Among the important functions of the healthcare provider in providing quality care is the monitoring of the social environment of the patient. Although it is increasingly recognized that caring activity must include the whole patient and not merely the technical and pharmacological aspects of the patient's needs, the impact of the social environment upon the total health state has not been explored and debated to the extent that It might be.

TODAY it would seem to be rather generally assumed that Kant had posed a problem for any future metaphysics which no future metaphysics has either been able to solve, or perhaps even tried very hard to solve. And it would further seem to be the consensus that Kant's famous challenge to metaphysics really turned on what, in the broad sense of the term, might be called a set of simple logical considerations, viz. that any judgment, and hence any metaphysical judgment, (...) must needs be either analytic or synthetic; that if metaphysical judgments be analytic, then, in modern parlance, they cannot be truths about the world; and that if they be synthetic, they cannot very well be empirical truths, since they would then be lacking in those very properties of necessity and universality which Kant felt had to characterize metaphysical truths, if such there be. Accordingly, on the Kantian analysis there is no logical slot left for metaphysical judgments save that of the synthetic a priori. And into this slot, for the well-known Kantian reasons, metaphysical judgments cannot seem to be fitted. (shrink)

This book critiques contemporary trends in ethical theory, including the deontological tradition dating back to Kant, the teleological tradition of the utilitarians, the analytic movement, and the existentialist-phenomenologist movement. In refuting these trends, Veatch argues that moral and ethical distinctions cannot be rightly or adequately understood if they are regarded simply as matters of linguistic use but are grounded in the very being and nature of things.

The physician who upholds the Hippocratic oath is supposed to be loyal to his or her patients. This requires choosing only the therapy that the physician believes is best for the patient. However, knowing what is best requires randomized clinical trials. Thus, clinicians must be willing to recruit their patients to be assigned at random to one of two therapies in order to determine which is best based on the highest standards of pharmacological science.

We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals. The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others. Featuring a (...) wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues. Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms. (shrink)

A “white coat” ceremony functions as a rite of passage for students entering medical school. This comment provides a second option in response to the earlier, more enthusiastic, discussion of the ceremony by Raanan Gillon. While these ceremonies may serve important sociological functions, they raise three serious problems: whether the professional oath or “affirmation of professional commitment” taken in this setting has any legitimacy, how a sponsor of such a ceremony would know which oath or affirmation to administer, and what (...) the moral implications of this “bonding process” are. I argue that the initiation oath is morally meanignless if students are not aware of its content in advance, that different students ought to commit to different oaths, and that bonding of students to the medical profession necessarily separates them from identification with lay people who will be their patients. (shrink)

Environmentalists consider invasions by exotic species of plants and animals to be one of the most serious environmental problems we face today, as well as one of the leading causes of biodiversity loss. We argue that in order to develop and enact sensible policies, it is crucial to consider two philosophical questions: What exactly makes a species native or exotic, and What values are at stake? We focus on the first of these two questions, and offer some preliminary suggestions with (...) regard to the second. Through a series of case studies, we show that it is not always clear whether a species is native or exotic. We identify five possible criteria that could be used for distinguishing natives from exotics. Rather than identifying one of these criteria as the 'correct' one, we suggest that the concepts of 'native' and ' exotic ' function more like what some philosophers have called cluster concepts. That is, there are several characteristics that are typical of native species, and a corresponding set of characteristics that are typical of exotic species. None of these characteristics is either necessary or sufficient for identifying a species as either native or exotic. We then identify several of the values that are at stake in dealing with exotic species, and we suggest that policies need to avoid being overly simplistic. (shrink)

The single most important intellectual event in my career in medical ethics occurred the day I realized that the Hippocratic ethic for medicine was not merely outdated and irrelevant but actually in conflict with all the dominant religious and secular moral traditions of our day. Whether one stood in any of the great modern religious traditions or in any of the camps of secular philosophy—the liberal tradition of political philosophy, Marxism, or more recent feminist or communitarian views—the Hippocratic ethic was (...) wrong, both metaethically and normatively. (shrink)

