ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

ABSTRACT Curtailing health care for the very old promises to free resources that can be devoted to others. Such self‐conscious limit‐setting, leading to premature death, requires both a moral justification and a change in the paradigm of physician obligation. This paper argues that the moral justification for curtailing care is absent, and that the paradigm of the physician as a servant of life, and the patient's agent, is worth preserving. Finally, it is suggested that, if the ailing old need to (...) be deprived of life‐extending care, then the state should undertake the task of killing them. Physicians should not undertake this role, for it is the state that may gain an advantage it seeks by saving money, not the physicians. (shrink)

The following article is a response to the position paper of the Hastings Center, “Ethical Challenges of Chronic Illness”, a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. (shrink)