The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of (...) practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order. (shrink)

For millennia physicians were admonished to obscure the details of patients’ illnesses and poor prognoses. The Hippocratic ethic precludes physicians from including patients in medical decisionmaking. That ethic demanded of doctors that they “[p]erform [their duties] calmly and adroitly, concealing most things from the patient … revealing nothing of the patient's future or present condition.”.

A sequel to Levinas' Totality and Infinity.

A sequel to Levinas's Totality and Infinity, this work is generally considered Levinas's most important contribution to the contemporary debate surrounding the closure of metaphysical discourse, much commented upon by Jacques Derrida. This work contains a fundamentally original theory of the ethical relationship and describes the face-to-face relationship, sensibility, responsibility and speech. Renowned Levinas scholar Richard A. Cohen has contributed a new foreword to this edition of Otherwise than Being, which is also the first time the work is available in (...) an affordable paperback edition. This foreword, along with Alphonso Lingis's extensive introduction to the work, is a valuable tool for researchers and students of Levinas's philosophy. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, (...) the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

"Political Ideas in the Twentieth Century", Historical Inevitability", "Two Concepts of Liberty", "John Stuart Mill and the Ends of Life". These four essays deal with the various aspects of individual liberty, including the distinction between positive and negative liberty and the necessity of rejecting determinism if we wish to keep hold of the notions of human responsibility and freedom.

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Emmanuel Levinas is one of the most important figures of twentieth-century philosophy. Exerting a profound influence upon such thinkers as Derrida, Lyotard, Blanchot, and Irigaray, Levinas's work bridges several major gaps in the evolution of continental philosophy--between modern and postmodern, phenomenology and poststructuralism, ethics and ontology. He is credited with having spurred a revitalized interest in ethics-based philosophy throughout Europe and America. _Entre Nous_ (Between Us) is the culmination of Levinas's philosophy. Published in France a few years before his death, (...) it gathers his most important work and reveals the development of his thought over nearly forty years of committed inquiry. Along with several trenchant interviews published here, these essays engage with issues of suffering, love, religion, culture, justice, human rights, and legal theory. Taken together, they constitute a key to Levinas's ideas on the ethical dimensions of otherness. Working from the phenomenological method of Edmund Husserl and Martin Heidegger, Levinas pushed beyond the limits of their framework to argue that it is ethics, not ontology, that orients philosophy, and that responsibility precedes reasoning. Ethics for Levinas means responsibility in relation to difference. Throughout his work, Levinas returns to the metaphor of the face of the other to discuss how and where responsibility enters our lives and makes philosophy necessary. For Levinas, ethics begins with our face to face interaction with another person--seeing that person not as a reflection of one's self, nor as a threat, but as different and greater than self. Levinas moves the reader to recognize the implications of this interaction: our abiding responsibility for the other, and our concern with the other's suffering and death. Situated at the crossroads of several philosophical schools and approaches, Levinas's work illuminates a host of critical issues and has found resonances among students and scholars of literature, law, religion, and politics. _Entre Nous_ is at once the apotheosis of his work and an accessible introduction to it. In the end, Levinas's urgent meditations upon the face of the other suggest a new foundation upon which to grasp the nature of good and evil in the tangled skein of our lives. (shrink)

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

This volume contains the speech given by Derrida at Emmanuel Levinas’s funeral on December 27, 1995, and his contribution to a colloquium organized to mark the first anniversary of Levinas’s death.

Beauchamp and Childress have performed a great service by strengthening the principle of respect for the patient's autonomy against the paternalism that dominated medicine until at least the 1970s. Nevertheless, we think that the concept of autonomy should be elaborated further. We suggest such an elaboration built on recent developments within the neurosciences and the free will debate. The reason for this suggestion is at least twofold: First, Beauchamp and Childress neglect some important elements of autonomy. Second, neuroscience itself needs (...) a conceptual apparatus to deal with the neural basis of autonomy for diagnostic purposes. This desideratum is actually increasing because modern therapy options can considerably influence the neural basis of autonomy itself.Sabine MNeuroScienceAndNorms: Ethical and Legal Aspects of Norms in Neuroimaging at Bonn University Hospital, Germany. Her main research interests are in neuroethics. She is coauthor of three German books about neuroethics and bioethics.Henrik Walter, M.D., Ph.D., is Full Professor of Medical Psychology at the University of Bonn, Germany, and vice-director of the Department of Psychiatry and Psychotherapy at the University Clinic of Bonn. He is author of Neurophilosophy of Free Will and editor of the book From Neuroethics to Neurolaw?. His research fields are biological psychiatry, cognitive neuroscience, neuroimaging, neurophilosophy, and neuroethics. (shrink)

