PubMed · 5328362
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A Meyer. Karl Friedrich Burdach on Thomas Willis.. https://doi.org/10.1016/0022-510x(66)90054-2
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A few years before the death of Queen Elizabeth I, a booklet entitled Work for Chimny-Sweepers or A Warning for Tabacconists [sic], was published. Written by a doctor who called himself Philaretes, it was the first publication to present the health risks of tobacco use. Using continuum content analysis, which follows each of Philaretes's main messages over the subsequent four centuries, this paper sets his publication in the historical context of the medical and social frame of reference in which it was produced, and charts the development of each theme in later scientific research. In the setting of contemporary Tudor medical theory, based on 'the humours', Philaretes discussed many of the health risks that later research has proven to be true. In common with many early attempts at health education, the principles of Philaretes's approach appear to be what were later to be called the Health Belief Model and the KAP formula. By providing information about serious personal health risks and, thus, increasing the readers' knowledge, he hoped to change their attitude and consequently their behaviour. Overshadowed by King James I's much less scientific Counterblaste to Tobacco, Philaretes's publication deserves more credit than it has been given.
BACKGROUND AND PURPOSE: Informed consent, especially in oncology, is predominantly seen from a legal point of view. Such a limited perspective runs the risk of reducing informed consent to some tiresome formalism. The present article highlights how the relationship between patient and physician might be enriched by a comprehensive historicocultural understanding of informed consent. The authors show in which future directions the practice of informed consent might develop. MATERIAL AND METHODS: Analysis of historical and forensic literature regarding informed consent. RESULTS: With the terms "information" and "consent" the last 2500 years of medical history can schematically be divided in three epochs: the first epoch started around 500 years BC, lasted until the 19th century AC and was dominated by the principle of "salus aegroti suprema lex". The patient's benefit was exclusively defined by the treating physician. Formal consent was not required in those times. The era of enlightment brought new ideas to Europe, especially the principle of individual autonomy. In 1894, the Supreme Court of the German Reich decided that any medical intervention without the patient's consent was regarded as physical injury and was thus illegal. Systematic requirements regarding patient information on planned medical interventions were not known. The beginning of the third epoch is marked by the introduction of the term "informed consent" in modern medicine in 1957. Since then, a comprehensive information of the patient is seen as a prerequisite for consent. The patient's right of self-determination is attributed a higher legal and moral value than the physician's concept of the proposed treatment. Nowadays, the debate regarding informed consent is dominated by the continuing differentiation of modern medicine, the development of medical practice as part of the service sector, and the changing ways how patients see themselves. CONCLUSIONS: Social and legal developments have strongly influenced medical practice in the past. The importance of informed consent will continue to rise in the future, while the emphasis of the physician's task will shift from information to counseling. Informed consent will be increasingly established as independent service.
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