This response to Kevin WildesÕs article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.

While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect physicians to be able to determine what will benefit their patients. Either they limit their attention to medical well-being when total well-being is the proper end of the patient or they strive for total well-being, which takes them beyond their expertise. Even within the (...) medical sphere, they have no basis for choosing among the proper medical goals for medicine. Also, there are many plausible strategies for relating predicted benefits to harms, and physicians cannot be expert in picking among these strategies. Second, increasingly plausible ethical systems recognize that in some cases, patient benefit must be sacrificed to protect patient rights including the right to the truth, to have promises kept, to have autonomy respected, and to not be killed. Third, ethics of the next century will increasingly recognize that some patient benefits must be sacrificed to fulfill duties to others - either the duty to serve the interests of others or other duties such as keeping promises, telling the truth, and, particularly, promoting justice. Physicians in the twenty-first century will be seen as having a new, more limited duty to assist the patient in pursuing the patient's understanding of the patient's interest within the constraints of deontological ethical principles and externally imposed duties to promote justice. The result will be a duty to be loyal to the consumer of health care with the recognition that often this will mean that the physician is not permitted to pursue the physician's understanding of the patient's well-being. (shrink)

An enormous intellectual adventure. In this groundbreaking new book, the American biologist Edward O. Wilson, considered to be one of the world's greatest living scientists, argues for the fundamental unity of all knowledge and the need to search for consilience --the proof that everything in our world is organized in terms of a small number of fundamental natural laws that comprise the principles underlying every branch of learning. Professor Wilson, the pioneer of sociobiology and biodiversity, now once again breaks out (...) of the conventions of current thinking. He shows how and why our explosive rise in intellectual mastery of the truths of our universe has its roots in the ancient Greek concept of an intrinsic orderliness that governs our cosmos and the human species--a vision that found its apogee in the Age of Enlightenment, then gradually was lost in the increasing fragmentation and specialization of knowledge in the last two centuries. Drawing on the physical sciences and biology, anthropology, psychology, religion, philosophy, and the arts, Professor Wilson shows why the goals of the original Enlightenment are surging back to life, why they are reappearing on the very frontiers of science and humanistic scholarship, and how they are beginning to sketch themselves as the blueprint of our world as it most profoundly, elegantly, and excitingly is. (shrink)

: During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and (...) health care. (shrink)