Persons concerned with medical education sometimes argued that medical students need no formal education in ethics. They contended that if admissions were restricted to persons of good character and those students were exposed to good role models, the ethics of medicine would take care of itself. However, no one seems to give much philosophic attention to the ideas of model or role model. In this essay, I undertake such an analysis and add an analysis of role. I show the weakness (...) in relying on role models exclusively and draw implications from these for appeals to virtue theory. Furthermore, I indicate some of the problems about how virtue theory is invoked as the ethical theory that would most closely be associated to the role model rhetoric and consider some of the problems with virtue theory. Although Socrates was interested in the character of the (young) persons with whom he spoke, Socratic education is much more than what role modeling and virtue theory endorse. It -- that is, philosophy -- is invaluable for ethics education. (shrink)

We consider the moral and social ingredients in physicians' relationships with patients of diminished capacity by considering certain claims made about friendship and the physician's role. To assess these claims we look at the life context of two patients as elaborated examples provided in two novels: Woman on the Edge of Time (1976) by Marge Piercy, a radical feminist; and It's Hard to Leave While the Music's Playing (1977) by I. S. Cooper, a prominent physician-researcher. At issue is how the (...) doctor-patient relationship should be structured. In question is whether the physician's friendship and professional expertise, together with the diminished capacity of the patient, authorize medical paternalism. From our examination, we find compelling insights against appealing to friendship both in good doctor-patient relationships and in more typical, not-so-good ones. (shrink)

Recently, a physician requested permission to include in the information packet about himself that he would not accept patients who smoke and would not continue the care of current patients who smoke. His poignant statement follows.

Philosophy is generally considered to be very abstract. How philosophical and abstract Is ethical thinking In clinical situations? This paper sketches an answer In the form of a case study and offers me the chance for some self-reflection and readers the chance to eavesdrop on that self-reflection. Aside from any Intrinsic worth of the questions and answers, they also have Implications for how clinical ethicists should be educated or trained, i.e., how abstract should one's work in moral philosophy be?

This paper is an analysis of the events recounted in 'Informed consent to septoplasty: An anecdote from the field.' As a commentary, it assesses the behavior of many agents who are parties to the story - physicians, nurses, friends of the patient, the patient's wife and the patient himself. This story is interesting for being mundane. The medical condition involved and the failures of care are not momentous. The patient's role as a medical ethicist led him to see things in (...) particular perspective and motivated or influenced his conduct sometimes not in the smartest of ways. Several accounts of informed consent are reviewed and used as measures of what happened. The moral vision behind informed consent, the rights and duties it implies and the elements of its contents are identified. No account was fulfilled. Some of the reasons and causes for this are discussed. Many sources of information and forces acting on the situation are explored. Post-operative experiences include severe irritation and discomfort as well as severe frustration and a sense of alienation and abandonment. The case communicates a hint about what physicians do not know in order to have informed consent occur. Physicians' lack of awareness about, e.g., post-operative experience means that they will not provide what the informed aspect of informed consent requires. Patients can feel abandoned and perhaps are abandoned in a variety of ways, subtle and not so subtle. A few issues besides informed consent are discussed (the roles of wives in working at their physician-husband's front desk, the language of reassurance). (shrink)

My aim in this paper is to correct Hume's gloss of the Crito both for the historical purpose of enhancing our understanding of the dialogue and for the philosophical aim of illuminating the grounds of morality and moral community. My thesis is that both Hume and Plato are sensitive to the human condition, which is manifestly a condition of inter- dependence, which means that rational, free, informed acceptance of a government depends on some government's prior parentalism.

This paper tells the story of events that led up to a septoplasty and the consequences that followed it. The patient is a medical ethicist. After scratching the inside of a nostril in 1976, he suffered with occasional bleeding and irritation for almost two decades. He tried topical treatment. As this failed, he sought help from an ENT specialist. The paper relates the conduct of the patient and others (friends in the medical field, the patient's spouse, nurses and anesthesiologists) vis-à-vis (...) informed consent. (shrink)

This essay announces the inauguration of a section ofTheoretical Medicine and invites submissions on the topic Method and Methodology in Medical Ethics. It offers some sketches of plausible meanings of method and of methodology and their relationships as these might apply to work in biomedical ethics. It suggests a broad range of issues, dilemmas or conflicts that may be addressed for help via method and/or methodology.

