What the philosophy of medicine is -- Philosophy of medicine: should it be teleologically or socially construed? -- The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions -- Humanistic basis of professional ethics -- The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic -- Medicine today: its identity, its role, and the role of physicians -- From medical ethics to a (...) moral philosophy of the professions -- Moral choice, the good of the patient, and the patient's good -- The four principles and the doctor-patient relationship: the need for a better linkage -- Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship -- Character, virtue, and self-interest in the ethics of the professions -- Toward a virtue-based normative ethics for the health professions -- The physician's conscience, conscience clauses, and religious belief: a Catholic perspective -- The most humane of the sciences, the most scientific of the humanities -- The humanities in medical education: entering the post-evangelical era -- Agape and ethics: some reflections on medical morals from a catholic christian perspective -- Bioethics at century's turn: can normative ethics be retrieved? -- Hippocratic tradition -- Toward an expanded medical ethics: the Hippocratic ethic revisited -- Medical ethics: entering the post-Hippocratic era. (shrink)
: Although the exclusion of LGBTs from the rites and rights of marriage is arbitrary and unjust, the legal institution of marriage is itself so riddled with injustice that it would be better to create alternative forms of durable intimate partnership that do not invoke the power of the state. Card's essay develops a case for this position, taking up an injustice sufficiently serious to constitute an evil: the sheltering of domestic violence.
What distinguishes evils from ordinary wrongs? Is hatred a necessarily evil? Are some evils unforgivable? Are there evils we should tolerate? What can make evils hard to recognize? Are evils inevitable? How can we best respond to and live with evils? Claudia Card offers a secular theory of evil that responds to these questions and more. Evils, according to her theory, have two fundamental components. One component is reasonably foreseeable intolerable harm -- harm that makes a life indecent and (...) impossible or that makes a death indecent. The other component is culpable wrongdoing. Atrocities, such as genocides, slavery, war rape, torture, and severe child abuse, are Card's paradigms because in them these key elements are writ large. Atrocities deserve more attention than secular philosophers have so far paid them. They are distinguished from ordinary wrongs not by the psychological states of evildoers but by the seriousness of the harm that is done. Evildoers need not be sadistic:they may simply be negligent or unscrupulous in pursuing their goals. Card's theory represents a compromise between classic utilitarian and stoic alternatives (including Kant's theory of radical evil). Utilitarians tend to reduce evils to their harms; Stoics tend to reduce evils to the wickedness of perpetrators: Card accepts neither reduction. She also responds to Nietzsche's challenges about the worth of the concept of evil, and she uses her theory to argue that evils are more important than merely unjust inequalities. She applies the theory in explorations of war rape and violence against intimates. She also takes up what Primo Levi called "the gray zone", where victims become complicit in perpetrating on others evils that threaten to engulf themselves. While most past accounts of evil have focused on perpetrators, Card begins instead from the position of the victims, but then considers more generally how to respond to -- and live with -- evils, as victims, as perpetrators, and as those who have become both. (shrink)
In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life (...) determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence (re-interpreted as beneficence-in-trust) to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient's values. In order to act in the patient's best interests, or the patient's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician-patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)
Commodification of health care is a central tenet of managed care as it functions in the United States. As a result, price, cost, quality, availability, and distribution of health care are increasingly left to the workings of the competitive marketplace. This essay examines the conceptual, ethical, and practical implications of commodification, particularly as it affects the healing relationship between health professionals and their patients. It concludes that health care is not a commodity, that treating it as such is deleterious to (...) the ethics of patient care, and that health is a human good that a good society has an obligation to protect from the market ethos. (shrink)
: The concept of a war on terrorism creates havoc with attempts to apply rules of war. For "terrorism" is not an agent. Nor is it clear what relationship to terrorism agents must have in order to be legitimate targets. Nor is it clear what kinds of terrorism count. Would a war on terrorism in the home be a justifiable response to domestic battering? If not, do similar objections apply to a war on public terrorism?
This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that (...) they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)
: Social death, central to the evil of genocide (whether the genocide is homicidal or primarily cultural), distinguishes genocide from other mass murders. Loss of social vitality is loss of identity and thereby of meaning for one's existence. Seeing social death at the center of genocide takes our focus off body counts and loss of individual talents, directing us instead to mourn losses of relationships that create community and give meaning to the development of talents.
