Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

Morals from Motives develops a virtue ethics inspired more by Hume and Hutcheson's moral sentimentalism than by recently-influential Aristotelianism. It argues that a reconfigured and expanded "morality of caring" can offer a general account of right and wrong action as well as social justice. Expanding the frontiers of ethics, it goes on to show how a motive-based "pure" virtue theory can also help us to understand the nature of human well-being and practical reason.

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues regarding ethics education: (...) the necessity of a continuous attention for and interpretation of the meaning of language, the importance of examining what aspect of “the other” touches one and what it is that evokes the urge to act morally and the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self-knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally. (shrink)

This essay critically assesses two strategies of accommodation used by defenders of impartialism in ethics to argue that the care orientation represents no genuine challenge to impartialist theoretical paradigms. One strategy focuses on impartiality as a constraint on moral deliberation, the other as a constraint on moral justification. While highlighting respects in which the commitment to impartiality is more consonant with the care orientation than many advocates of care have acknowledged, this essay attempts to clarify crucial ways in which each (...) accommodationist strategy falls, thus locating some of the more important contributions and challenges the care orientation offers to moral theory. (shrink)

We have seen important work on questions such as: whether there is a uniquely female approach to ethics, whether ethics should be par.

In recent years philosophers and bioethicists have given considerable attention to the concept of care. Thus we have seen important work on questions such as: whether there is a uniquely female approach to ethics, whether ethics should be partial or impartial, and whether care must be supplemented by justice. Despite this valuable and extensive work, however, some important distinctions have gone largely undiscussed. This paper tries to fill a gap left in our understanding of the concept of care itself by (...) distinguishing between compassion and two kinds of pity. While all three are kinds of caring, we should not give them similar moral evaluations. Consequently, the distinction between compassion and different kinds of pity gives us an important insight into the question of whether we can consider care a virtue for health care professionals. (shrink)

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

Schopenhauer plädiert in seiner Schrift "Über die Grundlagen der Moral" für einen deskriptiven und nicht für einen präskriptiven moralphilosophischen Ansatz. Trotz seiner Wertschätzung für Kant unterzieht er dessen Ethik einer eingehenden Kritik und ersetzt deren oberstes Prinzip, den kategorischen Imperativ, durch das Gefühl des Mitleids.

C. C. W. Taylor presents a clear and faithful new translation of one of the most famous and influential texts in the history of Western thought, accompanied by an analytical and critical commentary focusing on philosophical issues. In Books II to IV of the Nicomachean Ethics Aristotle gives his account of virtue of character, which is central to his ethical theory as a whole and a key topic in much modern ethical writing.

'Foot stands out among contemporary ethical theorists because of her conviction that virtues and vices are more central ethical notions than rights, duties, justice, or consequences - the primary focus of most other contemporary theorists. This volume brings together a dozen essays published between 1957 and 1977, and includes two new ones as well. In the first, Foot argues explicitly for an ethic of virtue, and in the next five discusses abortion, euthanasia, free will/determination, and the ethics of Hume and (...) Nietzsche. The final eight essays chart her growing disenchantment with emotivism and prescriptivism and their account of moral arguments. All the essays embody to some extent her commitment to an ethics of virtue... Foot's style is straightforward and readable, her arguments subtle, ingenious, and some of them important.' Choice. (shrink)

IN 1959 and 1960 I gave the Gifford Lectures in the University of St. Andrews. The lectures were called 'Norms and Values, an Inquiry into the Conceptual Foundations of Morals and Legislation'. The present work is substantially the same as the content of the second series of lectures, then advertised under the not very adequate title 'Values'. It is my plan to publish a revised version of the content of the first series of lectures, called 'Norms', as a separate book. (...) The two works will be independent of one another. (shrink)

While few soldiers may have read the works of Epictetus or Marcus Aurelius, it is undoubtedly true that the ancient philosophy known as Stoicism guides the actions of many in the military. Soldiers and seamen learn early in their training “to suck it up,” to endure, to put aside their feelings and to get on with the mission. This book explores what the Stoic philosophy actually is, the role it plays in the character of the military (both ancient and modern), (...) and its powerful value as a philosophy of life. Marshalling anecdotes from military history—ranging from ancient Greek wars to World War II, Vietnam, and Iraq—the book illuminates the military mind and uses it as a window on the virtues of the Stoic philosophy, which are far richer and more interesting than our popularized notions. The book explores the deep, lasting value that Stoicism can yield, in issues of military leadership and character; in the Stoic conception of anger and its control (does a warrior need anger to go to battle?); and in Stoic thinking about fear and resilience, grief and mourning, and the value of camaraderie and brotherhood. The book concludes by recommending a moderate Stoicism, where the task for the individual, both civilian and military, youth and adult, is to temper control with forgiveness, and warrior drive and achievement with humility and humor. (shrink)

Explores, at different levels, the social emotions of fellow-feeling, the sense of identity, love and hatred, and traces their relationship to one another and to the values with which they are associated. This book reviews the evaluations of love and sympathy in different historical periods and in different social and religious environments.

