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

A masterful series of interviews with Levinas, conducted by French philosopher Philippe Nemo, which provides a succinct presentation of Levinas's philosophy.

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)

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)

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)

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)

A sequel to Levinas' Totality and Infinity.

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)

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)

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

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

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)

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)

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)

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.”.