This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

The moral expertise of clinical ethicists is not a question of mastering codelike theories and lawlike principles. Rather, ethicists are architects of moral space within the health care setting, as well as mediators in the conversations taking place within that space.

This textbook brings the humanities to students in order to evoke the humanity of students. It helps to form individuals who take charge of their own minds, who are free from narrow and unreflective forms of thought, and who act compassionately in their public and professional worlds. Using concepts and methods of the humanities, the book addresses undergraduate and premed students, medical students, and students in other health professions, as well as physicians and other healthcare practitioners. It encourages them to (...) consider the ethical and existential issues related to the experience of disease, care of the dying, health policy, religion and health, and medical technology. Case studies, images, questions for discussion, and role-playing exercises help readers to engage in the practical, interpretive, and analytical aspects of the material, developing skills for critical thinking as well as compassionate care. (shrink)

Remer offers the surprising conclusion that humanist thinking on toleration was actually founded on the classical tradition of rhetoric.

In lieu of an abstract, here is a brief excerpt of the content:The Origins and Evolution of Bioethics: Some Personal ReflectionsEdmund D. Pellegrino (bio)AbstractBioethics was officially baptized in 1972, but its birth took place a decade or so before that date. Since its birth, what is known today as bioethics has undergone a complex conceptual metamorphosis. This essay loosely divides that metamorphosis into three stages: an educational, an ethical, and a global stage. In the educational era, bioethics focused on a (...) perceived “dehumanization” of medicine by the rising power of science and technology. Remedies were sought by introducing humanities, ethics, and human “values” into the medical curriculum. Ethics was one among the humanistic disciplines, but not the dominant one. In the second era, ethics assumed a dominant role as ever more complex dilemmas emerged from the rapid pace of biological research. As such dilemmas were applied to medical practice, the need for a more rigorous and more formal analysis of their moral status was clear. Philosophically-trained ethicists had an obvious role. They began to teach, write, and profoundly influence medical education and practice. In the third—and present—period, the breadth of problems has become so broad that ethicists must, themselves, draw on disciplines well beyond their expertise—e.g., law, religion, anthropology, economics, political science, psychology, and the like. The era of bioethics as a global enterprise is upon us. The original hope for humanizing medicine has not been overtly successful; however, much has been accomplished of value to patients, the profession, and society. Medical morality has been transformed into a formal, systematic study of a whole range of issues of the greatest significance to humanity. Now the major challenge is one of identity, or inter-relationships and connections between the theoretical and the practical. Bioethics has outgrown its beginnings.I have been invited to give a “personal recollection” of the early development of bioethics. Such invitations are notoriously hard to resist, but also problematic when they are the recollections of a participant [End Page 73] in the events to be described. We need only be reminded of the vagaries common to the plethora of memoirs on the book stands today. Few have escaped the perils of selective memory, self-promotion, or the settling of old scores. Yet their perils notwithstanding, memoirs may serve some useful purpose. They are the raw material—verbal kitchen middens so to speak—out of which historians can later sift fact from fancy. They enable “tribal elders” to give witness to the past from which the present can fashion some sense of continuity.I will organize my reflections around three very arbitrary time periods that represent my own way of thinking about the evolution of bioethics: (1) an era of “proto-bioethics” (1960–1972), (2) an era of philosophical bioethics (1972–1985), and (3) an era of global bioethics (1985-present). Each era, of course, overlaps with the others, and the dominant strand of each runs through the others as well.In the proto-bioethics period, the language of human values predominated; in the era of bioethics philosophically construed, it was the language of philosophical ethics; and in the era of bioethics globally construed, the social and behavioral sciences have gained greater prominence. In each period, interest in the traditional humanities other than philosophy waxed and waned. In the earlier years, religion and theology predominated. Beginning in the 1970s, philosophy took a dominant role. In the last two decades, other disciplines, like law, literature, and the social sciences, have exerted more and more influence (McNeur 1963; Pellegrino 1997; Barker 1987).I make no pretense here of writing any part of the formal “history” of bioethics. Works of this nature are beginning to appear (Rothman 1991; Jonsen 1998 ; Dell’Oro and Viafora 1996). Thomas McElhinney and I are preparing our own account of the work and influence of the Institute on Human Values in Medicine, one of the influential programs of the Society for Health and Human Values (Pellegrino and McElhinney, n.d.). Space limitations as well as prudence preclude any attempt to do justice to all the events, institutions, and people who have made the field of bioethics what it is today. I apologize for these omissions, for any unintentional lapses of... (shrink)

Careful reading of imaginative literature teaches an attentiveness fundamental to the care of the sick.

