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PubMed1986

The conflict between randomized clinical trials and the therapeutic obligation.

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating.

Clinical Trials as Topic↗
PubMed1987

The power of medicine, the power of ethics.

Foucault's genealogies and archeologies provide occasions in which one may come to know the powers, accidents, and influences that have structured a particular knowledge or discipline. The Birth of the Clinic shows the development of modern medicine in a process by which rational inference and emphasis on the history of a disease are replaced by pathological anatomy. In modern anatomy, the corpse, not reason, became the "space" of modern medical knowledge. In this "space" developed a confederation of dead body, knowledge, trained and noninferential gaze, organic unity, and the increased importance of bodily space instead of physical time. The discussion shows how Foucault's genealogy of modern medicine is influenced by and overcomes the knowledge that it describes. In this context, his genealogy is also shown to be self-overcoming and to raise important questions for medical ethics when ethical thought is conceived within the structures of knowledge that have been exposed by the genealogy.

Attitude to Death↗
PubMed1988

Animal welfare and animal rights.

Animal liberationists tend to divide into two mutually antagonistic camps: animal welfarists, who share a utilitarian moral outlook, and animal rightists, who presuppose a structure of basic rights. However, the gap between these groups tends to be exaggerated by their allegiance to oversimplified versions of their favored moral frameworks. For their part, animal rightists should acknowledge that rights, however basic, are also defeasible by appeals to consequences. Contrariwise, animal welfarists should recognize that rights, however derivative, are capable of constraining appeals to consequences. If both sides move to more defensible theoretical positions, their remaining differences on that level may be compatible with a broad area of convergence on practical issues.

Animal Care Committees↗
PubMed1988

On justifying the exploitation of animals in research.

In research employing animals we commonly do things to them which would be grossly immoral to do to humans. This paper discusses three possible justifications for so treating animals: (a) it is violating the autonomy of rational beings which makes actions immoral, and animals are not autonomous; (b) due to our participation in the human community, we have special obligations to humans that we do not have to animals; and (c) human life is morally more worthy than animal life. The conclusion of this discussion is that none of these three propositions justifies the routine sacrifice of animal interests for human benefit. Particular attention is paid to the idea that human life is morally more worthy than animal life, because I believe that to be the most common justification for our sacrifice of animal interests in research. The claim of greater worth is considered and criticized from both utilitarian and Kantian perspectives, and the inference from superior worth to being entitled to exploit one's inferiors is also criticized. The paper concludes by recommending a governing principle for research with animals which would bring that research into line with the rejection of hierarchical worldviews, social orders, and value systems which characterizes modern moral progress.

Animal Experimentation↗
PubMed1988

Sinking the research lifeboat.

A 'lifeboat' situation is one in which all are in great peril and someone must be sacrificed lest all perish. In such situations, it is permissible to do things which would be considered wrong under less drastic circumstances. Proponents of animal rights such as Tom Regan agree that in such circumstances it may be necessary to sacrifice a dog in order to save human life. Is such an admission consistent with calling for the abolition of all scientific research on animals? That is, is scientific research a 'lifeboat'? The analogy is tempting but flawed. The demand for abolition of animal research is not marred by consistency on this score.

Animal Experimentation↗
PubMed1988

The question is not, "can they talk"?

An argument for denying moral rights to nonhuman species is that beliefs, desires, and interests are inherent in the normal human capacity for speech and, since only humans are linguistically capable, only humans can have rights. We argue that linguistics and many conceptual abilities are ontogenetically independent in humans and that various morally relevant mental capacities can exist independently. We also then argue that phylogenetic independence is also possible and hence, that the concept of an inherent dependence of moral standing on having linguistic capabilities is insufficient for denying rights to nonhumans.

Animal Experimentation↗
PubMed1988

On not harming: two traditions.

While ancient in origin, the principle, "Do No Harm," continues to occupy a prominent place in many present-day medical ethics codes. Of all the versions of the principle two distinct varieties can be distinguished. These parallel two ethical traditions. This paper develops the contrast between the two versions, relates them to the two ongoing ethical traditions, and then uses insights from contemporary ethical theory to demonstrate the significance of one of the versions. Finally it suggests some contemporary applications for a medical ethic and medical education.

Beneficence↗
PubMed1988

The peaceable pluralistic society and the question of persons.

