Questo saggio ha come oggetto di riflessione i conflitti ambientali, i nuovi soggetti politici che ne sono protagonisti e le visioni collettive che paiono centrarsi in maniera inedita sulla cattiva gestione delle risorse locali e sui conseguenti rischi per la salute pubblica. Nuovi soggetti politici appunto che operano l'articolazione fra discorsi scientifici e discorsi politici. A partire da alcuni casi di studio l'articolo conduce una breve analisi sulle forme argomentative adottate da questi gruppi, sulle modalitÀ di intendere il rapporto con (...) le istituzioni democratiche e con la scienza, sui processi interni di leadership e sull'idea di ‘rivolta' da condurre. (shrink)

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)

This Handbook offers a broad yet unified treatment of many philosophical issues connected with climate change, ranging from foundational puzzles to detailed applications. It extends to many branches of philosophy that are relevant to the understanding of the premises and implications of the impacts of climate change on human and nonhuman life on Earth. More specifically, the handbook examines the scientific accounts of climate change as well as its causes. It explores the tools offered by social sciences and humanities to (...) study the societal premises and impacts of climate change as well as delving deeper into the ethical and political issues connected with and resulting from climate change. By doing so, it puts it all in an ecological and historical context. In addition, the book offers solutions to some important philosophical puzzles and problems, and indicates paths of interaction between philosophy and other disciplines. The discussion about climate change and the mitigation/adaptation policies spans many areas and levels – from abstract science and philosophy to current on-the-ground politics. However, climate change is also a great a philosophical puzzle. Indeed, its existential and practical relevance can be thought to largely derive from the philosophical complications it engenders. Climate change is applied philosophy par excellence. Preventing dangerous anthropogenic climate change needs very good philosophy applied to concrete and specific practical issues. Climate change is an area where scholars from very different provenances should cooperate on equal terms, having in view a common, and really important, purpose – contribute to preventing great burdens and even the extinction of humankind and the destruction of hospitable and valuable non-human nature. (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 arrive—together with the physician—at 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)

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 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)

In lieu of an abstract, here is a brief excerpt of the content:President’s Council on BioethicsEdmund D. Pellegrino (bio) and F. Daniel Davis (bio)Approximately two weeks before what was to have been its final meeting, the White House dissolved the President’s Council on Bioethics by terminating the appointments of its 18 members. The letters of dismissal, dated 10 June 2009, informed the members that their service on the Council would end with the close of business the next day.The Council’s (...) term was set to expire on 30 September 2009. After President Obama’s election in November and during the transition, we were advised to proceed on the assumption that the Council would be permitted to cease on that date. Reasons for the abrupt move to disband the Council are unknown. We have accepted the fact that we Council members served at the pleasure of the President and that he simply exercised his rightful prerogative. No explanation is therefore required.Some observers have speculated that the action was retaliatory. They related to the fact that several members of the Council disagreed with the President’s stem cell policy in a signed statement published in the Hastings Center’s Bioethics Forum. Others have speculated that the move was pre-emptive. At its final meeting, scheduled for 25–26 June, the Council was set to sign-off on two of its final publications. One was a comprehensive report on the ethics of organ transplantation, and the other a white paper entitled Health Care and the Common Good. The aim was immediately to release the latter as a contribution to the intensifying debate about health care reform. Health Care and the Common Good could well have aided rather than impeded the President’s drive to better control health care costs and achieve universal coverage. The Council report attempted to ground both goals in the ethical framework of, as the title indicates, the common good of all Americans.In his letter terminating the members’ appointments, Assistant to the President for Presidential Personnel Don Gips said that the President “recognizes the values of having a commission of experts in bioethical issues to provide objective and non-ideological bioethics advice to his administration.” Gips went on to say that the President is “currently rethinking the purposes and goals of such a bioethics commission, and is carefully considering a revitalized mission and mandate.” And, [End Page 309] responding to media enquiries, White House press officer Reid Cherlin explained that the President’s Council was terminated because it was a “philosophically leaning advisory group” and, according to a New York Times account by Nicholas Wade, “because it favored discussion over developing a shared consensus.” As for the ultimate outcome of the President’s “rethinking,” Cherlin indicated that President Obama will appoint a new commission with the mandate of offering “practical policy options” in bioethics.In the light of our experiences with the Council, we leave it with hopes that certain questions of national importance will be addressed. In light of the nature of federal advisory commissions, what is or are the proper roles of a national bioethics commission? If the aim is to provide advice and counsel to the President or, perhaps to the U. S. Congress, is that advice best rendered as a group consensus or as an in-depth exploration of the inevitably conflicting ethical perspectives on a given issue? How should such a commission be constituted—with what sorts of individuals? And what is the nature of the expertise that they individually and collectively bring to the commission’s functions? If the commission is to promote public debate and discussion, how exactly should it go about that task? And how is the efficacy of a commission to be assessed? Such questions inevitably lead us deep into contested territory, as the experience of this Council has shown: into the intersections of politics, religion, and science and into the relations between practice and theory—between policy and what some seem to deride as “philosophy.” Indeed, policy without an underlying philosophy is an edifice without a foundation; philosophy without policy is a foundation without an edifice.At the last meeting of the Council in March 2009, we launched a discussion of these questions with the... (shrink)

