Andreas-Holger Maehle, Doctors, honour and the law: medical ethics in imperial Germany, Basingstoke, Palgrave Macmillan, 2009, pp. viii, 198, £50.00 (hardback 978-0-230-55330-9).

Abstract

Research on the history of medical ethics in Germany has so far focused on the Third Reich and the Weimar period. Except for a few studies we hardly know how medical ethics developed and was shaped in the Kaiserreich. A new book by Holger Maehle provides for the first time a comprehensive overview on doctors’ professional ethics in Germany from the foundation of the German Empire in 1871 to the beginning of the First World War. In order to understand why there might have been a German Sonderweg (a unique way) in medical ethics, one has to remember that the professionalization of German doctors was more closely linked to state interventions than that of physicians in the United States or in Britain where a more liberal system prevailed. A special feature of the professionalization of medicine in Germany was the growing dependency of the medical profession due to the compulsory health insurance system which Chancellor Otto von Bismarck had introduced in the 1880s. “Medical professional ethics in Imperial Germany was”, according to Maehle, “as much about defusing competition among doctors as about enforcing solidarity vis-a-vis the health insurance boards” (p. 3). The Penal Code of 1871 also had an important influence on medical ethics in the Kaiserreich, especially those paragraphs dealing with physical injury and professional secrecy. The first chapter of this book shows that German doctors sought the backing of the state in disciplining their colleagues. An interesting fact is that in Germany the direct model for professional courts of honour was the Lawyers’ Ordinance of 1878. In 1899, a disciplinary tribunal was introduced in each of the twelve Prussian medical chambers, while in Bavaria, for example, this was the case only thirty years later. Examining the activities of these medical courts of honour one discovers that a relatively small number of cases were in fact brought before these tribunals, dealing mostly with maltreatment or with patients’ complaints. The most frequent reason for disciplinary punishment was excessive advertising, which was regarded as dishonourable and quack-like by the medical profession. Likewise, it does not come as a surprise that a large number of accusations were made by other doctors, indicating the fierce competition in the medical market in the age of professionalization. The second chapter discusses the codification of secrecy for medical staff in Germany, shedding light on the medico-legal debate on the priority of public versus private interests in cases where doctors were asked to give evidence in court. A good example of the way in which the doctor’s duties to the general public ought to carry more weight than his duty to the individual patient and to confidentiality is the debate on the combat of venereal diseases in Imperial Germany, culminating in the decision of the Supreme Court in 1905. One of the most fascinating and illuminating chapters in this book is that dealing with patients’ information and the right to self-determination. Germany can certainly be considered a pioneering state in this respect. In 1894, the German Supreme Court endorsed the legal view that medical interventions constituted physical injuries. This meant that any operation (except in medical emergencies) required the patient’s consent. The fourth chapter deals with the ethical views that were expressed in late-nineteenth- and early-twentieth-century writings about doctors’ duties, considering especially the issues of truth-telling, euthanasia and abortion. The main focus lies on Albert Moll’s seminal book on medical ethics, published in 1902. Maehle’s conclusion is convincing, although it does not come as a surprise for those who are familiar with the medical history of this period. Medical ethics in Imperial Germany were guided more by political considerations, notions of honour, and professional reputation than by any concern for patients’ interests.