Hume, bioethics, and philosophy of medicine.
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This article explores the theological foundations of both classical and contemporary Jewish ethics, with special reference to biomedical issues. Traditional views concerning God's revelation to Israel are shown to underlie the methodological orientation of classical Jewish ethics, which is both legalistic and particularistic. Contemporary Jewish ethicists, by contrast, have tended to embrace more liberal views of revelation which have mitigated both the legalism and the particularism of their approach. Apart from methodological considerations, much of the content of Jewish medical ethics has also been shaped by theological concerns. Specifically, a Jewish theology of creation provides basic norms and values which inform Jewish responses to a range of contemporary biomedical issues. Finally, it is suggested that the theological roots of this ethical tradition do not disqualify it from making a significant contribution to the wider discussion of biomedical issues in our secular, pluralistic society.
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The main contentions of this paper are two fold. First, there is a more than century-old Japanese tradition of human rights based on a fusion of Western concepts of natural rights and a radical reinterpretation of Confucianism, the major proponent of which was the Japanese thinker Nakae Chomin. Secondly, this tradition, although a minority view, is crucial for remedying the serious defects in the present Japanese medical system. In the latter half of the nineteenth century, Nakae Chomin sought to reinterpret Chinese tradition, especially Confucianism, by injecting the concepts of popular sovereignty and democratic equality, drawn from Western sources. The resulting view maintained the Confucian commitment to a moral nexus for society, but replaced hierarchy with egalitarianism. The pressing need for such an approach to patients' rights in present-day Japan is illustrated by two recent cases: the photographing and commercial exploitation of patients' genitals without serious response by authorities, and the attempt by physicians to manipulate the time of death and, possibly, to improperly pressure family members in order to transplant organs from the brain-dead victim of a criminal assault. Such problems stem from hierarchy and paternalism, which seem to be a legacy of the rapid, state-sponsored introduction of Western medicine in the mid-nineteenth century, and in particular from the government's adoption of and support for German military medicine as a model for Japan.
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In summary, I believe that ethics teaching based on actual cases, presented in a small-group format led by a clinician and an ethicist, offers the best prospect for achieving these goals. The physician serves as a role model and ensures that information and options are medically accurate. The ethicist helps to identify morally relevant features, can articulate ethical principles, and direct students to the appropriate literature. This method does not guarantee that the behavior of future health professionals will always be humane or ethically sound. But it is likely to get future health professionals to think about what they are doing when they encounter cases that resemble those discussed in teaching conferences devoted to clinical ethics.
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