Is it possible to apply a theoretical approach to ethics? The French philosopher Catherine Chalier addresses this question with an unusual combination of traditional ethics and continental philosophy. In a powerful argument for the necessity of moral reflection, Chalier counters the notion that morality can be derived from theoretical knowledge. Chalier analyzes the positions of two great moral philosophers, Kant and Levinas. While both are critical of an ethics founded on knowledge, their criticisms spring from distinctly different points of view. (...) Chalier reexamines their conclusions, pitting Levinas against (and with) Kant, to interrogate the very foundations of moral philosophy and moral imperatives. She provides a clear, systematic comparison of their positions on essential ideas such as free will, happiness, freedom, and evil. Although based on a close and elegant presentation of Kant and Levinas, Chalier's book serves as a context for the development of the author's own reflections on the question "What am I supposed to do?" and its continued importance for contemporary philosophy. (shrink)

Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood theory, epistemology, and political (...) philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring - stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. (shrink)

From the relative obscurity in which Levinas's work languished until very recently, Emmanuel Levinas must now be judged as one of the most influential figures in contemporary Continental philosophy. There is no better guide than John Lewelyn to lead one through the thickets of Levinas's prose. Bursting with questions, multiple references, cascading citations and multilingual puns and nuances, this book is the compelling record of intellectual obsession. Taking as its guiding thre the theme of genealogy, the book gives a broadly (...) chronological and impressively manageable presentation of the whole sweep of the Levinas's work. Balanced and finely grained, Llewelyn confronts questions of method, Heidegger, phenomenology, the theme of sensibility, religion, enjoyment, feminity, eros, justice and the political. The book reaches a stunning climax in a series of chapters that give a hestitant but tolerant discussion of the question of God in Levinas, the relation to Levinasian ethics to Nietzschean genealogy, and an extraordinary discussion of metaphor that leads into a wholly original analysis of Levinas's poetics and metaphorics. The book concludes with a sensitive reading of the autobiographical epigraphs to Levinas's Otherwise than Being... and a consideration of the Holocaust. (shrink)

This paper argues that the provision of effective informed consent by surgical patients requires the disclosure of material information about the comparative clinical performance of available surgeons. We develop a new ethical argument for the conclusion that comparative information about surgeons' performance - surgeons' report cards - should be provided to patients, a conclusion that has already been supported by legal and economic arguments. We consider some recent institutional and legal developments in this area, and we respond to some common (...) objections to the use of report cards on the clinical performance of surgeons. (shrink)

The thesis of this paper is that because the significance of Western medicine lies in its ability to enhance the health of persons within a society, the practice of medicine is foremost an ethic and only thereafter a science. In support of the priority of an ethical perspective in medical practice, the paper explores the socio-cultural nature of knowledge, upon which science itself is constructed. Next, it draws from Levinas' philosophy, which illumines the problem of ontological and epistemological priority. Specifically, (...) it examines Levinas' rendering of the human face and of language, as they found the case for the priority of justice, or ethics. Finally, the paper offers the practice of narrative discourse as one solution that elevates the status of ethics within the institution of medicine and that has the potential to counteract the tendency in medical practice to employ a universalizing methodology based in science's power to control the human Other. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The article calls for a departure from the common concept of autonomy in two significant ways: it argues for the supremacy of semantic understanding over procedure, and claims that clinicians are morally obliged to make a strong effort to persuade patients to accept medical advice. We interpret the value of autonomy as derived from the right persons have to respect, as agents who can argue, persuade and be persuaded in matters of utmost personal significance such as decisions about medical care. (...) Hence, autonomy should and could be respected only after such an attempt has been made. Understanding suffering to a significant degree is a prerequisite to sincere efforts of persuasion. It is claimed that a modified and pragmatic form of discourse is the necessary framework for understanding suffering and for compassionately interacting with the frail. (shrink)