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At least 865 records · Page 48Linked to original sources
PubMed2000

Specified principlism: what is it, and does it really resolve cases better than casuistry?

Principlism has been advocated as an approach to resolving concrete cases and issues in bioethics, but critics have pointed out that a main problem for principlism is its lack of a method for assigning priorities to conflicting ethical principles. A version of principlism referred to as 'specified principlism' has been put forward in an attempt to overcome this problem. However, none of the advocates of specified principlism have attempted to demonstrate that the method actually works in resolving detailed clinical cases. This paper shows that when one tries to use it, specified principlism fails to provide practical assistance in deciding how to resolve concrete cases. Proponents of specified principlism have attempted to defend it by arguing that it is superior to casuistry, but it can be shown that their arguments are faulty. Because of these reasons, specified principlism should not be considered a leading contender in the search for methods of making justifiable decisions in clinical cases.

Abnormalities, Multiple↗
PubMed1998

Impartial principle and moral context: securing a place for the particular in ethical theory.

This essay critically assesses two strategies of accommodation used by defenders of impartialism in ethics to argue that the care orientation represents no genuine challenge to impartialist theoretical paradigms. One strategy focuses on impartiality as a constraint on moral deliberation, the other as a constraint on moral justification. While highlighting respects in which the commitment to impartiality is more consonant with the care orientation than many advocates of care have acknowledged, this essay attempts to clarify crucial ways in which each accommodationist strategy fails, thus locating some of the more important contributions and challenges the care orientation offers to moral theory.

Empathy↗
PubMed1999

The appearance of Kant's deontology in contemporary Kantianism: concepts of patient autonomy in bioethics.

Kant's concept of autonomy and the Kantian notion of autonomy are often conflated in bioethics. However, the contemporary Kantian notion has very little at all to do with Kant's original. In order to further bioethics discourse on autonomy, I critically distinguish the contemporary Kantian notion from Kant's original concept of moral autonomy. I then evaluate the practical relevance of both concepts of autonomy for use in bioethics. I argue that it is not appropriate to appeal to either concept toward assessing which patients we ought to respect as autonomous. Finally, I sketch criteria for what I take to be a more promising concept of autonomy for patients.

Bioethics↗
PubMed2001

The internal morality of medicine: an evolutionary perspective.

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of 'the common morality' to medicine or whether some of these norms are 'internal' or 'proper' to medicine. In this article we describe and defend an evolutionary perspective on 'the internal morality of medicine' that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these goals. This perspective is developed by means of a critical examination of the 'essentialist' conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp.

Bioethics↗
PubMed2001

The impossibility of a morality internal to medicine.

After distinguishing two different meanings of the notion of a 'morality internal to medicine' and considering a hypothetical case of a society that relied on its surgeons to 'eunuchize' priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are 'socially constructed,' they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality.

Ethics, Clinical↗
PubMed2005

The virtue of moral responsibility and the obligations of patients.

The American Medical Association has provided a list of patient responsibilities, said to be derived from patient autonomy, without providing any justification for this derivation. In this article, the virtue of moral responsibility is proposed as a way to justify these kinds of limits on respect for individual autonomy. The need for such limits is explained by examining the traditional principles of health care ethics. What is missing in health care decision making, and can be provided by the virtue of moral responsibility, is a careful consideration of the impact of individual decisions on particular others and the community, as a whole. The concept of moral responsibility as a virtue is then developed and examples of its application to health care decision making are provided. Finally, the roles of both physicians and health care ethicists in promoting the morally responsible exercise of individual autonomy are explored.

Bioethics↗
PubMed2006

Bioethics as ideology: conditional and unconditional values.

For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a broader debate over fundamentals, and a different approach to bioethical debate.

Persons with Disabilities↗
PubMed2006

Between technocracy and democratic legitimation: a proposed compromise position for common morality public bioethics.

In this article I explore the underlying political philosophy of public bioethics by comparing it to technocratic authority, particularly the technocratic authority claimed by economists in Mexico in the 1980s and 1990s. I find that public bioethics--at least in the dominant forms--is implicitly designed for and tries to use technocratic authority. I examine how this type of bioethics emerged and has continued. I finish by arguing that, as claims to technocratic authority go, bioethics is in an incredibly weak position, which partly explains why it has never gained the degree of public legitimacy that other technocracies have gained. I conclude by arguing for a "technocracy-lite" orientation for public bioethics.

Ethicists↗
PubMed1985

Veatch's new foundation for medical ethics.

Robert M. Veatch proposes a "triple contract theory" as a new foundation for medical ethics. His criticisms of unilateral "physician ethics" are sound, but uncertainty as to whether he is proposing merely imaginary or real contracts vitiates his constructive arguments. If the former, he is recommending a minor heuristic device for thinking about ethics, not a foundation. If the latter, his proposal is utterly impractical and a medical covenant will have to be developed another way.

Bioethical Issues↗
PubMed1986

Methodological concerns in bioethics.

Methodological concerns are moving to the top of the bioethics agenda for the next decade. This paper examines some of those concerns: medical ethics as a subset of bioethics versus medical ethics as a subset of professional ethics; a more in-depth examination of some methodological problems in treating medical ethics as professional ethics; the senses in which bioethics constitutes an inquiry into secular undertakings in a pluralistic society; 'federal ethics', the emergence to prominence of public commissions and study groups; and the institutional impact of bioethics on the relationship between medical schools and the liberal arts core of their sponsoring universities.

Advisory Committees↗