History, Philosophy and Ethics of Medicine

ABSTRACT The article examines the historical change in medical ethics since the beginning of the early modern period, drawing on normative sources, mostly of German origin. The theoretical frame of reference is provided by historical moral sociology and the history of the modernisation, as expounded in Niklas Luhmann's system theory. In a first step, evidence for the change in the moral codes of the various social systems (science, economy etc.) of the early modern period is assembled (1) in order to approach the question, taking the medieval medical doctrines of salvation as a starting point (2), whether structurally analogous processes of change can be made out in the medical system. These are identified in the removal of a moral evaluation of disease and in the moral neutralization of doctors' behaviour which is reflected in the spread of medical happiness doctrines (3). Following an interim reflection on moral theory (4), the enforcement of a modern behavioural code in 19th-century medical deontology is outlined, which was based on moral restraint (5) and the specific professional identity of the doctor (6). A summary of the results leads to a concluding outlook on current trends in medical ethics discourse (7).

In the second half of the nineteenth centu¬ry venereal diseases attained more attention and explosiveness in public discourse than ever before. Collective fear of the so-called French disease culminated in the emergence of melancholic syphilophobia a previous¬ly unknown form of hypochondriac suffer¬ing. This paper addresses the question of how this development occurred and focuses more specifically on the epistemological implica¬tions of the pathological fear of syphilis and highlights the systematic significance of eti¬ological interpretation and nosological con¬ceptualization of venereal disease.

While the history of Soviet forensic psychiatry remains a subject of continuing interest in the "politics of remembrance," there is a conspicuous dearth of historiographic studies in this area. Drawing on newly accessible source material, this study addresses this gap in the literature, delineating issues of key concern to the topic. The paper first explores specific interrelationships between legal and nosological points of view in the theories of forensic psychiatry that prevailed in the USSR. On this basis, it then reconstructs the functional characteristics of the "diagnosis factory" run under the auspices of Andrej V. Sneshnewski, illuminating the role of this school of psychiatry in the context of the history of medicine. In the third section of the paper, the discussion turns to institutional conditions, political factors, ideological implications, and socio-cultural contexts related to how hegemonic actors in Soviet forensic psychiatry dealt with non-conformers. In this context, a focus is placed on instances of resistance and dissidence within Soviet psychiatry. In particular, the paper discusses how polemics that relied on values and norms were of central importance to the political misuse of psychiatry as a nucleus and catalyst of democratic self-reflection during the reform era that took place under Mikhail Gorbachev.

From its initial development by Carlo Forlanini at the end of the nineteenth century until the advent of antibiotics in the 1940s, artificial pneumothorax was one of the most widely used treatments for pulmonary tuberculosis. However, there were strongly held reservations about this therapy because of its risks and side effects. In the Soviet Union under Stalin, such uncertainties became instruments of political denunciation. The leading Soviet pulmonary physician Volf S. Kholtsman (1886-1941) was alleged to have used the so-called 'aristocratic therapy' of artificial pneumothorax to kill prominent Bolsheviks. Drawing on documents from Stalin's personal Secretariat, this historical study of the pneumothorax scandal contributes to the cultural history of tuberculosis, showing how it was instrumentalised for political purposes.

Using the current international debate surrounding the incorporation of medical humanities into medical curricula as a starting point, the authors address both the legitimacy and didactics of teaching medical humanities to medical students. They highlight the paradox of the increasing prevalence of medical humanities in medical curricula and the often critical reception humanities courses receive. The alleged lack of empirical evidence linking such courses with improved patient care cannot alone explain the criticism they engender. After a short overview of the debate surrounding medical humanities and their inclusion in outcomes-based education, the authors outline the medical humanities block, "The History, Theory, and Ethics of Medicine," which is part of the German medical curriculum. A model developed at Ulm University exemplifies the integrated inclusion of the heterogeneous aspects of medical culture into medical education. This model emphasizes a reflexive approach (i.e., understanding how the humanities are manifested in medicine) as an alternative to the currently dominant narrative approach (i.e., liberal arts, moral development, and/or mental retreat), which has gradually been limited to a quasi-"secular religion" for doctors. This model uses established concepts from science and cultural studies as the "instruments" for seminars and courses; paradigms, discourses, social systems, and cosmologies constitute the tools for teaching and learning about the historical, theoretical, and ethical dimensions of medicine. The authors argue that this approach both precludes the need to justify the medical humanities and overcomes the dichotomy that has heretofore existed between the two cultures of science and the humanities in medicine.