Moral Principles and Medical Practice | Page 4

term, and we shall accordingly continue the employment of that
which has only the sanction of usage to recommend it" (Ch. I).
I prefer to use terms in their genuine meaning; for misnomers are out of
place in science, since they are misleading. Yet, to avoid all danger of
misunderstanding, I will call my subject "Moral Principles and Medical
Practice," and distinctly style it "The Basis of Medical Jurisprudence."
On what lines will my treatment of the subject depart from the beaten
path? On the same lines on which most other improvements have been
made in the science of medicine. Science has not discovered new laws
of physical nature that did not exist before; but it has succeeded in
understanding existing laws more perfectly than before, and has shaped
its practice accordingly. So, too, the leaders of thought among
physicians, especially in English-speaking countries, now understand
the laws of moral nature--the principles of Ethics--more thoroughly
than most of their predecessors did, and they have modified their
treatment so as to conform it to these rules of morality. Hitherto
Medical Jurisprudence had regulated the conduct of practitioners by
human, positive laws, and sanctioned acts because they were not
condemned by civil courts. Now we go deeper in our studies, and
appeal from human legislation to the first principles of right and wrong,
as Jurisprudence ought to do; and, in consequence, some medical
operations which used to be tolerated, or even approved, by many in
the profession are at present absolutely and justly condemned. The
learned physician these days is no longer afraid to face the moral
philosopher; there is no longer any estrangement between Ethics and

Medical Practice. Medicine, sent from Heaven to be an angel of mercy
to man, is now ever faithful to its beneficent mission; it never more
performs the task of a destroying spirit, as--not in wantonness, but in
ignorance--it did frequently before.
On these lines, then, of the improved understanding of first principles, I
will now proceed to develop the teachings of Medical Jurisprudence.
The first principle that I will lay down for explanation is, that a man is
not to be held responsible for all his acts, but only for those which he
does of his own free will, which, therefore, it is in his power to do or
not to do. These are called human acts, because they proceed from a
distinctively human power. A brute animal cannot perform such acts; it
can only do under given circumstances what its impulses prompt it to
do; or, when it experiences various impulses in different directions, it
can only follow its strongest impulse; as when a dog, rushing up to
attack a man, turns and runs away before his uplifted stick. When a bird
sings, it cannot help singing; but a man may sing or not sing at his
choice; his singing is a human act. When, however, under the impulse
of violent pain, a person happens involuntarily to sigh or groan or even
shriek, this indeed is the act of a man, but, inasmuch as it is physically
uncontrollable, it is not a human act. So whatever a patient may do
while under the influence of chloroform is not a human act, and he is
not morally responsible for it. His conduct under the circumstances
may denote a brave or a cowardly disposition, or it may indicate habits
of self-command or the absence of them. His prayers or curses while
thus unconscious are no doubt the effects of acquired virtues or vices;
yet, in as far as his will has no share in the present acts, they are not
free or human acts. He deserves praise or blame for his former acts, by
which he acquired such habits, but not for his unconscious acts as such.
From this principle it follows that a physician is not responsible to God
or man for such evil consequences of his prescriptions or surgical
operations as are entirely beyond his will and therefore independent of
his control. If, however, his mistakes arise from his ignorance or want
of skill, he is blamable in as far as he is the wilful cause of such
ignorance; he should have known better; or, not knowing better, he

should not have undertaken the case for which he knew he was not
qualified.
But it often happens that the best informed and most skilful practitioner,
even when acting with his utmost care, causes real harm to his patients;
he is the accidental, not the wilful, cause of that harm, and therefore he
is free from all responsibility in the matter.
The practical lessons, however, which all of you must lay to heart on
this subject are: 1st. That you are in duty bound to acquire sound
knowledge and great skill in your profession; since the consequences