Holmes Rolston has defended certain forms of hunting and meat eating when these activities are seen as natural participation in the food chains in which we evolved. Ned Hettinger has suggested that some of Rolston’s principles that govern our interactions with plants and animals might appear to be inconsistent with Rolston’s defense of these activities. Hettinger attempts to show that they are not. We argue that Rolston’s principles are not consistent with hunting, given Hettinger’s modifications. In his defense of Rolston, (...) Hettinger has challenged animal welfare ethicists to show that they can value animal predation while consistently condemning human hunting. We answer that hunting and meat eating by humans are “cultural” rather than “natural” activities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionRobert M. Veatch (bio)The Kennedy Institute of Ethics regularly sponsors intensive bioethics courses for physicians, nurses, and other health care professionals. While the basic course, held in June of each year, provides a general introduction to bioethics, advanced courses, which are often held in March, focus on more specific topics such as death and dying, justice and the allocation of resources, or theories and methods in bioethics. This (...) year the advanced course addressed one of the most sensitive and complex bioethical issues of our day: managed care. This issue of the Kennedy Institute of Ethics Journal includes revised versions of many of the papers from that meeting.As defined by one of the papers in this issue, managed care involves a system of health care delivery that manages resources, quality, and access associated with the delivery of health care. The key element of managed care is that, for the first time, managers—often from outside the health care professions—are intentionally controlling resources, and therefore controlling health care professional decisions that use those resources. The objective is not merely to eliminate utterly useless interventions—no one could plausibly object to that. Rather the target is also the elimination of inefficient and wasteful resource consumption. Increasingly, we recognize that many diagnostic tests and treatments offer, at best, a very marginal chance of doing the patient good. Some of these come at considerable cost. From the point of view of the rational organization of resources, no rational person would insist on receiving every last procedure that offers only a tiny chance to do a small amount of good at great cost. Managed care is designed to bring to consciousness and rationalize the decisions about which of these marginal, expensive benefits are worth pursuing.The problem is that any effort to eliminate any of the these expensive marginal services flies directly in the face of the Hippocratic ethic. Physicians and other clinicians traditionally are trained to believe that it is their moral duty to do what is best for the patient. Only now are we realizing that, taken literally, no rational person would want literally the best possible care, assuming that such care would include thousands of long-shot, expensive efforts to get the most modest of benefits at great cost. In a world of finite resources, rational people would certainly want very good medical care; they would want reasonable care. But they would also want some criteria of efficiency and fairness applied. The Hippocratic tradition has never addressed the problem of the difference between the best care and care that is of very high quality, but is chosen with an awareness that the best in medicine will necessarily come at the price of potentially serious [End Page vii] deprivation in other spheres of life. The ethics of managed care is fundamentally an exploration of how health care professionals can reconcile their traditional, if short-sighted and naive, commitment to doing what is best for their patients with increasing realism about the absurdity of pursuing every last possible increment of benefit.To the clinical health care professional, the issue raised most poignantly by managed care is whether the various health professions can still be practiced with integrity in a setting in which outsiders are charged with the rationalization and systematization of limits placed on excessive use of marginally beneficial resources. Edmund D. Pellegrino, a clinician and former Director of the Kennedy Institute, sets the tone for the course and for this issue of the Journal by making an appeal for the retention of the highest ethical standards of integrity for clinicians practicing in a managed care setting. He is unwilling to let standards be lowered in the process of systematizing the rational use of health care resources. The remaining papers in this issue respond to those pressures to change the nature of the clinical lay-professional relationship. Some of these presentations originated as panels designed to bring out varying points of view. The published form of the presentations, like the original oral remarks, are of different lengths. All have been edited by the presenters, some taking on the form of more finished papers, others still reflecting the less formal conversation of... (shrink)

Assesses the ethical problems that doctors face every day and advocates a more universal code of medical ethics, one that draws on the traditions of religion and philosophy.

The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Equality. By Robert M. Veatch.

