Chapter 14 Toward an Expanded M edical Ethics:
T he Hippocratic Ethic Revisited Edmund D. Pellegrino, M D
T h e H ip p ocra tic eth ic is on e o f the most adm irable codes in the history o f man . . . but even its ethical sensibilities and high m oral ton e are insufficient fo r th e com plex ities o f today’s prob lem s. . . . A n evo lvin g , constantly refurbished system o f m edical ethics is requ isite in the
tw entieth century.
MORE IS NEEDED
Custom without truth is but the seniorityof error.
Saint Cyprian, Epistles L X X I V
The good physician is by the nature of his vocation called to practice his art within a framework of high moral sensitivity. For two millennia this sensitivity was provided by the Oath and the other ethical writings of the Hippocratic corpus. No code has been more influential in heightening the moral reflexes of ordinary men. Every subsequent medical code is essentially a footnote to the Hippocratic precepts, which even to this day remain the paradigm of how the good physician should behave.
The Hippocratic ethic is marked by a unique
Editor’s Note: Dr. Pellegrino is an accomplished clinician and respected medical investi gator. He contributed to the development of the innovative Hunterdon Medical Center in F lemington, New Jersey and the Univers
ity o f Kentucky School of Medicine. He is Professor o f Medicine, foun d e r and Director of the new six-school Health Sciences Center at the State University o f New York at Stony Brook.
combination of humanistic concern and practical wisdom admirably suited to the physician’s tasks in society. In a simpler world, that ethic long sufficed to guide the physician in his service to patient and community. Today, the intersections of medicine with con- temporary science, technology, social organization, and changed human values have revealed significant missing dimensions in the ancient ethic. The reverence we rightly accord the Hippocratic precepts must not obscure the need for a critical examination of their missing dimensions—those most pertinent for contemporary physicians and society. The need for expanding traditional medical ethics is already well-established. It was first underscored by the shocking revelations of the Nuremberg trials. A spate of new codes has appeared which attempt to deal more responsibly with the promise and the dangers of human experimentation; the inquiry is well under way.1-8
More recently, further ethical inquiries have been initiated to reflect the change in moral climate and medical attitudes toward abortion, population control, euthanasia, transplanting