The foundation for a system of morals, this 1749 work is a landmark of moral and political thought. Its highly original theories of conscience, moral judgment, and virtue offer a reconstruction of the Enlightenment concept of social science, embracing both political economy and theories of law and government.

The concept of "practices"--whether of representation, of political or scientific traditions, or of organizational culture--is central to social theory. In this book, Stephen Turner presents the first analysis and critique of the idea of practice as it has developed in the various theoretical traditions of the social sciences and the humanities. Understood broadly as a tacit understanding "shared" by a group, the concept of a practice has a fatal difficulty, Turner argues: there is no plausible mechanism by which a "practice" (...) is transmitted or reproduced. The historical uses of the concept, from Durkheim to Kripke's version of Wittgenstein, provide examples of the contortions that thinkers have been forced into by this problem, and show the ultimate implausibility of the idea. Turner's conclusion sketches a picture of what happens when we do without the notion of a shared practice, and how this bears on social theory and philosophy. It explains why social theory cannot get beyond the stage of constructing fuzzy analogies, and why the standard constructions of the contemporary philosophical problem of relativism depend upon this defective notion. This first book-length critique of practice theory is sure to stir discussion and controversy in a wide range of fields, from philosophy and science studies to sociology, anthropology, literary studies, and political and legal theory. (shrink)

While few soldiers may have read the works of Epictetus or Marcus Aurelius, it is undoubtedly true that the ancient philosophy known as Stoicism guides the actions of many in the military. Soldiers and seamen learn early in their training "to suck it up," to endure, to put aside their feelings and to get on with the mission. Stoic Warriors is the first book to delve deeply into the ancient legacy of this relationship, exploring what the Stoic philosophy actually is, (...) the role it plays in the character of the military (both ancient and modern), and its powerful value as a philosophy of life. Marshalling anecdotes from military history--ranging from ancient Greek wars to World War II, Vietnam, and Iraq--Nancy Sherman illuminates the military mind and uses it as a window on the virtues of the Stoic philosophy, which are far richer and more interesting than our popularized notions. Sherman--a respected philosopher who taught at the US Naval Academy--explores the deep, lasting value that Stoicism can yield, in issues of military leadership and character; in the Stoic conception of anger and its control (does a warrior need anger to go to battle?); and in Stoic thinking about fear and resilience, grief and mourning, and the value of camaraderie and brotherhood. Sherman concludes by recommending a moderate Stoicism, where the task for the individual, both civilian and military, youth and adult, is to temper control with forgiveness, and warrior drive and achievement with humility and humor. Here then is a perceptive investigation of what makes Stoicism so compelling not only as a guiding principle for the military, but as a philosophy for anyone facing the hardships of life. (shrink)

Virtue is the most perdurable concept in the history of ethics, which is understandable given the ineradicability of the moral agent in the events of the moral life. Historically, virtue enjoyed normative force as long as the philosophical anthropology and the metaphysics of the good that grounded virtue were viable. That grounding has eroded in both general and medical ethics. If virtue is to be restored to a normative status, its philosophical underpinnings must be reconstructed. Such reconstruction seems unlikely in (...) general ethics, where the possibility of agreement on the good for humans is remote. However, it is a realistic possibility in the professional ethics of the health professions where agreement on the telos of the healing relationship is more likely to arise. Nevertheless, virtue-based ethics must be related conceptually and normatively to other ethical theories in a comprehensive moral philosophy of the health professions. (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 basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

ACTION, EMOTION AND WILL "This a clear and persuasive book which contains as many sharp points as a thorn bush and an array of arguments that as neat and ...

