Abstract

The 1847 Code of Ethics of the American Medical Association is considered to be the first professional code of ethics. Evaluated extensively by historians, the dominant historical viewpoint of the Code is that it was a foundation document of professionalization of medicine. In this dissertation I reevaluate the social and cultural context of the AMA Code in terms of its function in the construction of a paternalistic and essentially masculine medical profession. I begin by presenting the textual evidence of moral ambiguities in the Code, ambiguities which have not been explained by prior interpretations. The next chapter shows how the medical doctors had been frustrated in their attempts to establish themselves as elite members of the society. These failed attempts at legitimation led to the introduction of the founding of the American Medical Association and its founding document, the Code of Ethics. The next part of the dissertation introduces evidence supporting the view that the regular medical doctors believed in the efficacy of their treatment. In such a situation they felt obligated to constitute a Code of Ethics elaborating the bilateral social relationship. It is found that the regular doctors utilized innovative new diagnostic technologies which came to constitute a new paradigm of "normality" which supported their belief in their justification to construct a Code of Ethics. In the situation of the failure of medical treatment in this paradigm, the blaming of the patient justified the elaboration of the paradigm such that there came to be the inclusion of ethical obligations of the patients towards the profession. A major contradiction between the Introduction to the Code and the Code of Ethics is resolved by examining the history of the medicalization of social deviancy. Sociological theory shows how the core paradigm is exploited, leading to the professionalization of medical practice. The functional consequence of this constitution of the medical profession is seen to be the masculination of medicine and the establishment of a paternalistic profession. The rationalization of the new paradigm leads to the AMA Code of Ethics