Pluralism,philosophies of medicine and the varieties of medical ethics: A commentary on Thomasma and Pellegrino

Some problems that arise in the account given by Thomasma and Pellegrino [6] of the foundations of medical ethics in a philosophy of medicine are addressed, in particular questions of a conceptual character about treating therelatum of medicine as health. Which concept of health is appropriate and which will bear the burden of the position thomasma and Pellegrino advance? It is argued that the proper relationship of medicine is one between a healer and developing embodied minds. As a consequence, the project of providing a univocal account of the nature of medicine fails. Instead, pluralism infects philosophy and medicine, resulting in different philosophies of medicine. From these philosophies of medicine will follow not a single medical ethics but a variety.     

Homage to David Thomasma: Introduction

Theoretical Medicine and Bioethics -     

Bioethics with a Difference: A Comment on McElhinney and Pellegrino

Theoretical Medicine and Bioethics -     

Pellegrino,MacIntyre, and the internal morality of clinical medicine

Theoretical Medicine and Bioethics - There has been significant debate about whether the moral norms of medical practice arise from some feature or set of features internal to the discipline of...     

Clinical ethics case report: questionable capacity and the guidance of living wills

After falling from a roof, an older man lost neurological function below his face. In two days, the patient regained consciousness, but it was unclear whether he could communicate his preferences, whether due to injuries or difficulties with language. His family believed he could communicate with them, and that he was capable of making treatment decisions. The staff did not think to contact the hospital's largely inactive ethics consultation service for assistance, and instead looked to the patient's living will for guidance, even though the patient was not terminally ill, and his lack of capacity had not been determined.     

Using Augustine in contemporary sexual ethics. A response to Gilbert Meilaender

In response to Gilbert Meilaender's innovative interpretation of Augustine and of Roman Catholic teaching, the author suggests (1) that Meilaender attributes to Augustine a more positive view of sexual pleasure than the texts will support, (2) that modern Roman Catholic teaching suggests that love should have priority over procreation as a meaning of sex; and (3) that the moral logic of Meilaender's argument does not require a rejection of all reproductive technologies. Nonetheless, the author agrees that a more critical attitude should be adopted toward the reasons for which technologically assisted reproduction is promoted and undertaken, as well as toward its social impact.     

Double agency and the ethics of rationing health care: a response to Marcia Angell

The arguments against doctors as "double agents" that are presented by Marcia Angell in the preceding article do not defeat the core justification for rationing some relatively high-expense, low-benefit care, and they do not enable us to conclude that clinicians should be barred from any active, substantive role in decisions to limit that care. They do, however, reveal several important conditions that need to govern cost-conscious medial practice in order to preserve an ethic of fidelity to patients: insurers' profits and providers' incomes must be fair, providers must inform patients of any economic reasons that lead to the foregoing of care, and "direct incentive" arrangements must not be used to contain costs.     

Amputees by choice: body integrity identity disorder and the ethics of amputation

ABSTRACT Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.