We elaborate and defend the claim that human affective states are, among other things, self-disclosing. We will show why affective intentionality has to be considered in order to understand human self-consciousness. One specific class of affective states, so-called existential feelings, although often neglected in philosophical treatments of emotions, will prove central. These feelings importantly pre-structure affective and other intentional relations to the world. Our main thesis is that existential feelings are an important manifestation of self-consciousness and figure prominently in human (...) self-understanding. We offer an ordering of four levels of existential feelings and also give considerations in favour of the essential bodily nature of these feelings. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ is (...) made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

This book has an ambitious aim—to make convincing the rejection of the hard and fast cognitive–conative divide currently so prevalent in philosophy of mind and moral psychology. Only such a rejection, Helm believes, can solve—or dissolve—the two major problems of practical reason. The ‘motivational problem’ is ‘a puzzle about the connection between our choosing something as the outcome of deliberation and our being motivated to pursue it’ (p. 1); the ‘deliberative problem’ concerns ‘how deliberation about value is possible’ (p. 11) (...) given that ‘our concept of value is pulled in seemingly opposed directions of objectivity and subjectivity’ (p. 200). Helm ‘suggests’ in chapter one, and argues with respect to particular attempts to solve these problems in later chapters, that acceptance of the cognitive-conative divide makes them quite intractable. (shrink)

Emotions, I will argue, involve two kinds of feeling: bodily feeling and feeling towards. Both are intentional, in the sense of being directed towards an object. Bodily feelings are directed towards the condition of one's body, although they can reveal truths about the world beyond the bounds of one's body – that, for example, there is something dangerous nearby. Feelings towards are directed towards the object of the emotion – a thing or a person, a state of affairs, an action (...) or an event; such emotional feelings involve a special way of thinking of the object of the emotion, and I draw an analogy with Frank Jackson's well-known knowledge argument to show this. Finally, I try to show that, even if materialism is true, the phenomenology of emotional feelings, as described from a personal perspective, cannot be captured using only the theoretical concepts available for the impersonal stance of the sciences. (shrink)

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

In this urbane and witty book, Ronald de Sousa disputes the widespread notion that reason and emotion are natural antagonists.

Obsessed with the twin beliefs that misbehavior is a medical disorder and that the duty of the state is to protect adults from themselves, we have replaced criminal-punitive sentences with civil-therapeutic 'programs.' The result is the relentless loss of individual liberty, erosion of personal responsibility, and destruction of the security of persons and property - symptoms of the transformation of a Constitutional Republic into a Therapeutic State, unconstrained by the rule of law.

First-person accounts from practicing nurses provide students with expert role models in this authoritative yet personal text that focuses on patients' responses to stress. The breadth and value of the nursing experience is reinforced as nurses share how their caring made a critical difference for patients and their families. This text, winner of two American Journal of Nursing Book of the Year Awards in 1988, is an ideal supplement for courses in advanced medical/surgical nursing, community health nursing, and particularly for (...) nursing trends and issues courses. (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)

Distinguished philosopher Richard Wollheim's rich and thought-provoking account of the emotions considers what emotions are, how they arise in our lives, and how standard and "moral" emotions differ.

Emotions shape the landscape of our mental and social lives. Like geological upheavals in a landscape, they mark our lives as uneven, uncertain and prone to reversal. Are they simply, as some have claimed, animal energies or impulses with no connection to our thoughts? Or are they rather suffused with intelligence and discernment, and thus a source of deep awareness and understanding? In this compelling book, Martha C. Nussbaum presents a powerful argument for treating emotions not as alien forces but (...) as highly discriminating responses to what is of value and importance. She explores and illuminates the structure of a wide range of emotions, in particular compassion and love, showing that there can be no adequate ethical theory without an adequate theory of the emotions. This involves understanding their cultural sources, their history in infancy and childhood, and their sometimes unpredictable and disorderly operations in our daily lives. (shrink)

How can we motivate ourselves to do what we think we ought? How can we deliberate about personal values and priorities? Bennett Helm argues that standard philosophical answers to these questions presuppose a sharp distinction between cognition and conation that undermines an adequate understanding of values and their connection to motivation and deliberation. Rejecting this distinction, Helm argues that emotions are fundamental to any account of value and motivation, and he develops a detailed alternative theory both of emotions, desires and (...) evaluative judgements and of their rational interconnections. The result is an innovative theory of practical rationality and of how we can control not only what we do but also what we value and who we are as persons. (shrink)

Linking the process of rational decision making to emotions, an award-winning scientist who has done extensive research with brain-damaged patients notes the dependence of thought processes on feelings and the body's survival-oriented regulators. 50,000 first printing.

In "Upheavals of Thought", Martha Nussbaum offers a theory of the emotions. She argues that emotions are best conceived as thoughts, and she argues that emotion-thoughts can make valuable contributions to the moral life. She develops extensive accounts of compassion and erotic love as thoughts that are of great moral import. This paper seeks to elucidate what it means, for Nussbaum, to say that emotions are forms of thought. It raises critical questions about her conception of the structure of emotion, (...) and about her conception of compassion, in particular. Finally, the paper seeks to show how analyzing the structure, as well as the moral value, of the emotions ultimately requires entering the realm of religious ethics. (shrink)