Medical Ethics, History of Europe: I. Ancient and Medieval. A. Greece and Rome
I. ANCIENT AND MEDIEVAL. A. GREECE AND ROME
Ancient Greece and Rome are often treated together by scholars who seek to describe in a limited space any aspect of those two civilizations. Greek history is typically divided into the Mycenaean period (2000–1200 b.c.e.), the "dark age" (1200–750 b.c.e.), the archaic period (750–500 b.c.e.), the classical age (500–323 b.c.e.), and the Hellenistic period (323–30 b.c.e.); and Roman history into three phases: monarchy (753–509 b.c.e.), Republic (509–31 b.c.e.), and Empire (31 b.c.e.–476 c.e.). During the archaic period the Greeks engaged in considerable colonization in the Near East and throughout the Mediterranean basin, including southern Italy. The Hellenistic period, which was immediately preceded by Alexander the Great's conquest of much of the Near East, was marked by a fusion of Greek and various Near Eastern civilizations. Roman culture was influenced by the Greeks of southern Italy and, to a much greater degree, by the various Hellenized peoples whom the Romans conquered during the last two centuries of the Republic. The culture of the first three centuries of the Empire is appropriately labeled Greco-Roman. During the last two centuries of the Empire, a gradual division between the Latin West and the Greek East culminated in the emergence of the European Middle Ages in the former and the Byzantine era in the latter.
The Ancient Medical Profession
Although some herbal medicine and primitive surgery were employed by Greeks as early as the time represented in the Homeric epics (before 750 b.c.e.), the understanding and treatment of disease were predominantly magico-religious. It was not until the late sixth or early fifth century b.c.e. that Greek philosophy provided a rational/speculative theoretical framework for understanding health and disease, and hence for the emergence of what may be called a medical profession. The development of such a framework for the practice of medicine marks the origin of the expectation that physicians are above all products of a scientific training and orientation; that is, that they deal with disease and other physical ailments both empirically and rationally, not magically, mystically, or superstitiously (Amundsen and Ferngren, 1983). Desacralized medicine was an important aspect of Greek culture that spread throughout the Mediterranean world during the Hellenistic period and was adopted and adapted by the Romans during the late Republic.
There were no institutions that granted medical degrees or certification, nor was there a licensure requirement at any time or place. All who wished could call themselves physicians and practice medicine. Nevertheless, from the fifth century b.c.e. until the end of the period under consideration, the prevailing picture is of a population that typically distinguished between physicians (iatroi in Greek, medici in Latin) and those who practiced a magico-religious healing.
THE HIPPOCRATIC OATH. Professional standards enforceable by sanctions against physicians did not exist. Those who chose to call themselves physicians and undertake the practice of medicine were not required to swear any oath or to accept and abide by any formal or informal code of ethics.
Several medical oaths, however, are known from classical antiquity. The most famous is the Hippocratic Oath, though no scholar today believes it was written by the historically elusive "father of medicine." Even the date of the oath's composition is unknown; some scholars place it as early as the sixth century b.c.e. and others as late as the first century c.e. Apparently it did not evoke much attention before the Christian era; the first known reference to it was made by the physician Scribonius Largus in the first century c.e.
Some of the stipulations in the oath are not consonant either with ethical precepts prevalent elsewhere in the Hippocratic Corpus and other classical literature or with medical practice as revealed in the sources. Attempts have been made either to explain away these inconsistencies or to attribute the oath to an author or school whose views were, in other respects as well, discordant with those characteristic of classical society. Most influential has been Ludwig Edelstein's theory (1967) that the oath was a product of the Pythagorean school, whose tenets included belief in reincar-nation, the practice of vegetarianism and sexual purity, and a condemnation of abortion, suicide, and the shedding of blood. Although his thesis has appealed to many scholars, few now accept it (Deichgräber; Kudlien, 1970; Lichtenthaeler; Nutton, 1993). Parallels for even the most esoteric injunctions in the oath can be found outside Pythagoreanism. Furthermore, the Greek text offers many variant readings, some of which can be translated in significantly different ways.
