SEARCH · Search PubMed
Results for “Philosophical Approach”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Diagnosis, therapy, responsibility, and ethical considerations.
Now more than ever before, scientific decisions have ethical and political implications. This means that both doctors and society as a whole are involved. If we consider the changes there have been in the paradigms that underlie medicine and the greater stress now placed on biology in medicine, it is obvious that we need to rethink standard definitions and thus, in turn, to redefine what is normal and what is pathologic. Medicine acts on what is pathologic, but how is this defined? Is medicine unique in needing new definitions? We have to give some thought to doctors' new responsibilities.
Science, technology and ethics: from critical perspective to dialectical perspective.
It has been agreed upon, according to critical perspective, to distinguish the problems raised by scientific issues on the one hand and the problems raised by moral issues on the other. This distinction, at the genesis of theoretical ideology, postulates that experimental science is mere knowledge which, since it has nothing to do with action, cannot raise a moral problem. Yet the use of experimental techniques turns out to be a necessary means, although an insufficient one, to put to the test and to confirm the theoretical hypothesis of science. Thus, those techniques produce perceptible effects which can be assimilated to genuine transformation and are consequently capable of raising moral problems. It follows that the technical imperative of science can be conditioned by a moral imperative of technique, which leads to modification of the object of the research and dubs it, a dialectical object. It is, however, advisable to effect a demarcation between that which, within the frame work of research in experimental science, can pose a moral problem and which cannot. The criterion of refusability of practical projects, by analogy with Popper's criterion of refutability of theoretical conjectures, allows for this demarcation to be implemented. It postulates that only the technical projects of science, apart from scientific theories, can pose a moral problem or can be recognized as moral, providing that the conditions of a possible ethical refusal can be expressed. From the analysis and the synthesis of heterogeneous possibilities, dialectical perspective thus outlined represents an endeavour to go beyond critical perspective, while trying to seek an intermediary channel between the "progressist dogmatism" of science and the obscurantist scepticism" of morals.
Reasonable partiality in professional relationships.
First, two aspects of the partiality issue are identified: (1) Is it right/reasonable for professionals to favour their clients' interests over either those of other individuals or those of society in general? (2) Are special non-universalisable obligations attached to certain professional roles? Second, some comments are made on the notions of partiality and reasonableness. On partiality, the assumption that only two positions are possible--a detached universalism or a partialist egoism--is challenged and it is suggested that partiality, e.g. to family members, lies between these two positions, being neither a form of egoism, nor of impersonal detachment. On reasonableness, it is pointed out that 'reasonable' is an ambiguous concept, eliding the notions of the 'morally right' and the 'rational.' Third, a series of practical examples are taken from counselling, medicine, law, education and religious practice and some common principles are abstracted from the cases and discussed. These include truth-telling, confidentiality, conflicts of interest between clients and particular others and between clients and society. It is concluded that while partiality can be justified as a useful tool in standard cases, particular circumstances can affect the final verdict.
The moral contours of empathy.
Morally contoured empathy is a form of "reasonable partiality" essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate "empathic" engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of morality's demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents.
Reasonable partiality in professional ethics: the moral division of labour.
Attention is given to a background idea that is often invoked in discussions about reasonable partiality: the idea of a moral division of labour. It is not only a right, but also a duty for professionals to attend (almost) exclusively to the interests of their own clients, because their partial activities are part of an impartial scheme providing for an allocation of professional help to all clients. To clarify that idea, a difference is made between two kinds of division of labour, a technical one and a social one. In order to assess the applicability of the idea of a moral division of labour to professional ethics, journalism is contrasted with other professions.
The quality of mercy: social health insurance in the charitable liberal state.
This paper has two, mutually supportive purposes: (1) to show that the modern economic rationale for universal social health insurance is consistent with the classical liberal understanding of property rights; (2) to show that the writings of the leading liberal sages-Locke, Smith, Mill, and Hayek-are congenial to programs economically similar to universal social health insurance, and, in Hayek's cases, were specifically approving. It is hoped that these facts and reasonings, which are unlikely to be known in toto to those who do not normally study across the intersection of philosophy and economics, will encourage a dialogue that reasserts in a non-ideological way the neglected role of property rights in the health economic assessment of social health insurance alternatives.
Foucault on the case: the pastoral and juridical foundation of medical power.
This paper employs Foucault's concept of "governmentality" to examine critically the efforts by medical humanists to reform the medical case. I argue that these reform efforts contribute to the individualizing dimensions of medical power through the development of a "pastoral" technique that medicine has taken over from religious authority. Clinical experiences at this NEH Institute also revealed a juridical dimension of the medical case that treats a patient's statements as suspect and in need of corroboration by evidence provided by the patient's body. The combination of these pastoral and juridical dimensions of the case contributes to the normalizing power of modern medicine, and medical humanists need to be aware of their own contribution to this form of power as they reform the case.
A window into Richard M. Zaner's clinical ethics.
This essay introduces a thematic issue focused on the contributions to clinical ethics and the philosophy of medicine by Richard M. Zaner. We consider the apparent divorce of Zaner's philosophical roots from his recent narrative immersions into the blooming, buzzing confusions of clinical-moral lifeworlds. Our considerations of the Zanerian context and origins of the clinical encounter introduce the fundamental questions faced by Zaner and his commentators in this issue, questions about the role of ethics consultants, moral authority, and clinical truths.
Richard Zaner's "troubled" voice in Troubled Voices: poseur, posing, possibilizing?