In his recent book The Foundation of Bioethics, H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises.

Beginning of Human Life↗
PubMed1988

Love and death: existential dimensions of physicians' difficulties with moral problems.

Physicians often appear more troubled by moral dilemmas than would seem justified given the present social and professional consensus on many of the questions involved. Their discomfort arises not only at ethical, technical, and behavioral levels (the most commonly identified sources of difficulty), but also at an existential level, that is, as the manifestation of conflicts rooted in the processes and conditions of our coming-to-be as persons. Analysis of this level of physicians' moral difficulties requires renewed attention to the physician as a person, and suggests new perspectives on the interpersonal environment of medical practice.

Bioethical Issues↗
PubMed1988

Ethics by committee: the moral authority of consensus.

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry.

Bioethical Issues↗
PubMed1988

Virtue and the practice of modern medicine.

Robert Veatch has claimed that virtue theory is not only irrelevant but potentially dangerous in medical ethics. I argue that virtue is a far more prominent factor in contemporary medical practice than Veatch admits. Even if 'stranger medicine' is taken as the norm, proper conduct on the part of physicians depends on certain character traits in order to be maintained consistently over a long period of time and in situations which run counter to the physician's own interests. Right conduct, which Veatch argues is the central moral issue in the physician-patient relationship, is intertwined with certain virtues. Moreover, the virtue of integrity and the concept of a unified life-narrative are especially useful in analyzing an important factor missing in modern medicine. And since medicine relies necessarily on some concept of human flourishing I argue that virtue theory can play a central role in helping to determine the goals of medical practice.

Beneficence↗
PubMed1989

The ethics of science: its problems and the sphere of research.

Moral principles are indispensable for the assessment of the sciences. Medicine is one of the sciences in need of the guidance of ethics. Ethical principles are put forward and interpreted by society. Vital principles for bioethics include a high standard for professional medical workers, confidentiality between the physician and the patient, and informed consent. Marxist teaching calls for the unity of science and ethics, based on humanist ideas.

Bioethics↗
PubMed1989

Studies in the explanation of issues in biomedical ethics: (II). On "on play[ing] god", etc.

A previous essay (Erde, 1988) tracked the influence of the major Western historical paradigm of the great chain of being through various positions taken about abortion. This essay shows the paradigm's influence on our language--especially in animating the use of "god" and phrases like "playing god". This is important given the prevalence of religious values in bioethics debates and the pervasiveness of the language. I hunt unsuccessfully for a meaning that could serve as a moral principle, and I show how these phrases are rooted in the paradigm. I conclude that all that such language can do is offer the pretense that there is a specific absolute ground for forbidding something which could otherwise be morally acceptable. But such language is nearly senseless, and worse still, it is immoral in that it cuts off reflection and debate.

Adult↗
PubMed1990

Moral discourse about medicine: a variety of forms.

Moral evaluations of medical research and care focus on different issues, e.g., clinical choices, public policy and cultural values. Technical ethical concepts and arguments do not suffice for all issues. Analysis of the literature suggests that, in addition to ethical discourse, prophetic, narrative, and policy discourse function morally. The article characterizes each of these forms, and suggests the insufficiency of each if it is taken to be the only mode of analysis.

Bioethical Issues↗
PubMed1990

Quality of scholarship in bioethics.

This paper identifies four major forms of scholarship in bioethics: empirical research, the articulation of mid-level principles of bioethics, the relating of these principles to fundamental moral theories, and discussions of the bioethical implications of legal principles and health delivery policies. It develops a reflective equilibrium approach to the relation between these four forms of scholarship. It then presents, in light of this approach, criteria for quality research in each of these forms of scholarship in bioethics.

Bioethical Issues↗
PubMed1990

Method in bioethics: a troubled assessment.

This discussion is a critical assessment of the methods employed by some leading writers in the field of bioethics. The author agrees with those in the field who regard its primary or essential method as moral philosophy, but he nevertheless finds a prevalent tendency among bioethical writers merely to apply received moral principles to issues and to avoid penetrating theoretical analysis, even when such analysis is unavoidably required. He explains these deficiencies in terms of the exigencies of interdisciplinary work and the affinity of much early bioethics with policy- or legislatively-oriented "public ethics". The discussion ends with a call for increased theoretical sophistication in this field.

Bioethics↗