THE IDEAL PHYSICIAN. One constant emerges from the variegated history of ancient medical ethics. When a Greek spoke of iatroi or a Roman of medici, each was using a word charged with meaning. Unless modified by a pejorative adjective, both meant compassionate, objective, unselfish persons, dedicated to their responsibilities. By the fifth century b.c.e.iatros was thus employed in a simile and metaphor; the good ruler, legislator, or statesman was frequently referred to as the physician of the state, and philosophers often described themselves as physicians of the soul. Such usage was carried over to the Latin medicus. The popular ideal of the physician was a dedicated, unselfish, and compassionate preserver or restorer of health—and, sometimes, inflicter of health-giving pain—always committed to the good of the patient, regardless of how far short of this ideal many physicians undoubtedly fell.
Beginning in the fifth century b.c.e., a body of medical literature developed that describes the ethics of Greek physicians. These books dealt with eminently practical concerns suggested by medical practitioners for their own benefit, such as issues of the physician–patient relationship, and obligations to the arts, to humanity, and to life itself.
General Etiquette and Deportment
Greek physicians' formulation of a standard of general etiquette and deportment provided the basis for a social expectation that has remained since that time: physicians are guided by certain basic standards of deportment or professional etiquette in dealing with patients (Amundsen and Ferngren, 1983). The physician should look healthy and be of suitable weight, "for the common crowd considers those who are not of excellent bodily condition to be unable to take care of others" (The Physician 1; in the Hippocratic Corpus). This is of particular significance, especially for classical Greek culture, in which health was considered by many both a virtue and an indicator of virtue. Health, the highest good, was set above beauty, wealth, and inner nobility. Health was a goal in itself, for without health, nothing else had value.
Especially in dealings with their patients, physicians should be cheerful and serene, but neither harsh nor silly. They should be reserved, speak decisively and briefly, exercise self-control, and not be excitable. Ostentation was regarded with particular distaste. Further, "It is disgraceful in any art and especially in medicine, to make a parade of much trouble, display, and talk, and then to do no good" (On Joints 44; in the Hippocratic Corpus). Physicians were urged to refrain from holding lectures for the purpose of drawing a crowd. Conducting one's practice with much fuss, although it might appeal to the vulgar crowd, smacked of charlatanism. Charlatans avoided consultations; good physicians, recognizing their own limitations and respecting their colleagues' knowledge, turned to other competent physicians for advice. Since consultations could lead to disputes, "Physicians who meet in consultation must never quarrel or jeer at one another" (Precepts 8; in the Hippocratic Corpus).
The Physician–Patient Relationship
Physicians' relationships with their patients usually commenced with an examination followed by a prognosis. Then the physician was faced with two or three ethical decisions:(1) whether to take the case if it appeared to be dangerous or hopeless; (2) what to tell the patient; and (3) what treatment to pursue.
INFORMING THE PATIENT. When determining what to tell their patients, two considerations impinged upon physicians: (1) the effect of their statement on the patient, and (2) the effect of these cases on their own reputation. There was considerable reluctance to take hopeless or doubtful cases. Some physicians, if they considered their cases hopeless, merely informed the patients that they were going to die, and left them. A treatise in the Hippocratic Corpus, probably written in the second century b.c.e., advises physicians to "conceal most things from the patient while you are attending to him … revealing nothing of the patient's future or present condition. For many patients through this cause have taken a turn for the worse" (Decorum 16). If the case was dangerous and the outcome uncertain but not hopeless, it was sometimes suggested that the patient's relatives or some other third party be informed, or that the patient should be told and advised to make a will. Sextus Empiricus, a physician and philosopher of the second century c.e., argued that "The physician who says something false regarding the cure of his patient, and promises to give him something but does not give it, is not lying though he says something false," since in saying it he has regard to the cure of the person he is treating (Against the Logicians 1, 43). The great diversity of advice and examples in both medical and other literature shows that opinions on this delicate question varied considerably then, just as they do now.
CHOICE OF TREATMENT. The question of what treatment to pursue posed an ethical problem for some ancient physicians. Therapeutics were placed in three categories: the mildest, dietetics; next, drug therapy; and the most drastic, cutting or cauterizing. Those who abided by the Hippocratic Oath swore not to "cut for stone," which some scholars interpret as a rejection of all operative surgery. Especially in the last century b.c.e. and the first century c.e., different medical sects vigorously debated whether drug therapy was unethical and whether milder therapeutics were preferable. But some, like Scribonius Largus, argued that it was even more unethical to refuse to employ drugs responsibly when their benefit to patients was so obvious (Hamilton).
