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PubMed1994

The idea of the absurd and the moral decision. Possibilities and limits of a physician's actions in the view of the absurd.

In reference to two central concepts of Albert Camus' philosophy, that is, the absurd and the rebellion, this article examines to what extent his The Plague is of interest to medical ethics. The interpretation of this novel put forward in this article focuses on the main character of the novel, the physician Dr. Rieux. For Rieux, the plague epidemic, as it is described in the novel, implies an unquestioning commitment to his patients and fellow men. According to Camus this epidemic has to be understood as a symbol of the absurd. Unable to base his actions on a Christian, metaphysical value system, Rieux sees his commitment as a continuous rebellion against the fact of the absurd, which opposes him in the form of evil, suffering and death. As a physician, Rieux is therefore forced to adjust his actions to life in its immediacy, that is, the suffering of his patients. In this article, it will be shown that Rieux's attention to the "immediate" is of particular interest to medical ethics: The other person in need, rather than my moral convictions, sets the norm.

Attitude to Death↗
PubMed1994

Style and responsibility: medicine in postmodernity.

To what extent can postmodern developments be observed in modern medicine and which theories of postmodern philosophy can we draw on with regard to medicine's theoretical problem? This article explores these questions with special emphasis on the epistemological status of medicine, the concept of disease, and the anthropological model. It is examined whether medicine's inherent duty to act can be questioned in the light of the plurality that characterizes postmodernity. It is concluded that, according to postmodern philosophy, medicine should be characterized by a justified variety of paradigms. Cooperation within the variety must continue to be guaranteed, always in favor of the constitutive moral duty of medicine.

Attitude to Health↗
PubMed1992

Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.

Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.

Adolescent↗
PubMed2004

'Miracle in Iowa': metaphor, analogy, and anachronism in the history of bioethics.

The term 'bioethics' is commonly associated with debates prompted by innovations in medical technology, yet the issues raised by bioethics are not that new. They concern the extent to which medicine and social morality exist in harmony or opposition--issues routinely addressed in the social history of medicine. This paper will argue that historical thinking, understood broadly, has a significant role to play in understanding relations between medicine and social morality, and therefore in contemporary bioethics. It explores past and present uses of metaphor and analogy in shaping perceptions of scientific innovation, and argues for the validity of apparently anachronistic thinking in our judgments of the past. The aims of this paper are ultimately pedagogical: to enable students to look at media reports about developments in medicine and biotechnology in order to problematise what are presented as the self-evident terms of current debate.

Bioethics↗
PubMed2005

Reasonable partiality and animal ethics.

Moral psychology is often ignored in ethical theory, making applied ethics difficult to achieve in practice. This is particularly true in the new field of animal ethics. One key feature of moral psychology is recognition of the moral primacy of those with whom we enjoy relationships of love and friendship--philia in Aristotle's term. Although a radically new ethic for animal treatment is emerging in society, its full expression is severely limited by our exploitative uses of animals. At this historical moment, only the animals with whom we enjoy philia--companion animals--can be treated with unrestricted moral concern. This ought to be accomplished, both for its own sake and as an ideal model for future evolution of animal ethics.

Animal Experimentation↗
PubMed2005

Constructing critical bioethics by deconstructing culture/nature dualism.

This paper seeks to respond to some of the recent criticisms directed toward bioethics by offering a contribution to a "critical bioethics". Here this concept is principally defined in terms of the three features of interdisciplinarity, self-reflexivity and the avoidance of uncritical complicity. In a partial reclamation of the ideas of V.R. Potter, it is argued that a critical bioethics requires a meaningful challenge to culture/nature dualism, expressed in bioethics as the distinction between medical ethics and ecological ethics. Such a contesting of the "bio" in bioethics arrests its ethical bracketing of environmental and animal ethics. Taken together, the triadic definition of a critical bioethics offered here provides a potential framework with which to fend off critiques of commercial capture or of being "too close to science" commonly directed toward bioethics.

Animals↗
PubMed2005

A new rejection of moral expertise.

There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the "Professionals", who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the "Ethicists", who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Attitude of Health Personnel↗
PubMed2000

Moral responsibility and the 'ignorant scientist'.

The question whether a scientist can be responsible for an outcome of her work which she does not foresee, and so is ignorant of, is addressed. It is argued that ignorance can be a ground for the attribution of responsibility, on condition that there are general principles, rules or norms, that the subject should be aware of. It is maintained that there are such rules which inform the practice of science as a social institution.

Ethics↗
PubMed1982

Ethical complications of clinical therapeutic research on children.

