Book Review

Medical Ethics in the Renaissance

N Engl J Med 1996; 334:1206May 2, 1996

Article

Medical Ethics in the Renaissance
By Winfried Schleiner. 230 pp. Washington, D.C., Georgetown University Press, 1995. $55. ISBN: 0-87840-593-3

Winfried Schleiner circumscribes his study of Renaissance medical ethics in two ways: first, by limiting his primary sources to the writings of physicians (excluding, for the most part, those of theologians, philosophers, and jurists) and, second, by selecting the ethical issues addressed by Renaissance physicians that intrigued him most because of their relevance to the present. These topics include truth and pretense in medical practice, the cure of the body versus the cure of the mind or soul, and (for about half of the book) sexuality and medicine, especially the moral dilemmas of “removing seed” to preserve or restore health and of treating and preventing syphilis.

The leitmotif of this book is that the most important contribution of the Renaissance to the development of modern medical ethics is the marked dichotomy that developed between what Schleiner calls the medicus prudens and the medicus Christianus. One whose medical ethics were functionally affected by Christianity was a medicus Christianus. A Christian whose medical ethics were little if at all influenced by Christianity was a medicus prudens. A Jewish physician was, by default as it were, a medicus prudens. This appears to be Schleiner's opinion, since he regularly contrasts the ostensibly bigoted and oppressive ethics of patently Christian physicians (whether Catholic or Protestant — although the former appear quite consistently in a worse light) with the ethics of his heroes: physicians whose ethics were “secular” (i.e., “progressive”) and therefore more enlightened. Their ethics were apparently better because they are supposedly similar to modern pluralistic ethics that are informed less by Judeo-Christian principles and more by ethical relativism.

Early in the book Schleiner admits that he may be revealing his bias, when he asserts that ecclesiastical authority “in many aspects of life was repressive.” He frequently identifies examples of “secular” medical ethics, which he contrasts with Christian (especially Catholic) medical ethics. He becomes enthusiastic whenever he detects in a primary source any apparent effort to “remov[e] the theologian” from medico-ethical considerations, which he regards as a praiseworthy act of “medicalization and concomitant secularization” of medical ethics.

How meaningful is Schleiner's concept of secular in his discussion? I find it intriguing that Jewish physicians, whom he lauds as secular, actually appear much closer in their moorings to physicians of today who are substantially affected by Judeo-Christian ethics than to those who disavow that ethical tradition. He comments that the Jewish physician Lusitanus “replaces the notion of the Christian physician . . . by that of the medicus timens Deum, `the God-fearing physician.' ” I assume that such a physician is a medicus prudens by virtue of not being a medicus Christianus. Not that a physician, by virtue of being a Christian, cannot be a medicus prudens. Sennert, a Protestant physician, apparently qualifies for that designation of honor. Indeed, Schleiner favorably compares him with the Jewish physician Castro because he ostensibly based his ethics on “the natural laws by which all sciences were bound.” Even the Catholic physician Sitoni may not have to bear the opprobrium of the epithet medicus Christianus. Surely he must be a medicus prudens since he advocated “a medical ethics guided by higher norms” but apparently not by “Christian” norms. Sassonia is described as “one of the most secular-minded writers on syphilis” in part because he did not “feel impelled to explain or excuse his treating prostitutes.” If he had felt impelled to explain or excuse his behavior, would Schleiner have labeled him as a medicus Christianus and denied him the laudatory appellation of medicus prudens?

Schleiner refers to ethical standards that he feels have in the past led to “obnoxious results.” By what standards are these results “obnoxious”? Obviously, by those of his personal value system. Since his values, which often coincide with some ephemeral trendiness of the moment, are in places quite conspicuous in this work, some readers will find various aspects of it obnoxious. The kind of moralizing that he uses, coupled with the regular use of trendy phrases such as “sexist views of disease,” “gendered views and practices,” “feminist sensibility,” and “homophobia,” cheapens the work and anchors it in the immediate present to such a degree that the next generation may find it more useful as an example of late-20th-century historiography than as a reliable tool for understanding Renaissance medical ethics. That is a pity, because Schleiner is so obviously an excellent scholar and his book the fruit of painstaking, diligent, and imaginative scholarship.

Darrel W. Amundsen, Ph.D.
Western Washington University, Bellingham, WA 98225