The four principles approach to biomedical ethics points to respect for autonomy, beneficence, non-maleficence and justice as the norms that should guide moral agents working in the biosciences, and particularly in health care. While the approach is well known, it is not without its critics. In this paper, which is primarily aimed at health professionals and students (from various disciplines) who are studying health care ethics, I consider four problems with the four principles, which respectively claim that the approach is (...) imperialist, inapplicable, inconsistent and inadequate. In keeping with the aims of the ‘five-minute focus’, the primary objective is to introduce these debates, rather than seek to resolve them. However, I will suggest that the approach does have its merits, not least for time-pressed clinicians who are keen to keep an eye on the ethical dimensions of their practices, and for students training in the health care professions, provided that they appreciate that the approach provides only a starting point for, and not the end point of, moral deliberation. (shrink)

Objetivo. Introducir en la reflexión bioética el concepto de “reconocimiento recíproco”, como herramienta para la fundamentación de la bioética y el análisis de casos problemáticos. Hipótesis. Para entender y buscar soluciones a los nuevos problemas surgidos en el contexto de la atención a la salud, no resulta suficiente el positivismo jurídico ético. El reconocimiento bidireccional, concepto desarrollado por Honneth en su matiz de reciprocidad, denominado mutuo por Ricoeur y Cortina, permite construir un modelo de justicia aplicable al ámbito sanitario, tanto (...) en lo relativo a relaciones entre pacientes y personal, cuanto a las relaciones entre los profesionales, o de todos ellos con la organización sanitaria. Su ausencia en la relación clínica, en la gestión sanitaria, o en la salud pública, es un buen factor explicativo de los conflictos. Aplicado al análisis de conflictos, el concepto de reconocimiento ofrece posibilidades para transformar las relaciones conflictivas en relaciones de cooperación. Todo ello es novedoso, ya que hasta ahora apenas se ha investigado sobre reconocimiento recíproco como fundamento de la bioética. (shrink)

According to the recovery model, mental healthcare should be aimed towards a conception of recovery articulated by a patient or service user in accord with his or her own specific values. The model thus presupposes and emphasises the agency of the patient and opposes paternalism. Recent philosophical work on the relations between respect, self-respect, self-esteem, shame, and agency suggests, however, two ways in which mental illness itself can undermine self-respect, promote shame and undermine agency, suggesting a tension within the recovery (...) model. I argue, however, that this is a tension rather than a fatal flaw by distinguishing between paternalist and non-paternalist clinical responses to this failure of agency. (shrink)

The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three (...) elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement. (shrink)

Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM Fulford, it goes further in the form of a radical liberal view: that (...) the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP. (shrink)