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PubMed1986

Mill and the right to remain uninformed.

In a recent article in the Journal of Medicine and Philosophy, David Ost (1984) claims that patients do not have a right to waive their right to information. He argues that patients cannot make informed rational decisions without full information and thus, a right to waive information would involve a right to avoid one's responsibility to act as an autonomous moral agent. In support of his position, Ost cites a passage from Mill. Yet, a correct interpretation of the passage in question would support one's right to remain uninformed in certain situations. If the information would hurt one's chances for survival or hurt one's ability to make calm, rational decisions, then one not only does not have a duty to find out the information, but one's exercising one's right to remain uninformed may be the only rational course of action to take.

Ethical Analysis↗
PubMedDate not supplied

Philosophy of medical practice: a discursive approach.

In spite of the seminal work A Philosophical Basis of Medical Practice, the debate on the task and goals of philosophy of medicine still continues. From an European perspective it is argued that the main topics dealt with by Pellegrino and Thomasma are still particularly relevant to medical practice as a healing practice, while expressing the need for a philosophy of medicine. Medical practice is a discursive practice which is highly influenced by other discursive practices like science, law and economics. Philosophical analysis of those influences is needed to discern their effect on the goals of medicine and on the ways in which the self-image of man may be changed. The nature of medical practice and discourse itself makes it necessary to include different philosophical disciplines, like philosophy of science, of law, ethics, and epistemology. Possible scenario's of euthanasia and the human genome project in the USA and Europe are used to exemplify how philosopy of medicine can contribute to a realistic understanding of the problems which are related to the goals of medicine and health care.

Ethics, Medical↗
PubMed1999

Situation-specific theories: philosophical roots, properties, and approach.

It is imperative to further develop theoretical bases in nursing, which incorporate diversities and complexities in nursing phenomena, and which consider sociopolitical, cultural, and historic contexts of nursing encounters. Situation-specific theories are proposed in this work as a future direction of such theoretical bases in nursing. Philosophical roots and properties of situation-specific theories are discussed, and an integrative approach to developing this type of theories is suggested. Situation-specific theories could be based on the assumptions of post-empiricism, critical social theory and feminism, and or hermeneutics. Six properties of situation-specific theories are presented: (1) low level of abstraction, (2) reflection of specific nursing phenomena, (3) context, (4) connection to research and/or practice, (5) incorporation of diversities, and (6) limits in generalization. The proposed integrative approach to developing situation-specific theories includes (1) a nursing perspective, (2) a linkage among theory, research, and practice, and (3) a conceptual scheme based on internal and external dialogues.

Humans↗
PubMed1990

The rights of man and animal experimentation.

Since emotions give contradictory signals about animal experimentation in medical science, man's relationship to animals must be based upon reason. Thomas Aquinas argues that man is essentially different from animals because man's intellectual processes show evidence of an abstract mechanism not possessed by animals. Man's rights arise in association with this essential difference. The consequence is that only man possesses true rights by Aquinas's definition; animals have them only by analogy. However, cruelty to animals is illicit and they should be protected, principally not because they have rights, but because he who is cruel to animals is more likely to be cruel to his fellowman. If there is a need for animal experimentation in science for the good of man, this approach gives philosophical justification for experimentation, since man's well-being must come before that of animals because of his unique possession of rights. However, those experiments should be carried out in the kindest way possible, to promote kindness towards man. To see man as solely part of a biological continuum in competition for rights with those beings close to him biologically, detracts from man's dignity.

Animal Experimentation↗
PubMed1992

Can ethnography save the life of medical ethics?

Since its inception contemporary medical ethics has been regarded by many of its practitioners as 'applied ethics', that is, the application of philosophical theories to the moral problems that arise in health care. This 'applied ethics' model of medical ethics is, however, beset with internal and external difficulties. The internal difficulties point out that the model is intrinsically flawed. The external difficulties arise because the model does not fit work in the field. Indeed, the strengths of that work are its highly nuanced, particularized analyses of cases and issues and its appreciation of the circumstances and contexts that generate and structure these cases and issues. A shift away from a theory-driven 'applied ethics' to a more situational, contextual approach to medical ethics opens the way for ethnographic studies of moral problems in health care as well as a conception of moral theory that is more responsive to the empirical dimensions of those problems.

Anthropology, Cultural↗
PubMed1986

Philosophical reflections on a rational treatment plan.

Diagnosis is widely regarded to be governed by logical rules, but constructing a rational treatment plan has received less philosophical attention. I examine such treatment plans under three senses of the term "rational": consensual, scientific, and ethical. My thesis is that treatment plans, even those based on medical indications alone, are inherently consensual and are governed by a logic of proportionality.

Beneficence↗
PubMed2001

Surrogate motherhood, rights and duties: a reply to Campbell.

In a recent article in Health Care Analysis (Vol. 8, No. 1), Campbell misrepresents our specific arguments about commercial surrogate motherhood (C.S.M.) and our general philosophical and political views by saying or suggesting that we are 'Millsian' liberals and consequentialists. He gives too the false impression that we do not oppose, in principle, slavery and child purchase. Here our position on C.S.M. is re-expressed and elaborated upon in order to eliminate possible confusion. Our general ethical and philosophical framework is also outlined and shown to be other than Campbell says that it is. In particular, a moral philosophy that is based on neither consequentialism nor Kantianism is presented. C.S.M., it is argued, is not child purchase. It is like it in some respects and unlike it in others. It is unlike it in the respects which, relative to the present discussion, matter.