This response to Kevin WildesÕs article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.

This Handbook offers a broad yet unified treatment of all the philosophical issues connected with climate change, ranging from foundational puzzles to detailed applications. It addresses the philosophical foundations of the discussion on the ethical, social, political and legal impacts of climate change. It covers all branches of philosophy that are relevant to the understanding of the premises and implications of the impacts on human, animal and natural life on Earth. More specifically, the Handbook examines the scientific accounts of climate (...) change as well as its causes. It explores the tools offered by social sciences and humanities to study the societal impact of climate change. It studies the ethical and political issues connected with and resulting from climate change, and puts it all in an environmental and historical context. In addition, the book offers solutions to the main philosophical puzzles and problems, and provides paths of interaction between philosophy and other disciplines. The discussion about climate change and the mitigation/adaptation policies spans many areas and levels – from abstract science and philosophy to current on-the-ground politics. However, climate change is also a great a philosophical puzzle. Indeed, its existential and practical relevance can be thought to largely derive from the philosophical complications it engenders. Climate change is applied philosophy par excellence. Preventing dangerous anthropogenic climate change needs very good philosophy applied to concrete and specific practical issues. Climate change is an area where scholars from very different provenances should cooperate on equal terms, having in view a common, and really important, purpose – contribute to preventing great burdens and even the extinction of humankind and the destruction of hospitable and valuable non-human nature. (shrink)

Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

Virtue is the most perdurable concept in the history of ethics, which is understandable given the ineradicability of the moral agent in the events of the moral life. Historically, virtue enjoyed normative force as long as the philosophical anthropology and the metaphysics of the good that grounded virtue were viable. That grounding has eroded in both general and medical ethics. If virtue is to be restored to a normative status, its philosophical underpinnings must be reconstructed. Such reconstruction seems unlikely in (...) general ethics, where the possibility of agreement on the good for humans is remote. However, it is a realistic possibility in the professional ethics of the health professions where agreement on the telos of the healing relationship is more likely to arise. Nevertheless, virtue-based ethics must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. (shrink)

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)

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.

In On a raison de se révolter Sartre identifies in idealistic unrealism, in amoralistic realism, and in materialistic and moralistic realism, the three decisive moments in his intellectual development. In the light of these caesuras, which interweave the gnoseological and the moral problem and find a possible key of interpretation in the progressive semantic mutation of the authenticity-unauthenticity dichotomy, the author intends to redesign the path that leads from absolute freedom, through the discovery of history and the theoretical redefinition of (...) the notion "freedom-world-others", to freedom as "total praxis". If man’s ontological difference runs through Sartre’s entire work and guides his critique of dialectical materialism, in the post-war writings that difference begins to be rethought within the historical horizon of the dialectical process of work . In presenting the morality-history relationship as inescapable, this horizon resolves the gnoseological and the moral problem in the revolutionary philosophy of work. With his adherence to historical materialism, to which Sartre lays claim in the Critique de la raison dialectique, and the dialectical connection between historical subject and method, the writings that appeared after May ’68 place within the dialectic of freedom the problem of the "total meaning" of the life of man and indicate in the «reign of freedom», of Marxian memory, the telos of history. (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)

