Medical ethics in Ottoman Constantinople was a daily practice, not a formal code, study finds

Medical ethics in the nineteenth century is often told through formal codes of conduct or read backwards through concepts invented by twentieth-century bioethics. A new study in BMC Medical Ethics takes a different route, examining how duties, the limits of professional authority, and responsibilities toward patients, colleagues, the public, and state institutions were actually articulated within one specific professional milieu: the French-language Gazette médicale d’Orient and its associated Société in Constantinople between 1857 and 1876.

The research, conducted by Rifat Vedat Yıldırım, used a structured historical qualitative content analysis of digitized issues and annual volumes of the journal. Candidate texts were screened for sustained actor-level normative reasoning rather than for what might simply look ethically salient to modern eyes. Only records classified as E2, meaning substantial embedded normative reasoning, or E3, meaning explicit sustained ethical or deontological argument, entered the analytical corpus.

Included publication units were then coded into nine primary themes and five source-origin categories, with serial and duplicate reconciliation, source-coverage auditing, and repeated boundary review built into the process. The result was an analytical corpus of 251 verified units, of which 118 were E3 records and 133 were E2 records.

The largest primary category was professional identity, deontology, and self-regulation, accounting for 109 of the 251 units. It was followed by public-health governance and regulation, with 58 units. The remaining verified units were distributed across assistance and social obligation, medico-legal and expert responsibility, therapeutic responsibility, duties concerning the scientific record and publication, mental-health and institutional authority, patient and family decision-making, and professional secrecy.

The study is careful about what its numbers can and cannot show. Because source coverage is uneven across the period, the author explicitly does not interpret differences in the numbers recovered from the three descriptive intervals as temporal increases or decreases in ethical discussion. The counts describe what survives in the record, not a trend over time.

Across the available material, the study concludes that within the Gazette–Société milieu, medical ethics appeared as an embedded normative practice rather than a discrete specialty. Professional authority was articulated through historically specific languages of duty, dignity, conscience, morality, humanity, honour, and responsibility, deployed in professional, clinical, sanitary, forensic, humanitarian, and communicative settings.

That framing matters for how the findings should be read. The author states that these findings characterize a particular institutional and linguistic professional arena and are not presented as representative of medical ethics throughout the Ottoman Empire. The Gazette médicale d’Orient was a French-language publication, and its readership and contributors formed a specific professional community in Constantinople, so the corpus reflects that arena rather than the empire as a whole.

The methodological contribution lies in the screening and coding design itself. By requiring sustained normative reasoning from identifiable actors, and by auditing source coverage and reconciling duplicates across serial publication, the study aims to distinguish genuine ethical argument from incidental moral language. The nine-theme coding scheme offers a structured map of where nineteenth-century professional ethical concern concentrated in this milieu, from self-regulation and sanitary governance to secrecy and the duties owed to the scientific record.

Published on 22 October 2026 as an open-access research article in BMC Medical Ethics, the paper is currently shared ahead of final production, subject to further edits before the Version of Record replaces it.

Subject of Research: A historical qualitative content analysis of ethical reasoning in a French-language medical journal and professional society in nineteenth-century Constantinople.

Article Title: Professional duty, public responsibility, and expert judgment in Ottoman Constantinople: the Gazette médicale d’Orient, 1857–1876

Article References: Yıldırım, R. V. (2026). Professional duty, public responsibility, and expert judgment in Ottoman Constantinople: the Gazette médicale d’Orient, 1857–1876. BMC Medical Ethics. https://doi.org/10.1186/s12910-026-01641-x

Image Credits: AI Generated

DOI: 10.1186/s12910-026-01641-x

Keywords: medical ethics, history of medicine, Ottoman Empire, Constantinople, Gazette médicale d'Orient, professional deontology, public health governance, content analysis, nineteenth century, bioethics history, Professional, duty