An historical take on the physician's charter
CMAJ 2000;162:1121
See response from: N. Kenny and C. Weijer
Nuala Kenny and her colleagues have expressed concern that the CMA Charter for Physicians will be seen as self-serving [Editorial].1 On the face of it, I share this feeling. But when I place the charter in an historical context I am reassured. For the Charter is not just a product of the "current political and economic climate," but one more expression of the centuries of efforts to define the relationship between physicians and the society they serve.
One concern expressed about the charter is that it is a further example of the entitlement that too often bedevils our profession.2 But compare the modest claim in the preamble to section III — "like all Canadians, Canadian physicians deserve fair treatment" [Charter for Physicians]3 — to our 1868 Code of Ethics,4 where we pronounced that "the benefits accruing to the public, directly and indirectly, from the active and unwearied beneficence of the profession are so numerous and important that physicians are justly entitled to the utmost consideration and respect from the community." As justification of this sentiment the code pronounced that "There is no profession from the members of which greater purity of character and a higher standard of moral excellence are required than the medical."
Our Code of Ethics has been strongly influenced by Thomas Percival's Medical Ethics (1803). Pellegrino5 has described how Percival urged physicians to speak out when economics conflict with ethics. Percival's issues have a contemporary ring: he condemned overcrowded wards and warned that unwise economies in treatment might lead to the use of drugs of inferior quality. It is therefore quite appropriate for our present-day charter to assert that physicians must act as advocates for their patients.
Finally, the charter's assertion that physicians need to be paid for their work has an even longer record. In his 1955 Osler lecture at McGill, Edelstein6 cited Aristotle's view that the function of medicine is to cause health, not wealth. But in The Republic Plato pointed out that there would be no benefit in a physician's work "unless pay is added to it," for the physician would consequently be unwilling to go to the trouble of taking care of the troubles of others.
There is a place for the charter. If society expects a great deal of its physicians then physicians must look for something in return. They are human and need their quid pro quo.
C.P.W. Warren
History of Medicine Program
University of Manitoba
Winnipeg, Man.
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References
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Kenny N, Weijer C, Baylis F. Voting ourselves rights: a critique of the Canadian Medical Association Charter for Physicians. CMAJ 1999;161(4):399-400. [MEDLINE]
Dubovsky SL. Coping with entitlement in medical education. N Engl J Med 1986;315:1672-4. [MEDLINE]
Canadian Medical Association. Charter for Physicians [policy]. CMAJ 1999;161(4):430-1. [MEDLINE]
Section D. Code of medical ethics. Article II. Obligations of the public to physicians. Minutes of the First Annual Meeting of the Canadian Medical Association; 1868 Sept 24; Montreal. Ottawa: Canadian Medical Association. p. 73.
Pellegrino ED. Percival's medical ethics: the moral philosophy of an 18th century gentleman. Arch Intern Med 1986;146:2265-9. [MEDLINE]
Edelstein L. Ethics of the Greek physician. Bull Hist Med 1956;30:391-419.
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