The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific (...) to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)
Moral absolutes have little or no moral standing in our morally diverse modern society. Moral relativism is far more palatable for most ethicists and to the public at large. Yet, when pressed, every moral relativist will finally admit that there are some things which ought never be done. It is the rarest of moral relativists that will take rape, murder, theft, child sacrifice as morally neutral choices. In general ethics, the list of those things that must never be done will (...) vary from person to person. In clinical ethics, however, the nature of the physician–patient relationship is such that certain moral absolutes are essential to the attainment of the good of the patient – the end of the relationship itself. These are all derivatives of the first moral absolute of all morality: Do good and avoid evil. In the clinical encounter, this absolute entails several subsidiary absolutes – act for the good of the patient, do not kill, keep promises, protect the dignity of the patient, do not lie, avoid complicity with evil. Each absolute is intrinsic to the healing and helping ends of the clinical encounter. (shrink)
It has been claimed that most of the world’s preventable suffering and death are caused not by terrorism but by poverty. That claim, if true, could be hard to substantiate. For most terrorism is not publicly recognized as such, and it is far commoner than paradigms of the usual suspects suggest. Everyday lives under oppressive regimes, in racist environments, and of women, children, and elders everywhere who suffer violence in their homes offer instances of terrorisms that seldom capture public attention. (...) Or so this essay argues, through exploring two models of terrorism and the points of view highlighted by each. (shrink)
The article offers an approach to inquiry about, the foundation of medical ethics by addressing three areas of conceptual presupposition basic to medical ethical theory. First, medical ethics must presuppose a view about the nature of medicine. it is argued that the view required by a cogent medical morality entails that medicine be seen both as a healing relationship and as a practical art. Three ways in which medicine inherently involves values and valuation are presented as important, i.e., in being (...) aimed at the good of health, in being a cognitive art evaluating towards that good, and as a manifestation of a virtuous disposition concerning that good. Finally, a value ontology drawn from these considerations is seen as necessarily underlying medical ethics. A set of three such basic values are promoted as crucial: the value of health; the value of the individual patient; and the value of altruism that mediates the class of potential patients. (shrink)
For ten years, 1971–1981, the Institute onHuman Values in Medicine (IHVM) played a keyrole in the development of Bioethics as afield. We have written this history andanalysis to bring to new generations ofBioethicists information about the developmentof their field within both the humanitiesdisciplines and the health professions. Thepioneers in medical humanities and ethics cametogether with medical professionals in thedecade of the 1960s. By the 1980s Bioethics wasa fully recognized discipline. We show the rolethat IHVM programs played in defining thefield, training (...) faculty and helping schools todevelop programs. We review the beginnings ofthe IHVM in the crucible of social andtechnological change that led to theestablishment of the IHVM's parentorganization, the Society for Health and HumanValues. We then turn to the IHVM programsthrough which Faculty members receivedfellowships to explore new crossovers betweenthe humanities and the health professions. Wehave not only described the Fellows Program asit existed in 1973–1980, but have completed asurvey of the fellows a quarter of a centuryafter they held their fellowships. We describeother IHVM programs designed to facilitate theinitiation and development of new humanitiesprograms, to explore conceptual issues betweenmedicine and five humanities fields, to conductissue driven or educational method conferencesand to advance humanities programs intograduate education through the Directors ofMedical Education. (shrink)
: Margaret Walker's Moral Understandings offers an "expressive-collaborative," culturally situated, practice-based picture of morality, critical of a "theoretical-juridical" picture in most prefeminist moral philosophy since Henry Sidgwick. This essay compares her approach to ethics with that of John Rawls, another exemplar of the "theoretical-juridical" model, and asks how Walker's approach would apply to several ethical issues, including interaction with (other) animals, social reform and revolution, and basic human rights.
