In his Treatise of Human Nature Hume makes clear that it is his aim to make moral philosophy more scientific and properly grounded on experience and observation. The “experimental” approach to philosophy, Hume warns his readers, is “abstruse,” “abstract” and “speculative” in nature. It depends on careful and exact reasoning that foregoes the path of an “easy” philosophy, which relies on a more direct appeal to our passions and sentiments . Hume justifies this approach by way of an analogy concerning (...) the relevance of anatomy to painting. “The anatomist,” he says, “ought never to emulate the painter.” At the same time, the painter cannot afford to ignore the anatomist: An anatomist [...] is admirably fitted to give advice to a painter ... We must have an exact knowledge of the parts, their situation and connexion, before we can design with any elegance or correctness. And thus the most abstruse speculations concerning human nature, however cold and uninteresting, become subservient to practical morality; and may render this latter science more correct in its precepts, and more persuasive in its exhortations. As these remarks suggest, Hume’s anatomy of virtue is not without its own practical aims and objectives. It is advanced with a view to identifying and carefully delineating the true foundations of morality in human nature and correcting our practices in light of this. With this improvement in our understanding of the nature and basis of virtue, we can better appreciate the way in which virtue secures happiness for ourselves and others and may also avoid the distortions and corruptions of morality by religious superstition. (shrink)

Medical clinicians – doctors, nurses, nurse practitioners etc. – are charged to act for the good of their patients. But not all ways of acting for a patient's good are on par: some are paternalistic; others are not. What does it mean to act paternalistically, both in general and specifically in a medical context? And when, if ever, is it permissible for a clinician to act paternalistically? In Medical Paternalism Part 1, I answered the first question. This paper answers the (...) second. The place of paternalism in clinical medicine is best understood, I argue, in terms of the potential for conflict between the autonomy principle and the beneficence principle. The first enjoins clinicians to respect the decisions of patients with respect to their (the patients') own care. The second enjoins clinicians to act for the good of their patients. Clinicians act paternalistically, I argue, when they act on the beneficence principle to the exclusion of the autonomy principle. Understanding just what these principles amount to (particularly the autonomy principle) reveals that the autonomy principle defeasibly trumps the beneficence principle and that, as a result, acting paternalistically (at least when it comes to competent patients) is presumptively impermissible. (shrink)

The principle of legal paternalism justifies state coercion to protect individuals from self-inflicted harm, or in its extreme version, to guide them, whether they like it or not, toward their own good. Parents can be expected to justify their interference in the lives of their children on the ground that “daddy knows best.” legal paternalism seems to imply that since the state often can know the interests of individual citizens better than the citizens know them themselves, it stands as a (...) permanent guardian of those interests in loco parentis. Put in this blunt way, paternalism seems a preposterous doctrine. If adults are treated as children they will come in time to be like children. Deprived of the right to choose for themselves, they will soon lose the power of rational judgment and decision. Even children, after a certain point, had better not be “treated as children,” else they will never acquire the outlook and capability of responsible adults. (shrink)

As an example of Aristotle's genre of epideictic, or ceremonial rhetoric, the Hippocratic Oath has the capacity to persuade its self-addressing audience to appreciate the value of the medical profession by lending an element of stability to the shifting ethos of health care. However, the values it celebrates do not accurately capture communally shared norms about contemporary medical practice. Its multiple and sometimes conflicting versions, anachronistic references, and injunctions that resist translation into specific conduct diminish its longer-term persuasive force. Only (...) when expunged of these elements and reconstructed using values over which there is widespread agreement can the Oath succeed in moving its audience from core values located in past discussions to principled action in the future. (shrink)

Most moral dilemmas in medicine are analysed using the four principles with some consideration of consequentialism but these frameworks have limitations. It is not always clear how to judge which consequences are best. When principles conflict it is not always easy to decide which should dominate. They also do not take account of the importance of the emotional element of human experience. Virtue ethics is a framework that focuses on the character of the moral agent rather than the rightness of (...) an action. In considering the relationships, emotional sensitivities, and motivations that are unique to human society it provides a fuller ethical analysis and encourages more flexible and creative solutions than principlism or consequentialism alone. Two different moral dilemmas are analysed using virtue ethics in order to illustrate how it can enhance our approach to ethics in medicine. (shrink)

