The book offers an introduction to the moral concepts and value of health care. It is written by a moral philosopher, a doctor and a nurse and contains questions, cases and exercises which are suitable for medical, nursing and all students and commentators on health care. Moral dilemmas include consent, confidentiality, the giving or withholding of information, and the economics of health care. The issues of artificial reproduction, terminal care and the research and testing of drugs are addressed.
The treatment decisions of competent adults, especially treatment refusals, are generally respected. In the case of minors something turns on their age, and older minors ought increasingly to make their own decisions. On the other hand, parents decide on behalf of infants and young children. Their right to do so can best be justified in terms of the importance of preserving intimate family relationships, rather than in terms of the child's best interests, although the child's best interests will most often (...) follow from this arrangement. Nevertheless, there are and ought to be legal, ethical, and financial constraints on parental decision making. (shrink)
In his paper ‘Collective Responsibility’ Mr. D. E. Cooper argues for the thesis that collectives can be held responsible in a sense not reducible to the individual responsibility of the members of the collective. And he uses this conclusion to support views of individual responsibility and of blame and punishment which he wishes to assert independently. Is hall argue that although there is a sense in which the actions and responsibility of a collective cannot be analysed in terms of the (...) actions and responsibilities of the individual persons who compose the collective, it is not moral responsibility which is involved. I shall then maintain that Cooper's account of collective responsibility does not support his account of individual responsibility; and that his account of individual responsibility is in any case false, if he means moral responsiblity. (shrink)
There are various ways in which medicine and literature interact, but this paper concentrates on the contribution which literature can make to 'whole person understanding'. Scientific understanding is concerned with seeing events and actions in terms of patterns or similarities. But 'whole person understanding' is concerned with uniqueness or with what it is for a given person to have an illness. Literature can in various ways develop this kind of understanding.
Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)
Supererogation can be distinguished from altruism, in that the former is located in the category of duty but exceeds the strict requirements of duty, whereas altruism belongs to a different moral category from duty. It follows that doctors do not act altruistically in their professional roles. Individual doctors may sometimes show supererogation, but supererogation is not a necessary feature of the medical profession. The aim of medicine is to act in the best interests of patients. This aim involves neither supererogation (...) nor even the moral quality of beneficence. It is simply a job description. Morality enters medicine through the quality of the individual doctor's work, not by the definition of that work. (shrink)
The concept of moral responsibility has many applications. We speak, for example, of a person's responsibilities, and mean his professional or domestic commitments. In this sense a person can be said to have too many responsibilities, or none at all, and he can be said to be responsible to or for another person. Again, we can speak of the person himself as being responsible or irresponsible, and mean that he is conscientious and trustworthy in the performance of his duties or (...) that he has a sense of responsibility. Finally, we can speak of a person as accepting responsibility for an action or another person. A thorough analysis of these complexities of usage would require the investigation of a number of background concepts, but in this paper I have the more limited object of classifying some of the usages. I propose to do this by constructing three analytical models based on the concept of a social role. (shrink)
Stephen Pattison outlines his vision for medical humanities and then offers cautionary notes on what might go wrong with the movement. These notes are based on what he holds has already gone wrong with medical ethics, dramatically described as the “death course of a discipline”. I have a great deal of sympathy both with his anxieties about the future development of medical humanities and with his critique of medical ethics. My reasons in both cases are a little different from his, (...) and indeed part of his vision for medical humanities constitutes part of my worries about its future! I shall begin with some comments on Pattison’s views on medical humanities, and then more briefly comment on his diagnosis of the ills of medical ethics. (shrink)
The difficulties of establishing a definition of torture are discussed, and a definition is suggested. It is then argued that, irrespective of general ethical questions, doctors in particular should never be involved because of their social role.
It is often said that human beings have the ability to plan and choose what to do, can think for themselves and have the freedom and the right to form their own opinions on moral questions. Such claims are sometimes expressed by saying that the human agent is autonomous. In this paper we shall try to disentangle various theses about the autonomy of the agent which the common claims do not always distinguish.
The aim of the article is to distinguish for a medical readership different senses of and connections between the words 'ethics', 'morals', and 'moral philosophy'. 'ethics' and 'morals' can be used as synonyms to refer to first order morality; they can be used to distinguish different areas within morality; 'professional ethics' can be a specialized form of first order morality; or it can refer to codified procedures; 'ethics' can be a synonym for moral philosophy, which is the study of first-order (...) morality. (shrink)
Critiquing many areas of medical practice and research whilst making constructive suggestions about medical education, this book extends the scope of medical ethics beyond sole concern with regulation. Illustrating some humanistic ways of understanding patients, this volume explores the connections between medical ethics, healthcare and subjects, such as philosophy, literature, creative writing and medical history and how they can affect the attitudes of doctors towards patients and the perceptions of medicine, health and disease which have become part of contemporary culture. (...) The authors examine a range of ideas in medical practice and research, including: the idea that patient status or the doctor/patient relationship can be understood via quantitative scales the illusion fostered by medical ethics that doctors, unlike those in other professions, are uniquely beneficent and indeed altruistic. An excellent text for undergraduate and postgraduate students of law, medical ethics and medical healthcare law, Bioethics and the Humanities shows the real ethical achievements, problems and half-truths of contemporary medicine. (shrink)
This paper examines the ethicalproblems that arise when research is carriedout after autopsy on dead infants. It comparesthe right of parents against that of the publicinterest in matters of research on dead minors. The basis for the respect that is widelyaccorded to the body of a dead person isexamined and is shown to ground the parentalinterest. A discussion of the nature of thefamily suggests that `informed consent' is notthe best term to apply to the process ofparental consultation. Some reasons areprovided (...) against using this term in the contextin which bereaved parents are consulted aboutautopsy and research on their dead infants. Itis suggested that a term such as `authorize'might better apply to this situation. (shrink)