Most of the attention regarding the balance between autonomy and paternalism has been focused on the therapeutic relation. Much less attention has been devoted to the problem of autonomy in the application of medical knowledge for preventive purposes. Here, because the good to be achieved is social as well as individual, an unavoidable dilemma ensues. Effective preventive measures of benefit to all must necessarily limit autonomy and involve some coercion. I argue that there are principles which can be established to (...) guide society in a moral use of coercion. The question of employing medical knowledge is not, as it is in therapeutic medicine, to preserve or enhance autonomy. Rather its aim is to enhance voluntary co-operation. Principles for moral use of coercion must thereby be derived from health as a moral value. (shrink)
: Managed care per se is a morally neutral concept; however, as practiced today, it raises serious ethical issues at the clinical, managerial, and social levels. This essay focuses on the ethical issues that arise at the bedside, looking first at the ethical conflicts faced by the physician who is charged with responsibility for care of the patient and then turning to the way in which managed care exacts costs that are measured not in dollars but in compromises in the (...) caring dimensions of the patient-physician relationship. (shrink)
Elizabeth Anderson claims that states of affairs are merely extrinsically valuable, since we value them only in virtue of the intrinsically valuable (e.g.) persons in those states of affairs. Since it considers states of affairs to be the sole bearers of intrinsic value, Anderson argues that consequentialism is incoherent because it attempts to globally maximize extrinsic value. I respond to this objection by distinguishing between two forms of consequentialist teleology and arguing that Anderson''s claim is either harmless or her argument (...) for the claim is uncompelling. On the first conception of teleology, consequentialists need not hold that states of affairs are the sole bearers of intrinsic value, which allows them to deflect this criticism. On the second account of teleology, even assuming that states of affairs are the sole bearers of intrinsic value, Anderson''s argument does not necessarily defeat such views. (shrink)
Actions within organizational contexts should be understood differently as compared with actions performed outside of such contexts. This is the case due to the agentic shift, as discussed by social psychologist Stanley Milgram, and the role that systemic factors play in shaping the available alternatives from which individuals acting within institutions choose. The analysis stemming from Milgram’s experiments suggests not simply that individuals temporarily abdicate their moral agency on occasion, but that there is an erosion of agency within organizations. The (...) point about the erosion of agency is deepened in the discussion of a case study which illustrates the difficulty of identifying even the bare “ownership” of actions within organizations. While this is the case, explicating these reasons suggests that both individual actors and firms can bear ethical responsibility within organizational contexts. As part of the effort to present the whole picture, business ethics courses should introduce students to the relevant insights from social psychology and human factors research. (shrink)
A rational justification for therapeutic decisions can be developed using probability and decision theory. The set of treatments and their outcomes or consequences, which are states of health, have to be defined; and estimates made of the probabilities of outcomes, their utilities, and the costs of treatments. Most difficult is the estimation of utilities of states of health but this may be possible using a wagering technique. Until it is possible to establish some equivalence between utility and money, costs may (...) be introduced by measuring the efficiency of treatment by comparing expected utilities per unit cost. The whole method is examined practically in a plausible clinical setting. Emphasis is laid on the value of testing the completed model using a computer to get an intimate feel of the problem using different assumptions and different values for all the parameters. (shrink)
In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)
At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. (...) The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arriveâtogether with the physicianâat a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. (shrink)
This essay argues that current advocacy of lesbian and gay rights to legal marriage and parenthood insufficiently criticizes both marriage and motherhood as they are currently practiced and structured by Northern legal institutions. Instead we would do better not to let the State define our intimate unions and parenting would be improved if the power presently concentrated in the hands of one or two guardians were diluted and distributed through an appropriately concerned community.
Torture is like slavery (and unlike murder and genocide) in that it is not inconceivable that torture might be justifiable. But the circumstances that would make it tolerable are unrealistic in philosophically interesting ways. It is unrealistic to think we can predict when torture will be effective and containable; unwarranted to suppose that humane alternatives are impossible; disastrous to remove motivations to create alternatives; unacceptable to be satisfied with available evidence regarding suspectsâ identity, knowledge of critical detail, ability to recall (...) it, or reasons for not providing it. Most importantly, the costs of even successful interrogational torture would negate the gains sought. Or so this essay argues. (shrink)
Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at (...) hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)
Martha Nussbaum's work has been characterized by a sustained critique of Stoic ethics, insofar as that ethics denies the validity and importance of our valuing things that elude our control. This essay explores the idea that the very possibility of morality, understood as social or interpersonal ethics, presupposes that we do value such things. If my argument is right, Stoic ethics is unable to recognize the validity of morality (so understood) but can at most acknowledge duties to oneself. A further (...) implication is that moral luck, so far from undermining morality as some have held, is presupposed by the very possibility of morality. (shrink)
This essay reflects on issues raised by commentators regarding my book, The Atrocity Paradigm: A Theory of Evil (Oxford 2002). They are (1) Robin Schott's observation of the tension between my discussion of forgiveness and of castration fantasies; (2) Bat-Ami Bar On's questions regarding whether evil is ethical, political, or both; (3) Adam Morton's queries regarding the relative seriousness of evils and injustices; and (4) María Pía Lara's concerns regarding what is valuable in Kant's ethics.
