The historical context of the American medical association’s 1847 Code of Ethics

Abstract

On the morning of May 7th, 1847, the national medical convention — soon to rename itself the American Medical Association - enacted a Code of Ethics. In the brief span of three years the frustration of a few New York physicians had led to the first national medical convention, to the first national medical association, and to the first national code of medical ethics. The object of the New Yorkers’ frustration, however, was neither the lack of a national organization, nor the state of medical morals, it was the state of medical education. Bad education was driving out good: the shorter and cheaper the route to medical qualification, the fewer the demands a college made on a medical student, the more likely it was to be a financial success. Worse yet, piecemeal reform seemed impossible. No single state could reform its system without a parallel reform in the others. Medical students, medical qualifications, and medical practices were all portable; were any single state to raise educational standards within its borders, it would merely create a competitive advantage for colleges beyond its borders. Moreover, once students had earned their qualifications, however poorly educated they might be, they could still practice anywhere. Consequently, were any state to attempt to raise educational standards on its own, it was likely undercut its medical colleges, without significantly raising the qualifications of its physicians. Educational reform would either have to be done by everyone, everywhere, or no one could successfully implement it anywhere.