Abstract
The introduction of the modern diagnostic and therapeutic procedures to the medical practice provided a new challenge for the medicine. The art of medicine, with its default purpose of acting for the benefit of health, is therefore required to derive from technological progress effectively and rationally. As a result, the medical ethics has been engaged with the rules of economy and management of deficit medical procedures as well as their rational and fair distribution. The above suggests, that medics, given these recourses, should approach each patient with a consideration to their therapeutic rights. However, the physicians cannot just concentrate on the good of one particular patient, but must take into account joint responsibility for the good of a potential patient. This makes medical ethical dilemmas similar to the ethical issues of business. The notion of responsibility is the key for discriminating these two kinds of ethics.
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Notes
This is also basically the way that one can interpret T.L. Beauchamp and J.F. Childress’ ethics of “Four Principles” defined in Principles of Biomedical Ethics, as the principle of respect for the patient’s autonomy and the principle of justice can be regarded as a means to interpret the two canonical principles of medicine with Hippocratic provenance—the principle of beneficence (doing good) and the principle of non-maleficence (doing no harm).
The contradiction between these two interests along with the lack of transparency that it is often accompanied by, are the most common reasons for pathologies in medical ethics concerning the health care system and in consequence medicine as such. On this subject see de Ville (1999).
See Aristotle, Nicomachean Ethics, 1097a 12.
Heidegger attempts to express this “hermeneutic character” of the man by such terms as: In-der-Welt-sein, Mitsein, Etwurf, Stimmung, Befindlichkeit, etc.
An interesting proposal to create such therapeutic unity is presented by Hilda Lindemann Nelson, who refers to the assumptions of feminist ethics (Lindemann Nelson 1999).
Tragic events which took place in European societies in the twentieth century clearly show that responsibility cannot be now measured by faithfulness to even most noble ideas, as these ideas can easily be transformed by clever ideologists into felonoius ideologies. The motto of moral revival can develop into advocating racial purity and as a result into a call for ethnic purges, which in extreme cases can lead to the extermination of whole nations. The real responsibility is born from the face to face contact with another human being, and more specifically from standing up to his difference, but not in order to abolish it, but declare its right to exist (Levinas 1979, pp. 218–219).
Ethical interpretation of reality requires analytical-synthetic transformation of science into a reflection of a theological character (Pfafferott 1981, p. 81).
Moral character of an individual does not mean, however, variability of ethical competence of an individual, the degree of his ethical sensitivity, or in general mental readiness to make ethically important decisions, but his individual axiological preferences, i.e. characteristic for a given individual hierarchic system of desirable values, which fit into the canon of generally acceptable values. The problems of ethical character as crossing over the sphere of natural life are dealt with in, among others (Bollnow 1956, pp. 141–142).
The problem lies not so much in the lack of firm ethical principles forced by special conditions. The above example in fact points to a somehow natural drive of ethics, which turns towards reality, towards relativist solutions. Ethics which teaches respect for the reality cannot simply ignore it to remain faithful to doctrinal assumptions. However, ethics does not advocate killing as a recommended behaviour. Death is still evil, which cannot be postulated in the realm of ethics. It is a pestilence which intrudes into its territory. It may be, and should be, fighted, but must also take its heavy toll. It is, thus, a necessity, which cannot be prevented by ethics, as its weapon is persuasion.
When responsibility is interpreted as individual sense of responsibility, which ignors the necessity of being involved in joint responsibility, ethical commitment is usually only a facade demonstration of following the “values”, or taking responsibility for principles, and not people. In business it means realisation of some economical project, which takes into consideration economical needs, and treats the participants in the programme instrumentally. Such activities, not supported by those who are necessary to its fulfillment (i.e. employees who do not identify with the plans of their employer) often are a failure. In business it usually concerns the idea of economical growth, or on a lesser scale the growth of a company, and thus actions theoretically just, but practically not, if their realisation requires for example drastic decrease of the living standards of the society or employees. It is clear that success of such actions depends on the degree of social identification with the aims, and thus on joint responsibility for these actions on the side of the majority of participants. The situation in therapy is similar. In particular this concerns treatment connected with high risk. Success of such therapy to a great extent depends on, as medical practice shows, the degree of involvement of the patient in the therapeutic process, on the degree to which he can take part of responsibility for his treatment (Scheler 1973, p. 136).
The so called critical ethical reflection tries to solve this difficulty by the so called bridging principles (Brucken-prinzipien) (Albert 1980, pp. 76 –79).
The above phrase suggests that dehumaninsing tendences are currently prevailing. It seems that this trend is inevitably connected with it. A good sign is that the famous “inhumanity” allows on one hand humanitarian actions on a scale not heard of before—a kind of international cooperation and help in fighting the cataclysms caused by natural elements.
Traditionally, this principle obliges the doctor to use all available means to save the life of the patient and his health. For more information on these limitations in medicine (Gillon 1986, pp. 73–74).
The term internal morality fits well with the personalistic attitude of medical ethics, for which the central idea determining the character of problems it deals with, as has been stated above, is the relation doctor–patient.
A separate and controversial issue is classification of these rights into rights-based and claims-based. For more on this differentiation (Bandman and Bandman, 1978, pp. 35–43).
This topic is discussed by Epstein (1999).
L.R. Churchill is trying to describe the essence of this relationship as follows: “Doctors can best embark upon therapeutic encounters with patients, it seems to me, not by making the relationship with their patients central, but by making their patients and their patients’ needs central.” L.R. Churchill 1997, p. 115.
Boorse presents health in the correlation with the illness. He defines the illness as functional (physiological-anatomical) nonsatisfiability of the patient to meet the basic conditions of a normal, i.e. statistically defined, biological existence of a particular population. Lt. Ch. Boorse, On the Distingtions between Disease and Illness, (1999, p. 18).
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Kwiatkowski, W. Medicine and technology. Remarks on the notion of responsibility in the technology-assisted health care. Med Health Care and Philos 21, 197–205 (2018). https://doi.org/10.1007/s11019-017-9788-8
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DOI: https://doi.org/10.1007/s11019-017-9788-8