THE NEW CODE OF ETHICS OF THE MEDICAL SOCIETY OF THE STATE OF NEW YORK.

The most important action by far of the late annual meeting of this State Society was the adoption of an amended code of ethics, or rather of a code of ethics in which one particular rule in regard to consultations is reversed from what it was before, and from what it is in a 1 other medical organizations of this country so far as known.

At the annual meeting of last year a committee was raised to revise the Code of Ethics, and at an early session this year that committee presented the following revised code as their report. The committee consisted of Drs. Wm. C. Wey, C. R. Agnew, S. Oakley Vander Poel, Wm. S. Ely and Henry G. Piffard.

CODE OF MEDICAL ETHICS.

I. THE RELATIONS OF PHYSICIANS TO THE PUBLIC.

II. RULES GOVERNING CONSULTATIONS.

III. THE RELATIONS OF PHYSICIANS TO EACH OTHER.

I. THE RELATIONS OF PHYSICIANS TO THE PUBLIC.

It is derogatory to the dignity and interests of the profession for physicians to resort to public advertisements, private cards, or handbills, inviting the attention of individuals affected with particular diseases, publicly offering advice and medicine to the poor without charge, or promising radical cures; or to publish cases or operations in the daily prints, or to suffer such publications to be made; or through the medium of reporters or interviewers, or otherwise, to permit their opinions on medical and surgical questions to appear in the newspapers; to invite laymen to be present at operations; to boast of cures and remedies; to adduce certificates of skill and success, or to perform other similar acts.

It is equally derogatory to professional character, and opposed to the interests of the profession for a physician to hold a patent for any surgical instrument or medicine, or to prescribe a secret nostrum, whether the invention or discovery or exclusive property of himself or of others.

It is also reprehensible for physicians to give certificates attesting the efficacy of patented medical or surgical appliances, or of patented, copyrighted or secret medicines, or of proprietary drugs, medicines, wines, mineral waters, health resorts, etc.

II-RULES GOVERNING CONSULTATIONS.

Members of the Medical Society of the State of New York, and of the Medical societies in affiliation therewith, may meet in consultation legally qualified practitioners of medicine. Emergencies may occur in which all restrictions should, in the judgment of the practitioner, yield to the demands of humanity.

To promote the interests of the medical profession and of the sick the following rules should be observed in conducting consultations.

The examination of the patient by the consulting physician should be made in the presence of the attending physician, and during such examination no discussion should take place, nor any remarks as to diagnosis or treatment be made. When the examination is completed, the physicians should retire to a room by themselves, and after a statement by the attending physician, of the history of the case and of his views of its diagnosis and treatment, each of the consulting physicians, beginning with the youngest, should deliver his opinion. If they arrive at an agreement, it will be the duty of the attending physician to announce the result to the patient, or to some responsible member of the family, and to carry out the plan of treatment agreed upon.

If in the consultation there is found to be an essential difference of opinion as to diagnosis or treatment, the case should be presented to the patient, or some responsible member of the family, as plainly and intelligently as possible, to make such choice, or pursue such course as may be thought best.

In case of acute, dangerous or obscure illness, the consulting physician should continue his visits at such intervals as may be deemed necessary by the patient or his friends, by him or by the attending physician.

The utmost punctuality should be observed in the visits of physicians when they are to hold consultations, but as professional engagements may interfere or delay one of the parties, the physician who first arrives should wait for his associate a reasonable period, after which the consultation should be considered as postponed to a new appointment. If it be the attending physician who is pres ent, he will of course see the patient and prescribe, but if it be the consulting physician, he should retire, except in an emergency, or when he has been called from a considerable distance, in which latter case he may examine the patient and give his opinion in writing, and under seal, to be delivered to his associate.

III. THE RELATIONS OF PHYSICIANS TO EACH OTHER.

All practitioners of medicine, their wives, and their children while under paternal care, are entitled to the gratuitous services of any one or more of the faculty residing near them, whose assistance may be desired.

Gratuitous attendance cannot, however, be expected from physi cians called from a distance, nor need it be deemed obligatory when

opposed by both the circumstances and the preferences of the patient.

The affairs of life, the pursuit of health and the various accidents and contingencies to which a medical man is peculiarly exposed may require him temporarily to withdraw from his duties to his patients, and to request some of his professional brethren to officiate for him. Compliance with this request is an act of courtesy which should always be performed with the utmost consideration for the interests and character of the family physician, and when exercised for a short period, all the pecuniary obligations for such service should be awarded to him. But if a member of the profes sion neglect his business in quest of pleasure and amusement, he cannot be considered as entitled to the advantages of the frequent and long-continued exercise of this fraternal courtesy without awarding to the physician who officiates the fees arising from the discharge of his professional duties.

In obstetrical and important surgical cases, which give rise to unusual fatigue, anxiety and responsibility, it is just that the fees accruing therefrom should be awarded to the physician who officiates.

