After distinguishing two different meanings of the notion of a morality internal to medicine and considering a hypothetical case of a society that relied on its surgeons to eunuchize priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists (...) multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are socially constructed, they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality. (shrink)

Most agree that when it comes to so-called 'first-order' normative ethics and political philosophy, constructivist views are a powerful family of positions. When it comes to metaethics, however, there is serious disagreement about what, if anything, constructivism has to contribute. In this paper I argue that constructivist views in ethics include not just a family of substantive normative positions, but also a distinct and highly attractive metaethical view. I argue that the widely accepted 'proceduralist characterization' of constructivism in ethics is (...) inadequate, and I propose what I call the 'practical standpoint characterization' in its place. I then offer a general taxonomy of constructivist positions in ethics. Since constructivism's standing as a family of substantive normative positions is relatively uncontested, I devote the remainder of the paper to addressing skeptics' worries about the distinctiveness of constructivism understood as a metaethical view. I compare and contrast constructivism with three other standard metaethical positions with which it is often confused or mistakenly thought to be compatible: realism; naturalist reductions in terms of an ideal response; and expressivism. In discussing the contrast with expressivism, I explain the sense in which, according to the constructivist, the distinction between substantive normative ethics and metaethics breaks down. I conclude by distinguishing between two importantly different debates about the mind-dependence of value. I argue that a failure to make this distinction is part of what explains why the possibility of constructivism as a metaethical view is often overlooked. (shrink)

The practice of voluntary physician‐assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity.

John Mackie's stimulating book is a complete and clear treatise on moral theory. His writings on normative ethics-the moral principles he recommends-offer a fresh approach on a much neglected subject, and the work as a whole is undoubtedly a major contribution to modern philosophy.The author deals first with the status of ethics, arguing that there are not objective values, that morality cannot be discovered but must be made. He examines next the content of ethics, seeing morality as a functional device, (...) basically the same at all times but changing significantly in response to changes in the human condition. He sketches a practical moral system, criticizing but also borrowing from both utilitarian and absolutist views. Thirdly, the frontiers of ethics, areas of contact with psychology, metaphysics, theology, law and politcs, are explored.Throughout, his aim is to discuss a wide range of questions that are both philosophical and practical, working within a distinctive version of subjectivism-an "error" theory of the apparent objectivity of values. John Mackie has drawn on the contributions of such classic thinkers as Plato, Aristotle, Hobbes, Hume, Kant and Sidgwick, and on more recent discussions, to produce a thought-provoking account that will inspire both the general reader and the student of philosophy. (shrink)

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality (...) is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. (shrink)

Ethical concepts are, or purport to be, normative. They make claims on us: they command, oblige, recommend, or guide. Or at least when we invoke them, we make claims on one another; but where does their authority over us - or ours over one another - come from? Christine Korsgaard identifies four accounts of the source of normativity that have been advocated by modern moral philosophers: voluntarism, realism, reflective endorsement, and the appeal to autonomy. She traces their history, showing how (...) each developed in response to the prior one and comparing their early versions with those on the contemporary philosophical scene. Kant's theory that normativity springs from our own autonomy emerges as a synthesis of the other three, and Korsgaard concludes with her own version of the Kantian account. Her discussion is followed by commentary from G. A. Cohen, Raymond Geuss, Thomas Nagel, and Bernard Williams, and a reply by Korsgaard. (shrink)

In recent years, virtue theories have enjoyed a renaissance of interest among general and medical ethicists. This book offers a virtue-based ethic for medicine, the health professions, and health care. Beginning with a historical account of the concept of virtue, the authors construct a theory of the place of the virtues in medical practice. Their theory is grounded in the nature and ends of medicine as a special kind of human activity. The concepts of virtue, the virtues, and the virtuous (...) physician are examined along with the place of the virtues of trust, compassion, prudence, justice, courage, temperance, and effacement of self-interest in medicine. The authors discuss the relationship between and among principles, rules, virtues, and the philosophy of medicine. They also address the difference virtue-based ethics makes in confronting such practical problems as care of the poor, research with human subjects, and the conduct of the healing relationship. This book woith the author's previous volumes, A Philosophical Basis of Medical Practice and For the Patient's Good, are part of their continuing project of developing a coherent moral philosophy of medicine. (shrink)