Ethics: The Heart of Health Care - a classic ethics text in medical, health and nursing studies - is recommended around the globe for its straightforward introduction to ethical analysis. In this new edition David Seedhouse demonstrates tangibly and graphically how ethics and health care are inextricably bound together, and creates a firm theoretical basis for practical decision-making. He not only clarifies ethics but, with the aid of the acclaimed Ethical Grid, teaches an essential practical skill which can be productively (...) applied in day-to-day health care. This edition, which is even more readable than the first, includes additional case studies and teaching exercises, contains new material on ethical theory and offers two further decision-making tools - The Rings of Uncertainty and the Autonomy Test. The engaging new introduction reveals the genesis of the Ethical Grid, illuminates the intent and argument of the first edition, and explains why the book is needed today as much as ever. Intended for all who work in health care or health studies - indeed for anyone with an interest in health issues - this is a highly original, innovative and accessible work on a subject traditionally regarded as lofty and obscure. It clarifies a wide variety of complex ethical issues and will give the reader fresh inspiration and renewed confidence in dealing with the demands of modern health work. (shrink)

It is difficult to understand the meaning of ‘dignity’ in human rights, bioethics and nursing literature because the word is used so vaguely. Unless dignity’s meaning is spelt out it can disappear beneath more tangible priorities. In this article we define dignity and show how this can help health workers to maintain the dignity of people in their care.

Bioethicists are increasingly commenting on health care resource allocation, and sometimes suggest ways to solve various rationing dilemmas ethically. I argue that both because of the assumptions bioethicists make about social reality, and because of the methods of argument they use, they cannot possibly make a useful contribution to the debate. Bioethicists who want to make a practical difference should either approach health care resource allocation as if the matter hinged upon tribal competition (which is essentially what it does), or (...) they should do political philosophy in the traditional sense, and examine the health system from the outside. (shrink)

Declarations of the importance of dignity in health care are commonplace in codes of practice and other mission statements, yet these documents never clarify dignity’s meaning. Their vague aspirations are compared to comments from staff and patients about opportunities for and barriers against the promotion of dignity in elderly care institutions. These suggest that while nurses and health care assistants have an intuitive understanding of dignity, they either do not or cannot always bring it about in practice. Thus, despite stated (...) intentions to promote dignity, it appears that the circumstances of at least some elderly care institutions cause patients to experience avoidable indignities. Such institutions are “undignifying institutions” because they fail to acknowledge dignity’s basic components, focus excessively on quantifiable priorities, and have insufficient resources available to assure consistently dignifying care. As a partial solution, we argue that health workers should be taught to understand and specify the components of dignity, which will better prepare them to challenge undignifying practices and to recognise opportunities for dignity promotion. (shrink)

This paper responds to Dr Cassell's request for a fuller explanation of my argument in the paper, Against medical ethics: a philosopher's view. A distinction is made between two accounts of ethics in general, and the philosophical basis of health work ethics is briefly stated. The implications of applying this understanding of ethics to medical education are discussed.

Many leading health economists hold misconceived ideas about central components of their work. In particular, they assume that their methods are in principle valueneutral. This belief is demonstrably false. Health economic investigations incorporate mainly unexpressed theories of health. Unless this fact is recognised health economics will shortly reach a conceptual and practical dead end. The way to avoid this dead end is to express implicit theories of health, and explicitly to base philosophically and economically justifiable policy proposals on them.

The author responds to Professor Kottow's criticisms, explaining numerous errors and misconceptions.

It has been said that I am against medical philosophy. This is a misrepresentation of my position. I am against conventional medical ethics teaching as it has to be done in medical schools, but very much in favour of philosophy in medicine.

This paper is in three parts. In Part One we briefly explain that an unsophisticated form of utilitarianism—economic rationalism (ER)—has become dominant in many health systems. Its proponents argue that one of ER’s most important effects is to increase consumer choice. However, evidence from New Zealand does not support this claim. Furthermore, the logic of ER requires the construction of systems which tend to restrict individual participation.In Part Two we argue that although some have advocated an ‘ethic of care’ in (...) an attempt to counteract ER’s utilitarianism, two decades of campaigning have had little influence on health policy. ER’s pro-care adversaries have failed to make an impact because they have not developed a taxonomy of care—they have not established a language compatible with, or as powerful as, ER’s.In Part Three, in an attempt to raise the conceptual and practical status of caring in contemporary health systems, we distinguish four different forms of care. In opposition to those who believe the ‘ethic of care’ can adequately direct health care practice, we demonstrate that care is a secondary notion. We show that in order for a carer to decide which form of care to adopt in different situations she requires a more powerful idea. We contend further that health care ought to be governed by a theory of health, and suggest that ‘the foundations theory of health’ should be adopted by planners searching for a more humane alternative to ER. We conclude that ER’s dominance can and must be challenged. However, only those arguments which offer detailed theoretical analyses of health care, as well as meticulously derived practical policies, have any chance of success. (shrink)

It is difficult to understand the meaning of 'dignity' in human rights, bioethics and nursing literature because the word is used so vaguely. Unless dignity's meaning is spelt out it can disappear beneath more tangible priorities. In this article we define dignity and show how this can help health workers to maintain the dignity of people in their care.

Those who would enquire into therelationship between health conceptions and health care consequences are faced with a formidable task. In order to make this challenge manageable it is necessary to define the scope of the task as precisely as possible. Are we, for instance, faced with a purely theoretical challenge; a task for applied philosophy, or must we employ multi-disciplinary methods?This paper argues that while philosophy has a central clarifying role, inquiry into the relationship between health conceptions and health care (...) organisation can be done properly only through the combined efforts of several disciplines. Unless we are to be concerned only with abstract models it is essential to take account of the reality of health care situations. Given this it is suggested that the study of health conceptions is only a part of a greater task (unless all conceptions are to count as health conceptions). What is needed is understanding of the possible and actual purposes of health care, and detailed study of their practical implications. (shrink)

Any attempt to describe a "best health service' must make political assumptions. For example, should it help everyone? Do different people have different entitlements to its support? Should its help be offered according to need, value for money or ability to benefit? These assumptions are not always clear to health service decision-makers immersed in clinical and economic technicalities, so HCA invited two philosophers --John Shand and David Seedhouse -- to engage in conversation about the political philosophy of health care.

ConclusionA map of mental health is admittedly the vaguest of speculations at the moment. It is nowhere near as precise as anything presently seen through the mental health microscope. Indeed it may well turn out to offer nothing at all. On the other hand, the truth remains that unless we beat our addiction to microscopes we will never get even a glimpse of mental health: you can’t read a map with a microscope.

It is difficult to understand the meaning of ‘dignity’ in human rights, bioethics and nursing literature because the word is used so vaguely. Unless dignity’s meaning is spelt out it can disappear beneath more tangible priorities. In this article we define dignity and show how this can help health workers to maintain the dignity of people in their care.

A map of mental health is admittedly the vaguest of speculations at the moment. It is nowhere near as precise as anything presently seen through the mental health microscope. Indeed it may well turn out to offer nothing at all. On the other hand, the truth remains that unless we beat our addiction to microscopes we will never get even a glimpse of mental health: you can’t read a map with a microscope.