Journal of International Society for the History

Ayşegül DEMIRHAN ERDEMIR, Hanzade DOĞAN THE DEVELOPMENTS IN THE PATIENT-PHYSICIAN
RELATIONSHIP FROM THE 19 th TO THE 20 th CENTURY
physicians of the 18th and 19th centuries, allocated a
special section for Hippocrates’s 24 rules in his “Makâlât-ı
Tıbbiye” (12).
The Developments in the Patient-Physician
Relationship in Senior Prof. A.S.Ünver’s Book “A Brief
Discussion of Medical Deontology Classes” written in
20th century.
The book contains a closer analysis of the work that
shows that it is full of medical ethics principles. Summarizing
the content of the Medical Deontology classes Ünver gave,
the book occupied a prominent place in the domain of
medicine in 1940s. The author mentions in his preface that
the Medical History and Medical Deontology classes were
taught regularly in the winter and summer terms respectively
in 1933, the year which Istanbul University was established
in, and there were many valuable sources and documents
not only about medical history but also about deontology in
the Medical History and Deontology Department founded
in the same year.
In the preface, Ünver also states that medical history
and deontology were both placed profound importance
then and physicians who do not know about medical
deontology and preserve medical morality would never
have a successful career. He also reminds that the book
is a pamphlet compiling related information from the
literature of the medical world.
The section on history gives a brief account of the
development of medical deontology. It reports that interest
in medicine is as old as humanity is, people have always
practiced it and some ethical, social and technical rules
have been set out to govern the ways it is practiced.
Medical morality is as old as medicine itself. Therefore,
medical ethics has a historical development on its own,
which Ünver considers in terms of the periods of ancient
Indians, ancient Israelites, ancient Greeks, Islamic
civilization, Ottoman Empire, and Turkish Republic. He
talks about the physicians’ oath of ancient Greeks and
states that it covers all the medical issues of that time. He
refers to some of Hippocrates’s rules of medical ethics in
the following way: “Starting to study medicine at young
ages, taking great care of bodily cleanliness, having moral
virtues, being true and honest, not having relationships
with bad people, not staying too much with patients, not
reveling in money, not displaying unacceptable behavior
and getting drunk, seeing patients on time and treating
them kindly, keeping secrets, not preparing the drugs
prescribed, not seeing patients until called again, following
the developments about new works and operations, not
prescribing new drugs until having an opinion about them,
not depending on anyone, not performing abortions, not
insulting anyone, being humanistic, acknowledging and
defending patient rights, not being haughty.” It can be
seen that they cover most of the ethical principles which
we still adhere to. Ünver emphasizes the fact that such
Ottoman physicians as Abbas Vesim Efendi and Hayrullah
Efendi attached great importance on Hippocrates’s pieces
of advice above.
In the historical development section of his book, Ünver
reports that the Islamic world of the Middle Ages attached
importance on medical ethics too. For instance, Ebubekir
Muhammed bin Zekeriya Razi (854-932) states that
physicians are supposed to treat their patients well and keep
secrets about them in terms of respect for medical privacy
and ethics. İbn Sina (980-1037), who was an eminent
physician, deals with similar issues in his works. Nizami-i
Aruzi, a physician from Semerkand, wrote in his “Çehar
Makale” in the 12th century the qualities he would expect
to fi nd in good physicians: “They treat patients kindly and
always control themselves. A physician over the age of 40
is an experienced one and psychiatric treatments should be
given by experienced and knowledgeable patients.”
Ünver also gives examples from İbn Şerif’s “Yadigâr”
and talks about the information some other Turkish writers
gave about deontology and ethics. He mentions that Dr.
Nurican held conferences in 1877 on medical deontology
and the instructors of the medical school dealt with
deontology in their classes and conferences. Dr. Galib Ata
taught deontology classes together with those of medical
history between 1924 and 1926. Ünver reports that Prof.
Dr. Akil Muhtar Özden organized two conferences on
deontology in 1932 and 1933, Prof.Dr. Mustafa Münif
Paşa translated but did not publish texts from some books
on deontology and Dr.Marko, Dr.Henif, Dr.Aziz Fikret
etc. published articles on deontological issues (13).
Ünver emphasizes that the professorships of
deontology and medical history were controlled by the
Medical History Institute he founded himself and the
professorship of deontology had a big library of its own
in the institute. As can be seen, Ünver notes that medical
history and deontology were separate disciplines even at
that time. The moral aspects of medical problems, i.e. the
ethical rules and principles, were considered in terms of
medical deontology then. Moreover, patient rights, which
is viewed as a subject on its own now, was within the
framework of such deontological issues as physicians’
duties and patient-physician relationships. Thus, all the
points recently investigated by medical ethicists were
already examined years ago by the Senior Prof. Dr. A. S.
Ünver as the founder of the discipline in Turkey and they
had been taught even before him by some amateur people
94 JISHIM 2007-2008, 6-7