David C. Thomasma – författare

Beneficence - doing the right and good thing - is the fundamental principle of medical ethics. It points all medical decisions and actions toward advancing the patient's best interests. Yet in our normally pluralistic society where rights are asserted more frequently than obligations, this ancient principle tends to be obscured or confused with paternalism. This book attempts to rejuvenate and redevelop the notion of beneficence as a guiding principle within the ethics of medicine. The authors examine the content of the concept of 'patient good' from both philosophical and practical viewpoints, and they strive to supplement and in some ways transcend duty- and rights-based ethical systems. The book is divided into three sections. The first develops the authors' model of the doctor-patient relation as 'beneficence-in-trust'. The second examines the implications of the model for that relationship. The third explores some consequences of the beneficence model with respect to the difficult challenges facing health care, such as allocation of resources and decisions about incompetent patients. Like the authors' earlier work, A Philosophical Basis of Medical Practice (Oxford 1981), this book argues that the special nature of the doctor-patient relationship should be the primary source of the canons of professional medical ethics. It will be of value to physicians and ethicists as well as students of medicine and bioethics.

This book constructs a virtue-based ethics for medicine and health care. Beginning with the problem of relating virtues to principles, the authors develop a theory that this linkage lies in the goals of medicine and the nature of medical practice as a moral community. Specific virtues such as trust, compassion, prudence, justice, courage, temperance, and self-effacement are discussed in separate chapters. The book ends by examining how a virtue-based ethic of medicine makes a difference in analysing problems like caring for the poor, research on human subjects, whether the medical virtues can be taught in professional training, and how a refurbished philosophy of medicine can enhance medicine and health care in the future.

claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient’s unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court''s decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the • patient; Requests based on full information; • The patient is in a situation of intolerable and hopeless suffering (either • physical or mental); No further acceptable alternatives to euthanasia. All alternatives • acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be • 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.

Biology has been advancing with explosive pace over the last few years and in so doing has raised a host of ethical issues. This book, aimed at the general reader, reviews the major advances of recent years in biology and medicine and explores their ethical implications. From birth to death the reader is taken on a tour of human biology - covering genetics, reproduction, development, transplantation, aging, dying and also the use of animals in research and the impact of human populations on this planet. In each chapter there is a sketch of a field's most recent scientific advances, combined with discussions of the ethical and moral principles and implications for social frameworks and public policy raised by those advances. Anybody interested or concerned about the ethical dilemmas caused by advances in science and medicine should read this book.

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well, as the dilemmas posed are generally beyond their direct control, and being a student or junior doctor brings its own set of ethical concerns. The editors have addressed this need by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. Over 80 actual cases cover the range of possible problems a medical trainee may encounter on the ward, from drug and alcohol abuse, whistleblowing and improper sexual conduct to performing procedures, handling authority, disclosure, blaming, personal responses to patients, and misrepresentation of research. The book will be an essential guide on how to cope with the ethical dilemmas of those embarking on medical careers.

This volume is dedicated to the philosophy of medicine advanced by Edmund D. Pellegrino, a renowned physician educator and philosopher. Pellegrino's thinking about the philosophy of medicine centers on the importance of illness in the life of the patient, and the professional relationship established by promising to alleviate suffering. From this relationship norms are established that contribute to the staying power of medicine as a moral enterprise. Chapters are included from established thinkers and newcomers to the field, all of whom have been influenced by Pellegrino. Some chapters expand upon his thinking for primary care, managed care, and other delivery systems. Other chapters explain in more detail certain key concepts in Pellegrino's thought, like beneficence, doing no harm, and clinical phronesis or prudential decision making. Still others explore areas of difficulty like the reliance on role modeling and virtue ethics, the problem of pluralism and a loss of professional normative ethics, and the search for the foundations of the philosophy of medicine. Constructing a viable philosophy of medicine for the next century is an essential task for grounding the morality of medicine during enormous social and economic change. Pellegrino's thinking and the ideas of those he has influenced will contribute immensely to this challenge.

