Philosophy 383 M. Rorty SFSU Fall 2009 Lecture: Week 4 page 1Week 4: Medicine, Medical ethics and Physician Responsibilities (Sept 22)Housekeeping: Next week (Week 5) we will talk about privacy, confidentiality, truthtelling and disclosure.Week 6, next week, and Week 7, the week after that, we will devote to talking about the right side ofthe autonomy mobile: the importance of informed consent for treatment plans, and the role of patientcapacity in deciding who should make decisions about (and give consent for) treatments of incapablepatients. There will be a midterm in week 7 (October 13). The midterm will consist of a short-answersection, administered in class—and an essay, probably another 3 pager, to be e-mailed to me before the20th. It’s required for BOTH journalers and traditional students.Some good background reading for this lecture: On bioethics: David Rothman: Stranger at the Bedside (1991) Albert Jonsen: The Birth of Bioethics (2000) On cultural issues:Ann Fadiman: The Spirit Catches You and You Fall DownThe Story of Aesclepius:According to legend, the first physician, Asclepius, was the child of a mortal and a god. His father wasApollo. His mother was the daughter of a king of Thessaly. Coronis was unfaithful to Apollo, andArtemis, Apollo's twin sister, killed her for her unfaithfulness. Coronis was placed upon a funeral pyre.As her body started to burn, Apollo felt sorrow for his unborn son and snatched the child Asclepiusfrom his mother's corpse, saving him from death. Apollo then handed Asclepius to a Centaur (Chiron)who became his tutor and mentor.Chiron taught Asclepius the art of healing. Asclepius also acquired the knowledge of surgery, the useof drugs, love potions and incantations, and according to one source, Athena gave Asclepius a magicpotion made from the blood of the Gorgon. Legend tells that the blood of the Gorgon has a differenteffect depending from which side the blood was taken. If taken from the right side of the Gorgon, it hasa miraculous effect and is said to be able to bring the dead back to life, but taken from the left side it isa deadly poison.With these gifts Asclepius exceeded the fringes of human knowledge, and cured many illnesses. But oneday he offended the high god, Zeus by accepting money in exchange for transgressing the limits of hispractice, by raising the dead. In the eyes of Zeus, Asclepius' action upset the natural order of theuniverse - a mere mortal helping man evade death. Zeus sent down a thunderbolt, killing Asclepius.At the same time, Zeus realised the good Asclepius had brought to man. So he made him into a god,placing him among the stars, transforming Asclepius into the constellation Ophiuchus (the serpent-bearer). The snake was used in the healing ritual; non-poisonous snakes were left in the dormitorywhere the sick slept overnight on the bare ground.The cult of Asclepius became very popular during the 4th century BC and the cult centers (known as anPhilosophy 383 M. Rorty SFSU Fall 2009 Lecture: Week 4 page 2Asclepieion) were used by priests to cure the sick. Invalids also came to the shrines of Asclepius to findcures for their ailments (in the same fashion pilgrims visit Lourdes today.) It is believed thatHippocrates, a great doctor of antiquity, plied his trade on the island of Cos, where many Asclepieionswere located.. It is also said that Hippocrates was a descendant of Asclepius.I: Medicine and Professional Ethics It is safe to say that at the beginning of the 20th century, the physician dominated health carelike a colossus. The ethics of healthcare for the majority of the century was medical ethics, with a longand distinguished history. The Hippocratic oath dates to the 5th century BC; and Hippocrates himself,myth tells us, was the descendent of a child of the gods. Insofar as medicine takes Hippocrates as itsfounder and guiding spirit, it is a 2500 year old tradition. As I mentioned last week, the turn of the century physician had complete control of thetreatments and therapies available to the patient. As more complex treatments became availablebecause of the scientific and technological advances in medicine, the hospital began to assume a largerrole in medical treatment. Both birth and death (as well as increasingly complex diagnostic,therapeutic, surgical or life-supporting interventions) gradually migrated into institutional settings.(Recent calculations suggest that in the US 90% of births and 80% of deaths took place in institutionsby the end of the 20th century.) But even with the growth in importance of the hospital, the physicianremained dominant; he was the source of patients for the hospitals, gatekeeper for their services. Hepracticed in hospitals which for the most part he ran. Nurses carried out his orders, and other healthprofessionals reported to him and provided services at his discretion. Even today the role in hospitaladministration of the medical board (the physicians with admitting privileges to a given communityhospital) remains strong. The physician was a professional—indeed, the very model of a professional. Whensociologists began trying to define professions and establish criteria for what it meant to be a memberof a profession, the physician, along with the judge and the priest, was the example to which theylooked. Medicine was a “calling” that demanded of its practitioners a publicly-declared vow ofdedication or devotion to a way of life: the relief of human suffering as their highest duty, and afiduciary relationship to their patients. Characteristics of a profession:The following characteristics are very important in understanding the extent to which the physician is aprofessional. Expertise: It is his command of a special expertise which justifies admission to membership ina profession. Medical education in early America was an apprenticeship: you learned how to be adoctor by following an older, respected, physician around for a number of years; and modern medicaleducation maintains this apprenticeship aspect, added in on top of the information-content courses.Since the time of Hippocrates medicine has been considered a specialized body of knowledge whichmust be mastered and is handed down only to selected novitiates, rather than being general knowledge.Continuing education, to