McCullough Laurence B
Kennedy Inst Ethics J. 1999 Mar;9(1):7-23. doi: 10.1353/ken.1999.0005.
At different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenonmenon of laying medicine open has sometimes resulted in major turning points in the history of medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724-1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician's fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.
在医学发展历程中的不同时期，医学一直面临着对其科学品质和道德品质负责的要求。这种将医学公开的现象有时会导致医学伦理史上的重大转折点。在本文中，我将审视医学公开引发此类转折点的两个例子：18世纪的英国医学和20世纪后期的美国医学。在18世纪，苏格兰医生兼哲学家约翰·格雷戈里（1724 - 1773），鉴于当时医学实践中存在的不科学、商业逐利、自私自利的本质，运用医学伦理学和哲学工具使医学对责任负责。在此过程中，格雷戈里基于医生对患者的信托责任，撰写了英语文献中的首部医学专业伦理学著作。在20世纪后期，医学的管理实践使医学对其科学质量和经济成本负责。当前这种对医学的公开为基于人群的医学科学与实践发展医学伦理学和生物伦理学带来了挑战。
