INTRODUCTION: Medical behavior in the eighteenth century differed from that of the twentieth century. Although some ethicists maintain that the integration of modern science into medicine in the 1700s wrought the crucial change, that perspective properly applies only to the century's closing decades. For most of the long eighteenth century (1650–1815) in Europe no scientific medicine as we today understand it existed. Whereas one might speak of medicine as a “proto-science” in the eighteenth century and earlier in the sense that physicians based their social status and cultural prestige on appeals to intellectually authoritative sources, the idea of subjecting medical theory to any sort of scientific assessment was still rudimentary. The conflict between what science could do and what medicine should do simply did not pertain to medical situations before the 1790s. Thomas Percival introduced the phrase, “medical ethics,” in 1803 (see Chapter 36). One might therefore contend that before the phrase the thing itself did not exist (see also Chapter 46). Certainly, the sharp division of “ethics” and other forms of proper medical conduct was not apparent before 1803. What we might be tempted to call “medical ethics” for most of the eighteenth century approximated more closely a form of deontology or the science of duty or moral obligations than a modern ethical system.
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