"Honour and interests": Medical ethics in Britain, and the work of the British Medical Association's Central Ethical Committee, 1902-1939

Histories of medical ethics have neglected the early twentieth century, and concentrated on philosophical principles, codes, current concerns, or have described older ethical systems as etiquette, designed to enrich doctors. I have examined the Central Ethical Committee (CEC) of the BMA, an organisation then representing most practising doctors, and analysed medical ethics as a social historical phenomenon and aspect of medical professionalisation. In 1902 the new BMA and CEC emerged from a medico-political crisis in which failures of solidarity were construed as ethical issues. The key members of the CEC were senior middle-ranking practitioners, but the organisation had strong links with the General Medical Council and the Medical Defence Union. The committee dealt largely with enquiries and disputes between doctors, but also formulated policy on medical ethics, considering all the issues prominent in the sparse contemporary literature. These issues have been examined in turn, along with the literature starting with Percival's 1803 Code, and the behavioural strictures inherent in collegiate organisations. These issues were, solidarity in boycotting unsuitable appointments; the use of local 'courts of honour' to settle disputes; the etiquette and ethics of consultation; relationships with unqualified and unorthodox practitioners; advertising that both directly and indirectly involved doctors; relationships with medical businesses of all kinds; and confidentiality, particularly in courts of law. Abortion is discussed as an example of a moral question not then included in medical ethics per se. This system aimed to uphold unwritten medical characteristics and traditions, to differentiate doctors from quacks and tradesmen, and to promote professional honour, as a means of defending medical interests. It defined the profession behaviourally, and created a 'space' in which medical excellence could flourish. Despite profound social and technological change medical ethics can still be construed as a moral adjudication of medical behaviour integral to defining the boundaries between profession, patients and society