In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

Imagine first the case of J (who might be anybody, jemand). J used to inhabit a social order, or rather an area within a social order, where socially approved roles were unusually well-defined. Responsibilities were allocated to each such role and each sphere of role-structured activity was clearly demarcated. These allocations and demarcations were embodied in and partly constituted by the expectations that others had learned to have of those who occupied each such role. For those who occupied those roles (...) to disappoint those expectations by failing to discharge their assigned responsibilities was to invite severe disapproval and other sanctions. To refuse to find one's place within the hierarchies of approved roles, or to have been refused a place, because judged unfit for any such role, was to be classified as socially deviant and irresponsible. The key moral concepts that education had inculcated into J were concepts of duty and responsibility. His fundamental moral beliefs were that each of us owes it to others to perform her or his assigned duties and to discharge her or his assigned responsibilities. A good human being performs those duties, discharges those responsibilities, and does not trespass into areas that are not her or his concern. A philosopher who comes across the likes of J will understand his attitudes as cultural parodies, in part of Plato (conceiving of justice as requiring ‘that each do her or his own work and not meddle with many things’ Republic 433a) and in part of Kant (doing one's duty just because it is one's duty and not for the sake of any further end), authors who had influenced J's school teachers. A sociologist will entertain the suspicion that in certain types of social order it may be only in the form of parodies that some types of concept can continue to find expression. But for the moment let us put this thought on one side and return to J. (shrink)

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical (...) students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless. (shrink)

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.

In the last forty years, Roman Catholic moral theology has been experiencing revolutionary tension and change. In this unique and thoroughly documented study, a distinguished Jesuit moral theologian examines the events, personalities, and conflicts that have contributed, from New Testament times to the present, to the Roman Catholic moral tradition and its contemporary crisis, and interprets the fundamental changes taking place in the subject today. Among the topics covered in this volume are papal infallibility, confession as a sacrament, the legacy (...) of Augustine, the dramatic change in attitude to "salvation outside the Church," and the continuing impact on moral theology of the 1968 papal encyclical on birth control and of the Second Vatican Council. (shrink)

Argues that standard forms of bioethics support the technological utopianism of medicine. Puts forth an alternative agenda arguing that the task of bioethics is to explore the moral significance of the body as it is expressed in the discourse and practice of moral and religious traditions.

: 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)

Cooperation in evil or wrongdoing is one of the most perplexing areas in bioethics, both for those working in the field and those seeking their advice. The papers collected in this book are written by philosophers, theologians and lawyers who have studied these problems and / or by those who have faced these problems in their own work in law, healthcare and research, and political campaigning. The volume includes both general treatments of the subject of cooperation and conscientious objection, and (...) more specific treatments of topics such as voting to improve unjust laws, research on fetal / embryonic cells, and care of suicidal patients. The book is offered as a guide to a field which is both of academic interest and of personal concern to those who face cooperation problems in their own life and work. Contributors include: Bishop Donal Murray, Bishop Anthony Fisher OP, Jane Adolphe, Mike Delany, John Finnis, Luke Gormally, Colin Harte, Cathleen Kaveny, Richard Myers, Charlie O'Donnell, Alexander Pruss, Neil Scolding and Helen Watt. (shrink)