Extract While recent scholarship has – for the past two decades – endeavoured to transcend initial reservations about these forms of testimony, the difficulty with some of these memoirs – namely their authors’ implicit complicity in unethical medical research and in the Nazi Holocaust in general – remains however problematic. To address this thorny issue, in this article I consider the memoirs of a Jewish inmate doctor and forensic pathologist who worked with and for SS medical officers in Auschwitz, particularly Josef Mengele. His name was Mikló Nyiszli. . .
Richard Sorabji. Moral Conscience Through the Ages: Fifth Century BCE to the Present. Oxford: Oxford University Press, 2014, 240 pp. ISBN 9780199685547
Always let your conscience be your guide,” sings Jiminy Cricket, conscience personified as a kindly bowler-hatted cricket, to Pinocchio in Walt Disney’s 1940 film classic about a wooden puppet being transformed into a real-life boy. It is one of the few significant social pronouncements about the role of conscience in making us human not found in Richard Sorabji’s compact history of the ideas that important thinkers and doers, beginning with Euripides and Plato and ending with Martin Luther, Thomas Hobbes, Henry David Thoreau, Leo Tolstoy, Friedrich Nietzsche, Sigmund Freud and Mahatma Gandhi, have had about how a conscience works, where it comes from, and what good it is, if any – Nietzsche had no use for conscience, believing that modern men “inherit thousands of years of the vivisection of conscience”.
Sorabji’s close reading of subtle arguments spanning 25 centuries, as he transliterates key Greek and Latin terms and does his best to define their particular meanings in different periods, enables us to see how later figures took up or rejected earlier ideas. Gandhi, for example, came to believe unshakeably in his “still small voice within” – no Jiminy Cricket for him – as “the true voice of God”, as it steeled his commitment to non-violent social actions. Gandhi’s voice of God, we learn, sounded a lot like Tolstoy in his 1894 treatise The Kingdom of God is Within You and Socrates in Plato’s Apology, set in 399BC.
The Greek word for conscience first appears in passages in the work of late 5th-century playwrights where characters wrestle with what we would call moral choices, or defects in Sorabji’s view. The Greek compound verbal formation expresses the notion of a shared knowing (sun: “with” and oida: “know”, literally “I saw and I still see”), Latin con-sciens. The precise meaning of conscience is further complicated by the abstract nouns used for it that are derived from other verbal roots, eg, sunesis and the Latinised sunderesis. The notion of with-ness is the common element.
The key question is: shared with whom? In Sorabji’s view – surprisingly given the role that conscience plays in our interactions with others – we share our thoughts about moral behaviour and moral choices with ourselves. Conscience splits us into two people. From this come expressions like “I could not live with myself” and feelings of having a voice within or a cricket or guardian angel advising from without, as in Freud’s superego or Socrates’ daimōn.
Sorabji also argues that the original concept of conscience, ie, “sharing knowledge with oneself of a defect”, was a largely secular idea. Stoics and Christians turned conscience into a religious concept associated with the law or will of gods or God. Michel de Montaigne, Hobbes and John Locke began a resecularisation process that continued through Thoreau’s civil disobedience and then on to conscientious objection to armed service during the First World War.
But what does a largely secular idea in ancient Greek look like in context? Sorabji gives few original source passages at any length. Conscience appears as a daimōn in Plato’s Apology and arguably also in Euripides’ Orestes, where grief is called a terrible goddess in a kind of chiasmus. So how the Greeks viewed daimones becomes relevant to whether conscience ab origine is secular or religious or something in between. And Hesiod’s thoughts two centuries earlier in Works and Days about daimones as immortal and beneficent guardians of justice should be relevant, too.
Tom Palaima is professor of Classics, University of Texas at Austin.
Abstract Although 65 treatises – either preserved or lost, but quoted by ancient authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and Galen (c. 129-199 A.D.) – are ascribed to Hippocrates (c. 469-c. 399 B.C.) and consist of nearly 83 books, nonetheless there is no doubt that none of them was written by Hippocrates himself. This being the fact, we cannot help agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained that Hippocrates is a name without writings!
Indeed the most of the treatises of the “Corpus hippocraticum” are not the collection of Hippocrates’ works, but were likely the “library” of the Medical School of Kos. The fact that it contains some treatises that represent the theories of the Medical school of Cnidos (most probably founded by a certain Euryphon, almost contemporary with Hippocrates), with which it seems that Hippocrates entered into a relentless debate, is an absolute evidence.
Moreover, we must confess that, although Celsus (1st century B.C.-1st century A.D.) (De medicina, I, Prooemium) writes that “Hippocrates of Kos…separated this branch of learning (i.e. Medicine) from the study of philosophy”, we have nothing to learn from the hippocratic treatises under the scientific point of view.