THE PATIENT'S COOPERATION. The cooperation of patients was, of course, recognized as important (Aphorisms; in the Hippocratic Corpus), for if they did not obey their physicians' instructions, their condition might worsen or they might die, in which case their physicians would be blamed (The Art; Decorum; both in the Hippocratic Corpus). A brilliant prognosis, including a description of what course their illnesses had already taken, might so impress the patients that they would be inclined to obey their physicians (Prognostics; in the Hippocratic Corpus). Persuasion might be used; a passage in the Laws of Plato advances the idea that good physicians will reason with their patients and persuade them to follow the treatments prescribed (cf. The Statesman). Galen remarks on the importance of convincing patients that remarkable benefit will ensue if their physicians' orders are obeyed. But it is the patients' respect and admiration for their physicians that are most desirable. Since faith in one's physician could render treatment more efficacious, Galen, for example, maintained that patients should admire their physician like a god.
CONFIDENTIALITY. Should physicians treat as confidential any information they acquired in their contact with patients? In the Hippocratic Oath, the following injunction appears: "What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about." Edelstein sees in this stipulation a clear indication of Pythagorean purity, an insistence on secrecy "not as a precaution but as a duty" (p. 37). Those things that one ought not spread abroad, whether encountered within or outside of practice, are categorized as "shameful to be spoken about," or in another translation, "holy secrets." Elsewhere in the Hippocratic Corpus the physician is advised to "say only what is necessary. For … gossip may cause criticism of his treatment" (Decorum 7). In another treatise in the Hippocratic Corpus, the physician is urged "not only to be silent but also of a great regularity of life, since thereby his reputation will be greatly enhanced" (The Physician 1). While the stipulation to refrain from speaking too much may be motivated by a sense of duty to keep inviolable especially those private things physicians encounter in practice, the other two quotations belong in the context of a self-interested regard for reputation rather than a concern for the supposed "rights" of patients.
SEXUAL PROPRIETY. A very practical stipulation in the Hippocratic Oath reads, "Whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief, and in particular of sexual relations with both female and male persons, be they free or slaves." Edelstein stresses again the Pythagorean tone of this injunction, especially the emphasis on justice, and sees in the prohibition of sexual relations with members of the patient's household evidence of Pythagorean severity in sexual morality. Whether this advice was motivated by ideals of purity or by merely pragmatic concerns, physicians who used their close contact with patients or their households to satisfy their sexual passions would earn not only disrespect and contempt but also distrust. Having a reputation as a seducer of patients and their family members simply did nothing to enhance one's medical career (see also The Physician).
Duty to the Art, Society, and Life
LOVE OF HUMANITY. Sometimes ancient medical literature addresses very fundamental questions of motivations for practicing medicine, physicians' role in society, and the obligations incumbent upon them in that role. One statement in the Hippocratic Corpus—"Where there is love of humanity [philanthropia] there is also love of the art [philotechnia]" (Precepts 6)—has often been taken to demonstrate that for Greek physicians, love of humanity and love of the art were the foundational motivations for their practicing medicine. Sir William Osler saw in it the Greek physician's "love of humanity associated with the love of his craft—philanthropia and philotechnia—the joy of working joined in each one to a true love of his brother" (Edelstein, pp. 319f.). The precept in question, however, may not be so lofty. Vivian Nutton, for example, sees it as simply a pragmatic assertion that physicians' showing love for humanity will foster in their patients a love for the medical art (1993). In any event, it is evident that for many physicians, love of one's honor, glory, and reputation provided a greater motivation than philanthropia (Amundsen and Ferngren, 1982).
The statement quoted from the Precepts in the preceding paragraph occurs in the context of a discussion about fees that is introduced by the admonition "I urge you not to be too unkind." The noun apanthropia, the antonym of philanthropia, is here translated by the adjective "unkind." In the Hippocratic Corpus philanthropia generally is little more than kindness and compassion. Owsei Temkin, however, emphasizes that one must take care not to trivialize their philanthropy (1991), which one may easily do by contrasting it with the nearly religious flavor that philanthropy took on during subsequent eras. A profound change occurred in late Hellenistic and Roman thought, which, affected by the influence of humanitarian and cosmopolitan ideas on both philosophical and popular ethics, began to see philanthropia (Latin, humanitas) as humane and civilized feeling toward humanity in general; that is, the principle of the common humanity of all people as expressed by the Stoic philosopher Sarapion around 100 c.e. in a poem titled "On the Ethical Duties of the Physician": "Like a savior god, let [the physician] make himself the equal of slaves and of paupers, of the rich and of rulers of men, and to all let him minister like a brother; for we are all children of the same blood" (Oliver, p. 246).
