Percival's Medical Ethics

In 1789 typhus swept Manchester and strained its infirmary. The managers doubled the staff, and the larger staff fell to quarreling; in 1791, with the epidemic still flaring, the fever ward was closed. After the scandal the managers asked Thomas Percival, one of the hospital's most respected members, to draw up rules of conduct.

Percival talked the draft over at length with friends and colleagues. The first chapter was printed in 1792 and the whole work in 1794 for private distribution, under the title Medical Jurisprudence. Some friends objected to the word jurisprudence, and the final edition, printed in Manchester in 1803 and dedicated to his son, who was entering medicine, was called Medical Ethics. Earlier writers on physicians' duties, among them John Gregory and Thomas Gisborne, had not in Percival's view addressed the specific tasks of medical practitioners.

The code has four chapters: on conduct in hospitals and other medical charities, in private or general practice, toward apothecaries, and in cases that require a knowledge of law. It opens by reminding hospital physicians and surgeons that their patients' ease, health and lives depend on their skill, attention and fidelity, and that they should unite tenderness with steadiness and condescension with authority. It set rules for consultations between colleagues, asked for delicacy and in some cases strict secrecy, urged hospitals to study insanity more closely, and required practitioners to attend one another and their families free of charge.

Whether the book is a work of ethics or a code of professional etiquette, a question its first title already raised, is still debated, as a 2018 review by Patuzzo and colleagues sets out. New editions and extracts followed in 1821, 1823, 1827 and 1849, and the American Medical Association's first code of ethics, adopted in 1847, drew on it.