Parent Category: 18th Century History Articles
Category: Medical History
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As long as civilization has existed, there has been a need for healthcare — and we've come a long way from basic medical treatment that consisted primarily of homeopathic remedies and prayer. Along with the quality of treatment and sanitary facilities, having ethical standards in place is an integral component of modern medical care.

In medical settings, there are four basic ethical principles that healthcare providers should adhere to autonomy, beneficence, justice, and nonmaleficence. Those ethical tenants are rooted in the Hippocratic oath, a binding document that originated in ancient Greece. Since that time, ethics have continued to serve as a cornerstone of medical care throughout history, into the 1700s and the modern era.


While some of the ethical dilemmas that arise in today’s healthcare industry are vastly different than the prevalent issues of the 18th century, many parallels also exist. The world saw numerous medical advancements in the 1700s, as well as a renewed emphasis on ethics. And today, in the wake of continuously evolving medical technology and a growing global population, ethics remain essential to medical care.

Medical Ethics in the 1700s

In the 18th century, healthcare was practiced in a variety of settings, from hospitals to homes where the sick and infirm lived. Those suffering from mental illness in the 1700s, including depression and anxiety, were typically remanded to asylums. Regardless of the location of patient care, however, modern matters such as billing, fiscal responsibility, and legal repercussions were rarely emphasized. Yet the possibility of economic and ethical conflicts didn't escape notice among medical professionals in the 1700s.


In the United States, the concept of medical ethics became official as of 1847. That year, the newly formed American Medical Association drafted its ethical code, which was based on the work of physician Thomas Percival. While Percival's "Code of Institutes and Precepts" was initially published in 1803, his ideas were developed in the mid- to late-1700s, as he sought to improve relations among hospital staff. His unofficial role as arbitrator of the Manchester Infirmary would eventually become an essential position within the hospitals and medical centers of the future.


To better balance ethics and economics, the modern healthcare industry created the job of professional healthcare administrator. These professionals are tasked with organizing and managing patient care delivery, while also looking out for their medical facility's best interests. According to Ohio University, the role of healthcare administrator is inherently challenging, as "it sometimes pits budget, quality, and ethics against each other."

Ethics and Patient Privacy

Privacy considerations are also factored into decisions made by healthcare administrators. Today, health information is increasingly stored in digital channels, known as electronic health records (EHRs), which are considered more secure than paper records. Modern patients enjoy increased data privacy and discretion, but those seeking medical care in the 1700s didn't typically have that luxury.


An individual's medical data can include everything from birthdate and blood type to lab results, such as glucose monitoring and screenings for sexually transmitted diseases. And patients have an inherent right to keep their medical data confidential — thus, ensuring patient privacy is an essential part of any healthcare professional's job, no matter the diagnosis. For those who have contracted an STD or similarly stigmatized condition, discretion is often of paramount importance.


The negative stigma surrounding an STD diagnosis is far from a modern problem. Syphilis and venereal disease were the most prevalent STDs of the 18th century, and individuals who contracted either disease were often seen as morally unsound. According to a letter penned by physician Thomas Hewitt in 1721, he was reluctant to administer syphilis treatments to a 60-year-old male patient because he considered the man to be honest and trustworthy. Unfortunately, STDs have a similar reputation in modern times.

How Healthcare Costs Have Evolved

No matter if an individual is diagnosed with an STD, cancer, or other medical condition, treatment, and medication costs often factor into the equation when considering treatment options. The economic side of medical care affects both patients and healthcare providers alike and effectively originated in the late 1700s. As 18th-century healthcare providers gained the confidence of their community, they began to charge for their services, and bartering was encouraged. For example, documents held by the Library of Congress indicate that a baker in 18th century Philadelphia paid for his family's smallpox inoculations in bread.


Today, throughout most of the developed world, universal healthcare is considered an inherent right. The U.S. is a notable exception, and health insurance is unfortunately out of reach for many low-income Americans. In the event of a medical emergency, uninsured and underinsured U.S. citizens often face the burden of bills they are unable to pay.


Unpaid medical bills can adversely affect one's credit score and may end up in the hands of a collection agency. When that happens, patients and their families have several options. By offering a lump sum payment, partial forgiveness of medical debt may be granted. Collection agencies may also agree to accept small, regular payments over time until the medical debt is satisfied.


Medical ethics codes notwithstanding, high treatment costs can be linked to inadequate care, low patient satisfaction, and heaps of medical debt. Fortunately for our ancestors living in the 1700s, medical care wasn't so intrinsically linked to income. But today's patients are better-protected thanks to the ethical standards first put in place by 18th-century physicians.


About the Author:
Frankie Wallace contributes to a wide variety of blogs and writes about many different topics, including politics and the environment. Wallace currently resides in Boise, Idaho and is a recent graduate of the University of Montana.