Child↗
PubMed1988

Self-determination, incompetence, and medical jurisprudence.

Philosophers and others have criticized the courts for ascribing a right of self-determination to severe incompetents. I defend ascription of a right of self-determination to these incompetents against both conceptual and normative attacks. I argue that a court need make no conceptual error when it ascribes a right of self-determination to a being who never had capacity for rational choice, and I argue that proper judicial deference to reflective conventional morality supports ascription of a right of self-determination to severe incompetents.

Bioethical Issues↗
PubMed1986

The sense of suffering.

Medical practice is animated by the intention to cure; it aims to relieve the immense variety of sufferings to which human beings are subject in virtue of the conditions of their embodied existence. My purpose here is to demonstrate how a philosophical analysis of the formal structures and kinds of human suffering provides an essential foundation for determining certain ethical dimensions of the physician's relation to his suffering patient. Can paternalism in medical practice be justified by the aim of relieving suffering? What are the scope and limits of the patient's responsibility for his suffering, and what difference does this make in the physician's response to it? How is the suffering that medical treatment itself exacts in the name of cure to be justified? Such questions can be answered only by an analysis of the sense or value of suffering in human life.

Emotions↗
PubMed1990

Physician investment and self-referral: philosophical analysis of a contentious debate.

A new economic phenomenon, in which physicians refer their patients to ancillary facilities of which they themselves are owners or substantial investors, presents a 'laboratory' for assessing philosophers' potential contributions to public policy issues. In this particular controversy, 'prohibitionists' who wish to ban all such self-referral focus on the dangers that patients and payers may receive or be billed for unnecessary or poor-quality care. 'Laissez-fairists', in contrast, argue that self-referral should be freely permitted, with a reliance on personal ethics and internal professional monitoring to guard against abuse. Undue government regulation, they argue, infringes providers' and patients' economic freedom, and stifles the competition that can yield better quality care at lower prices. As this debate features basic values and large amounts of money, it has been marked by rancorous rhetoric, shallow argument, and muddled reasoning. The philosopher's first contribution, therefore, is to expose simplistic and fallacious arguments, whether empirical, conceptual, moral, or legal. Beyond this the philosopher can help to identify the important values at stake and, perhaps, to identify resolutions that honor those values better than the more simplistic answers proffered previously. For abusive self-referral, as distinguished from kickbacks, the author recommends that civil remedies be favored over criminal prohibitions. She suggests that the doctrine of 'bad faith breach of contract' might appropriately be extended into this new area to provide a powerful means by which aggrieved patients and payers can hold physicians personally accountable for abusive self-referrals.

Conflict of Interest↗
PubMed1985

Lay obligations in professional relations.

Little has been written recently about the obligations of lay people in professional relationships. Yet the Code of Medical Ethics adopted by the American Medical Association in 1847 included an extensive statement on "Obligations of patients to their physicians'. After critically examining the philosophical foundations of this statement, I provide an alternative account of lay obligations in professional relationships. Based on a hypothetical social contract and included in a full specification of professional as well as lay obligations, this account requires lay people to honor commitments and disclose relevant information. Ethically, the account assumes that all parties in lay-professional relationships should be given equal consideration and respect in determining rights and obligations. Factually, it assumes that the treatment of many illnesses and injuries required collaboration and cooperation among lay persons and health professionals, that medical resources and personnel are limited, and that medicine, nursing, and related health professions, are, in MacIntyre's sense, practices.

American Medical Association↗
PubMed1994

Authenticity as a foundational principle of medical ethics.

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.

Cultural Diversity↗
PubMed2005

Quality of life considered as well-being: views from philosophy and palliative care practice.

The main measure of quality of life is well-being. The aim of this article is to compare insights about well-being from contemporary philosophy with the practice-related opinions of palliative care professionals. In the first part of the paper two philosophical theories on well-being are introduced: Sumner's theory of authentic happiness and Griffin's theory of prudential perfectionism. The second part presents opinions derived from interviews with 19 professional palliative caregivers. Both the well-being of patients and the well-being of the carers themselves are considered in this empirical exploration. In the third part the attention shifts from the description of "well-being" to prescriptions for the promotion of well-being. Our interview data are analysed in light of the theories of Sumner and Griffin for clues to the promotion of "well-being." The analysis (1) underscores the subject-relativity of well-being, (2) points out that values that are considered important in every life still seem to be relevant (at least in palliative care practice), and (3) shows the importance of living a certain sort of life when aiming to enhance dying patients' well-being.

Humans↗
PubMed1985

What is wrong with 'wrongful life' cases?

'Wrongful life' torts raise a number of interesting and perplexing philosophical issues. In a suit for 'wrongful life', the plaintiff (usually an infant) brings an action (usually against a physician) claiming that some negligent action has caused the plaintiff's life, say by not informing the parents of the likely prospect that their child would be born with severe defects. The most perplexing feature of this is that the plaintiff is claiming that he would have been better off if he had never been born. A number of arguments have appeared which purport to show that "wrongful life' claims should not be allowed, either because it is senseless to claim that one would be better off if one had not existed or that it is impossible to assess the extent to which someone has been damaged by being brought into existence. In our paper we rebut these arguments and suggest a procedure for determining damages in 'wrongful life cases'.

California↗