The problems of racism and racially motivated violence in predominantly African American communities in the United States are complex, multifactorial, and historically rooted. While these problems are also deeply morally troubling, bioethicists have not contributed substantially to addressing them. Concern for justice has been one of the core commitments of bioethics. For this and other reasons, bioethicists should contribute to addressing these problems. We consider how bioethicists can offer meaningful contributions to the public discourse, research, teaching, training, policy development, and (...) academic scholarship in response to the alarming and persistent patterns of racism and implicit biases associated with it. To make any useful contribution, bioethicists will require preparation and should expect to play a significant role through collaborative action with others. (shrink)

Since the late 1980s, the human genetics and genomics research community has been promising to usher in a “new paradigm for health care”—one that uses molecular profiling to identify human genetic variants implicated in multifactorial health risks. After the completion of the Human Genome Project in 2003, a wide range of stakeholders became committed to this “paradigm shift,” creating a confluence of investment, advocacy, and enthusiasm that bears all the marks of a “scientific/intellectual social movement” within biomedicine. Proponents of this (...) movement usually offer four ways in which their approach to medical diagnosis and health care improves upon current practices, arguing that it is more “personalized,” “predictive,” “preventive,” and “participatory” than the medical status quo. Initially, it was personalization that seemed to best sum up the movement's appeal. By 2012, however, powerful opinion leaders were abandoning “personalized medicine” in favor of a new label: “precision medicine.” The new label received a decisive seal of approval when, in January 2015, President Obama unveiled plans for a national “precision medicine initiative” to promote the development and use of genomic tools in health care. (shrink)

All illness represents a state of diminished autonomy and therefore the doctor-patient relationship necessarily and justifiably involves a degree of medical paternalism argues the author, an American medical student. In a broad-ranging paper he discusses the concepts of autonomy and paternalism in the context of the doctor-patient relationship. Given the necessary diminution of autonomy which illness inflicts, a limited form of medical paternalism, aimed at restoring or maximising the patient's autonomy is entirely acceptable, and indeed fundamental to the relationship he (...) argues. However, the exercise of this paternalism should be flexible and related to the current 'level of autonomy' of the patient himself. An editorial in this issue comments briefly on this paper. (shrink)

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. (...) In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit. (shrink)

New medical technologies provide us with new possibilities in health care and health care research. Depending on their degree of novelty, they may as well present us with a whole range of unforeseen normative challenges. Partly, this is due to a lack of appropriate norms to perceive and handle new technologies. This article investigates our ways of establishing such norms. We argue that in this respect analogies have at least two normative functions: they inform both our understanding and our conduct. (...) Furthermore, as these functions are intertwined and can blur moral debates, a functional investigation of analogies can be a fruitful part of ethical analysis. We argue that although analogies can be conservative; because they bring old concepts to bear upon new ones, there are at least three ways in which they can be creative. First, understandings of new technologies are quite different from the analogies that established them, and come to be analogies themselves. That is, the concepts may turn out to be quite different from the analogies that established them. Second, analogies transpose similarities from one area into another, where they previously had no bearing. Third, analogies tend to have a figurative function, bringing in something new and different from the content of the analogies. We use research-biobanking as a practical example in our investigations. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about (...) the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

Facilities that emit hazardous toxins, such as toxic landfills, oil refineries, and chemical plants, are disproportionately located in predominantly Black, Latinx, and Indigenous neighborhoods. Environmental injustices like these threaten just distribution of health itself, including access to health that is not dependent on having the right skin color, living in the right neighborhood, or making the right amount of money. Facilities that emit environmental toxins wrongly make people's race, ethnicity, income, and neighborhood essential to who is allowed to breathe clean (...) air and drink clean water, and thus, who is allowed to be healthy. This can be seen in the environmental crises in Louisiana; Mississippi; Houston, Texas; and Flint, Michigan. Since bioethics purports to concern itself with the principle of justice as applied to individuals and increasingly to populations, the field ought to concern itself more with environmental injustice. (shrink)