As Montaigne put it, on the highest throne in the world man sits on his arse. Usually this epigram makes people laugh because it seems to reclaim the world from artificial pride and snobbery and to bring things back to egalitarian values. But if we push the observation even further and say men sit not only on their arse, but over a warm and fuming pile of their own excrement—the joke is no longer funny. The tragedy of man's dualism, his (...) ludicrous situation, becomes too real. The anus and its incomprehensible, repulsive product represents not only physical determinism and boundness, but the fate as well of all that is physical: decay and death. [Becker, 1973, p. 31]. (shrink)

This essay is an array of several taxonomies of values which bear on medicine. The first is a rather low-level list of types of values, meant to be adequate to observational data collection about human valuing. It proceeds to a discussion of levels of valuing so that senses of higher and lower values are articulated. Next, it offers a consideration of intrinsic versus extrinsic and of fundamental versus domestic (or mediating, enabling) values, along with the notions of a practice and (...) virtues. Finally it offers an analysis of clusters of value types along the lines of personal values, social values and professional values acting as interlocking force fields affecting the judgments, reactions and decisions of persons working in health care. In addition to the anticipated elucidation contained in the dialectic, two conclusions are intended: (1) the topic of values in medicine is staggeringly complex, and (2) a medical career is in the best sense a tragic fate in that a noble calling is doomed to many failures because of an inability to reconcile conflicts of values as much as because techniques cannot accomplish everything. (shrink)

The essays by Scott DeVito and Abraham Rudnick are on largely the same topics - the meanings of health(y), normal, disease, pathological, diagnosis , etc., and they contain compatible conclusions - that medical precepts are value-laden and less objective than some na?ve model of scientific objectivity would suggest. This commentary opens with a brief critique of each and ends with a more in-depth account, one complaint being how lacking in weight the analyses are. In the middle portion of this commentary, (...) I consider the sorts of values that are present in some case studies - values that give the project much more weight . These include the values, scientific and self-serving, that professionalism provides. I show how medicine and its disease-related concepts can be thought to evolve in many ways. (shrink)

There are many calls for a definitions personhood, but also many logical and Wittgensteinian reasons to think fulfilling this is unimportant or impossible. I argue that we can consider many contexts as language-games and consider the person as the key player in each. We can then examine the attributes, presuppositions and implications of personhood in those contexts. I use law and therapeutic psychology as two examples of such contexts or language-games. Each correlates with one of the classic “theories” of ethics-deontology (...) and consequentialism. But each is a large enough cluster to consider them as paradigms in a sense related to Thomas Kuhn's notion in The Structure of Scientific Revolutions. Showing the presuppositions about and “takes” on personhood together with the connections involved in the paradigms deepens the dilemmas we already know to be present. (shrink)

Concerning the thing of which I am most in earnest] I certainly have composed no work in regard to it, nor shall I ever do so in the future, for there is no way of putting it in words like other studies. (Plato, Seventh Letter 341c.

I assess the ethical content of Philip Roth's account of his father's final years with, and death from, a tumor. I apply this to criticisms of the nature and content of case reports in medicine. I also draw some implications about modernism, postmodernism and narrative understandings.

The variety of general issues and particular controversies in biomedical ethics can be understood as reflecting a deeper unity than normally supposed. The principle of plenitude and the paradigm of the "chain of Being" form the tie among the phenomena. They are defined, and their presence is tracked especially through some of the ideas and language in the debate about the ethics of abortion. Keywords: plenitude, great chain of Being, abortion, explanation CiteULike Connotea Del.icio.us What's this?

tracked the influence of the major Western historical paradigm of the great chain of being through various positions taken about abortion. This essay shows the paradigm's influence on our language – especially in animating the use of "god" and phrases like "playing god". This is important given the prevalence of religious values in bioethics debates and the pervasiveness of the language. I hunt unsuccessfully for a meaning that could serve as a moral principle, and I show how these phrases are (...) rooted in the paradigm. I conclude that all that such language can do is offer the pretense that there is a specific absolute ground for forbidding something which could otherwise be morally acceptable. But such language is nearly senseless, and worse still, it is immoral in that it cuts off reflection and debate. Keywords: play[ing] god, great chain of being, principle of plenitude CiteULike Connotea Del.icio.us What's this? (shrink)