Bioethical decision-making depends on presuppositions about the function and goal of bioethics. The authors in this issue of The Journal of Medicine and Philosophy share the assumption that bioethics is about resolving cases, not about moral theory, and that the best method of bioethical decision-making is that which produces useful answers. Because we have no universally agreed upon background moral theory which can serve as the basis for bioethical decision-making, they try to move bioethics away from theory. For them, a (...) good method of bioethical decision-making is one which resolves cases in ways that are justifiable to the parties involved, not necessarily in ways that bring us ‘close’ to the right and the true. The authors consider how the move away from theory and toward actual cases is best accomplished. In particular, the debate in this issue is about specification, specified principlism, and casuistry. (shrink)

Bioethicists are increasingly commenting on health care resource allocation, and sometimes suggest ways to solve various rationing dilemmas ethically. I argue that both because of the assumptions bioethicists make about social reality, and because of the methods of argument they use, they cannot possibly make a useful contribution to the debate. Bioethicists who want to make a practical difference should either approach health care resource allocation as if the matter hinged upon tribal competition (which is essentially what it does), or (...) they should do political philosophy in the traditional sense, and examine the health system from the outside. (shrink)

This paper responds to Dr Cassell's request for a fuller explanation of my argument in the paper, Against medical ethics: a philosopher's view. A distinction is made between two accounts of ethics in general, and the philosophical basis of health work ethics is briefly stated. The implications of applying this understanding of ethics to medical education are discussed.

The notions of health, illness, and disease are fuzzy-theoretically analyzed. They present themselves as non-Aristotelian concepts violating basic principles of classical logic. A recursive scheme for defining the controversial notion of disease is proposed that also supports a concept of fuzzy disease. A sketch is given of the prototype resemblance theory of disease.

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The “Wider View”: André Hellegers’s Passionate, Integrating Intellect and the Creation of BioethicsWarren Thomas Reich* (bio)AbstractThis article provides an account of how André Hellegers, founder and first Director of the Kennedy Institute of Ethics at Georgetown University, laid medicine open to bioethics. Hellegers’s approach to bioethics, as to morality generally and also to medicine and biomedical science, involved taking the “wider view”—a value-filled vision that integrated and gave meaning (...) to what otherwise was disparate, precarious, and conflicting. This article shows how Hellegers’s wider view of bioethics was shaped by events in his own life, his resultant sense of the precariousness of life and health, his commitment to religious inclusiveness, his research in fetal medicine, his clinical experience in obstetrics, his role in the struggle to change the teaching of the Roman Catholic Church on fertility control, and his developing concepts of health and disease. Hellegers was committed to and worked toward bioethics as a self-consciously interdisciplinary field in which the contributing disciplines adapt to each other—rather than sustain themselves as autonomous disciplines—to create a dynamic and complex intellectual, clinical, and social activity.André Hellegers’s personality and life were like that of a meteor: brief appearance on the scene; high-speed, flaming trajectory; quick burn-out; its smallest residue worth examining for ages to come. You had to watch carefully, for otherwise you might miss what he was about—what he was really about. He had an unusually probing and unflagging mind, coupled with the ability to make people think; and in a very real sense, that is what he was always about. André was an extremely effective communicator. He was like Fred Astaire: he had flair and charm, and no matter how crowded the room, you instantly knew when he entered it. Like Astaire, he had a deep intensity and striving for perfection while making his art always look like great fun. He was an engaging [End Page 25] story-teller who also knew how to stun intelligent people with his insightful, often ironic and humorous thinking that got to the bottom of things very quickly, leaving his interlocutors with a huge agenda for further reflection. Yet in spite of all this alluring talent, André never attracted attention to himself in a vain way. Even as raconteur, he was always working, getting people to think and talk.There were three great passions in Hellegers’s life that enabled him to inspire and shape bioethics as he did. He had a passionate intellect that was constantly probing for new clarity at new levels of understanding and values, and he had the ability to infect other people with his intellectual passion. André Hellegers was deeply rooted in a Catholicism scarcely imaginable in the United States—an open, historically-conscious, northern European faith that kept him free of ideology while providing him a foundation on which he built a rich ecumenicity of theological and philosophical bioethics. Finally, and perhaps most decisively for his founding work in bioethics, Hellegers pushed and probed to get a world that was almost totally unaccustomed to communicating over disciplinary lines (incredibly, virtually no interdisciplinary conferences had taken place before his day) to dialogue and collaborate across the barriers of medicine, politics, and religion.IntroductionThe customary way of writing a history of someone’s involvement in the origins of something—say, the origins of a nation or, I suppose, the origins of bioethics—certainly would not customarily start with the foregoing type of vignette. It would have as its purpose to discuss such things as issues, events that raised issues, methods pursued and applied, and outcomes achieved. However, in this modest account of some of the major contributions of the late André E. Hellegers, M.D., to the development of the field of bioethics, I intend to focus on a different level of historical inquiry, one that portrays and explains the person, his world-view, and his motivation, as well as the cultural forces and events that conspired to make Hellegers and the people with whom he came into contact vibrant with a sense of innovative and creative—not to mention urgent—inquiry. I believe that... (shrink)

The traditional paradigm of medicine assumes that health is a natural given depending on a body's intrinsic teleology, and that medicine aims at restoring or preserving health, making a physician only an "assistant to nature." I argue that nowadays this paradigm is becoming obsolete, because the concept of health is no longer a "natural given" and interventions on the human body attempt not only to help nature's teleology, but also to change it whenever doing so can satisfy human needs and (...) wants. We should abandon the term "medicine" and adopt the term "health care" to mark such an epoch-making transition, analogous to that marking the passage from "alchemy" to "chemistry.". (shrink)

The modernist “biomedical model” offers an inadequate understanding of illness. At the same time, some of the conceptual constructs that are offered to supplement the biomedical model are carelessly employed. Much that is said and written about empathy and healing, in particular, fails to reflect the historical and critical self‐awareness of postmodern thinking at its best.

We find our way in the world partly by means of the discriminatory power of our emotions. The gut sense that something is repugnant or unsavory—the sort of feeling that many now have about various forms of biotechnology—sometimes turns out to be rooted in articulable and legitimate objections, which with time can be spelled out, weighed, and either endorsed or dismissed. But we ought not dismiss the emotional response at the outset as “mere feeling.”.

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement may be (...) nearer at hand. (shrink)

This paper looks at the future from the perspective of the way in which present thinking can influence what the future might be. It assumes that history shapes the future and that the present generation is in a position to shape it. It looks at the future of medicine as a science and a professional discipline, of health care as policy and politics, of culture and ideology as forces shaping medicine and health care, and of biomedical ethics as an influential (...) source of wisdom and perspective. The paper argues that a strong future for bioethics requires a broad rather than a reductionistic vision of its proper work. (shrink)

Discusses the ethical implications of modern technology and examines the responsibility of humanity for the fate of the world.

In these essays, Gadamer justifies the reasons for a philosophical interest in health and medicine, and a corresponding need for health practitioners to enter into a dialogue with philosophy.

The concepts of health and disease play pivotal roles in medicine and the health professions This volume brings together the requisite literature for understanding current discussions and debates these concepts. The selections in the volume attempt to present a wide range of views concerning the nature of the concepts of health and issues using both historical and contemporary sources -- Back cover.