The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician’s role in managed care take root in medicine’s past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives (...) can function as “master narratives” that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform. (shrink)

There are competing accounts of the birth of bioethics. Despite the differences among them, these accounts share the claim that bioethics was not born in a single disciplinary home or in a single social space, but in numerous, including hospitals, doctors' offices, research laboratories, courtrooms, medical schools, churches and synagogues, and philosophy classrooms. This essay considers the interdisciplinarity of bioethics and the contribution of new disciplines to bioethics. It also explores the implications of interdisciplinarity for bioethics education. As bioethics develops, (...) it will be helpful to identify essential elements in the education of bioethicists and to distinguish between members of other disciplines who make important contributions to bioethics and bioethicists. (shrink)

In their target article, Doernberg and Truog (2023) correctly recognize that the doctor-patient relationship is considered a “fiduciary” relationship (i.e., other-regarding rather than self-interes...

Although the notion of empiricism looms large in many histories of early modern philosophy, its origins are not well understood. This paper aims to shed light on them. It examines the notions of empirical philosopher, physician, and politician that are employed in a range of seventeenth- and eighteenth-century texts, alongside related notions (e.g. "experimental philosophy") and methodological stances. It concludes that the notion of empiricism used in many histories of early modern thought does not have pre-Kantian origins. It first appeared (...) and became widely used in late eighteenth-century Germany, in the course of the early debates on Kant's Critical philosophy. (shrink)

When Australia was circumnavigated by Europeans in 1801–02, French and British natural historians were unsure how to describe the Indigenous peoples who inhabited the land they charted and catalogued. Ideas of race and of savagery were freely deployed by both British and French, but a discursive shift was underway. While the concept of savagery had long been understood to apply to categories of human populations deemed to be in want of more historically advanced ‘civilisation’, the application of this term in (...) the late 18th and early 19th centuries was increasingly being correlated with the emerging terminology of racial characteristics. The terminology of race was still remarkably fluid, and did not always imply fixed physical or mental endowments or racial hierarchies. Nonetheless, by means of this concept, natural historians began to conceptualise humanity as subject not only to historical gradations, but also to the environmental and climatic variations thought to determine race. This in turn meant that the degree of savagery or civilisation of different peoples could be understood through new criteria that enabled physical classification, in particular by reference to skin colour, hair, facial characteristics, skull morphology, or physical stature: the archetypal criteria of race. While race did not replace the language of savagery, in the early years of the 19th century savagery was re-inscribed by race. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

The writings of the Scottish physician and philosopher John Gregory play an important role in the modern codification of medical ethics. It is therefore appropriate to use his work as a historical example in approaching the question how elements of aesthetics were incorporated in 18th century medical ethics. The concept of a Gentleman is pivotal to the entire medical ethics of John Gregory as it provides him with the ethical source of the duty to patients. Gregory makes the trustworthiness of (...) the physician a central point of his medical ethics, and it is in this context that Gregory declares good manners as an essential moral quality of a physician. This paper delineates how good manners are ethically justified in Gregory's medical ethics and concludes with an exploration of the importance of Gregory's conception for present day reflection on the inherence of aesthetics in ethical determinations. (shrink)

Nancy Jecker (2013) mounts a sustained and formidable critique of Norman Daniels's prudential lifespan account (PLA) as a reliable basis for justice between age groups in the responsible allocation...

(2001). The History of Medical Ethics Is Crucial for a Critical Perspective in the Continuing Development of Ethics Consultation. The American Journal of Bioethics: Vol. 1, No. 4, pp. 55-57.