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This chapter discusses the financial aspects of practising medicine in the 19th century. General practitioners as a class appear to have been reluctant to adopt more efficient financial management in their practices. The cultural ethos doctors themselves had helped to foster — in attempting to distance themselves from ‘trade’ and therefore try to establish themselves as professionals — had involved separating their services from immediate payment, which itself then contributed to patients' belated recompense of their doctors. During the mid-19th century easier conditions in the medical market seem likely to have enabled practitioners to give a higher priority to the clinical, compared to the economic, aspects of their practice. But during the late 19th century an unregulated growth of medical graduates, and a continued competitive struggle with other suppliers of health care, made it harder for GPs to make a medical living.

This chapter explores the changing climate for legal reform with regard to active voluntary euthanasia by considering a number of related issues: public opinion which appears to be increasingly in support of the legalization of active voluntary euthanasia performed by doctors for terminally ill or incurable patients; the development of voluntary euthanasia organizations campaigning for the legalization of active voluntary euthanasia; and developments within the medical profession indicating growing support for the concept of active voluntary euthanasia. This chapter divides the discussion into three ares: opinion polls, voluntary euthanasia movement, and changes within the medical profession in the United Kingdom, United States, Canada, and Australia.

This chapter highlights emerging themes from the study, including regional variations; the relationship between the regions and London, the centre and localities; the role of clergy as gatherers and disseminators of information, both from and to the centre and localities; and the role of clergy as opinion-formers. It is suggested that clergy were unifying influences in society. The clergy were closely integrated with their local economies and local society, but they formed a distinct social and professional group, which distanced them from their neighbours. The clergy were not an archaic group compared to other professional bodies, but provided something of a model for the reformation and regulation of the legal and medical professions in the 1820s and 1830s.

This chapter examines the double-bed relationship between the state and the medical profession in Great Britain, one of the key organisational features of the NHS. It explains that under this relationship there was a dynamic of national accountability and local paternalism. It discusses the changes in the politics of the double-bed since 1948 and suggests that the wider participation of the private sector in the NHS has made the relationship between the state and the medical profession more contingent than before.

Financial conflicts of interest threaten patient care, taint medical information, and raise costs. They create deception, impair physicians' judgment, and reduce their willingness to be their patients' advocates. They reduce professional dignity and integrity, denigrate the profession, and erode trust in the profession's practitioners, researchers, and institutions. This chapter argues that reversing the exceptional toll that financial conflicts exact will take some doing, starting with principles. First, financial considerations must never be allowed to compromise physicians' decisions about the care of individual patients or the safety of subjects involved in medical research. Second, because the integrity of scientific knowledge directly affects patient care, physicians' medical information must be free of bias generated by financial entanglements. Third, the profession must be accountable for insuring that undue commercial influence does not make the cost of care so high that it excludes many from receiving it. Last, we must aspire to the ideal of eliminating financial entanglements, but if physicians cannot or will not, we must have clear and enforceable methods that protect patients and complete disclosure about the conflicts.

This chapter considers the relevance of studying the history of medical law. The history of medical law has been little explored, at least by legal scholars. It is argued that even a brief excursion into past centuries demonstrates that many of the fundamental questions of medical law and ethics today have an ancient lineage. By treating too many developments as wholly ‘new’, we fail to learn from the past.

This chapter examines the movement to protect the French medical profession against foreigners and naturalized citizens during the interwar period. It first considers the issue of overcrowding in the French medical profession, along with the scapegoating of foreigners as the cause of overcrowding and the source of unfair competition in the field. It then discusses the burgeoning movement against foreigners in French medicine, the Armbruster law of 1933, the role of anti-Semitism in the exclusion of Romanians from French medicine, and the intensification of mobilization against foreigners and naturalized citizens in medical circles. It also looks at the strike launched by medical students in France as part of a nationwide student movement against foreigners in all disciplines. The chapter concludes with an assessment of the Cousin-Nast law of 1935, the persistence of exclusionism during the period 1935–1940, and how the shortage of physicians during World War II affected restrictionism against foreigners and naturalized citizens.

This chapter examines the institution of a corporatist structure in the French medical profession under the Vichy regime. Prior to 1940, the medical profession had no central authority to unify the various career trajectories of physicians into a coherent profession or to set standards for medical practice. In October 1940, the Vichy regime created a Medical Order (Ordre des Médecins), whose centralized corporatist structure would control the right to practice medicine in France. Doctors' control over their membership was the most important prerogative of the Medical Order. This chapter considers the exclusionism of Ordre des Médecins and how doctors became dismayed by the statism inherent in Vichy's style of corporatism. It also discusses the law passed in August 1940 banning foreign-fathered doctors, along with a decree of October 1940 spelling out the process of requesting exemptions from the August law. Finally, it analyzes how xenophobia and anti-Semitism became the cornerstones of the Vichy regime in 1940, citing the implementation of an anti-Semitic quota against Jewish doctors.

This chapter explores the ways in which the city corporately, working together with religious houses and city companies, and much assisted by charitable individuals, provided welfare support for the young, the ill, the poor, and the old. Provision was made for orphans, for the destitute poor, for the sick, those who were terminally ill, and for the old. The role played by hospitals and the medical profession in the care of the sick is examined. The gradual invasion of lay professionals into areas previously the exclusive domain of the Church is observed and discussed.

This chapter explores how money came to exert such a remarkable influence over the medical profession. It considers some of the factors that made many of America's doctors pay more attention to their own desires than to the health of their patients. It proposes that the runaway cost of care, changing financial incentives, inflated income expectations, falling physicians' income, changes in patent law, and substantial influence of industry on medical research were essential ingredients. Societal and cultural factors also contributed heavily. Putting “business strategies” on a high pedestal encouraged many in medicine to ignore a long-held principle that the patient comes first, and a permissive attitude outside of medicine toward financial conflicts of interest, undoubtedly led many to think that such arrangements were also acceptable inside the walls of health care. The new complicity with industry spread like an infectious disease through a community.

