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a recent action by the New York State Medical Society, this code has remained without any material additions or modifications. It has had, therefore, the approval of the medical profession of the United States for a period of over thirtyfive years. It is but justice to the memory of an excellent English physician to state that the American code is based on that prepared by Thomas Percival, and published in 1803. Credit to Percival was given by Hays, in a note accompanying his report, as follows: “On examining a great number of codes of ethics adopted by different societies in the United States, it was found that they were all based on that by Dr. Percival, and that the phrases of this writer were preserved to a considerable extent in all of them. Believing that language so often examined and adopted must possess the greatest of merits for such a document as the present-clearness and precision and having no ambition for the honors of authorship, the committee which prepared this code have followed a similar course, and have carefully preserved the words of Percival whenever they convey the precepts it is wished to inculcate.” Percival's code of ethics was prepared for a son who was about to engage in medical practice, and who died before its publication. It was dedicated to another son who was engaged in the study of medicine. In its composition, as he says in the dedication, his thoughts were directed to bis son,“ with the tenderest impulse of paternal love, and not a single moral rule was framed without a secret view to his designation, and an anxious wish that it might influence his future conduct.” The following is another quotation from the dedication : “The relations in which a physician stands to his patients, to his brethren, and to the public, are complicated and multifarious, involving much knowledge of human nature and extensive moral duties. The study of professional ethics, therefore, can not fail to invigorate and enlarge your understanding, while the observance of the duties which they enjoin will soften your manners, expand your affections, and form you to that propriety and dignity of conduct which are essential to the character of a gentleman."
The code of the American Medical Association will form the basis of this work. The arrangement of topics adopted in that code will be followed, namely: 1st. The duties of physicians to their patients, and the obligations of patients to their physicians. 2d. The duties of physicians to each other and to the profession at large. 33. The duties of the profession to the public, and the obligations of the public to the profession. A chapter will be devoted to each of these three divisions. The three chapters will embrace the entire code, with such comments as may suggest themselves. In a few instances the writer will renture upon critical remarks. In connection with topics which belong to medical ethics will be introduced remarks upon etiquette.
THE DUTIES OF PHYSICIANS TO THEIR PATIENTS, AND THE
OBLIGATIONS OF PATIENTS TO THEIR PHYSICIANS.
The plan which will be pursued, as regards the code and the commentaries, is the introduction of a portion of the code to serve as the text for the comments which will follow. The latter will be distinguished by a difference in print, and will therefore not require a distinctive heading. It would be easy for a writer full of admiration of the code to amplify largely upon it; but, appreciating the importance of having the volume of small size, the commentaries will be brief. The code offers very little opportunity for controversial discussion; all who have studied it must admit the difficulty of taking exceptions to its ethical rules.
Art. I.-Duties of Physicians to their Patients. SECTION 1. A physician should not only be ever ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mission, and the responsibility he habitually incurs in its discharge. These obligations are the more deep and enduring, because there is no tribunal other than his own conscience to adjudge penalties for carelessness or neglect. Physicians should, therefore, minister to the sick with due impressions of the importance of their office, reflecting that the ease, the health, and the lives of those committed to their charge depend on their skill, attention, and fidelity. They should study, also, in their deportment, so to unite tenderness with firmness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect, and confidence.
The sentiments so admirably expressed in the foregoing first paragraph of the code need no arguments for their support, nor any comments to increase their force. They antagonize undue influences arising from self-conceit, an irritable temper, indolence, devotion to pleasure or to occupations which divert from professional duties, and all mercenary considerations. At the same time, they do not contravene self-respect and a proper regard for personal interests. It is not to be assumed that the practice of medicine is a sacred calling in the sense in which this expression is applied to the clerical profession, nor that it is adopted for purely benevolent or philanthropic purposes. The medical profession holds out to its candidates the inducements of an honorable pursuit, studies which are not only attractive, but afford ample scope for the mental faculties, labors which may carry with them the satisfaction of saving life and restoring health, but, conjoined with these, an expectation of gaining a livelihood, together with means for the enjoy. ment of the pleasures of domestic and social life, a fair prospect for acquiring a competency, and, with prudence and perseverance, even wealth. The last of these inducements are by no means necessarily inconsistent with the higher sentiments which should govern the conduct of physicians. Self-abnegation is a noble trait, not infrequently exemplified in the lives of members of the medical profession, but communities have no more right to demand it of them than of those in other callings, and indifference to their own worldly interests and the claims of their families is not to be enjoined upon them more than upon
those engaged in other pursuits. This principle is one to be understood both by physicians and the public. Writers of fiction and dramatists have depicted lives devoted to the duties of medical practice purely as works of charity.* These delineations have their analogues in real life. On the other hand, there are those whose absorbing aim is to acquire either distinction or pecuniary gain. Without undertaking to interfere with motives and objects, for which every one must be responsible to his own conscience, the code of ethics places before the mind of the physician sentiments peculiarly applicable to the exercise of the medical profession.
Sec. 2. Every case committed to the charge of a physician should be treated with attention, steadiness, and humanity. Reasonable indulgence should be granted to the mental imbecility and caprices of the sick. Secrecy and delicacy, when required by peculiar circumstances, should be strictly observed ; and the familiar and confidential intercourse to which physicians are admitted in their professional visits should be used with discretion, and with the most scrupulous regard to fidelity and honor. The obligation of secrecy extends beyond the period of professional services; none of the privacies of personal and domestic life, no infirmity of disposition or flaw of character observed during rofessional attendance, should ever be divulge by the physician except when he is imperatively required to do
The force and necessity of this obligation are indeed so great that professional men have, under certain circumstances, been protected in their observance of secrecy by courts of justice.
Most persons, of “ all sorts and conditions," regard physicians with respect in consideration of their calling. Even they who are notoriously rough and uncivil in their intercourse with others are often gentle and courteous to those from whom they expect to receive medical aid in sickness. As a rule, the physician, in his visits to his sick patients, re
* E. g., "Le médecin de campagne,” by Balzac.