This paper offers a critical review of William F. May's chapter "Code and Covenant or Philanthropy and Contract?" in which May examines accountability within the medical profession. The review summarizes May's analysis of the Hippocratic Oath's competing obligations, the limitations of philanthropic and contractual models of care, and his proposal for an expanded covenantal relationship between doctors and the public. The reviewer engages personally with May's arguments, largely agreeing with his conclusions while offering measured critiques of his characterization of the code of ethics and the practical challenges of implementing a new professional paradigm.
This paper demonstrates evaluative summarization: the writer does not merely restate May's chapter but actively assesses each concept (code, philanthropy, contract, covenant) on its merits, noting both strengths and weaknesses. The reviewer also practices intellectual honesty by separating persuasion by writing style from persuasion by argument, acknowledging May's "seductive style" as a possible source of agreement rather than treating every point as self-evidently correct.
The paper opens with a brief orientation to May's chapter and its central concern — medical accountability. It then works through May's key concepts in the order they appear in the source text, devoting a paragraph to each. A transitional section addresses the reviewer's overall agreement before introducing specific reservations. The paper closes with a brief personal synthesis that connects the reviewer's own experiences to May's covenantal solution, ending on a cautiously optimistic note about professional reform.
In his chapter entitled "Code and Covenant or Philanthropy and Contract?" William F. May considers the concepts named in the title within the context of the medical profession and its accountability — or lack thereof. In this process, May highlights the fact that the medical profession tends to be largely unaccountable for its often serious errors. This is both to the immediate detriment of the patient and to the indirect disadvantage of the profession in terms of reputation and public trust. The chapter is devoted to seeking reasons for this tendency, as well as a remedy by means of paradigm shifts in the doctor-patient relationship.
The chapter is structured clearly, with each concept thoroughly explained in relation to the medical profession. It begins with an introduction that explicates the problem of accountability. May appears to blame the concepts inherent in the Hippocratic Oath, and the way they are interpreted by the modern medical mind, for the current situation. According to May, the concepts of code and covenant — and how they relate to the medical profession and patients respectively — are specifically at fault.
May notes that the Hippocratic Oath requires three obligations from the medical professional, two of which appear to be in conflict with each other. These include the obligation to the patient, the obligation among doctors and their instructors, and the obligation of the doctor toward divinity. The latter is largely irrelevant to the problem addressed in the chapter. Code and covenant are related to the relationship between doctors and patients, and between doctors and their instructors, respectively.
"Code" refers to the code of ethics that doctors are required to follow in their relationship with patients. This entails a rather one-sided relationship in which the doctor is obliged to provide patients with a particular standard of care according to a defined set of rules. However, the doctor also often feels compelled to act protectively toward fellow medical professionals — a dynamic that falls into the "covenant" category. Originally, the covenant exists between the doctor and his or her instructors, to whom the medical professional is beholden for knowledge. This translates into the interrelationship among members of what May calls the medical "guild."
While not inherently problematic, the guild covenant becomes an issue when doctors become incompetent or negligent. In such cases, doctors who observe incompetence feel more obliged to protect the colleagues involved than to protect the patients who may be harmed. The reason lies in the difference in the relationships required by the covenant and by the code of ethics. The former carries greater force than the latter, leaving patients regularly disadvantaged as a result.
May notes that, in order to remedy the lower priority given to the code, philanthropy has been introduced into the doctor-patient relationship. He is, however, highly critical of this concept, arguing that it implies a condescending attitude on the part of the medical professional. The term suggests that the patient has no autonomy as a human being once he or she enters the doctor's office. Under this model, the patient is the recipient of selfless charity, while the doctor is the noble actor in the relationship. This also leaves the patient with no recourse should the doctor act harmfully or unethically. Furthermore, it places the doctor in a godlike position of authority over the patient, with little compelling the professional to adhere to either the code of ethics or any meaningful standard of philanthropic conduct. For a broader discussion of medical ethics frameworks, including the tension between paternalism and patient autonomy, the Wikipedia overview provides useful context.
You’re 44% through this paper. Sign up to read the remaining 3 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.