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The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D. , joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J.
Polish School of Philosophy of Medicine
From Tytus Chalubinski (1820–1889) to Ludwik Fleck (1896–1961)
Inbunden, Engelska, 1990
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From Tyfus Chalubinski (1820-1889) to Ludwik Fleck (1896-1961)
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Human existence is marked by pain, limitation, disability, disease, suffering, and death. These facts of life and of death give ample grounds for characterizing much of the human condition as unfortunate. A core philosophical question is whether the circumstances are in addition unfair or unjust in the sense of justifying claims on the resources, time, and abilities of others. The temptation to use the languages of rights and of justice is und- standable. Faced with pain, disability, and death, it seems natural to complain that "someone should do something", "this is unfair", or "it just isn't fight that people should suffer this way". Yet it is one thing to complain about the unfairness of another's actions, and another thing to complain about the unfairness of biological or physical processes. If no one is to blame for one's illness, disability, or death, in what sense are one's unfortunate circumstances unfair or unjust? How can claims against others for aid and support arise if no one has caused the unfortunate state of affairs? To justify the languages of fights to health care or justice in health care requires showing why particular unfortunate circumstances are also unfair, in the sense of demanding the labors of others. It requires understanding as well the limits of property claims. After all, claims regarding justice in health care or about fights to health care limit the property fights of those whose resources will be used to provide care.
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Some conferences produce proceedings, others an inspiration to labor, which finally leads to a published work. Such has been the case with regard to this volume. In 1984, the Center for Ethics, Medicine, and Public Issues held a conference with the title 'When are Competent Patients Incompetent?' with the support of the Texas Committee for the Humanities, a state-based program of the National Endowment for the Humanities. Assistance was provided by both Baylor College of Medicine and the Institute of Religion. This conference evoked a con siderable interest in examining further the moral status of competency determinations in the clinical setting. This interest is realized in this volume, which now affords us an opportunity to thank all those individ uals who made the conference possible, only some of whom are acknowledged in this Preface. In particular, we wish to express our gratitude to Baruch A. Brody, Rebecca Dresser, the Honorable Jerome Jones, H. Steven Moffic, Margery W. Shaw, Eleanor Tinsley, and Albert Van HeIden. The volume took its shape through the labors of Earl Shelp and Mary Ann Gardell Cutter, who inspired the further evolution of the papers presented at the conference and attracted contributions from individuals who had not attended. Earl Shelp and Mary Ann Gardell Cutter have produced a volume following extensive reflection and dialogue; they were ably assisted in the final preparation of the manu script by Thomas J. Bole III and George Khushf, to whom special thanks are due.
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A major focus of the philosophy of medicine and, in general, of the philosophy of science has been the interplay of facts and values. Nowhere is an evaluation of this interplay more important than in the ethics of diagnosis. Traditionally, diagnosis has been understood as an epistemological activity which is concerned with facts and excludes the intrusion of values. The essays in this volume challenge this assumption. Questions of knowledge in diagnosis are intimately related to the concerns with intervention that characterize the applied science of medicine. Broad social and individual goals, as well as diverse ethical frameworks, are shown to condition both the processes and results of diagnosis. This has significant implications for bioethics, implications that have not previously been developed. With this volume, "the ethics of diagnosis" is established as an important branch of bioethics.
Meaning of Illness
A Phenomenological Account of the Different Perspectives of Physician and Patient
Inbunden, Engelska, 1992
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This work provides a phenomenological account of the experience of illness and the manner in which meaning is constituted by the patient and the physician. Rather than representing a shared reality between doctor and patient, illness represents two quite distinct realities - the meaning of one being significantly and qualitatively different from the meaning of the other. Drawing upon insights derived from psychological phenomenology, the author explores this difference and provides a detailed account of the way in which illness and body are apprehended differently by doctor and patient. The author considers the implications for medical practice, particularly in terms of achieving successful communication between doctor and patient, providing a comprehensive account of illness, alleviating suffering, and devising maximally effective therapeutic interventions. Consideration is given to ways of developing a shared world of meaning through the use of clinical narrative, empathic understanding and an explicit focus on the lifeworld interpretation of illness.
