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July 9, 1997

Crisis, Ethics, and the American Medical Association 1847 and 1997

Author Affiliations

From the Philosophy Department, Union College, Schenectady, NY (Dr Baker); the Center for Bioethics, University of Pennsylvania, Philadelphia (Drs Baker and Caplan); and the Ethics Standards Division. American Medical Association, Chicago, Ill (Drs Emanuel and Latham).

JAMA. 1997;278(2):163-164. doi:10.1001/jama.1997.03550020095046

American medicine in 1997: the core values of the medical profession are being decided, not by physicians and surgeons acting through medical societies, but by lawyers and judges taking action in courtrooms and by managed care administrators overriding the decisions of trained medical professionals in response to the imperatives of commodified medicine. American medicine is in crisis. To put this crisis in perspective, however, consider the state of medicine in the United States 150 years ago. Licensing laws had been repealed as "elitist" and "antidemocratic."1(pp43 -63) The New York physician Nathan Smith Davis (1817-1904) reported that, in the absence of minimal licensing standards, "The college that offered to confer [an MD] after attendance on the shortest annual courses of instruction and the lowest college fees could generally draw the largest class."2 Consequently, as Dr Nathaniel Chapman (1780-1853) of Philadelphia remarked, "The too ready admixture into [medicine] of individuals