claim was that he had faced a conflict of duties pitting his legal duty not to kill against his duty as a physician to relieve his patient’s unbearable suffering. He was acquitted on the important grounds of conflict of duty. These grounds are based on a concept in Dutch law called "force majeure" 4 which recognizes extenuating circumstances such as conflicts of duty. The acquittal was upheld by the Lower Court of Alkmaar, but revoked by an Amsterdam court of appeal. The case went on to the Supreme Court, but before the Supreme Court's decision was issued, the Royal Dutch Medical Association (RDMA) attempted to clarify the criteria for euthanasia that many within the profession already accepted. The RDMA proposed that physicians be permitted to perform euthanasia provided that a set of procedures had been met. Variously stated, the guidelines contain the following central provisions: Voluntary, competent, explicit, and persistent requests on the part of the • patient; Requests based on full information; • The patient is in a situation of intolerable and hopeless suffering (either • physical or mental); No further acceptable alternatives to euthanasia. All alternatives • acceptable to the patient for relief of suffering having been tried; Consultation with at least one other physician whose judgment can be • 5 expected to be independent. Indirectly, these guidelines became the criteria prosecutors used to decide whether or not to bring charges.

This book arises from a two-fold conviction. The first is that autonomy, despite recent critiques about its importance in bioethics and philosophy of medicine, and the traditional resistance of medicine to its "intrusion" into the doctor-patient relation, is a fundamental building block of an individual's identity and mechanisms for dealing with illness, disease, and incapacity. As such it is an essential component in the health care professional's armamentarium employed to bring about healing. Furthennore, it functions in a similar way to assist the health professional in his or her relations to the sick and injured. The second conviction follows from the fITst. Autonomy is far more complex than appears from the philosophical use of the concept. In this conviction we join those who have criticized the over-reliance on autonomy in modem, secular bioethics originating in the United States, but gaining ascendancy in other cultures. This critique relies on appeals to the richer contexts of persons' lives. Elsewhere the contemporary critique of autonomy appears in a variety of alternative ethical models like narrative ethics, casuist ethics, and contextualism. Indeed, postmodern criticism of all bioethics argues that there is no defensible foundation for claims that one ought to respect autonomy or any other principle as a way of ensuring that one is ethical.

Christian health care professionals in our secular and pluralistic society often face uncertainty about the place religious faith holds in today's medical practice. Through an examination of a virtue-based ethics, this book proposes a theological view of medical ethics that helps the Christian physician reconcile faith, reason, and professional duty. Edmund D. Pellegrino and David C. Thomasma trace the history of virtue in moral thought, and they examine current debate about a virtue ethic's place in contemporary bioethics. Their proposal balances theological ethics, based on the virtues of faith, hope, and charity, with contemporary medical ethics, based on the principles of beneficence, justice, and autonomy. The result is a theory of clinical ethics that centers on the virtue of charity and is manifest in practical moral decisions. Using Christian bioethical principles, the authors address today's divisive issues in medicine. For health care providers and all those involved in the fields of ethics and religion, this volume shows how faith and reason can combine to create the best possible healing relationship between health care professional and patient.

Exploring the moral foundations of the healing relationship, Edmund D. Pellegrino and David C. Thomasma offer the health care professional a highly readable Christian philosophy of medicine. This book examines the influence religious beliefs have on the kind of person the health professional should be, on the health care policies a society should adopt, and on what constitutes healing in its fullest sense. "Helping and Healing" looks at the ways a religious perspective shapes the healing relationship and the ethics of that relationship. Pellegrino and Thomasma seek to clarify the role of religious belief in health care by providing a moral basis for such commitment as well as a balancing role for reason. This book establishes a common ground for believers and skeptics alike in their dedication to relieve suffering by showing that helping and healing require an involvement in the religious values of patients. It clearly argues that religion provides crucial insights into medical practice and morality that cannot be ignored, even in our morally heterogeneous society.Central to the authors' message is the concept of patients' vulnerabilities and the need to help them recover not only from the disease but also from an existential assault on their personhood. They then show how this understanding can move caregivers to view their professions as vocations and thereby change the nature of health care from a business to a community of healing. Physicians, nurses, administrators, clergy, theologians, and other health professionals and church leaders will find this volume helpful for their own reflections on the role of religion in the health care ministry and for making a religious commitment integral to their professional lives.

This book illuminates issues in medical ethics revolving around the complex bond between healer and patient, focusing on friendship and other important values in the healing relationship. Embracing medicine, philosophy, theology, and bioethics, it considers whether bioethical issues in medicine, nursing, and dentistry can be examined from the perspective of the healing relationship rather than external moral principles. Distinguished contributors explore the role of the health professional, the moral basis of health care, greater emphasis on the humanities in medical education, and some of the current challenges facing healers today.