Usual discussion by ethicists and physicians of the ethical implications of research on children with catastrophic disease, and the guidelines established by the Federal Government for this research, rest on applying general moral principles to problems. Whatever the merits of this approach for establishing policy, it does not adequately reflect the life situation of patients and the complexity of a single regimen which is simultaneously both therapeutic and research oriented. Also, the issues become more complex when there is disagreement among the parents about a course of treatment. It is our contention that such cases are properly resolved by considering the degree of paternalism to be exercised by the clinician-researcher.

Adolescent↗
PubMed1983

Processes in the formulation and legitimisation of professional ethics in a changing world.

Within any given profession two sorts of moral problems arise: 'general' problems which are solvable by universal moral considerations, and 'role-specific' problems, which are generated or solved by norms unique to the profession. It is role-specific norms which are theoretically significant to professional ethics. This essay begins an investigation of role-specific norms for medical ethics, concentrating in particular upon the traditional claim that a physician's primary duty is the restoration and preservation of a patient's health. This norm is derivable from the concept of medicine itself, and can be defended against contemporary sceptical and relativistic attacks designed to show it has no useful content. The medical profession has been attacked recently on the ground that the 'patient-health' norm conflicts with more fundamental general moral principles, especially that of personal autonomy. This criticism is justified with respect to the interpretation of the patient-health norm which has often been given by the medical profession. A more careful investigation of both the empirical requirements of successful treatment and the concept of health itself shows that the theoretical conflict is largely resolvable. This implies that the traditional basic medical norm is morally appropriate.

Codes of Ethics↗
PubMed1983

Killing and letting die: hidden value assumptions.

In this paper I argue for several related theses: first, that the distinction between killing and letting die, as it is drawn by ordinary persons in ordinary contexts, is more complex than is generally understood; second, that the key feature of this complexity lies in the presence of a hidden normative component in what appears to be a straightforwardly descriptive distinction; and, third, that this complexity renders the killing/letting die distinction an inadequate and hazardous guide for moral reasoning.

Death↗
PubMed1983

The place of the ideal observer in medical ethics.

The idea of an ideal observer is frequently employed in ethical reasoning and has recently been introduced into medical ethics. The contemporary use of this idea, however, is deeply flawed. It ignores important social and personal dimensions of ethics. By espousing a perspective of observation removed from history and community, the ideal observer notion encourages a pretense of objectivity and overlooks the distortions of distance. If taken seriously as a model for choice, the ideal observer is incoherent, as it dispenses with the concrete moral agent and the locus of choice. Adam Smith's 'impartial spectator' is examined as a more adequate statement of the need for appreciating diverse perspectives in ethical choices.

Choice Behavior↗
PubMed1986

Divided loyalties and ambiguous relationships.

The author argues that conflicts of obligation may, but need not, give rise to issues of divided loyalties. Given this, the question then becomes under what circumstances and conditions a simple internal conflict may escalate into the problem of divided loyalties or fiduciary ambiguities. After discussing conflicts of obligation, it is asserted that loyalties are divided only when the demands of the various relationships involved are irreconcilable. As this is an extreme, the major problematic issues fall, then, in between, on multiple loyalties and ambiguous loyalties. How and where multiple loyalties arise, and under what conditions they may become ambiguous loyalties lead to the recognition that moral problems are created by leaving in ambiguity things about the relationships involved that would be better sorted out. Finally the author looks at situations in which physicians are systematically exposed to irresoluble ambiguity.

Bioethics↗
PubMed1987

Medical ethics, moral philosophy and moral tradition.

Medical ethics is commonly assumed to be a form of 'applied moral philosophy' in which practical moral judgments are deduced from moral theories. This account of the relationship between moral theory and moral judgment is inadequate in several reports. The deductivist approach often results in inadequate attention being given to social, historical and developmental contexts. It also fails to explain some common phenomena in practical moral reasoning. In contrast to the emphasis in deductivism, a case-centered or casuistic practical ethics insists on immersion in the particularities of cases and on interpretation of details in light of moral maxims and other mid-level forms of moral reasoning. Two features of casuistics that ought to be distinguished but frequently are not, are: (1) the emphasis on immersion and interpretation, and (2) a claim about the relation between moral judgment and moral theory as sources of moral knowledge. Once we consider case-centered moral judgments as sources of moral knowledge, we must also begin to look critically but open-mindedly to moral traditions which, upon examination, appear to be more dynamic and to have more reformist potential than is commonly assumed.

Cultural Diversity↗