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Biomedical subjects

Alfred I Tauber

Publications and source records attributed to Alfred I Tauber.

7 recordsLinked to original sources
PubMed2005

Medicine and the call for a moral epistemology.

For over a century, medicine has prided itself on its scientific orientation and technological accomplishments. But a conceptual crack lies at the foundation of contemporary medicine, one that may be characterized as a conflict between medicine's scientific epistemology and its moral philosophy. Moral refers to value, and more specifically in the clinical setting, to how facts must be ordered by the values attached to them. A "moral epistemology" seeks to bring these two domains into closer proximity. Clinical facts always reside in a complex array of systems that confer specific and often unique meanings to any finding. An integration of unsteady norms and the intuitive inference arising from the individuality of disease expression require that judgments order facts into their proper placement. And beyond this relaxed view of objectivity, clinical care must also incorporate judgments arising from the patient's (as well as the physician's) social and psychological realms that are removed from scientific concerns. Together, these various kinds of value judgments erect the scaffold of clinical care, in which a more complex moral epistemology emerges. A comprehensive biopsychosocial model of illness and its treatment articulates this integrated orientation, but until medicine embraces a philosophy that legitimates the full integration of facts and values, the appeal of such an approach will remain limited and its application ineffective.

Decision Making↗
PubMed2003

A philosophical approach to rationing.

Rationing, the equitable allocation of medical resources, is both an economic and moral challenge--economic, because the various components of healthcare must be budgeted; moral, because the prioritisation of these resources is a value-laden decision. The moral debate about rationing pits individual choice against communal interests. The advocacy of equitable distribution of healthcare resources originates in arguments for distributive justice and a revised version of individual autonomy. If autonomy is defined strictly in terms of atomistic individuality, then the social obligations and duties of persons are subordinated to their individual rights. Alternatively, when people are defined by their relationships, "relational autonomy" balances responsibilities against the claims of individual rights to maximise distributive justice. The concept of relational autonomy provides medicine with a philosophical basis for communal rationing of healthcare resources.

Ethics, Medical↗
PubMed2003

Sick autonomy.

Complex social and economic forces have placed patient autonomy at the center of medical ethics, and thereby displaced an older ethic of physician beneficence. This development arose, and is sustained, by waning trust in the traditional doctor-patient relationship. As patients have increasingly become clients and consumers, a contract basis for medical care has put the ancient covenant of care in jeopardy. Here, a philosophical approach to harmonize the apparent conflicting claims of patient autonomy and physician beneficence is offered by demonstrating that autonomy need not be understood as protecting a threatened identity. If persons are regarded as atomistic, certain defensive notions of individualistic rights-based autonomy prevail; if a relational construction of personal identity is employed instead, then respect for autonomy becomes part of a wider morality of relationship and care. By reconfiguring trust within this latter understanding of personhood, bioethics better balances its concerns over choices and actions with those of relationship and responsibility. Neither atomistic autonomy nor the ethics of responsibility can claim hegemony, for they are mutually interdependent, and a complete account of medicine's moral axis requires that they be integrated. This reorientation is crucial for reasserting the ethos of clinical medicine, whose fundamental mandate remains the care of others.

Ethics, Medical↗
PubMed2002

Medicine, public health, and the ethics of rationing.

Physicians, like all citizens, have communal and private identities, each attending various associated roles and fulfilling diverse obligations. In light of these dual personae, we seek a moral philosophy which encompasses the responsibility for providing care to the patient and at the same time acknowledges the physician's role of arbiter of distributed care. In the traditional doctor/patient relationship, rationing, the admission that health resources are limited and must be distributed equitably by universally accepted criteria, is essentially ignored. When the physician assumes a population-based system of ethics to optimize care for all patients within a group, rationing is embraced as the realistic admission that any social action resides within boundaries--in this case health care resources--and that such restraints have economic consequences that present ethical choices. A common ground to accommodate these dual allegiances is offered by communitarian philosophy, whose outline and applicability is presented here as an alternative to the apparent moral opposition of optimized individual care and the requirement of community-wide distribution of limited health resources.

Bioethics↗
PubMed2002

Implementing medical ethics.

How to place medical ethics more firmly into medical practice continues to be a central concern of physician training and practice. One strategy is to make medical ethics an explicit focus of attention in the medical record. A separate section of the medical chart, one integral to clinical evaluations and ongoing progress notes, should be devised to articulate both the obvious and less apparent ethical issues pertinent to each patient. This so-called Ethical Concerns section is designed to proactively identify such problems and thereby raise these issues as part of routine evaluation and care. The historical developments and ethical challenges leading to the need for such a revision in record-keeping is reviewed.

Ethics, Medical↗