PERSONHOOD AND HEALTH CARE This book arose as a result of a pre-conference devoted to the topic held June 28, 1999 in Paris, France. The pre-conference preceded the Annual Congress of the International Academy ofLaw and Mental Health. Other chapters were solicited after the conference in order to more completely explore the relation of personhood to health care. The pre­ conference was held in honor of Yves Pelicier who led so many of our French colleagues in medicine, philosophy, and ethics as Christian Herve notes in his Tribute. As health care is aimed at healing persons, it is important to realize how difficult it is to construct a theory of personhood for health care, and thus, a theory of how healing in health care comes about or ought to occur. The book is divided into four parts, Concepts of the Person, Theories of Personhood in Relation to Health Care and Bioethics, Person and Identity, and Personhood and Hs Relations. Each section explores a critical arena in constructing the relation of personhood to health care. Although no exploration ofthis nature can be exhaustive, every effort was made to present both conflicting and complementary views of personhood from within similar and different philosophical and religious traditions. PART ONE: CONCEPTS OF THE PERSON Tracing the origins of the concept of person from antiquity through present day, Jean Delemeau provides an historical sketch of the development of a wide range of meanings.

Demographic studies foreshadow a dramatic increase in the proportion of "older" members of our global population. The task of allocating public and private resources to accommodate present and future generations is a daunting challenge for all nations. Not surprisingly, planning for the health of an ageing society raises profound issues in law, ethics, and public policy. "Culture, Health, and Social Change" is the first of three volumes on aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "ageing" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of ageing is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

Positive conceptions of "healthy aging" are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When, through the natural course of aging or due to illness or injury, the body or mind begins to fail, a legitimate need for intervention - and care - will arise. In such cases, the aging process can indeed lead one down the path toward vulnerability, or at the very least, reliance on some form of support. Scholars from a range of disciplines address some of the major issues in elder care facing modern nations: familial duties of care, the future of social welfare systems, housing, dementia, abuse and neglect.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

Culture, Health, and Social Change is the first of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "aging" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of aging is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

Moral capacity is an important feature of what it means to be human. In this volume, the contributors have taken on the daunting task of trying to distinguish between legal and moral capacity. This distinction is difficult at times for clinicians, philosophers and legal scholars alike. Part of the challenge of defining moral capacity lies in the difficulty of adequately categorizing it. For this reason, the editors have chosen to divide the book into three parts. The first looks at the concepts involved in the discussion of moral capacity; the second considers the role of moral capacity in the lives of professionals; and the final part reflects on case studies of moral capacity or incapacity illustrating the challenge that moral capacity presents - its definition lying between two seemingly incommensurable models, those of the threshold and continuum. This volume takes a multidisciplinary approach to the subject, and ties the disciplines of medicine, philosophy and law into the health context. It will be of interest to medical health professionals as well as researchers working in the areas of philosophy and law.

Moral capacity is an important feature of what it means to be human. In this volume, the contributors have taken on the daunting task of trying to distinguish between legal and moral capacity. This distinction is difficult at times for clinicians, philosophers and legal scholars alike. Part of the challenge of defining moral capacity lies in the difficulty of adequately categorizing it. For this reason, the editors have chosen to divide the book into three parts. The first looks at the concepts involved in the discussion of moral capacity; the second considers the role of moral capacity in the lives of professionals; and the final part reflects on case studies of moral capacity or incapacity illustrating the challenge that moral capacity presents - its definition lying between two seemingly incommensurable models, those of the threshold and continuum. This volume takes a multidisciplinary approach to the subject, and ties the disciplines of medicine, philosophy and law into the health context. It will be of interest to medical health professionals as well as researchers working in the areas of philosophy and law.

This volume is dedicated to the philosophy of medicine advanced by Edmund D. Pellegrino, a renowned physician educator and philosopher. Pellegrino's thinking about the philosophy of medicine centers on the importance of illness in the life of the patient, and the professional relationship established by promising to alleviate suffering. From this relationship norms are established that contribute to the staying power of medicine as a moral enterprise. Chapters are included from established thinkers and newcomers to the field, all of whom have been influenced by Pellegrino. Some chapters expand upon his thinking for primary care, managed care, and other delivery systems. Other chapters explain in more detail certain key concepts in Pellegrino's thought, like beneficence, doing no harm, and clinical phronesis or prudential decision making. Still others explore areas of difficulty like the reliance on role modeling and virtue ethics, the problem of pluralism and a loss of professional normative ethics, and the search for the foundations of the philosophy of medicine. Constructing a viable philosophy of medicine for the next century is an essential task for grounding the morality of medicine during enormous social and economic change. Pellegrino's thinking and the ideas of those he has influenced will contribute immensely to this challenge.

