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Of the first sentence of the original section four, Doctor Flint says in his commentaries:
"The grounds for the injunction not to patent remedies or surgical instruments, and not to dispense secret nostrums, are not always appreciated by the public. Some appear to think that it is dictated by jealousy or professional prejudice. The reasons are concisely but clearly stated in the National System. Imagine Jenner to have applied for a patent giving exclusive property to vaccination, or keeping it a secret! How different would the names of those identified with the discovery and introduction of anesthesia in surgical and medical practice appear in history, had the attempt not been made to withhold from the profession and the public the agent employed, and to secure a proprietary interest therein! Here, as in all other instances, the restrictions of the National System of morals have reference to the welfare of the community, and not to the selfish interests of the medical profession."
The fourth section of the sixth article of the second chapter of the abstract has no place whatever in its letter. The practices it decries are as strongly condemned by the spirit of the medical laws of 1847 rightly interpreted. It belongs to local associations to declare such or such conduct unbecoming a loyal physician and gentleman, and to take fit action thereon. The conduct specified in the section in question degrades not only the general profession but the vile guilty culprit, and unfortunately prejudices the undiscriminating public against the local physicians. The committee in charge of the abstract seems to have been
led to insert this fourth section because of the well-known corrupt and dishonorable practice, in some parts of the country, of openly offering the percentages of moneys in question and that these moneys have been habitually received and accepted; and when the demand of a commission is denied, the unfortunate patient, victim of the rapacious proponant or broker, is sent to any other physician who will pay the required dishonest commission. Thus making a vile trade of a noble profession by buying and selling patients like chattel to the dealer or pigs to the slaughter house!
Such is the morally debauched condition of many in whose souls the spirit of the grand National System has not entered, that they are even willing to receive from tradesmen commissions on business sent to their shops.
ANALYSIS OF DOCTOR FLINT'S COMMENTARIES
THE subjoined analysis of Doctor Austin Flint's admirable commentaries designed as a plea for the maintenance of the American system of medical morals, is intended for those who have not read that valuable contribution to the moral philosophy of medicine.
The work begins with a modest preface, characteristic of the truth-loving and guileless author who died full of years and honors, deeply regretted by all who knew him. The commentaries, which show ripe scholarship, good taste and loftiness of mind, were composed in moments snatched from his hours of rest and were truly a labor of love.
In the introductory remarks the author says: "A reader who has given to the subject little or no attention may be supposed to ask, 'wherefore the propriety of recognizing the principles of duty applied to medicine as constituting a distinct branch of moral science? Are not the rules . . which would govern the practiser of medicine the same as in other applications?' There are certain fundamental truths which, of course, underlie all possible applications of morals; but the adaptation to different conditions of life call for a separate consideration.
The rules of conduct adapted to the peculiarities of medicine constitute medical morals. These rules have a moral weight. Medical etiquette, on the other hand, consists of the forms to be observed in professional intercourse. These are conventional. They have not the binding force of moral rules; nevertheless, they claim observance. The medical profession receives not a little ridicule for observing rules of etiquette, but their observance is a protection against not only embarrassment and confusion, but misapprehensions and dissensions, injurious alike to physicians and patients. If there be ground for a distinct system of morals applied to medicine, the rules of conduct which the system requires should be codified. A system of morals adopted by the profession represents the views held by the majority of its members, and is, therefore, binding on all. It is indispensable for the sake of reference whenever differences of opinion arise. It indicates the proper course to those whose moral perceptions may be defective. It may prove a safeguard against the bias of personal interests. It thus contributes to the purity and dignity of the medical profession. Much would be gained in the popular respect for the profession, were the public better acquainted than they are with the rules by which its members assume to be governed. It is, perhaps, a common impression that the objects of a system of medical morals have exclusive reference to the interests of the medical profession. So far from this, the objects are of far more importance to the public welfare than to physicians." Farther on in the intro
duction he gives the origin of the system, and then concludes with a statement of the arrangement proposed for the commentaries. The work is divided into three chapters, which embrace the entire system, and to each section appropriate comments are appended.
CHAPTER I.-THE DUTIES OF PHYSICIANS TO THEIR PATIENTS, AND THE OBLIGATIONS OF PATIENTS TO THEIR PHYSICIANS
ARTICLE I.--DUTIES OF PHYSICIANS TO THEIR PATIENTS
SECTION 1 of this article is so clearly defined and so well adapted to the instruction of young physicians, that it is difficult to conceive what could have induced any physician to suggest its suppression. That its provisions are self-evident to physicians of experience is not doubted, but they are all necessary for the information of beginners, and are as brief as consistent with distinct statement. "They antagonize," says Dr. Flint, "undue influences arisign 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." There surely is no doubt of the necessity to tell young physicians of their obligations to obey promptly the calls of the sick; that their mission is always one of mercy; that the responsibility they incur in the discharge of their duties is great, and that since their work is generally performed in privacy, the only punishment for carelessness or neglect is through