The American Medical Association was founded in 1847 and published its first code of medical ethics in that year. It is fascinating that the code prescribes duties to the patient as well as to the doctor. You could even argue that the code is more concerned about the duties of the patient (ten enumerated duties) than those of the doctor (seven enumerated duties). Through this document, we can see the ideal doctor-physician relationship, as understood by Victorian physicians.
The first duty of the patient is, in a sense, a meta-duty: to recognize that in light of the virtues of the medical profession, she is obligated to recognize that she has duties toward her doctors, and to internalize them.
§ 1. The members of the medical profession, upon whom are enjoined the performance of so many important and arduous duties towards the community, and who are required to make so many sacrifices of comfort, ease, and health, for the welfare of those who avail themselves of their services, certainly have a right to expect and require, that their patients should entertain a just sense of the duties which they owe to their medical attendants.
The second enumerated duty -- but the first substantive one -- is to respect professional credentials.
§ 2. The first duty of a patient is, to select as his medical adviser one who has received a regular professional education.
The third (and also the seventh) duty is that patients should select just one physician, "a physician, whose habits of life are regular, and who is not devoted to company, pleasure, or to any pursuit incompatible with his professional obligations." The third and the fourth duties stress the importance of patients willingness to communicate intimate details of life to the doctor. And brace yourselves, ladies: "Even the female sex should never allow feelings of shame or delicacy to prevent their disclosing the seat, symptoms and causes of complaints peculiar to them."
That being said, there are limits to what doctors wanted to hear from patients. They are being interogated, and the doctor is asking the questions.
§ 5. A patient should never weary his physician with a tedious detail of events or matters not appertaining to his disease. Even as relates to his actual symptoms, he will convey much more real information by giving clear answers to interrogatories, than by the most minute account of his own framing. Neither should he obtrude the details of his business nor the history of his family concerns.
The conversation being over, the patient is to shut up, let the doctor do the thinking, and do what she is told.
§ 6. The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them.
After recovery, the patient should be grateful.
§ 10. A patient should, after his recovery, entertain a just and enduring sense of the value of the services rendered him by his physician; for these are of such a character, that no mere pecuniary acknowledgment ran repay or cancel them.
There are no duties, however, prescribing the appropriate sentiments when physicians are negligent or in error, or when treatment fails.
The history of the AMA ethics codes is here. The section about the duties of the patients has vanished. I expected that it became clear that you can lecture your customers all you want, it won't promote trade.
I couldn't resist mocking these gentlemen, but it isn't news that male Victorians were paternalists. I admire these doctors for writing a code of professional ethics as a first task ot the AMA. My point is that there is progress in ethical culture. You just need to take the long view.
h/t Michael Millenson and the Participatory Medicine blog. This excellent post has much more on how patients' voices came to be heard, but not prescribed, in medicine.
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