Medical Ethics and Professional Monopoly

The study of medical ethics should properly include codes of ethics issued by Enlightenment philos ophers and modern medical associations. Official codes of ethics adopted by the medical profession in England and the United States have exhibited monopolistic tendencies which have strengthened over time. Examination of Thomas Percival's 1803 code of ethics reveals monopolistic rules in the areas of trust inducement, consultations, criticism, and fee setting. Another ethical code, written by John Gregory in 1770, provides evidence of antimonopolistic ethical atti tudes during the Enlightenment which were not subse quently adopted by official professional bodies. The series of ethical codes issued by the American Medical Association since its inception in 1847 exhibits even more monopolistic rules than had Percivalean ethics. In contrast to the mono polistic tendencies of official medical ethics, however, trends are currently emerging toward nonmonopolistic counter- ethics in the areas of restraint of competition, patient decision making, professional review mechanisms, and rational health care services planning.