Diversity of opinion and opposition of interest may, in the medical as in other professions, occasion controversy and even contention. Whenever such cases unfortunately occur, and cannot be im. mediately terminated, they should be referred to the arbitration of a sufficient number of physicians before appealing to a medical society or the law, for settlement.

If medical controversies are brought before the public in newspapers or pamphlets, by contending medical writers, and give rise to, or contain assertions or insinuations injurious to the personal character or professional qualifications of the parties, the effect is to lower in the estimation of the public, not only the parties directly involved, but also the medical profession as a whole. Such publications should therefore be brought to the notice of the County societies having jurisdiction, and discipline inflicted, as the case may seem to require.

This committee report was not radical enough for some members, and Dr. D. B. St. John Roosa offered the following substitute for the report, and explained and supported the substitute very warmly throughout the animated discussion which followed.

SUBSTITUTE FOR THE REPORT OF THE SPECIAL COMMITTEE ON AMENDMENTS TO THE SYSTEM OF MEDICAL ETHICS.

The Medical Society of the State of New York, in view of the apparent sentiment of the profession connected with it, hereby adopt the following declaration, to take the place of the formal code of ethics, which has up to this time been the standard of the profession in this State:

With no idea of lowering, in any manner, the standard of right

and honor in the relations of physicians to the public, and to each other, but on the contrary, in the belief that a larger amount of discretion and liberty in individual action, and the abolition of detailed and specific rules, will elevate the ethics of the profession, the medical profession of the State of New York, as here represented, hereby resolve and declare, that the only ethical offences for which they claim and promise to exercise the right of discipline, are those comprehended under the commission of acts unworthy a physician and a gentleman.

Resolved, Also, that we enjoin the County Societies and other organizations in affiliation with us, that they strictly enforce the requirements of this code.

This substitute was first discussed, and much was said in advocacy of it about the puerility and narrowness of codes of ethics as formularies, and of the great superiority of the "unwritten law." One who attempted to listen to all this dispassionately, and who did not know beforehand that the medical profession of this State was not yet angelic, could only reach one conclusion, namely, that "acts unworthy a physician and a gentleman" were well known and well defined, and had the same force, value and acceptation to all men; and that there was so little disposition left in the profession to commit any such acts that it was only necessary to make a resolution and declaration in regard to them. But just here it would occur to the listener to ask for the logical basis of any such resolution or declaration. If codes and laws were illiberal, puerile and unnecessary in the presence of the "unwritten law," why should it be necessary to resolve and declare." The more logical course would seem to be to simply abolish all codes and laws when they were no longer necessary. The proposition to have any substitute whatever, simply weakens the position taken and begs the question. For example, suppose that because there had not been a burglary committed in any court-room of the State, or within the personal knowledge of any judge for a year, the laws against burglary should be abolished as being illiberal, puerile and unnecessary in the presence of the "unwritten law," this would be equivalent to assuming that there were no longer any burglars left. Then, what would be the force of resolving and declaring that all burglars must be gentlemen?

Yet, notwithstanding the apparent absurdity of abolishing law, with human nature constituted as it is, so ably was the proposition advocated, or rather so feebly was it opposed, that upon a critical vote, by calling the yeas and nays, there were found to be 40 votes

for the substitute and 38 against it-78 votes in all. Then, as a two-thirds vote was necessary to change the by-laws, as this would do, the substitute was declared to be lost and the consideration of the report of the committee resumed, Dr. Roosa advising all who had supported his substitute to transfer their support now to the report of the committee as being the best they could now get.

In this report of the committee, as above given, the only very material change from the old code, and apparently the chief object of interest to the committee in the old code, was in regard to the law forbidding consultations with irregular practitioners of medicine, or those who profess to be or are unfaithful to the "scientific principles and approved doctrines" of medical practice. This prohibition is withdrawn and a permission, which is the reverse of it, is given in the words "may meet in consultation legally qualified practitioners of medicine," because in this State and others many "practitioners of medicine" are qualified by law who profess or practice upon dogmas which are at variance with or in opposition to the principles of established rational medicine as represented in this State Medical Society. It is with these lawful professional outlaws that the committee wish to establish consultations, and some of the prominent reasons advanced for this during the discussion were as follows:

First, on grounds of common humanity, it was wrong to refuse skilled services to suffering when in need.

Next, it was illiberal and ungenerous, and inconsistent with the spirit of the age to withhold professional aid from other practitioners simply because they were of a different creed or belief.

Next, by consulting with such in a proper spirit these errors might be better shown to them and be corrected.

Next, by consulting with them the charge of persecution against them would be silenced, and they would soon return to the regular practice, and suffer their fallacies to die out.

These reasons were met and controverted by others which are familiar to all medical men as set forth in the various codes of ethics, but it soon became plain that the committee's arguments would carry the day. This writer urged that, inasmuch as this proposed change was not only radical but revolutionary, and that it legislated for all the county societies of this State without giving them a hearing upon it,—that the report be laid over until the next meeting for final action, and that in the meantime both the report and the present discussion be published, so that the general profession