The structure and function of serpins

From Deontology to Discipli,
! German medical ethics, 1800-19
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Debotes about medicd ethics open hmk bock to ihc oncirni
prcreplr orthe Hippirmtic oath, such 01 nonmoiefiirenre. confi.
dcniidiry and prcrervoiian ofhumin bfe. Fmm this pcrtpmire,
the dcreiopmenr almid!al ethics may oppeor 0 scrm ofdcvio.
tien$ from a iimeierr idrrri. In meni yecm howewr, hirtorionr
hove begun to erpiore the toiid proferrionof ond intcileauoi
conditions that *hoped medimi cihirr in defined periods. AL the
Univerriry ofourham Dr AndreorHoiger Modile il mmpormg
Germon and Bnti$h medid ethics in Ihe IBOOi and miy
1900s. and hem he prcrenir some inilid infighli. firuring an
Gcrmon drvriopmenir.
In the early nineieemh centuq German docton expetienced
profound pmrernonai change. a relull of mduittializa1,on.
uri>aazation and paupenzation. Al warken migrated to indurinal
regionr. hospmi medme expanded 10 cope and towns
created publicly funded pmi for phyrcianr 10 treat the poor.
Cornpired 10 their predecerran in the eighteenth mtuq,
dmon were ranfmnted with patients from a broad 10m1
spectrum. indudinglhe lower clai~e~. Cholera epldemiir in the
Memnhcna, v , ~ / ~ thrTr, ~ ~ ~ dareare. Sooally-minded phywani. such as Rudoif Vmhaw.
admanirhed thetc colleaguer 10 act as 'advocate$ of the pooi
At the same lime. demands on practical competence in rugeq
and ObnetncI increased. culminating sn the so.cnlied uniGed
rncdiial pmferrion (onIlicher Einheitrriand). Fint iamduced in
P ~ w 8n a 1852. it abolished the dichotomy of lppreni#Celh!P
trained iuqeonr and academ8cnlly educated physician$.
Moreover. dmon had new publx health duties to periom. II
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were expressed. foi innançe. in theloumrl der pmnisdw
Heilhnde. edited by the Mnyential hnian COU~ physician and
Min pmielror Chnnoph Wilhelm Hufeland. Even the old s p
lem of remunerating donon with an amual lump rum began
10 fail. In 1823 the Bonn dinidan oitinim Friednch Narre rug
gened that medical iocietier should be founded to collect and
redinnkne fees. Dlhen favoured the example re1 by the
Kingdom of Hanover, which paired I law in 18 18 to limit
licenser for practice in re*m that already had noqh donon
Againnthir bacligmund. doct~nincre8sing~wmteabouttheir
pmrerrional obügatimr. ertablirhing a ïnemv genre that
became known as 'medical deontology' (i&nnic ofthe doaofr
duties). This lnerature fomr I major area of DI Msehle'r
research. The pmtotype was Hufeland's elhical essay 'Die
Verhdirnirre der Amer', which detailed the physician's obliga
tiom to patienü. deaguer and roiiay. and CM be seen 8s the
bke Pm'val'r Eth:~, Hufelanüs deonlolqy &ad a
~onxwative effort Io uphold &id Mddom in the face of
pmlarimd conflid and %cial change Forthe PwYan dortor
anNim was the fovndation of the di pmfprbh and
atit it ion of human life iü MY a~me Acmidmgly. he
rejected abonion and my life-horlmhg memm in dying
patiemr. Though refang m the Hipppo~tic oah in this mn-
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tuL he chiefly wed vrhat pment4ay efhiN rail a 'dippy
slope' argumm ifa doMImade iudgemü ab- the nh
andrrcerrityofhuman1ife.hcw8s bwndtobecomeWe
dangernus Inthe -'.
The bmdw r-1 rpccuvm of patients was &ed in
Hufcland's mng plea for equal mmmt hdcpndm of
we& and rtatm Echoing Kantisn nhx* he fustheradnuin-
iBed doam nwerto rrgard a patim 8s a 'means' or'merr
objeect of a naluml up&mem'. but ahnp asharm's highnt