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In the second half of the 20th century, the body has become a central theme of intellectual debates. How should we perceive the human body? Is it best understood biologically, experimentally, culturally? How do social institutions exercise power over the body and determine norms of health and behaviour? The answers arrived at by phenomenologists, social theorists and feminists have radically challenged the conventional notions of the body dating back to the 17th century Cartesian thought. This volume explores the range of contemporary thought concerning the body and aims to draw out its crucial implications for medicine. The book suggests that many of the problems often found in modern medicine - dehumanized treatment, overspecialization and neglect of the mind's healing resources - are directly traceable to medicine's outmoded concepts of the body. Alternatives are proposed by physicians and philosophers working in the medical humanities today.
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A collection of papers by eminent scholars who discuss issues and concepts regarding the character of medicine. Special attention is given to the extent to which medicine is a science, art and technology. Investigations are carried out with a particular focus on the nature of medical knowledge. Concepts of medical research, medical causality, intuition and medical decision making are examined in the light of medicine's revolutionary advances in the 20th century. Past perspectives and present perplexities are also examined.
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Offers a wide-ranging survey of early medical ethics, primarily in the English-speaking world. The period covered is the "long 18th century", culminating in the formal ethics of John Gregory and Thomas Percival. The relationship between ethical dilemmas of actual practice and the formulations of philosophically-minded physicians is closely examined, and the historical and philosophical roots of late Enlightenment medical-ethical theories are also explored. A second volume is planned, to examine developments in the 19th century.
Meaning of Illness
A Phenomenological Account of the Different Perspectives of Physician and Patient
Häftad, Engelska, 1993
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This work provides a phenomenological account of the experience of illness and the manner in which meaning is constituted by the patient and the physician. Rather than representing a shared reality between doctor and patient, illness represents two quite distinct realities - the meaning of one being significantly and qualitatively different from the meaning of the other. Drawing upon insights derived from psychological phenomenology, the author explores this difference and provides a detailed account of the way in which illness and body are apprehended differently by doctor and patient. The author considers the implications for medical practice, particularly in terms of achieving successful communication between doctor and patient, providing a comprehensive account of illness, alleviating suffering, and devising maximally effective therapeutic interventions. Consideration is given to ways of developing a shared world of meaning through the use of clinical narrative, empathic understanding and an explicit focus on the lifeworld interpretation of illness.
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For centuries the Roman Catholic Church has been concerned with the moral implications of medical practice. Indeed, until two decades ago, Catholic moral theologians were the major source of moral guidance, scholarly reflection and teaching on a variety of medical-moral topics, particularly those bearing on human life. Many, not only those within the Catholic communion, turned to the Church for guidance as each new possibility for altering the conditions of human life posed new challenges to long held moral values. Two decades ago, the center of gravity of ethical reflection shifted sharply from theologians and Christian philosophers to more secular thinkers. A confluence of forces was responsible for this metamorphosi- an exponential rate of increase in medical technologies, expanded education of the public, the growth of participatory democracy, the entry of courts and legislation into what had previously been private matters, the trend of morality towards pluralism and individual freedom and the depreciation of church and religious doctrines generally. Most significant was the entry of professional philosophers into the debate, for the first time. It is a curious paradox that, until the mid-sixties, professional philosophers largely ignored medical ethics. Today they are the most influential shapers of public and professional opinion.
Concept of Moral Consensus
The Case of Technological Interventions in Human Reproduction
Inbunden, Engelska, 1994
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Books do not come about by accident. This is especially the case when a volume grows out of a conference for which the participants wrote the original contributions in different languages. This volume descends from a conference held at the Zentrumjiir interdiszipliniire Forschung, University of Bielefeld, Germany, October 4 through 6, 1990, under the title "Technische Eingriffe in die menschliche Reproduktion: Per- spektiven eines moralischen Konsenses". Many with great generosity helped to ensure that the conference was a success and that the papers presented grew into a book. We want in particular to acknowledge our deep gratitude to the Zentrumjiir interdiszipliniire Forschung for spon- soring this important conference, and to its director, Peter Weingart, for his important guidance and support. Our thanks are also due to all of the staff ofthe Zentrum. It is they who made the conference successful. We are also grateful to Prof. Hilmar Stolte, head of the Institut jiir System- und Technologieanalysen in Bad Oeynhausen, Germany, for making available additional financial support for the conference.Our thanks are also owed to the participants who inspired us to transform a collection of papers into a completed volume. The general trans- formation of the original papers required translation. Here we must acknowledge the labors of Sarah L. Kirkby, who rendered many parts of the volume into English. Finally, we want to recognize the invaluable support given by the ecumenical teamwork of Kurt W.
