The Bioethics Program

THE CAMBRIDGEWORLD HISTORY OF MEDICAL ETHICS

Edited by Robert B. Baker and Laurence B. McCullough

876 pp, $250

New York, NY, Cambridge University Press, 2009

ISBN-13: 978-0-5218-8879-0

IT TOOK BAKER ANDMCCULLOUGH 10 YEARS TO EDIT THECAMbridge

World History of Medical Ethics, but the result is 876

pages �written by the editors and by 55 other bioethics scholars

and �historians from around the globe. It took me a month

to �read the book comprehensively and critically, but this was

one �of the most pleasant and interesting reads I have ever had.

The editors took a unique 2-step approach to present the

material , embracing an innovative literary design for the

project . �First, rather than treating medical ethics as begun

by the 18th-century English physicians Thomas Percival and

John Gregory, as most medical historians have done, they

enlarged the historical concepts of the subject. They insist

that, when pertinent, contributors always include material

from ancient Egyptian, Hindu, Babylonian, Chinese, and Sanskrit

texts as well as from the Greek philosophers of the fifth

through third centuries CE. Contributors reported the concerns

and reservations expressed in these historical texts by

patients about their physicians and their practices. Simultaneously,

they reported on the various problems that contemporary

physicians dealt with concerning honor, professional

decorum, know-how, religious duty, jurisprudence,

and prudential judgment, all of which would now assuredly

be classified as problems of medical or bioethics.

Second, influenced by J�rgen Habermas, a proponent of

�discourse ethics,� the editors planned the encyclopedia

around discourses by scholars in many different fields. They

asked these scholars to consider carefully and fully the interconnections

between health care and morality in exceptionally

different and specific ways. After the contributors

had done this thoroughly, they wrote a discourse on the assigned

subject. For this purpose, the editors defined �discourse�

[A] written or oral communication about a subject over time. Until

recently, the history of medical ethics has focused on formalizations

of medical morality, such as oaths and codes. The expression

�discourse� indicates a broader conception of this history

embracing the perspectives of religious figures, philosophers, the

public and patients, as well as practitioners. �Discourses� include

oral forms of expressions as well as texts on medicine, religion,

philosophy, and bioethics. It also includes various forms of patient

and public expression and social commentary. Sources may

include not only published texts but cartoons, graffiti, inscriptions,

letters, pamphlets and other vehicles that the general public,

patients, practitioners, and religious and social figures have used

to express moral values, ideals, standards and norms for health care

and sickness care, and for practitioners and medical practice.

Thus, the editors sought discourses written by religious

scholars, philosophers, practitioners, and bioethicists. Importantly,

the editors believe that such discourses would negate

criticism for including information gleaned from Western

writings prior to those of Percival and Gregory as well

as those from non-Western cultures. Using this �technique

of discourses,� the editors believed they would be able to

avoid imposing post�19th-century Western concepts onto

their contributor�s presentations, thus producing a history

of medical ethics free of �essentialism� (fundamentalism),

�presentism� (previous connections), traditionalism, and Eurocentrism

and responsive to the voices of different cultures.

They have succeeded admirably.

The encyclopedia consists of 8 parts. The first is an introduction

to the history of medical ethics; the second is a

chronology of medical ethics. The third comprises discourses

on medical ethics through the life cycle; the life cycles

described are those of persons living in Hindu India, Buddhist

India, China, Japan, Europe, the Americas, and the Islamic

Middle East. The fourth part comprises discourses on

religious beliefs related to medical ethics as developed from

the perspectives of Hindu, Buddhist, Confucian, Early Christian,

Orthodox Christian, Roman Catholic, Protestant, Jewish,

and Islamic beliefs. The fifth part considers discourses

of philosophy on medical ethics. The sixth part comprises

discourses by medical ethics practitioners from Africa, India,

China, Japan, and ancient Europe, as well as European

practitioners in the Hippocratic tradition. The division of

historical times for discourses written by practitioners were

the ninth to 14th centuries in the Middle East; medieval and

renaissance Europe; 16th- and 17th-century Europe; 18thcentury

France and Germany, Spain, Britain, and North

America; 19th- and 20th-century France, Spain, Germany,

Russia, and the United States and the contemporary Middle

East. The seventh part comprises discourses on bioethics

written by well-known bioethicists in the United States, the

United Kingdom, Western Europe, post-Communist Eastern

Europe, Latin America, East Asia, South Asia, and sub-

Saharan Africa. The editors divided the eighth part, dealing

with medical ethics and society, into 3 subparts. Part A

deals with discourses on the ethical and legal regulation of

medical practice and research; part B with medical ethics,

imperialism, and the nation-state; and part C with medical

ethics and health policy.

The information presented is rich and exciting. By requiring

that contributors use the discourse technique and

by insisting that contributors understand that the date heretofore

typically considered the �beginning� of bioethics is

incorrect, the editors have done every reader a tremendous

service. The contributors have brought to light innumerable

historical facts relating to bioethics, all of which were

likely previously unknown by most if not all bioethicists. I

am certain that a single bioethicist would never have been

able to become acquainted with many of the facts in this

volume. No one scholar could possibly have read and digested

all the information in the various presentation �discourses�

that the scholars in specific fields�philosophy, theology,

history, jurisprudence, geography, hagiography, and

others�have now presented.

One section I know I will find useful was part 2, �Chronology

of Medical Ethics,� prepared by the editors. They listed

facts in 4 columns�dates, events, persons, and texts. The

76 pages that comprise the chronology list a large number

of facts pertaining to bioethics, many of which were new to

me. I am sure other readers will find this part of the encyclopedia

fascinating and useful, and I believe scholars of bioethics

will use this chronology more than other parts of the

book, because it contains an exceedingly easy-to-use history

of bioethics that provides the most complete outline

of the history of bioethics I have read. Searching for correct

historical facts in bioethics is quickly and easily accomplished

in this part of the encyclopedia, and this part will

help every bioethics scholar in his or her work. I predict that

this will be the most thumbed and worn part of the volume

in every library.

Every municipal library should have a copy of The Cambridge

World History of Medical Ethics, and it should be a

mandatory purchase for every university reference library,

bioethics center, and bioethicist.

John Collins Harvey, MD, PhD

Center for Clinical Bioethics (Emeritus)

Georgetown University

Washington, DC

jcviola@aol.com

Financial Disclosures: None reported.

of the entire patient, both mind and body. Sadly, a common

observation is that, in contrast to mission statements

acknowledging the need to work not only with the patient

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