This book arises from a two-fold conviction. The first is that autonomy, despite recent critiques about its importance in bioethics and philosophy of medicine, and the traditional resistance of medicine to its "intrusion" into the doctor-patient relation, is a fundamental building block of an individual's identity and mechanisms for dealing with illness, disease, and incapacity. As such it is an essential component in the health care professional's armamentarium employed to bring about healing. Furthennore, it functions in a similar way to assist the health professional in his or her relations to the sick and injured. The second conviction follows from the fITst. Autonomy is far more complex than appears from the philosophical use of the concept. In this conviction we join those who have criticized the over-reliance on autonomy in modem, secular bioethics originating in the United States, but gaining ascendancy in other cultures. This critique relies on appeals to the richer contexts of persons' lives. Elsewhere the contemporary critique of autonomy appears in a variety of alternative ethical models like narrative ethics, casuist ethics, and contextualism. Indeed, postmodern criticism of all bioethics argues that there is no defensible foundation for claims that one ought to respect autonomy or any other principle as a way of ensuring that one is ethical.

PERSONHOOD AND HEALTH CARE This book arose as a result of a pre-conference devoted to the topic held June 28, 1999 in Paris, France. The pre-conference preceded the Annual Congress of the International Academy ofLaw and Mental Health. Other chapters were solicited after the conference in order to more completely explore the relation of personhood to health care. The pre­ conference was held in honor of Yves Pelicier who led so many of our French colleagues in medicine, philosophy, and ethics as Christian Herve notes in his Tribute. As health care is aimed at healing persons, it is important to realize how difficult it is to construct a theory of personhood for health care, and thus, a theory of how healing in health care comes about or ought to occur. The book is divided into four parts, Concepts of the Person, Theories of Personhood in Relation to Health Care and Bioethics, Person and Identity, and Personhood and Hs Relations. Each section explores a critical arena in constructing the relation of personhood to health care. Although no exploration ofthis nature can be exhaustive, every effort was made to present both conflicting and complementary views of personhood from within similar and different philosophical and religious traditions. PART ONE: CONCEPTS OF THE PERSON Tracing the origins of the concept of person from antiquity through present day, Jean Delemeau provides an historical sketch of the development of a wide range of meanings.

Culture, Health, and Social Change is the first of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "aging" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of aging is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.

Caring for Our Elders is the second of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines address some of the major issues in elder care facing modern nations: familial duties of care, the future of social welfare systems, housing, dementia, abuse and neglect.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

Moral capacity is an important feature of what it means to be human. In this volume, the contributors have taken on the daunting task of trying to distinguish between legal and moral capacity. This distinction is difficult at times for clinicians, philosophers and legal scholars alike. Part of the challenge of defining moral capacity lies in the difficulty of adequately categorizing it. For this reason, the editors have chosen to divide the book into three parts. The first looks at the concepts involved in the discussion of moral capacity; the second considers the role of moral capacity in the lives of professionals; and the final part reflects on case studies of moral capacity or incapacity illustrating the challenge that moral capacity presents - its definition lying between two seemingly incommensurable models, those of the threshold and continuum. This volume takes a multidisciplinary approach to the subject, and ties the disciplines of medicine, philosophy and law into the health context. It will be of interest to medical health professionals as well as researchers working in the areas of philosophy and law.

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

Caring for Our Elders is the second of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines address some of the major issues in elder care facing modern nations: familial duties of care, the future of social welfare systems, housing, dementia, abuse and neglect.

Culture, Health, and Social Change is the first of three volumes on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines contest some of the predominant paradigms on aging, and critically assess modern trends in social health policy. How we approach and understand "aging" will have indelible effects on existing and future elder citizens. Acknowledging the cultural variances that exist in the human experience of aging is therefore of vital importance in order to respond to individual needs in a manner that is not paternalistic, discriminatory, or exclusionary.