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This volume brings together a number of scholarly studies on the definition, assessment and measurement of human quality of life. The book contains fundamental analyses of basic concepts such as welfare, well-being, happiness and quality of life itself, but contains also discussions on the application of such concepts for measuring purposes mainly in a health-care context. Although the approach to these problems in the book is predominantly philosophical, there are also some studies which take a different, mainly sociological and medical, point of view. Most of the authors have a Scandinavian origin and their essays mirror the current debate on quality of life in northern Europe. The book, however, also contains contributions by scholars from the UK, France, Italy and the Netherlands.
Legislating Medical Ethics
A Study of the New York State Do-Not-Resuscitate Law
Inbunden, Engelska, 1995
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Can medical ethics be legislated? Can a complex bioethical question be definitively answered through legislation? In July 1987 the New York State legislature experimented with legislating medical ethics by amending the state's public health law to regulate "Do Not Resuscitate" orders. The consequent law was complex and remains controversial. This volume reviews both the background bioethical debates and the elements of the public policy-making process that are essential to understanding New York's experience with the DNR law. It features debates between leading exponents and critics of the law; case studies that examine the impact of New York's DNR law on clinicians, hospitals and patients; and a review of all empirical studies of the law by their lead authors. Appended to the volume is the New York State DNR law and a comprehensive set of background documents.
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This study of the concept of health combines central ideas in modern philosophy of medicine with some results from analytical action theory. The concept which emerges is one of health founded on an action-theoretic platform: a person's health is characterized by his/her ability to achieve his/her vital goals. The book draws on insights from a number of modern philosophers of medicine - in particular, C. Boorse, C. Whitbeck and I. Porn. Some conclusions, however, are quite different from all the modern theories discussed. This mainly concerns the analysis of the concept of a vital goal which is, in the present study, connected with human happiness. The book should be of particular interest to philosophers of medicine and philosophers in general. It is also of value to medical personnel and health policy-makers who take an interest in the conceptual foundations of health care.
Critical Choices and Critical Care
Catholic Perspectives on Allocating Resources in Intensive Care Medicine
Inbunden, Engelska, 1995
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This text brings together the traditional reflections on ordinary and extraordinary means with Catholic social thought. It examines the difficult questions on the allocation of high technology resources used in intensive care medicine. The book also provides relevant background information (- such as statements by the Society of Critical Care Medicine and the Congregation for the Doctrine of the Faith) and should approve accessible to theologians, philosophers, and health-care professionals.
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This study of the concept of health combines central ideas in modern philosophy of medicine with some results from analytical action theory. The concept which emerges is one of health founded on an action-theoretic platform: a person's health is characterized by his/her ability to achieve his/her vital goals. The book draws on insights from a number of modern philosophers of medicine, in particular C. Boorse, C. Whitbeck and I. Porn. The conclusions mainly concern the analysis of the concept of a vital goal which is, in the present study, connected with human happiness. This text will be of particular interest to philosophers of medicine, philosophers in general, medical personnel and health policy makers who take an interest in the conceptual foundations of health care.
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The Codification of Medical Morality, the second volume in a two-volume survey of pre-twentieth century modern medical ethics, presents fresh historical research and philosophical analyses of the evolution of medical ethics in nineteenth century America and the development of a different, but parallel, tradition of medical jurisprudence in nineteenth century Britain. These original papers are supplemented by reprints of: the first American Code of medical ethics, the Boston Medical Police of 1808; and an unabridged version of the American Medical Association's 1847 Code of Ethics; and the second (1886) edition of Jukes Styrap's Code of Ethics - a Code which, although officially rejected by the British Medical Association, nonetheless defined the 'done thing' for British practitioners in the last decades of the nineteenth century.
