'Not at all at odds with mercy': Redescribing the historical emergence of codified medical ethics.

摘要

I believe the orthodox and revisionist views inadequately convey the significance of the early history of medical ethics. A further revision is in order, one that employs a heuristic Foucauldian redescription of the historical choice to base early codes upon professionally centred ideas such as Percival's. Using Foucault's deliberately ambiguous notion of the historicized subject, and his ideas on how this subject is produced by discipline and normalization in a web of power relations, I argue that medical ethical codes have served to support the emergence of a problematic self-image for medical practitioners and equally problematic policies for the medical profession. Under the rule of professionally oriented codes of ethics, medical practitioners are normalized as the purveyors of “evidence-based,” “one size fits all”—i.e., “one size fits none”—medical care. I maintain that this determination of the practice of medicine has been to the detriment of patients' individual needs because patients are then inadequately treated according to “managed case” standards as “average patients.”;However, I take care to avoid either denouncing current medical ethical endeavours or supporting the medicalization critique, since I do not think that either of these approaches is fair or productive. Rather, and in order to avoid the mistake of merely re-writing codes in an attempt to expand their efficacy and meet the situational demands of current medical practice, I argue that we must, when developing ethical codes, acknowledge their normalizing effects on both patients and practitioners insofar as they are self-directing and resistant subjects. (Abstract shortened by UMI.).