William Osler’s lasting influence on medical ethics

Originally posted on the BMJ Opinion

By Daniel Sokol

One hundred years ago, on 29 December 1919, Sir William Osler died in Oxford from a haemorrhage following an operation to treat his empyema. He was 70. In his obituary of Osler in the New York Evening Post two days later, the celebrated haematologist Richard Cabot wrote: “I doubt if any single man has ever so deeply influenced any other profession.” The Royal Society of Medicine is currently putting on an exhibition in memory of Osler, described in the programme as the “father of modern medicine.”

Since his death, dozens of books and thousands of articles have been written on Osler and his impact on many facets of medicine, from pathology to infectious diseases. This widespread influence is not surprising; Osler was one of the last “super generalist” doctors, having single handedly written the leading medical textbook The Principles and Practice of Medicine in 1892.

He certainly was no medical ethicist in the modern sense and once observed that he was “neither a philosopher nor the son of a philosopher.” Yet, his influence on the ethical standards of frontline doctors is likely to have been profound. You will still find doctors who will tell you how Osler’s writings played a role in their professional development.

However, based on my experience of teaching medical students and doctors, the ripples of his influence are fading. Mention Osler to a young medical audience today and you are likely to hear about Osler’s nodes, those lesions that suggest a bacterial infection of the heart. The average age of members of the Osler Clubs and Societies of the world probably exceeds 60.

In 2007, I wrote provocatively in The BMJ:

I have long held the dangerous belief that William Osler’s essays, judiciously used, could render teachers of medical ethics redundant.  Virtually all the medical student needs for ethical behaviour is contained within them.”

Osler has had a lasting impact on my development as a medical ethicist and, later, as a lawyer. His encouragement to treat patients with infinite patience and without judgement, to stand up for principle and justice, to apply the Golden Rule of Humanity (“what you do not like when done to yourself, do not do to others”) and not to let “the ceaseless panorama of suffering dull that fine edge of sympathy with which we started” still rings true to modern ears. So too his emphasis on hard work, heeding the lessons of experience, and cultivating the heart just as much as the head. I try to apply those lessons—with variable success—in my own practice.

Only last month, when representing a doctor who had acted benevolently towards a patient but in breach of guidelines, a line from Osler came to mind: “I have made mistakes, but they have been mistakes of the head not of the heart.”

My client erred but it was a mistake of the head. Those are generally more amenable to correction than mistakes of the heart.

Osler’s influence on medical ethics, from 1919 to 2019, is unclear. To my knowledge, no book has been published on the subject. While medicine has changed enormously in the last century, and so too the context in which it is practised, I am convinced that much of Osler’s writing, life, and work remains of value to the ethical and humane practice of medicine today.

If unfamiliar with Osler, do consider a visit to the RSM’s exhibition in London (open until 1st February 2020) or Osler’s former home at 13 Norham Gardens in Oxford, read the excellent biography by Michael Bliss (“William Osler: A Life in Medicine”) and start with Osler’s essays with annotations by the Japanese Oslerians Dr Hinoara and Professor Niki.

Daniel Sokol is a medical ethicist and barrister at 12 King’s Bench Walk.  He is a former Council Member of the Osler Club of London and the author of ‘Tough Choices: Stories from the Front Line of Medical Ethics’.

Competing interests: None declared.

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