This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

During the past four decades, the Netherlands played a leading role in the debate about euthanasia and assisted suicide. Despite the claim that other countries would soon follow the Dutch legalization of euthanasia, only Belgium and the American state of Oregon did. In many countries, intense discussions took place. This article discusses some major contributions to the discussion about euthanasia and assisted suicide as written by Nigel Biggar, Arthur J. Dyck, Neil M. Gorsuch, and John Keown. They share a concern (...) that legalization will undermine a society's respect for the inviolability and sanctity of life. Moreover, the Report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill is analyzed. All studies use ethical, theological, philosophical, and legal sources. All these documents include references to experiences from the Netherlands. In addition, two recent Dutch documents are analyzed which advocate further liberalization of the Dutch euthanasia practice, so as to include infants and elderly people "suffering from life". (shrink)

But as Harvard ethicist Arthur J. Dyck shows in this powerful work, there are solid moral and practical bases for the existing laws against assisted suicide in ...

Examines ethics as a discipline from which knowledge may be derived, which offers guidance for practical understanding and moral decision making, and which underlies methods of effecting such moral decisions.

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The ideal physician is confident, empathic, forthright, respectful, and thorough. These ideals allow us to define broadly "the excellence" of being a physician. At the core of these ideals is the ability to be empathic. Empathy exhibits itself in attributes of an individual's moral character and also in actions that actualize and support (...) communal life. Empathy, however, can be diminished or even lost and must be nurtured on an ongoing basis. The development of ethical physicians is strongly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. Creating a clinical environment that is ethically nurturing and sustaining is an indispensable component of practicing medicine. (shrink)

Contemporary moral philosophy tends to equate what is moral with what is obligatory. Hence, there is a tendency to exclude all virtues from what is moral because they are dispositions other than the one morally good disposition to fulfill obligations out of a sense of obligation. This has the effect of excluding much of what we admire about persons from moral philosophy and from the moral life. This essay argues that there are at least two virtues, both forms of love, (...) moral perceptivity and moral tenacity, which are moral and obligatory. The author explores some of the relationships of these two moral virtues to the traditional theological virtues of faith, hope, and love, and to heroism and saintliness. (shrink)

This book focuses on justice and its demands in the way of providing people with medical care. Building on recent insights on the nature of moral perceptions and motivations from the neurosciences, it makes a case for the traditional medical ethic and examines its financial feasibility. The book starts out by giving an account of the concept of justice and tracing it back to the practices and tenets of Hippocrates and his followers, while taking into account findings from the neurosciences. (...) Next, it considers whether the claim that it is just to limit medical care for everyone to some basic minimum is justifiable. The book then addresses finances and expenditures of the US health care system and shows that the growth of expenditures and the percentage of the gross national product spent on health care make for an unsustainable trajectory. In light of the question what should be changed, the book suggests that overdiagnosis and medicalizing normal behavior lead to harmful, costly and unnecessary interventions and are the result of unethical behavior on the part of the pharmaceutical industry and extensive ethical failures of the FDA. The book ends with suggestions about what can be done to put the U.S. health care system on the path to sustainability, better medical care, and compliance with the demands of justice. (shrink)

Part I of this essay described "Ought" and "Value" as forms of moral requiredness. Now in Part II, a description of the ideal conditions for veridical perceptions of moral requiredness are specified. This is done in the form of an ideal observer type of analysis. This analysis is defended against those who oppose naturalism by assuming a bifurcation between 'ought' and 'is' and those who accuse naturalism of a "naturalistic fallacy." It is argued that theistic versions of the ideal observer (...) form of analysis exist in the Christian tradition in logically acceptable and plausible formulations. Specific illustrations are provided. (shrink)

This is the first of two essays concerned to specify in what sense "ought" and "value" are genuine characteristics of reality serving as data that help us empirically verify the truth and falsity of our moral judgments. This, the first, essay discusses the significance of the ought/is question for moral philosophy and theological ethics, giving reasons for the inadequacy of current views on the relation between "ought" and "is." Building on the perceptual theories of Gestalt psychologists yields a phenomenological description (...) of the nature of "ought" and "value" as unique experiences of gap-induced demands or requiredness. These moral experiences of requiredness are delineated in such a way that they are distinguishable from aesthetic, logical, and causal forms of requiredness. (shrink)

Just below the surface of public life in the United States, a biblically based theory of rights vies with a theory that first appeared in the work of Bentham and Mill, and the latter is gaining increasing dominance. The resolution of this conflict has implications for a host of legal matters and public policy decisions, including life and death issues like physician-assisted suicide. Though the ascendancy of the Millian tradition reflects widespread skepticism concerning the possibility of developing a basis for (...) a common morality or defending a conception of natural inalienable rights, the author argues that a plausible account of common human morality can be developed from attention to the relationships that are requisite for sustaining the communities that are the condition of moral agency. (shrink)

In Joseph Butler, we have an account of human beings as moral beings that is, as this essay demonstrates, being supported by the recently emerging findings of the neurosciences. This applies particularly to Butler's portrayal of our empathic emotions. Butler discovered their moral significance for motivating and guiding moral decisions and actions before the neurosciences did. Butler has, in essence, added a sixth sense to our five senses: this is the moral sense by means of which we perceive what we (...) ought or ought not do. The moral sense yields relatively reliable moral perceptions when we love our neighbors as ourselves, and when our love for ourselves is genuine. Accurate moral perceptions will be thwarted by self-deceit—that is, by a self-partiality devoid of neighbor love, a condition that thwarts genuine self-love. This essay explores the parallels between Butler's understanding of self-deceit and Robert J. Lifton's understanding of "doubling.". (shrink)