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This text, the second volume in a two-volume survey of pre-20th century modern medical ethics, presents fresh historical research and philosophical analyses of the evolution of medical ethics in 19th-century America and the development of a different, but parallel, tradition of medical jurisprudence in 19th-century Britain. These original papers are supplemented by reprints of: the first American Code of medical ethics, the Boston Medical Police of 1808; and an unabridged version of the American Medical Association's 1847 Code of Ethics; and the second (1886) edition of Jukes Styrap's Code of Ethics - a Code which, although officially rejected by the British Medical Association, nonetheless defined the "done thing" for British practitioners in the last decades of the 19th century.
Philosophy of Medicine and Bioethics
A Twenty-Year Retrospective and Critical Appraisal
Inbunden, Engelska, 1997
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Papers presented at a symposium on philosophy and medicine at the Institute for the Medical Humanities at the University of Texas Medical Branch in 1974 were published in the inaugural volume of this series. To help celebrate more than 20 years of success with the series, another symposium was convened in Galveston in 1995. The convenors asked the participants these questions: In what ways and to what ends have academic humanists and medical scientists and practitioners become serious conversation partners in recent years? How have their dialogues been shaped by prevailing social views, political philosophies, academic habits, professional mores, and public pressures? What have been the key concepts and questions of these dialogues? Have the dialogues made any appreciable intellectual or social difference? Have they improved the care of the sick? Authors respond here from a variety of theoretical perspectives in the humanities. They also articulate conceptions of philosophy of medicine and bioethics from various practice experiences, and bring critical attention to aspects of the contemporary health policy.
Critical Choices and Critical Care
Catholic Perspectives on Allocating Resources in Intensive Care Medicine
Häftad, Engelska, 1995
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This text brings together the traditional reflections on ordinary and extraordinary means with Catholic social thought. It examines the difficult questions on the allocation of high technology resources used in intensive care medicine. The book also provides relevant background information (such as statements by the Society of Critical Care Medicine and the Congregation for the Doctrine of the Faith) and should prove accessible to theologians, philosophers and health-care professionals.
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"Sanctity of life" and "human dignity" are two bioethical concepts that play an important role in bioethical discussions. Despite their separate history and content, they have similar functions in these discussions. In many cases they are used to bring a difficult or controversial debate to an end. They serve as unquestionable cornerstones of morality, as rocks able to weather the storms of moral pluralism. This work provides the reader with analyses of these two concepts from different philosophical, professional and cultural points of view.
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This text brings together a diverse group of clinicians, theologians, and philosophers to examine the use of reproductive technologies in the light of the Roman Catholic moral tradition and recent teaching. The book provides relevant background information (e.g. "Donum Vitae" from the "Congregation for the Doctrine of the Faith") as it explores the psychological, social, legal, and moral contexts of reproductive medicine.
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The essays in this volume, while exploring bioethical issues bearing on death and dying, the use of scarce resources, and genetic interventions, also implicitly compare approaches to bioethics in Japan versus Western countries. This volume provides a cross-cultural comparison of Japanese, American and European approaches to bioethics and health care policy. In a world of international bioethics, it explores the similarities and dissimilarities between bioethics in Japan and the Western world. The collection gives both a portrayal of current approaches as well as an analysis of the character and grounds for the similarities and dissimilarities. The similarities reflect attempts to find morally justified bases for collaboration when individuals do not share taken-for-granted understandings of the proper use of health care, the meaning or form of a good death, and the correct ways to collaborate. Similarities also derive from Western bioethical reflections that have been exported to Japan, which, for better or worse, have entered and altered traditional Japanese understandings. Japan and the West have been exposed to the post-traditional character of the age.Many of the dissimilarities stem from the fact that Japan remains in large measure a traditional society with strong ties to family, culture and community. Japanese share many common understandings of values, while the West has long struggled with moral diversity. These essays explore particular bioethics, which reflect particular moral commitments, as contributions to the emerging international dialogue concerning bioethics and health care policy.