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs can (...) provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

‘Apologetics’ is hardly a word to be used without apology in the present dispensation. And to speak of anything like a neglected avenue or opportunity in religious apologetics might almost seem as if one were speaking of an opportunity in just such an enterprise as no self-respecting philosopher would nowadays wish even to be associated with. For all of their avoidance of the term, however, the thing designated by the term is something with which not a few philosophers of recent (...) years have been not above dabbling in, albeit usually under other names and other labels. After all, religious language has now come to be recognized as not just a legitimate, but even a fashionable object of philosophic attention. And a concern with religious language has often brought with it a concern with religious attitudes, religious behaviour, religious argumentation — yes, even to the point of occasionally becoming a concern with the very religious realities themselves that religious language, religious attitudes, religious behaviour, and religious argument are presumably all about. True, religious realities in this sense are to today's garden of philosophy pretty much what the tree of knowledge once was to the garden of Eden. In fact, one even suspects that there could be a serpent about somewhere, for cases have been reported of an occasional philosopher Adam or philosopher Eve having yielded to temptation: a consideration of God-talk has been known to lead to cautious admissions that such talk might be cognitively meaningful; a consideration of God-experiences to the admission that such experiences under certain circumstances could be veridical; or, even more rarely, a consideration of proofs for God's existence to the gingerly admission that at least some of these proofs might just possibly be valid. Needless to say, though, such a yielding to temptation on the part of some few contemporary philosophers, while it may not have led to any manifest sewing together of fig-leaves, has certainly brought with it the danger, if not always the reality, of a supercilious expulsion from the glorious Eden of contemporary professional philosophy. (shrink)

The puzzling case of the broken arm -- Hernias, diets, and drugs -- Why physicians cannot know what will benefit patients -- Sacrificing patient benefit to protect patient rights -- Societal interests and duties to others -- The new, limited, twenty-first-century role for physicians as patient assistants -- Abandoning modern medical concepts: doctor's "orders" and hospital "discharge" -- Medicine can't "indicate": so why do we talk that way? --"Treatments of choice" and "medical necessity": who is fooling whom? -- Abandoning informed (...) consent -- Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing -- The end of prescribing: why prescription writing is irrational -- The alternatives to prescribing -- Are fat people overweight? -- Beyond prettiness: death, disease, and being fat -- Universal but varied health insurance: only separate is equal -- Health insurance: the case for multiple lists -- Why hospice care should not be a part of ideal health care I: the history of the hospice -- Why hospice care should not be a part of ideal health care II: hospice in a postmodern era -- Randomized human experimentation: the modern dilemma -- Randomized human experimentation: a proposal for the new medicine -- Clinical practice guidelines and why they are wrong -- Outcomes research and how values sneak into finding of fact -- The consensus of medical experts and why it is wrong so often. (shrink)

INTRODUCTION Five Questions of Ethics Medical ethics as a field presents a fundamental problem. As a branch of applied ethics, medical ethics becomes ...

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one (...) to ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both fields were richer for it. (...) This volume begins with the 18th century Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, at meetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changes in the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronic disease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue. (shrink)

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health: We have become (...) aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”. (shrink)

This modern interpretation of Aristotelian ethics is ideally suited for undergraduate philosophy courses. It is also an engaging work for the expert and the beginner alike, offering a middle ground between existential and analytic ethics. Veatch argues for the existence of ethical knowledge, and he reasons that this knowledge is grounded in human nature. Yet he contends that the moral life is not merely one of following rules or recipes, nor is human well being something simple. Rather, the moral (...) life, which Veatch calls 'rational or intelligent living', is the life of practical wisdom where individual judgement of the particular and the contingent is paramount. Veatch's Rational Man offers a pluralistic understanding of human well being without lapsing into moral relativism. For those interested in morality and liberty, Rational Man offers fertile ground for developing an account of free and responsible persons. It has profoundly influenced the work of Den Uyl, Campbell, Machan, Miller, Mack, and many others. (shrink)

Twelve contributors discuss critical issues affecting medical ethics. Topics include: the normative principles of medical ethics, concepts of health and disease, the physician-patient relationship, human experimentation, informed consent, genetics, ethical issues in organ transplantation, and moral.

About 1000 references to books, journal articles, government publications, reports, and bibliographies. Topical arrangement under headings such as History of medical ethics, Behavior control, and Truth-telling in medicine. Entries include bibliographical information and occasional brief annotations. Author index.