The medical humanities were organized, beginning in the late 1960s, by a small group of people who shared a critique of medical education and a commitment to vigorous action to change it. They proposed to create several demonstration programs in humanities education at American schools. Although the group began with a religious orientation, it soon acquired a broader, more secular mission. As a result of shrewd political organizing, the group attracted members from within medicine, and was awarded a grant to (...) promote the medical humanities. This paper describes these events and sets them in the context of the social and medical history of the 1960s and early 1970s. (shrink)

Charles Taylor's retrieval of an expressivist understanding of persons, and of language as constitutive of meaning, contains promising insights for restoring moral connectedness between patients and physicians.

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric as a Balancing of Ends:Cicero and MachiavelliGary RemerIn his youthful work on rhetoric, De inventione (published about 86 B.C.E.), Cicero lists the ends for deliberative (political) oratory as honestas and utilitas (the good or honorable and the useful or expedient). In more mature writings, like De oratore (55 B.C.E.) and De officiis (44 B.C.E.), Cicero maintains a similar position: that the morally good and the beneficial are reconcilable. (...) For example, Cicero assumes in De officiis the identity of the honestum and the utile. He states there that "there is one rule for all cases;... either the thing that seems beneficial must not be dishonorable, or if it is dishonorable, it must not seem beneficial" (On Duties 3.81).1 In recent years, Victoria Kahn (1994) and J. Jackson Barlow (1999) have offered Machiavelli's "rhetorical politics"—a politics "attuned to the rhetorical concerns of effective political action" (Kahn 1994, 24)—as a more coherent and intellectually honest alternative to Cicero's attempt to reconcile irreconcilables.2 They contend that, unlike Cicero, Machiavelli accepts the impossibility of simultaneously upholding the morally good and the useful. For Machiavelli, the successful political actor must choose the utile over the honestum.Cicero, however, is not alone in his inconsistency. As Kahn demonstrates, Machiavelli's account of virtù is itself inconsistent. For example, he sometimes includes morality as an element of excellence (virtù) and at other times does not. I contend in this article, however, that Kahn's interpretation [End Page 1] of Machiavelli's contradictoriness as only "apparent," a variability, she argues, that is rhetorically inspired rather than logically deficient, applies not only to Machiavelli, as Kahn would have it, but also to Cicero. I argue that both Machiavelli and Cicero eschew "clear-cut or permanent distinctions" within virtù and between the honestum and the utile, respectively, because they wish to signal the political actor's need for flexibility (Kahn 1994, 30). Insofar as Cicero's internal contradictions, like Machiavelli's, are apparent but not real, I hold that Machiavelli does not offer a political approach that is superior to Cicero's, at least not in the sense of greater intellectual coherence.Despite their similarities, however, Cicero and Machiavelli differ from each other in that Cicero, in contrast to Machiavelli, openly affirms that politics is incomplete without a dual commitment to the good and the beneficial. I examine Machiavelli's focus on the useful and public as opposed to Cicero's additional commitment to the honorable and to the private. I analyze, in particular, the pursuit of glory in Machiavelli as it derives from early classical culture, which was preoccupied with appearances and the search for immortality. I argue that Cicero, while not abandoning the quest for glory, also vests this concept (under Stoic influence) with a private, moral character. In doing so, Cicero adheres to the rhetorical principle of decorum, which obliges orators to adapt themselves to context. This principle, I maintain, is not only a matter of expediency for Cicero but also a moral duty. While Cicero accommodates himself to a Roman world in which private morality was already an important part of one's life, Machiavelli violates decorum, attempting to resurrect a heroic ideal that disappeared long ago.Although most recent work on the revival of rhetorical ethics focuses on Aristotle (see Allen 2004, 140–59; Furley and Nehamas 1994; Garver 1994; Rorty 1996), I discuss Cicero in this essay. Not only has Cicero been the dominant influence on the Western tradition of rhetoric, but he also (unlike Aristotle) includes the honorable as one of the ends of deliberative oratory. Thus Cicero states in De inventione that while "Aristotle accepts advantage as the end [of deliberative oratory],... I prefer both honor and advantage" (2.52.156). And while Aristotle's position on deliberative oratory's ends does not mean that he ignores moral considerations, Cicero's decision to promote the good as an explicit rhetorical end forces his readers (and Machiavelli) to confront the relationship between virtue and expediency in a way that Aristotle's readers do not (Cox 1997, 1113). I concentrate, in particular, on Cicero's De officiis because... (shrink)

Because the medical humanities are multidisciplinary, participants tend to see one another's work through their own disciplinary lens. This can lead to misinterpretations.

The definition of ‘medical humanities’ may be approached via three conceptions—the humanities as a list of disciplines, as a program of moral development, and as a supportive friend. The conceptions are grounded by linking them to three narratives—respectively, the history of the modern liberal arts college; the history of Petrarch and the studia humanitatis of the early Renaissance; and the life of Sir William Osler. The three conceptions are complementary, each filling gaps in one or more of the others. Getting (...) clearer on a definition of ‘medical humanities’ is practically important if this field is to take its rightful place within health professions education and practice. (shrink)