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In contemporary ethical discussion widespread concern about the potential risks of genetic engineering is raising new and fundamental questions about our responsibilities towards unborn generations. Newly acquired knowledge in genetic engineering techniques has brought about not only potential benefits but also immense risks for the well-being of both present and future generations. This text raises a number of ethical issues concerning the impact of genetic engineering on generations yet to be born. The four topical areas that constitute the focus of the volume, namely (1) from laboratory to germ-line therapy, (2) the concept of human nature: theological and secular perspectives, (3) genetic intervention and the common heritage view, and (4) social responsibilities of geneticists towards future generations, raise intriguing ethical and legal questions, as well as important policy issues. As much as any set of issues, they reflect the hopes and fears, prejudices and uncertainties that people associate with germ-line intervention and the future of human kind.
John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine
Inbunden, Engelska, 1998
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A study of the medical ethics of John Gregory (1724-1773), who wrote the first English-language bioethics. This book shows how Gregory invented professional medical ethics and, in the process, the concept of the profession of medicine as a fiduciary profession. Making use of manuscript and other primary sources, the book provides a biography of Gregory, placing his medical ethics in its 18th-century contexts of Scottish Enlightenment history and culture, Baconian science and philosophy of medicine, medical practice, the feminine and feminist philosophy of the Bluestocking Circle, and moral sense philosophy, particularly David Hume's concept of sympathy. A detailed examination of his texts on medical ethics is followed by a consideration of the implications of Gregory's medical ethics for contemporary bioethics, especially feminist bioethics. This book is intended for scholars, teachers and students of bioethics, medical ethics, the history of medicine, and the history of medical ethics.
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Consensus is an important topic in bioethics. Approaches to consensus formation developed over the last decade to establish standards of clinical practice are now extended to moral issues. Healthcare ethics committees, ethics advisory boards, and national ethics committees aim at creating and formulating consensus. The essays in this volume analyze the various dimensions of consensus formation. They demonstrate the clinical, institutional and political context of consensus regarding ethical issues. Consensus formation as a dialogic and discursive activity is also deeply influenced by the socio-cultural context, as examples from Europe, Japan and the US illustrate. Specific problems in consensus formation are discussed in regard to genetic counselling, psychiatry, treatment decisions in family medicine, futility, and reproductive technology. The essays in the volume explore the potentials and problems of forming consensus at various levels of health care in modern pluralist societies.
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This volume reprints in a scholar's edition the first English-language texts on bioethics, John Gregory's (1724-1773) "Observations on the Duties and Offices of a Physician" and on the "Method of Prosecuting Enquiries in Philosophy" (London, 1770) and "Lectures on the Duties and Qualifications of a Physician" (London, 1772). Five previously unpublished manuscripts of Gregory's lectures are also included. An introduction places Gregory's medical ethics and philosophy of medicine in their 18th-century contexts of Scottish Enlightenment history and culture, Baconian science and philosophy of medicine, medical practice, the feminine and feminist philosophy of the Bluestocking Circle, and moral sense philosophy, particularly David Hume's concept of sympathy, and provides a bibliography of primary and secondary sources as an aid to teaching and future scholarship. The book's index provides access to Gregory's texts, by using both historical terms and current terminology of bioethics.
Ownership of the Human Body
Philosophical Considerations on the Use of the Human Body and its Parts in Healthcare
Inbunden, Engelska, 1998
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This is a study of healthcare ethics, addressing the moral issues regarding ownership of the human body. Modern medicine increasingly transforms the body and makes use of body parts for diagnostic, therapeutic and preventive purposes. This book analyzes the concept of body ownership. It also reviews the ownership issues arising in clinical care (for example, donation policies, autopsy) and biomedical research. Societies and legal systems also have to deal with issues of body ownership. A comparison is made between specific legal arrangements in the Netherlands and France, as examples of legal approaches. In the final section of the book, different theoretical perspectives on the human body are analyzed - libertarian, personalist, deontological and utilitarian theories of body ownership.