Medical ethics and the regulation of medical practice with particular reference to the development of medical ethics within the British Medical Association 1832-1993

Horner, John Stuart (1995) Medical ethics and the regulation of medical practice with particular reference to the development of medical ethics within the British Medical Association 1832-1993. Masters thesis, Victoria University of Manchester.

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This volume records observed data between 1984 and 1994 with a more formalised observational period between January 1991 and December 1993. It records data taken from original historical records kept in the Association's Archive at BMA House in London. These data have been analysed and categorised so that deductions may be drawn and conclusions reached. Every attempt has been made to present an original historical record of the events described, and to catalogue the issues discussed within the medical ethics committee (and its predecessors) and the decisions reached. In some cases a total record is supplied and in others, because of the volume of data, a sampling system has been employed.
This analysis, together with the study of four issues in depth, ie advertising; assisted conception; confidentiality; and euthanasia has shown that 'medical ethics' has changed over the last 150 years. Its initial pre-occupation was distinguishing between recognised healers who had satisfied some form of apprenticeship and examination and other healers who had not. About 100 years ago it became preoccupied with what is sometimes known as medical etiquette, establishing codes of behaviour between one doctor and another and setting up procedures to resolve disputes between them. At a later stage, it
became involved in employment and contractual matters first with local insurance committees and local authorities and later with central government. The current stage of medical ethics began as recently as 1975 and is occupied with the moral and philosophical dilemmas which modern medicine now presents for patients, their relatives, practitioners and society at large. The preliminary historical review shows that the changing content of medical ethics is not a new phenomenon. It arises as a direct response by doctors to the social situation of the time and is often concerned with the pursuit of power by a particular group of 'healers'.
The decision making process within the committee has been analysed and the role of key players studied. The influential role of the secretariat was more pivotal than expectd and the diffici;tu of retaining an electoral mandate has become greater because of the emphasis on published authoritative documents designed for a wide readership.
The research has established, apparently for the first time, the origins and outcomes of the early attempts within the Association to establish an ethical committee and an ethical code. It contradicts the official history of the British Medical Association. It has demonstrated the way that the concept as well as the content of medical ethics has changed over time. It has established that a process of, possibly unconscious, selection occurs in the membership of the committee so that ethics are determined not by the ten most popular doctors but by those with particular aptitudes and characteristics for the work. It has established that the major publications on ethics by the Association do not necessarily keep in step with this evolving process.
The research questions the dominant roles of philosophy and law in ethical thinking about medical issues at the present time. Doctors have traditionally seen their own discussion of such matters as an essential part of the art of Medicine securely set within a series of shared professional values. This consensus may be breaking down. Serious flaws in the decision making process within the BMA are identified and the teaching of medical ethics and the publication of the committee's recommendations are considered to be inadequate. Medical ethics is significantly influenced by and responds to the health care environment in which Medicine is practised. Historical parallels with the health care system proposed by recent changes
in the National Health Service suggest a need for a major review of the basis of ethical practice in Medicine.

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