejoratives like wog, etc. Norming around the abortion issue is an example of this.

Abortion advocates use both of these. Even medical personnel refer to the object being aborted as a zef and ridicule the idea of a zef ever being a person. They use the term just as pejoratives like wog, etc. have been used. Other pro-choice persons refer to the unborn using terms like tumor, disease, parasite, etc.

The degree to which pro-choice advocates are unable to appreciate average cultural norms in this area may be demonstrated by looking at issues like partial birth abortion. The fact that pro-choice advocates cannot feel any difference between this procedure and an abortion a few weeks into pregnancy demonstrates that their norms are way outside those of average Americans.

There is nothing truly abnormal about humans having a learned indifference to the suffering of others. It is perfectly normal for human beings to be indifferent to or even enjoy the suffering of those designated 'other'. Among many primitive peoples the name of their tribe means simply people and the word for stranger is the same as the word for enemy.

American norms are so far to the nice guy side of the hypothetical scale that they could be considered abnormal in a historical sense. This is largely due to the "Civil Religion" of the US. Documents like the Declaration of Independence and the Bill of Rights tend to teach Americans to norm more strongly towards respect for the rights of others than most human societies in history.

Another issue in medical ethics is organ transplant. More and more it appears that medical personnel are hurrying up the process of death for potential organ donors. Organs must be fresh to be useful. Hearts and Livers are generally useless for transplant if harvested after fresh blood stops flowing. This means that the earlier you get the donor the better the organs.

This has introduced some frightening ethical dilemmas and situations. At one point a local prosecutor informed medical personnel that if they followed a recommended procedure for dealing with potential donors he would prosecute them for murder. The Doctor in charge was outraged. Who was this incompetent layman to be telling him what medical ethics should be. The Hospital Administrator, not the Doctor told the Prosecutor that they would not use the recommended procedure. Doctors cannot do glory winning medical procedures unless they have the organs to perform the operations. They are strongly motivated by pride and self-interest to press the limits of ethical behavior and normed to an indifference to superstitious respect for human life by the fact they have to make life and death decisions and decide who will live and who will die on a daily basis.

From this discussion it is apparent that Medical Doctors operate in an ethical gray area. They are normed far outside what is normal for the average American and are daily in danger of crossing invisible lines that can lead to their prosecution for murder or crimes against humanity. Roe may have unfortunately placed many of them in danger of criminal prosecution. As is discussed at length in the section on Abortion.

“Virtue, then, is a state of character concerned with choice, lying in a mean, i.e. the mean relative to us, this being determined by a rational principle, and by that principle by which the man of practical wisdom would determine it. Now it is a mean between two vices, that which depends on excess and that which depends on defect; and again it is a mean because the vices respectively fall short of or exceed what is right in both passions and actions, while virtue both finds and chooses that which is intermediate. Hence in respect of its substance and the definition which states its essence virtue is a mean, with regard to what is best and right an extreme.” The basic principle of ethics is the golden rule. Do not do to others what you do not want done to you. The political version of this principle is do not give the Government or other authorities the power to do unto others what you would not want done to you.

In terms of medical procedures like abortion and organ transplant, one extreme is when the people insist on norms based on their feelings which prevent Doctors from doing necessary things religious prohibitions of dissecting human bodies for medical research for example. The other extreme is when Doctors insist on setting their own ethics completely independent of the ignorant opinions of lay persons and end up doing things to people which should not be done. Virtue lies in finding that middle ground where Doctors are allowed to harvest organs in a way which most Citizens would find acceptable if it happened to them but not in any way that they would not. This is not a decision which Doctors can be allowed to make independent of the voice of the Citizens.

The questions of medical ethics and military ethics are very similar. No one thinks it is wrong that the Military should have Civilian oversight. Similarly, because of the Norming differences which medical personnel are forced into by the requirements of their training and profession, they require Civilian oversight. In Military issues it is necessary to allow the Military sufficient freedom of action to do their job, while ensuring that certain humanitarian fundamentals are not infringed. It is necessary to allow Medical personnel sufficient freedom to do needed research and investigation including in the laboratory and research institute many procedures which would not be acceptable in common practice of if undertaken by an average Citizen, while still ensuring that certain fundamental humanitarian principles are not infringed.