This sentiment is strongly present in Galen (second century c.e.), for whom the best physician was also a philosopher, motivated by philanthropia (Brain). Galen, however, conceded that many physicians were motivated not by philanthropia but by the pursuit of money or love of glory (Temkin, 1973). Although a few sources, such as Scribonius Largus, held that to be truly a physician, one must be motivated by philanthropia (Hamilton), a majority of our sources concur with Plato that the motivation to practice any art, including medicine, has little or nothing to do with the integrity of the art itself: the practitioner must only be competent (Republic). Nevertheless, while few physicians or laymen may have regarded philanthropia as essential for the physician, most people probably regarded lack of kindness and compassion as distinctly undesirable for a physician. Ample evidence suggests that the "presence of compassion among doctors was taken for granted by authors of the first century" and that, even much earlier, physicians "could think of compassion as rooted in medical ethics" (Temkin, 1991, pp. 33, 34).
FEES. Ancient medical writers expressed much concern about fees. Physicians were acutely aware that the appearance of greed could have a detrimental effect on their reputations. Hence, in the Hippocratic Corpus physicians are urged to be more concerned with their reputation than with financial reward, sometimes to give their "services for nothing, calling to mind a previous kindness or [their] present reputation," and to avoid beginning a case by discussing fees, since it could adversely affect patients, particularly those whose condition was acute (Precepts 6). Physicians were admonished to consider their patients' economic situation in setting fees and to provide less expensive remedies for the poor than for the rich (On Diet). In spite of such sentiments, physicians do not appear to have engaged in much charitable activity from a sense of duty to humanity, to the community, or to the poor (Hands). Furthermore, the subject of medical fees in antiquity is complicated because some physicians objected to being considered "hirelings" and, especially during the Empire, some insisted that medicine was a liberal art, which entangled their remuneration with the complexities of Roman laws governing honoraria (Kudlien, 1976; Temkin, 1979).
EXPERIMENTATION. Ancient physicians strove to improve their proficiency and the efficacy of their art. The most extreme example of medical experimentation was vivisection of human subjects, a very controversial subject (Ferngren, 1982). Celsus states that Herophilus and Erasistratus in Ptolemaic Alexandria performed vivisections on condemned criminals supplied by the crown. Whether or not Celsus's statement is accurate is debated (Von Staden, 1989; Scarborough), but he presents the arguments for and against the value of vivisection, concluding that "to lay open the bodies of men while still alive is as cruel as it is superfluous … [since] actual practice will demonstrate [what can only be learned from the living] in the course of treating the wounded in a somewhat slower yet much gentler way" (pr. 74f.). There is ample evidence for the vivisection of animals either to gain new knowledge or to test new theories (Galen, On Anatomical Procedures).
Some physicians recognized that without attempting new procedures and remedies, medical knowledge and techniques would not advance (Michler). The author of On Joints in the Hippocratic Corpus, after describing the failure of a novel attempt at reducing a dislocation, writes, "I relate this for a purpose: Those things which after a trial show themselves to have failed and which show why they failed, also provide good instruction" (On Joints 47). The author of the same treatise urges physicians to study incurable cases. Commenting on the Hippocratic maxim "Experiment is perilous" (which can also be translated "Experience is unreliable"), Galen cautions that "In the human body, to try out what has not been tested is not without peril in case a bad experiment leads to the destruction of the whole organism" (Temkin, 1991, p. 60). Further, he asserts that in several instances he had refrained from testing some remedies when he had others whose effects he knew better, and he points out that rash experimentation presents a danger to the life of the patient (Ferngren, 1985).
Some physicians may have been deterred from experimenting on patients by a fear of being brought to court. Complaints can be found in classical sources that only the physician can commit homicide with complete impunity, but there were some very limited means for seeking redress against the negligent or incompetent physician, at least in Athenian and Roman law (Amundsen, 1973; 1977). But most physicians were probably deterred from any compelling desire to experiment primarily by concern for their reputations rather than by fear of litigation. Classical literature provides numerous examples of the worry expressed by laymen that physicians experiment at their patients' risk (Ferngren, 1982; 1985).