This chapter explains the differing engagement of the medical associations with abortion politics by focusing on the ways in which they constructed their “interests” and priorities in the context of national medical-care systems. The chapter speaks of how the British and Canadian reforms delegated responsibility for abortion to the medical profession, removing the issue from public decision making and confining it to a realm in which decisions were made “neutrally” on the basis of “knowledge.” By contrast, the American reform made abortion a public issue decided on the basis of “values.” Finally, the minimal involvement of American mainstream medicine in abortion provision reduced the availability of abortions by concentrating provision in single-purpose clinics in large cities and being served by doctors that were often stigmatized by their mainstream peers. British abortion services were better distributed and better integrated into mainstream medicine, though Canadian ones were not.

This chapter discusses accountability in medical practice. Accountability confirms that doctors provide safe care for patients. Openness regarding quality of care contributes to the trust in, and status of, the medical profession. Accountability is a key component of the regulation of the medical profession. Accountability in doctors' working lives fulfills a necessary condition for the recognition of their professionalism.

This chapter examines how the French medical profession sought to protect itself against foreigners and naturalized citizens through distinction. In particular, it considers how physicians tried to elevate their status by distancing themselves from other health care providers and to restrict the access of French people to their profession. Manifestations of this strategy included the repression of charlatanism and illegal medical practice by non-doctors, protection of the title of “doctor,” and campaigns against dentists, pharmacists, nurses, and midwives to preserve doctors' professional domain. Turf protection also led to battles among doctors themselves. Finally, two specific categories of French citizens were blamed for dragging down the profession and were targeted for exclusion: women and elderly doctors. This chapter first considers the opinion of a small minority of doctors who rejected the myth of overcrowding in their field before discussing the various protectionist mechanisms employed by doctors.

This chapter discusses how medical explanations for pain, based on the body and its neurological organization, both created and went some way towards filling the gap in conceptualizing physical suffering left by the failure in Christian rationales of benevolently inflicted pain. Advances in medical knowledge breached Christian certitude as they undermined the naturalness of pain and put in its place a bodily function that could be removed, or at least alleviated, by chemical or surgical interference. Christianity was forced by its nature to accept pain not as a function of the body in distress, but rather as a counter in God's interaction with humankind.

Apart from the Northern Territory of Australia, where legislation has recently been enacted, the country which has come closest to the legalization of active voluntary euthanasia is the Netherlands. Although active voluntary euthanasia is still illegal in that country, it is now practised quite openly by the medical profession and there are very few prosecutions of doctors involved in the practice. Developments in the Netherlands have naturally attracted interest in other countries, including the United Kingdom, the United States, Canada, and Australia where there is growing pressure for the legalization of active voluntary euthanasia. The Dutch position is often cited by euthanasia proponents as a model of social reform which demonstrates the benefits of sanctioned active voluntary euthanasia and which ought to be followed in other countries. This chapter examines the law and practice with regard to active voluntary euthanasia in the Netherlands, the Dutch penal code, jurisprudential developments, and Dutch case law developments.

Most physicians work hard, dedicate themselves to their patients, and preserve their professional rectitude. Tens, perhaps hundreds of thousands never take a free meal and never make a deal that could taint their clinical judgments. Unfortunately, many, often those with power and influence, have been compromised by greed. Their willingness to put personal income ahead of patients' well-being has been made possible by an enormous infusion of cash into medicine from industry, especially pharmaceutical companies. In taking meals, gifts, and trips, in joining drug company advisory boards and speaker's bureaus, and in giving industry-sponsored clinical talks and writing industry-sponsored brochures, physicians increasingly harbor financial conflicts of interest that tend to bias them in the sponsor's favor. The full extent of the collaboration may even be undiscoverable. Nonetheless, innumerable stories about these conflicts are compelling. This chapter illustrates how ubiquitous they are, who has the conflicts, and how they are manifested. These stories give a broad overview of a profession on the take.

The American health care system, which appears on its surface as a predominantly private endeavour, actually rests on a foundation of government support. Itreflects a huge public-private partnership that drives one-sixth of the economy. Four key sectors poignantly demonstrate this dynamic. Pharmaceutical manufacturing depends on the National Institutes of Health for research funding and on the Food and Drug Administration for public reassurance of safety. The hospital industry depends on Medicare for a large share of its revenue. The medical profession garnered public trust from regulatory oversight that it developed in collaboration with state governments, and many specialties rely heavily on Medicare for reimbursement. And private insurance companies depend on a huge tax subsidy for employment-based policies and on opportunities to administer coverage under Medicare and Medicaid. The public-private relationship is complex with industry segments routinely capturing their regulators, yet it represents the system’s defining economic paradigm.

This chapter investigates how Irish medical schools from the mid-nineteenth century attempted to inculcate students with the ideals of the profession and reform the reputation of the rowdy medical student in order to help improve the status of the profession. Utilising lecturers’ introductory addresses, contemporary medical journals and doctors’ memoirs, it illustrates the role of lecturers in enforcing decorum, shaping the image and identity of students and encouraging traits such as gentility. The chapter explores what was considered to be a ‘good’ medical student in the period, assessing the role of medical schools in shaping respectable gentlemen who were most likely Protestant and middle-class in the nineteenth century and Catholic and middle-class in the twentieth century. Representations of medical students in the Irish press are also examined. This chapter shows how such representations changed over the period, examining the importance of class, religious affiliation and the appropriate traits that students were expected to possess.