Since its beginning in 1848, the American Medical Association (AMA) has required its members to subscribe to its code of ethics. The code, however, speaks more to medical etiquette—proper relations among doctors—than to medical ethics or, more broadly, bioethics. Indeed, throughout the 19th century and well nto the 20th century, doctors’ ideas regarding bioethics remained vague, and their commitment to bioethics remained weak. Although doctors undoubtedly would have identified relieving human suffering as their primary goal in both research and clinical practice, they sometimes behaved in ways that would horrify modern doctors and bioethicists. For example, Dr. J. Marion Sims, considered the father of modern obstetrics, achieved fame during the 1840s for developing a surgical procedure to correct vesicovaginal fistulae, tears in the wall between a woman’s vagina and bladder usually caused by overaggressive medical intervention during childbirth. Women who suffered these fistulae could not control the leakage of urine and often had to withdraw from social life altogether because of odor and the resulting social shame. To develop a surgical cure, Sims bought black women slaves who had fistulae and then operated on them as many as 30 times each in an era before antibiotics and antisepsis and with only addictive drugs for anesthetics. When Sims announced his new surgical technique, the med- ical world and the public greeted him with acclaim. No one questioned his ethics.

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