SHARING NEW TECHNIQUES. When new knowledge and techniques were discovered or developed, physicians were faced with the question of whether they should share this information with their colleagues—their competitors—and with the public at large. The Hippocratic Oath appears to have been composed for an exclusive sect. In it physicians swear not to impart their knowledge to those outside their sect. Similar sentiments are expressed elsewhere in the Hippocratic Corpus: "Things … that are holy are revealed only to men who are holy. The profane may not learn them until they have been initiated into the mysteries of the science" (The Law 5).
Apart from a few such statements, a desire to share new techniques or knowledge with other physicians pervades the medical literature. Those who published their medical knowledge and experience obviously did not desire to keep them secret. Galen was motivated in part by the wish to help physicians after him. But many physicians undoubtedly guarded their special techniques with jealousy. Galen shows no surprise at a surgeon's intentionally concealing his operative procedures from view, but expresses disappointment that even some of his own pupils would not share their anatomical knowledge with others (On Anatomical Procedures). His "philanthropy is not only that of the physician, but more comprehensively that of a philosopher who subjectively delights in study and objectively labors for the good of mankind. He thinks of his work as belonging to posterity …" (Temkin, 1973, p. 50). Some physicians wrote to instruct other physicians and also to edify laymen. In their desire to share medical knowledge with contemporaries and with posterity, at least a few Greek and Roman physicians achieved the most enduring manifestation of their philanthropia and philotechnia (Temkin, 1949).
Respect for Life
How did physicians view their responsibility to nature and, more specifically, to life? Or, to put it differently, how might they have interpreted and applied the maxim frequently quoted in the Hippocratic Corpus, "to help or at least to do no harm" (Epidemics 1.11)? Did the Greek or Roman physician feel bound by any sense of "respect for life"?
ABORTION. The Hippocratic Oath enjoins that the physician "will not give a pessary to a woman to cause abortion" (Jones's translation ; Edelstein's  "I will not give to a woman an abortive remedy" appears broader in scope than the Greek). Here again we encounter a situation in the oath that runs counter to the realities of ancient medical practice. Many physicians did perform abortions, and various techniques are described in the medical literature (Carrick). Both Plato (Republic) and Aristotle (Politics) encouraged abortion as a means of population control and for eugenics. Objections to abortion were relatively rare before the beginning of the Christian era; in both Greek and Roman law, abortion was a criminal offense only if performed without the consent of the woman's husband (or father, if she was not married). By the first century c.e., some pagan physicians such as Scribonius Largus (Hamilton), influenced as much by an increasing humanitarianism as by the Hippocratic Oath per se, refused to perform abortions under any circumstances. The physician Soranus of Ephesus (late first/early second century c.e.) gives three reasons for which a woman seeks an abortion: to rid herself of the consequence of adultery, to maintain her beauty, and to preserve her health. Only for the last would he perform an abortion (Gynaecia). Soranus was highly critical of physicians who so strictly adhered to the injunction in the oath that they refused to perform an abortion even to save the life of the mother. It appears, then, that some physicians would perform abortions on request, some refused to do so for any reason, and others assumed a position on therapeutic abortion consonant with that of Soranus. The decision to perform or not to perform an abortion ultimately rested on the convictions of the individual physician. The opposition to abortion of the author of the Hippocratic Oath and such physicians as Scribonius Largus and Soranus was based less upon an idea of the inherent value or sanctity of life than on an abhorrence of physicians' using their art in actively terminating even fetal life.
DEFECTIVE NEWBORNS. While some voices were raised against exposure of healthy newborns, the morality of killing weak, sickly, or deformed newborns appears not to have been questioned by either nonmedical or medical authors (Amundsen, 1987). Soranus, who condemned any but therapeutic abortion, not only raised no objection to rejecting a defective newborn; he also provided criteria to be used by midwives in determining which newborns were worth rearing (Gynaecia).