This essay considers Richard Zaner's storytelling in Troubled Voices as a form of possibilizing which uses the stories to exemplify important moral themes such as contingency and freedom. Distinguishing between activities of moral discovery through the telling of a story and "posing" in the sense of writing to tell the "moral" of the story, I suggest that something crucial goes on for Zaner in his own tellings. Several of the more insistent implications Zaner reveals about the moral relationships encountered in the activity of clinical ethics consultation are examined in that light, especially regarding this question: is it more beneficial, or harmful, to articulate elements of core meanings and values that are entailed in individual viewpoints, which, prior to an ethics consultant's participation, may have remained unspoken and possibly unacknowledged?
Ethical reasoning and the embodied, socially situated subject.
My discussion is concerned with how symbolic power constitutively structures our very identities in relation to one another and at the bodily level of lived experience. Although many accounts of the self and of subjectivity as socially situated have difficulties in their explanations of agency, Zaner's work suggests a basis upon which the self's independence from others can be understood. His phenomenology of embodied subjectivity explains how the emerging self presupposes presence with others. At the same time, however, "co-presence" also reveals the self's distinct perspective and capacity for "circumstantial possibilizing," that is to say, "actualizing another possible than the actual." My aim is to examine critically the intersections between Zaner's phenomenology and other theoretical accounts of the socially situated self. I also show how Zaner's work contributes to these discussions a way of understanding the possibility of agency that is rooted in embodied experience.
Richard Zaner's phenomenology of the clinical encounter.
The "clinical ethics" propounded by Richard Zaner is unique. Partly because of his phenomenological orientation and partly because of his own daily practice as a clinical ethicist in a large university hospital, Zaner focuses on the particular concrete situations in which patients and their families confront illness and injury and struggle toward workable ways for dealing with them. He locates ethical reality in the "clinical encounter." This encounter encompasses not only patient and physician but also the patient's family and friends and indeed the entire "lifeworld" in which the patient is still striving to live. In order to illuminate the central moral constituents of such human predicaments, Zaner discusses the often-overlooked features of disruption and crisis, the changed self, the patient's dependence and the physician's power, the violation of personal boundaries and their necessary reconfiguring, and the art of listening.
A work in progress.
After expressing gratitude to each contributor, and briefly commenting on each, I probe several main themes of my work, addressing the question of the apparent difference between my earlier "philosophical" and later "clinical" writings. Central to both is the reflexivity of the human agent, and that each exhibits a form of practice regardless of the specific aims embedded in each. I then address the theme of narrative writing as my work has developed over the past several decades at the heart of which are questions of self and integrity.
On potentiality and respect for embryos: a reply to Mary Mahowald.
In order to understand the nature of human embryos I first distinguish between active and passive potentiality, and then argue that the former is found in human gametes and embryos (even in embryos in vitro that may fail to be implanted) because they all have an indwelling power or capacity to initiate certain changes. Implantation provides necessary conditions for the actualization of that prior, active potentiality. This does not imply that embryos are potential persons that do not deserve the same respect as actual persons. To claim that embryos "become persons" is to understand the predicate "person" as a phase sortal, roughly equivalent to "adult person." This entails that we would not be essentially persons. In order to explain the traditional understanding of "person" as a proper sortal rather than a phase sortal, the author distinguishes between proximate and remote potentiality, and shows that, unlike feline embryos, human embryos, by their genetic constitution, possess the remote potentiality to later exercise the typically human activities. It follows that they are already persons essentially.
Australian consequentialism: an Australian critique.
Explore the source record for details and available documents.
Peter Singer's argument for utilitarianism.
The paper begins by situating Singer within the British meta-ethical tradition. It sets out the main steps in his argument for utilitarianism as the 'default setting' of ethical thought. It argues that Singer's argument depends on a hierarchy of reasons, such that the ethical viewpoint is understood to be an adaptation--an extension--of a fundamental self-interest. It concludes that the argument fails because it is impossible to get from this starting-point in self-interest to his conception of the ethical point of view. The fundamental problem is its mixing the immiscible: the Humean subordination of reason to interest with the Kantian conception of reason as universal and authoritative.
The prodigal and his brother: impartiality and the equal consideration of interests.
At the heart of Peter Singer's utilitarianism is the impartial weighing of the interests of those affected by our actions. Singer calls this the Principle of Equal Consideration of Interests. This paper argues that Singer's Principle does not accord with our moral intuitions and the logic of our moral thinking. It discusses the Principle in the context of the parable of the Prodigal Son and his Brother--a parable that raises the issue of impartiality in a particularly challenging way. What the parable shows is, first, that our moral thinking often turns on judgements of fairness that are prior to any impartial weighing of interests; and, second, that impartial fairness itself is sometimes transcended by compassionate love. Both of these points have important implications for bioethics.
Life and death matters: losing a sense of the value of human beings.
The essay combines a specific and a more general theme. In attacking 'the doctrine of the sanctity of human life' Singer takes himself thereby to be opposing the conviction that human life has special value. I argue that this conviction goes deep in our lives in many ways that do not depend on what Singer identifies as central to that 'doctrine', and that his attack therefore misses its main target. I argue more generally that Singer's own moral philosophy affords only an impoverished and distorted sense of the value of human life and human beings. In purporting to dig below the supposedly illusion-ridden surface of our thinking about value, Singer in fact often leads us away from the robust terrain of our lived experience into rhetorical, and sometimes brutal, fantasy.