Increased emphasis has been placed on teaching ethics in business schools. A recent meta-analysis of business ethics instruction indicated that instructional programs have a minimal impact on improving ethical behaviors (Waples et al. 2008). One of the newest trends in MBA education is gamification which allows instructors to employ video game concepts to engage students in serious business problems. Educators are attempting to harness a similar sort of power exhibited by games like FarmVille or Call of Duty and translate this (...) power into improved educational outcomes. This trend leads to the question; can gamification improve ethical learning outcomes? Using a single cohort of MBA students, ethics instruction in the MBA program was gamified and then operationalized in the students’ first required class and last required class. Although the sample was limited to a single cohort of students, results were promising, indicating improvement in ethical decision making and warranting further study. (shrink)

Las biotecnologías son ciencias destinadas a incidir en manera profunda en la sociedad. El alcance de los cambios que a través de ellas será posible realizar es notable, pero sobre todo se aleja de las ciencias de ingeniería, de las alimentarias, de las médicas. La bioética está decididamente llamada a acoger el reto representado por las biotecnologías. La presente contribución parte precisamente de aquí: captar los aspectos característicos y peculiares de algunas de las posibles aplicaciones biotecnológicas para encuadrar la singularidad (...) de las problemáticas bioéticas que de estas aplicaciones pueden derivar con el fin de leer tales contribuciones a la luz del valor al cual se refieren y por el cual están pensadas: la persona En lo específico, los autores se detienen en tres específicas aplicaciones biotecnológicas que representan sectores cuyas potencialidades preanuncian grandes promesas y, en ciertos aspectos, algunos retos verdaderamente cautivadores; en particular: los OGM, las nanotecnologías y la farmacogenética, temas en diversos modos considerados en la revista en el curso de los años.Biotechnologies, the use of living organisms or their products to modify human environment, are flourishing very rapidly. They cover many fields: from engineering science, to food, to medicine. Bioethics is therefore called to face the challenge given by biotechnologies. The present contribution takes advantage from this: it catches all the scientific peculiarities showed by these technologies and their application to outline the peculiarities of their ethical issues and to read them in the light of their end: the human persono In fact, thanks to them, it will be possible to realize many transformations within the society. In particular, the authors evaluate three main aspects of biotechnologies OGM, Nanotechnologies and pharmacogenetics, topics covered in the journal on several occasions over the years. (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)

Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty. Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. Their proposal (...) balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions. Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient. (shrink)

Richard Lamm is an eloquent and insistent advocate for healthcare reform. In his paper, he argues that if reform is to be effective, a radical metamorphosis in the values underlying our present system must take place. “New realities” have made the “old values” unsustainable. Unless they are replaced by “new values,” we face a future of disastrous overspending, gross inequities in accessibility, poorer health for many, and more expensive dying.

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries[5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog (...) nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ([8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics[ll]. (shrink)

It is very curious that C.G. Jung has had so little influence upon the anthropology of consciousness. In this paper, the reasons for this oversight are given. The archetypal psychology of Jung is summarized and shown to be more complex and useful than extreme constructivist accounts would acknowledge. Jung's thinking about consciousness fits very well with a modern neuroscience view of the psyche and acts as a corrective to relativist notions of consciousness and its relation to the self.

Fifty years ago, 23 Nazi physicians were defendants before a military tribunal in Nuremberg, charged with crimes against humanity. During that trial, the world learned of their personal roles in human experimentation with political and military prisoners, mass eugenic sterilizations, state-ordered euthanasia of the and the program of genocide we now know as the Holocaust. These physicians, and their colleagues who did not stand trial, were universally condemned in the free world as ethical pariahs. The term became the paradigm for (...) total defection from the most rudimentary elements of medical morality. The caduceus literally became the instrument of the swastika. (shrink)

“Hence it is necessary for a Prince wishing to hold his own to know how to do wrong and to make use of it according to necessity.”—Machiavelli“Every state is a community of some kind and every community is established with a view to some good…”—Aristotle.