Controversies and medicine
Guillotine blade used at the execution of Carrier in 1794, France
Try to manage an epidemic
We usually imagine medical science and doctors never doing anything except making revolutionary discoveries and saving lives. Is this realistic or a rose-tinted view? History shows medicine and doctors can ‘go bad’ spectacularly. Some medical controversies were accidents, but many have resulted from deliberate actions. Sometimes doctors believed the greater good (as they saw it) was more important than ethical behaviour. Many of these incidents were not problematic at the time, and only became controversial when society’s values and opinions changed.
The Hippocratic oath
The Hippocratic oath was introduced in ancient Greece as a guide for new doctors on how to behave in their work. The oath was incorporated into Islamic medical practice. However, in Europe it was forgotten after the fall of the ancient Greek civilisation. It was ‘rediscovered’ after the Second World War and the discovery of human experiments on concentration camp prisoners by Nazi doctors. The oath was re-established as ethical behaviour guidelines for medical practitioners.
Science and medicine have been used to justify prejudice. In the 1800s and early 1900s scientists examined human difference using the language of racial difference. Assumptions of European superiority influenced how data were collected and interpreted. The conclusions drawn are now discredited, but were considered mainstream science at the time. They were also used to justify European colonialism and older ideas about European superiority. Only a few critics pointed to the racism of the underlying assumptions.
Medical science also determined ‘normal’ physiology and psychology. Eugenics emerged in the late 1800s. Eugenicists argued the human race was ‘degenerating’, losing its ‘normal’ qualities. They believed individuals with ‘superior’ qualities should have children to improve the population. Eugenics was popular in many countries, and was seen to ‘improve’ the population. Sometimes this meant improving poor people’s living conditions and health. More often it focused on preventing those deemed inferior from reproducing.
Family-planning campaigners such as Marie Stopes and Margaret Sanger embraced eugenics in calls for birth control. In the 1930s, government programmes in the USA and in countries across Europe sterilised ‘unfit’ individuals such as the severely disabled. In Sweden, this practice only stopped in the 1970s.
There was also a belief that intelligence and likelihood of criminal behaviour could be determined based on physical appearance. This was widespread in Europe during the late 1800s. Criminal anthropologists such as Cesare Lombroso, Alphonse Bertillon and the surgeon and anthropologist Paul Broca made these arguments.
Ideas of degeneration and racial superiority became extreme in the Nazi ideology of a pure Aryan race. This ‘superior’ race needed to be defended against degeneration by systematically exterminating the biologically ‘inferior’ in concentration camps. This included disabled people, homosexual men and women, and Jewish and Roma people. Nazi doctors such as Josef Mengele also used camp prisoners in human experiments. Doctors’ use of torture in the name of science was examined during the Nuremberg trials. It shocked the medical profession into accepting medical ethics and moral responsibilities.
Withholding treatment: the Tuskegee study
Unethical experiments and research did not end after the Second World War, and included cases in which drugs were deliberately withheld. For example, in the 1932-72 Tuskegee Study of Untreated Syphilis in the Negro Male, US doctors secretly withheld penicillin from black patients to see what happened if they were left untreated for decades. The scandal led to another overhaul of medical trials involving humans.
Insufficient clinical testing can have a huge human cost. This was the case with thalidomide. The drug was thought harmless, but around 1960 it resulted in thousands of babies born with limb malformations. There were many other examples where drugs were tested on patients without permission, even when outcomes had been positive. The 1960s debate over ‘human guinea pigs’ led to tough controls on the testing and release of drugs. New drugs had to be formally tested before release.
Using animals in medical research has infuriated animal rights activists since the Victorian age. Testing drugs on human volunteers who may feel under pressure has also been problematic. Until the early 1970s, prisoners were sometimes used to test drugs in the USA. Experiments on uninformed patients in poor parts of the world have also been condemned.
Pharmaceutical research and ethics
Pharmaceutical companies invest huge sums in researching new drugs. Critics question the ethics of companies using placebo trials. For instance, people with HIV/AIDS would benefit from existing antiretroviral drugs.
Patients in developing countries are increasingly used as cheap and available subjects to test new drugs. Critics ask how they can give informed consent when many are illiterate and the financial reward is more important than any risk. The free medication is taken away at the end of a trial, and patients cannot afford to continue treatment.
Doctors and legitimate death
Finding a cure might not be the doctor’s intention. Some brought ‘legitimate’ death to thousands without being seen as murderers.
In the 1700s, Joseph Guillotin and Antoine Louis developed the guillotine as a more ‘humane’ way of executing criminals. In the late 1800s dentist Alfred Southwick and doctor Julius Mount Bleyer invented the electric chair and the lethal injection respectively. Both wanted to find a more humane method of execution.
The death penalty is problematic for doctors. In the USA a physician must oversee any execution, but the American Medical Association forbids it. Euthanasia and physician-assisted suicide are even more controversial. In both cases, patients living in conditions they find intolerable can end their lives with medical advice or assistance. This is hotly debated in many countries.
Some issues accepted in their time are now shocking. Other medical techniques and practices, such as genetic screening, vaccination and stem-cell research, are still debated, particularly when they are seen to conflict with other beliefs and value systems.
Related Themes and Topics
Techniques and Technologies:
S Jay Gould, The Mismeasure of Man (New York: WW Norton, 1996)
M H Pappworth, Human Guinea Pigs: Experimentation on Man (Harmondsworth: Penguin Books, 1969)
J Hazelgrove, ‘The Old Faith and the New Science: The Nuremberg Code and Human Experimentation Ethics in Britain, 1946–73’, Social History of Medicine 2002 15(1), pp 109-135
A M Hornblum, ‘They were cheap and available: prisoners as research subjects in twentieth century America’, British Medical Journal 1997;315(7120), p 1437
D Steinberg (ed.), Biomedical Ethics: A Multidisciplinary Approach to Moral Issues in Medicine and Biology (Hanover: University Press of New England, 2007)
A G Christen and J A.Christen, ‘Alfred P. Southwick, MDS, DDS: Dental Practitioner, Educator and Originator of Electrical Executions’, Journal of the History of Dentistry 48/3 (2000), pp 117-122
H Pigaillem, Le Docteur Guillotin: Bienfaiteur de l’Humanité (Paris: Pygmalion, 2004)
J S Hawkins and E J.Emanuel (eds.), Exploitation and Developing Countries: The Ethics of Clinical Research (Princeton: Princeton University Press, 2008)
E Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley, 1997)
S M Reverby (ed.), Examining Tuskegee: The Infamous Syphilis Study and its Legacy (Chapel Hill: University of North Carolina Press, 2009)
A Jonsen, A short history of medical ethics (Oxford University Press 2000)
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