However, whatever its origin, the “Oath” is a real landmark in the ethics of medicine and we can say – with Thuchydides (460/455-400 B.C.) (Histories, I, 22, 4) – that it is “an achievement for eternity”.
Suffice it to remember that every graduand in Medicine is generally still bound to take an oath that is a more or less modified and more or less updated text of the “Hippocratic oath” and that even the modern concept of bioethics has its very roots in the Hippocratic medical ethics.
“The art is long; life is short; opportunity fleeting; experiment treacherous; judgment difficult: The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals, ” says the first “Aphorism” and the latest author of “Precepts” (chapter VI) writes: “where there is love of man, there is also love of the art”, and the “art” par excellence is medicine! These precepts go surely back to Hippocrates’s moral teaching.
Nonetheless, the preserved text of the marvellous “Oath” raises many problems. Namely:
1) which is the date of it”?
2) Is it mutilated or interpolated?
3) Who took the oath, i.e. all the practitioners or only those belonging to a guild?
4) What binding force had it beyond its moral sanction”?
5) Last but not least: was it a reality or merely a “counsel of perfection”?
In this article we have gathered and discussed all the available and most important sources, but do not presume to have solved all these problems and confine ourselves to proposing some reasonable hypotheses and letting the readers evaluate the positive and negative points of our proposals.
Howard Brody, Sarah E. Leonard, Jing-Bao Nie, Paul Weindling
Cambridge Quarterly of Healthcare Ethics
Abstract In 1945–46, representatives of the U.S. government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the United States, influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the United States played an equally key role in concealing information about the biological warfare experiments and in securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes.
Washington and Lee Journal of Civil Rights and Social Justice
Extract As is now known, from 1946–48, the Venereal Disease Research Laboratory of the U.S. Public Health Service (PHS), the Pan American Sanitary Bureau (PASB), and the Guatemalan government spearheaded a study4 that intentionally infected and tested Guatemalan prisoners, asylum inmates, soldiers, and orphaned children.5 The research team, led by Dr. John C. Cutler, exposed Guatemalans to syphilis “through the use of infectious prostitutes or directly through [an] inoculum made from tissue of human and animal syphilitic gummas and chancres,”6 and then treated the Guatemalans with penicillin.7 Although the researchers acknowledged they could not use such methods in the United States,8 they experimented in secrecy and did not seek consent from human subjects.9 . . .
The Guatemala study was horrendous, and the legal standards and guidelines of its day failed to protect Guatemalans who were infected with syphilis. Similar studies are being conducted by U.S. researchers in developing nations around the world, whether through grants from the U.S. government or by private U.S. companies. These problems must be remedied, and the Research Participants Protection Modernization Act of 2011 provides the impetus for the U.S. to do so. As Amy Gutmann, Chair of the Presidential Commission for the Study of Bioethical Issues stated, “a civilization can be judged by the way that it treats its most vulnerable individuals. There is no position of vulnerability that is greater than to be the subject of a medical experiment.”.
Abstract In much contemporary constitutional thought the exercise of state power unbounded by or contrary to the law is nothing other than the failure of justice in the constitutional order. Yet it has not always been so. For a substantial period of common- law legal history the exercise of judgment despite the law was viewed as essential to seeing that justice was done. This article argues that attention to the imaginative architecture of our criminal justice system discloses the continued presence of the concept of the positive conscience-based exception as a dimension of modern constitutionalism. This article looks at jury nullification, the royal prerogative of mercy, and prosecutorial discretion as abiding expressions of the idea that law and reason alone are insufficient to give full expression to our sense of state justice. The persistence of these sites for conscience-based decisions unbounded by the law ought to trouble prevailing theories of modern constitutionalism based on the preeminence of a reason- driven proportionality in which all decisions must be contained and regulated by the reason of law. Without denying the dangers of the exception, this article suggests that the conscientious decision made against or in spite of the law remains an important component of the way in which we imagine criminal justice.
Abstract Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.
Abstract John Harris and Julian Savulescu, leading figures in the “new” eugenics, argue that parents are morally obligated to use genetic and other technologies to enhance their children. But the argument they give leads to conclusions even more radical than they acknowledge. Ultimately, the world it would lead to is not all that different from that championed by eugenicists one hundred years ago.
European Archive of Psychiatry & Clinical Neuroscience
Abstract Under the Euthanasia Program of Nazi Germany, more than 200,000 psychiatric patients were killed by doctors in psychiatric institutions. After summarising the historical facts and the slow and still going-on process of illuminating and understanding what happened, some ethical consequences are drawn. What can we learn from history? The following aspects are addressed: the special situation of psychiatry in times of war, bioethics and biopolitics, the responsibility of the psychiatrist for the individual patient, the effects of hierarchy on personal conscience and responsibility, the unethical “curable- uncurable” distinction and the atrocious concept that persons differ in their value.
Abstract The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient’s autonomy and doctor’s duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive.
