The Morality of Medicine
The rise of laboratory science in the late 19th century put stark focus on the moral cost of medical innovation.
‘Modern medical science has given us a choice where there was once none.’ So said John Simon at the International Medical Congress in London in 1881. Simon, who had been the UK’s first Chief Medical Officer, was speaking about the purpose and value of state medicine, the government funding and direction of medical research and public health policy.
The choice of which he spoke concerned the means of producing new knowledge that would permit the ‘prevention and cure of diseases’. Such knowledge had always been the product of experiments, he said, but, before the development and expansion of laboratory-based experimental medicine involving animals, they were ‘ad hoc and uncontrolled’ social experiments: new knowledge was gained at the expense of human suffering. The laboratory offered the opportunity to take the experiment in hand, to remove ‘human suffering, misery and death’ and replace it with the cost of ‘a quantity of experimental animals, who serve humans by taking our stead as the experimental subject’.
Simon had devised and directed public health policy for the government since the 1850s, as well as administering Crown funding for medical research (£2,000 annually) and keeping abreast of the latest developments in laboratory science. In a long career, Simon had publicly battled those who thought science immoral or callous and those who opposed vaccination on libertarian grounds. At times he was authoritarian, overseeing policy that made vaccination compulsory and non-compliance punishable by imprisonment. At times he was unsympathetic, accusing the public of sentimentality and ignorance. He is often feted as having paved the way for a national health service. He understood that the state had a vested interest in the health of the population at large, that controlled experiment was the best source of new knowledge about disease and that it was therefore a requirement of government to organise, administer and apply this knowledge, even at the expense of individual freedoms. He was a controversial visionary.
The stakes were high in 1881. It was a crisis point for medical research, given a rising tide of anti-vivisectionist activity. The antis, often seen now as social progressives, but then as conservatives, were concerned for the morals of civilisation. The heart of the nation was risked, they thought, by the indulgence of a limitless scientific curiosity through experimentation on living beings. Perturbed, the scientific community, led by Charles Darwin, had attempted to gently regulate itself, proposing legislation to formalise experimental ethics. It was botched by internal disagreements and competition from their opponents. A Royal Commission and new anti-vivisection legislation followed. In their attempt to amend the proposed legislation, prominent scientists ended up providing tacit support for the principle of the Bill. The result was the Cruelty to Animals Act of 1876, which required medical researchers to apply to the government for licences to carry out their experiments. It was widely considered to have asphyxiated British scientific progress. In the eyes of men like Simon, it had the effect of fixing ‘a standard of right and wrong’ on ‘grounds which are merely sentimental’, borne by ‘screamers and agitation-mongers who, happy in their hysterics … go about day by day calumniating our profession’. His contempt was bitter. His profession’s ‘verb of life’, he said, was to work, not to feel (and, to distance scientific practice from common sentiment, he expressed it in Greek). Laboratory-based medicine’s humanity was intrinsic to this ethos of professional effort. Emotional concerns about animals were simply out of place. Thus, when Simon spoke about the virtues of state medicine, he had in view an innovation in humanitarianism among experts, policy makers and administrators. It was guided by a shared principle of the greatest happiness for the greatest number, grounded in the practical activities of the laboratory and applied through the machinery of government.
If the principle was utilitarian in its social outlook, the practical execution of it was idiomatically Darwinian, based on a fundamental human-animal connection and an ethical priority to extend human knowledge and reduce suffering. Darwin’s tree of life did not knock humanity off the highest branch. He celebrated the evolution of civilisation and saw its future in the scientific intellect and the techniques of physiology. They were the vehicles for the extension of sympathy to all, even to the ‘weak’. Simon would argue that the best delivery method for this scientific humanity was to place medical expertise at the heart of government policy. As his contemporary and great Darwinian acolyte T.H. Huxley had put it in 1871, individual liberties could, in times of medical crisis, risk everyone: ‘If my next-door neighbour … be allowed to let his children go unvaccinated’, he said, ‘he might as well be allowed to leave strychnine lozenges about in the way of mine.’ Thus, the knowledge acquired through laboratory-based medicine and the government control of its applications had become combined in principle. Libertarian evolutionists like Herbert Spencer and Alfred Russel Wallace would object in strong terms. But the tide was against them.
Simon’s speech, and the IMC in general, rallied the scientific community. Shortly afterwards, the Association for the Advancement of Medicine by Research was founded, with funds provided by a broad swathe of the British scientific community and a committee comprising the country’s most prominent medical scientists. Darwin, who died just before the inaugural meeting in 1882, contributed to its success with a gift of £100. The AAMR would effectively remove the stranglehold of legislation, persuading the Home Office to refer all applications for experimental licences to its committee. Licensing became the de facto remit of the very men who sought the licences. Successive governments willingly accepted this conflict of interest, fostering a massive expansion of laboratory-based medicine in the UK over the next decades. By 1913, under the auspices of the Medical Research Committee, the Crown was funding laboratory research to the tune of £57,000 annually. Public health policy had come to embrace the ethos of Simon’s vision for modern state medicine: a social, collective good, guided by experts, safeguarded by laboratory research.
Rob Boddice is a Senior Research Fellow at the Centre for the History of Experiences in Tampere, Finland.