The good, the bad and the morality: New book traces history of American medical ethics

Publication Date

In the early 18th century, Rebekah Chamblit, an unwed mother in Puritan Massachusetts, was executed for concealing the dead body of her newborn child.

Chamblit’s trip to the gallows was aided in part by the testimony of a midwife, who, in upholding the oath she took to report any “lewd” woman found with the body of a newborn infant, notified authorities. Under the 1696 law, these women were presumed guilty of infanticide unless they could prove “by one witness at least” that the child was stillborn.

“Midwives were inextricably ensnared in the spinster mother’s dilemma,” Robert Baker writes in his new book, Before Bioethics: A History of American Medical Ethics from the Colonial Period to the Bioethics Revolution (Oxford University Press).

“Their testimony would either condemn the woman to public censure or consign her to the gallows. The Puritan law punishing “lewd” women made midwives both protectors of bastard infants’ lives and guardians and guarantors of Puritan sexual morality.”

Examples like this are explored throughout the nearly 500-page book, which tracks the history of American medical ethics from its origins, when primary healthcare professionals were midwives, not physicians.

He shares the stories of colonial physicians like Benjamin Rush, who signed the Declaration of Independence and served with George Washington at Valley Forge, and addresses current bioethical controversies over abortion, AIDS, animal rights and physician-assisted suicide.

“Any history of medical ethics focuses primarily on oaths and codes,” said Baker, the William D. Williams Professor of Philosophy, director of the Ethics Across the Curriculum Program and director of the Union Graduate College-Mount Sinai School of Medicine Bioethics Program.

“My book has its share of oaths and codes, but I also wanted to tell the story of ordinary people who get caught up in medical ethics issues.”

Given nearly unlimited access to the archives of the American Medical Association and through other research, Baker is able to trace the evolution of American ethics by exploring the ethics taught in America's medical schools, the medical treatment of African American slaves - and their use as human "guinea pigs" - and discuss the exclusion of African American and female physicians from the AMA. He also offers an analysis of why a newer, more inclusive form of ethics known as bioethics, took root in ICUs and in American medicine more generally.

“I take stands on things that people are mealy-mouthed about,” said Baker, now in his 40th year at Union.

The author of American Medical Ethics Revolution and The Cambridge World History of Medical Ethics, Baker spent the past three years writing his latest book. But its roots date back decades, when, in his mid-30s “with a goatee and just out of jeans,” he joined the faculty at Wayne State University in Detroit.

Using a grant to explore the moral methodologies of intensive care units (ICUs), Baker also spent 18 months living in ICUs, interviewing clinicians, patients and families.
“I was telling doctors what to do,” said Baker. “I was walking families through disconnecting plugs. Here I am, getting calls from governors looking for advice about medical issues. It was weird, because I was a philosopher.”

Early reviews have been favorable.

Calling it a “remarkable and important book,” Raymond de Vries, Bioethics Program, School of Medicine, University of Michigan, said Baker “reminds us that bioethics did not appear from nowhere, but rather is the most recent incarnation of medical morality: the contemporary version of the codes that have governed medical practice in America since the Puritans."

And R.F. Gillum, M.D., Howard University College of Medicine, said Baker’s use of historical and clinical vignettes throughout to illustrate concepts such as ethics (e.g., formal codes) and morality (e.g., unwritten systems such as truth and forgiveness in clinical training), “makes for interesting and enjoyable reading even in the case of a seemingly arcane subject such as midwives oaths of the seventeenth century.”

One interesting footnote: While the book was at the printer, Baker was contacted by the American Civil Liberties Union for a deposition about whether the authors of the U.S. Constitution accepted the notion that medical records were confidential.

The U.S Drug Enforcement Agency, seeking to control prescription drug abuse, was collecting data on all drugs prescribed in Oregon, and the ACLU was challenging their data mining as unconstitutional.

“I was happy to declare that George Washington's personal physician, Samuel Bard, had signed an oath pledging to keep all patient information confidential and that most colonial physicians had sworn a similar oath. It turns out that, as William Faulkner once wrote, "the past is never dead. It is not even past."