PROLONGING LIFE AND PASSIVE EUTHANASIA. The Art, a treatise in the Hippocratic Corpus, defines medicine as having three roles: doing away with the sufferings of the sick, lessening the violence of their diseases, and refusing to treat those overwhelmed by their diseases, realizing that in such cases medicine was powerless. The decision whether to take on a possibly incurable case was entirely the individual physician's. Some cases in the therapeutic treatises in the Hippocratic Corpus are introduced with the advice that certain procedures should be followed if the physician chooses to attempt treatment (Amundsen, 1978). Ancient medical literature is divided on the question of whether physicians should withdraw from cases once it becomes clear that they will not be able to help. Some urged that physicians ought not to withdraw, even if by so doing they might avoid blame. Others felt that they should withdraw if they had a respectable excuse, particularly if continuing treatment might hasten the patient's death. Physicians did, however, sometimes attend cases considered incurable. In the Hippocratic Corpus many diseases that then generally ended in death are described with no mention of prognosis and with no recommendation to the physician that such cases be undertaken or rejected. For most of them, medications to be employed are named. It was recognized that it was necessary to deal with incurable conditions in order to learn how to prevent curable states from advancing to incurability, particularly in the case of wounds (Michler). Opinions varied on the physician's responsibility to undertake treatment of hopeless or dangerous cases. In recent times it has become almost dogma to assert that the Hippocratic physician would not take on hopeless cases, but this is demonstrably false (Von Staden, 1990). Nevertheless, some laymen in antiquity held that, as Cicero wrote to his friend Atticus, "Hippocrates too forbids employing medicine in hopeless [cases]" (Temkin, 1991, p. 139).
Celsus, a medical compiler of the first century c.e., appears to represent the mainstream of medical thought: "For it is the part of a prudent man first not to touch a case he cannot save, and not to risk the appearance of having killed one whose lot is but to die; next when there is grave fear without, however, absolute despair, to point out to the patient's relatives that hope is surrounded by difficulty, for then if the art is overcome by the malady, he may not seem to have been ignorant or mistaken" (De Medicina 5.26.1.c). Available evidence suggests that physicians who prolonged or attempted to prolong the life of patients who could not ultimately recover their health were generally viewed as acting unethically (Amundsen, 1978).
ASSISTED SUICIDE OR ACTIVE EUTHANASIA. Would the ancient physician have thought it helping or harming to agree to assist those who for any reason wished to end their lives? To this question a majority of ancient physicians would probably have replied, "Helping, or at least not harming." The right of a free person to control his or her life as each saw fit—if not always in its living, at least in its termination—was a generally accepted view (Cooper). Suicide was, under most circumstances, outside the moral interest of the law; the exception was whether the suicide of one accused of a crime should be construed as an admission of guilt (Hooff). If a person who wished to commit suicide enlisted the aid of a second party, the latter was not legally culpable for rendering such assistance. Extralegal sources contain few objections to suicide in general, fewer still to the suicide of the hopelessly ill (Gourevitch; Hooff). Assisting in suicide was a relatively common practice for Greek and Roman physicians, and condemnations of the practice were infrequent.
One such condemnation appears in the Hippocratic Oath: "I will neither give a deadly drug to anybody, not even if asked for it, nor will I make a suggestion to this effect" (following Kudlien's translation, 1970, p. 118, n.47). This statement immediately precedes the prohibition of abortion. Both prohibitions have at least this much in common: They are inconsistent with the values expressed by the majority of sources and atypical of the realities of ancient medical practice as revealed in most medical and lay literature. Some physicians, however, may have preferred not to assist a suicide, for it could prove to be a messy business, at least from a legal point of view. Under Greek and Roman law, physicians could be charged with poisoning their patients. Indeed, physicians were sometimes charged with, or at least frequently suspected of, doing so (Kudlien, 1970; Nutton, 1985). Some physicians refused to aid anyone in committing suicide; perhaps they condemned assisting suicide under all circumstances for philosophical or religious reasons, or on the grounds that such action was inconsistent with the role of medicine (e.g., the first-century physicians Scribonius Largus [Hamilton, 1986] and Aretaeus [Amundsen, 1978]).
AT THE MOST, A LIMITED "RESPECT FOR LIFE." In light of the Hippocratic Oath and several later sources that also condemn abortion and active euthanasia, Temkin asserts that "Sufficient material has now been gathered to prove the existence of a tradition which, in its uncompromising form, did not sanction any limit to the respect for life, not even therapeutic abortion …" (1976, p. 5). This tradition appears to have been entirely negative in its emphasis: The physician would not actively terminate life by abortion or euthanasia. But it laid no stress on the positive correlate that would require the physician actively to attempt to prolong life. This negative tradition did, indeed, become stronger with the rise of Christianity and its introduction of the principle of sanctity of life: Abortion, infanticide, suicide, and euthanasia became sins. In addition, philanthropy became a virtue—the highest virtue, in fact—and the love of humanity and Christian compassion became central to the Western ideal of medical practice.
darrel w. amundsen (1995)
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