Review: Beyond the Hippocratic Oath

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I have just now finished with a copy of Beyond the Hippocratic Oath: A memoir on the rise of modern health ethics by the late Dr. John B. Dossetor. This is appropriate for me, as I need to return the book to a preceptor before I move, but more so because I performed a bioethics elective during my fourth year of medical school. This was done through the John Dossetor health ethics centre at the University of Alberta, which should tell you how great this man’s impact on health ethics is!

This book is thoroughly Canadian, although it begins with the author in the United Kingdom. That said, health ethics is concerned with everyone, so readers out of Canada should not be deterred by much of its setting.

It is part autobiography, part textbook, and part philosophical work. It’s highly accessible to people who are just starting an enquiry into medical ethics, written in a clear language. It contains some surprising historical anecdotes, many which reveal the dark side of the “bad old days” of medicine. (e.g. The damaging and unethical research into ‘psychic driving’ carried out by Dr. Ewan Cameron in the 1950’s at McGill.)

In particular, Dr. Dossetor writes with humility derived from grappling with the most difficult of difficult medical/ethical/legal cases. He also injects awe for the knowledge increase in the field of nephrology, and reveals just how new some of our practices really are. He also pulls a lot on Hume, which I approve of, as the little of Hume I have read has been some of my favourite philosophy.

This book should be handed out to students starting on their their year rotations, rather than the collection of Osler that I received. (Though I suspect that not many modern medical students would be inclined to read either, sadly.) This text is more up-to-date with contemporary ethical issues, which makes its ideas more informative for present medical practice.

I will warn that while I find Dossetor’s language pleasantly reflective, his older, British style may make him a more difficult read for some. His writing can easily be called stately, and if you are not on fire from the ideas put forth, you may find your attention wandering.That said, he does a good job of defining medical terms for a wider readership (and people practising in health care will find his information on kidney transplant and HLA receptor research fascinating!)

What makes this book particularly appropriate for me is that many of the people mentioned in Dossetor’s writing are people that I have met, as much of his academic career was centred at the University of Alberta. I am humbled by the strides this man and his colleagues have made in medical ethics, and I hope that I may continue to keep these thoughts active as I head into my residency.

I must admit now that I really am attracted by health ethics, even though I used to always say that “ethics is like epistemology– only boring.” In particular, the very last chapter of the memoir has left my mind ignited.

In the interest of spreading the fire, I wholeheartedly recommend this read.

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