This essay examines how rape of women and girls by male soldiers works as a martial weapon. Continuities with other torture and terrorism and with civilian rape are suggested. The inadequacy of past philosophical treatments of the enslavement of war captives is briefly discussed. Social strategies are suggested for responding and a concluding fantasy offered, not entirely social, of a strategy to change the meanings of rape to undermine its use as a martial weapon.
Gray zones, which develop wherever oppression is severe and lasting, are inhabited by victims of evil who become complicit in perpetrating on others the evils that threaten to engulf themselves. Women, who have inhabited many gray zones, present challenges for feminist theorists, who have long struggled with how resistance is possible under coercive institutions. Building on Primo Levi's reflections on the gray zone in Nazi death camps and ghettos, this essay argues that resistance is sometimes possible, although outsiders are rarely, (...) if ever, in a position to judge when. It also raises questions about the adequacy of ordinary moral concepts to mark the distinctions that would be helpful for thinking about how to respond in a gray zone. (shrink)
Simone de Beauvoir was a philosopher and writer of notable range and influence whose work is central to feminist theory, French existentialism, and contemporary moral and social philosophy. The essays in this volume examine all the major aspects of her thought, including her views on issues such as the role of biology, sexuality and sexual difference, and evil, the influence on her work of Heidegger, Sartre, Merleau-Ponty, Husserl, and others, and the philosophical significance of her memoirs and fiction. New readers (...) and nonspecialists will find this the most convenient and accessible guide to Beauvoir currently available. Advanced students and specialists will find a conspectus of recent developments in the interpretation of Beauvoir. (shrink)
Machine generated contents note: Part I. The Concept of Evil: 1. Inexcusable wrongs; 2. Between good and evil; 3. Complicity in structural evils; 4. To whom (or to what?) can evils be done?; Part II. Terrorism, Torture, Genocide: 5. Counterterrorism; 6. Low-profile terrorism; 7. Conscientious torture?; 8. Ordinary torture; 9. Genocide is social death; 10. Genocide by forced impregnation; Bibliography; Filmography; Websites; Index.
Marilyn Frye's first book, The Politics of Reality: Essays in Feminist Theory, presents nine philosophical lectures: four on women's subordination, four on resistance and rebellion, one on revolution. Its approach combines a lesbian perspective with analytical philosophy of language. The major contributions of the book are its analysis of oppression, highly suggestive discussions of the roles of attention in knowledge and ignorance and in arrogance and love, a defense of political separatism not based on female supremacism, and a development of (...) the idea of lesbian epistemology. Its proposal for resisting White racism will be controversial. Its treatment of gay rights is not balanced by an acknowledgement that drag queens, like "totaled women," are products of oppression, not simply of intolerance. The most philosophically problematic aspect of the book is its analysis of coercion and of the roles of coercion in women's subordination. This creates an unresolved tension with the positive message of the second half of the book. Despite this difficulty, these essays are an outstanding contribution to contemporary feminist theory. (shrink)
A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.
Nel Noddings, in Caring: A Feminine Approach to Ethics and Moral Education (1984), presents and develops an ethic of care as an alternative to an ethic that treats justice as a basic concept. I argue that this care ethic is unable to give an adequate account of ethical relationships between strangers and that it is also in danger of valorizing relationships in which carers are seriously abused.
Learning about martial sex crimes against men has made me rethink some of my ideas about rape as a weapon of war and how to respond to it. Such crimes can be as racist as they are sexist and, in the case of male victims, may be quite simply racist.
Particularism denies that invariant valence is always possible and that it is needed in sound moral theorising. It relies on variabilism, namely the idea that the relevant features of a given situation can alter their moral valence even across seemingly similar cases. An alternative model is defended (the “disappearing model”), in which changes in the overall relevance of complex cases are explained by re-individuation of the constituent features: certain features do not alter their relevance in consequence of contextual changes, but (...) rather they disappear, either because they are embedded within larger complexes or are substituted by different features. This view is shown to be compatible with the main premises of variabilism and explanatorily superior to it. Nevertheless, it does not involve particularism, but rather a peculiar form of generalism. (shrink)
This review essay on Janice Raymond's A Passion for Friends, sympathetic to the author's inquiry into the institutional contexts of female friendship, criticizes as unnecessary its rejection of feminist separatism and of the "lesbian continuum" and formulates a possible connection of its account of sources of passionate friendship among women to the new research on women and violence.