Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

In Reasons and the Good Roger Crisp answers some of the oldest questions in moral philosophy. Fundamental to ethics, he claims, is the idea of ultimate reasons for action; and he argues controversially that these reasons do not depend on moral concepts. He investigates the nature of reasons themselves, and how we come to know them. He defends a hedonistic theory of well-being and an account of practical reason according to which we can give some, though not overriding, priority to (...) our own good over that of others. (shrink)

The purpose of this book is to clarify the concept of definition and improve defining activities.

The book also includes a chronological table of significant events, select bibliography, succinct explanatory notes, and an index--all of which supply ...

The prelims comprise: I II III IV V VI VII VIII IX Notes Reference Further reading.

Philippa Foot has for many years been one of the most distinctive and influential thinkers in moral philosophy. Long dissatisfied with the moral theories of her contemporaries, she has gradually evolved a theory of her own that is radically opposed not only to emotivism and prescriptivism but also to the whole subjectivist, anti-naturalist movement deriving from David Hume. Dissatisfied with both Kantian and utilitarian ethics, she claims to have isolated a special form of evaluation that predicates goodness and defect only (...) to living things considered as such; she finds this form of evaluation in moral judgements. Her vivid discussion covers topics such as practical rationality, erring conscience, and the relation between virtue and happiness, ending with a critique of Nietzsche's immoralism. This long-awaited book exposes a highly original approach to moral philosophy and represents a fundamental break from the assumptions of recent debates. Foot challenges many prominent philosophical arguments and attitudes; but hers is a work full of life and feeling, written for anyone intrigued by the deepest questions about goodness and human. (shrink)

Virtue ethics is perhaps the most important development within late twentieth-century moral philosophy. Rosalind Hursthouse, who has made notable contributions to this development, here presents a full exposition and defense of her neo-Aristotelian version of virtue ethics. She shows how virtue ethics can provide guidance for action, illuminate moral dilemmas, and bring out the moral significance of the emotions.

Moral Realism is a systematic defence of the idea that there are objective moral standards. Russ Shafer-Landau argues that there are moral principles that are true independently of what anyone, anywhere, happens to think of them. His central thesis, as well as the many novel supporting arguments used to defend it, will spark much controversy among those concerned with the foundations of ethics.

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)

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)

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)

The key term of Aristotle’s teleology is “the cause for the sake of which”. Aristotle discusses in several key texts the fact that this has two different senses: aim and beneficiary. The aim of a knife is cutting, but the beneficiary is the person who does, or orders, the cutting. Aristotle uses this distinction to show how natural things have both aims and are beneficiaries of their functions. He also shows how non-natural things, such as god, can operate as causes (...) for the sake of which, but not as beneficiaries. Eternal things cannot be beneficiaries, because they cannot undergo change. Thus, the beneficiaries of Aristotle’s teleology are the elements, plants, and animals that can both undergo change and have functional aims. A survey of other terms of Aristotle’s teleology, such as “nature does nothing in vain”, the terms “complete” or “perfect”, as well as “end” and “entelechy” further show the specific orientation of Aristotle’s teleology, as do his use of axiological terms such as “better” and “fine”. (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.

This Hackett edition, first published in 1981, is an unabridged and unaltered republication of the seventh edition as published by Macmillan and Company, Limited. From the forward by John Rawls: In the utilitarian tradition Henry Sidgwick has an important place. His fundamental work, The Methods of Ethics, is the clearest and most accessible formulation of what we may call 'the classical utilitarian doctorine.' This classical doctrine holds that the ultimate moral end of social and individual action is the greatest net (...) sum of the happiness of all sentient beings. Happinesss is specified by the net balance of pleasure over pain, or, as Sidgwick preferred to say, as the net balance of agreeable over disagreeable consciousness.... (shrink)

Monte Johnson examines one of the most controversial aspects of Aristiotle's natural philosophy: his teleology. Is teleology about causation or explanation? Does it exclude or obviate mechanism, determinism, or materialism? Is it focused on the good of individual organisms, or is god or man the ultimate end of all processes and entities? Is teleology restricted to living things, or does it apply to the cosmos as a whole? Does it identify objectively existent causes in the world, or is it merely (...) a heuristic for our understanding of other causal processes? Johnson argues that Aristotle's aporetic approach drives a middle course between these traditional oppositions, and avoids the dilemma, frequently urged against teleology, between backwards causation and anthropomorphism. Although these issues have been debated with extraordinary depth by Aristotle scholars, and touched upon by many in the wider philosophical and scientific community as well, there has been no comprehensive historical treatment of the issue. Aristotle is commonly considered the inventor of teleology, although the precise term originated in the eighteenth century. But if teleology means the use of ends and goals in natural science, then Aristotle was rather a critical innovator of teleological explanation. Teleological notions were widespread among his predecessors, but Aristotle rejected their conception of extrinsic causes such as mind or god as the primary causes for natural things. Aristotle's radical alternative was to assert nature itself as an internal principle of change and an end, and his teleological explanations focus on the intrinsic ends of natural substances - those ends that benefit the natural thing itself. Aristotle's use of ends was subsequently conflated with incompatible 'teleological' notions, including proofs for the existence of a providential or designer god, vitalism and animism, opposition to mechanism and non-teleological causation, and anthropocentrism. Johnson addresses these misconceptions through an elaboration of Aristotle's methodological statements, as well as an examination of the explanations actually offered in the scientific works. Reviewed in: Notre Dame Philosophical Review 2006.06.15; Bryn Mawr Classical Review 2006.08.37; Il-Sole – 24 Ore 6 Aug. 2006; Philosophy in Review 26 (2006): 360-2; Rhizai 3 (2006): 171-8; Journal of the History of Philosophy 45 (2007): 323-4; Ancient Philosophy 27 (2007): 191-200; Phronesis 52 (2007): 248-9; Isis 98 (2007): 375; Aestimatio 4 (2007) 146-152; The British Journal for the History of Science 41 (2008): 129-130. The European Legacy 14 (2009); La Cultura 47 (2009): 174-175; Sean M. Row, Teleology in Political Contexts: an assessment of Monte Ransome Johnson’s “Aristotle on Teleology”. (A thesis presented to the faculty of the college of arts and sciences of Ohio University, 2009.). (shrink)

Book reviewed in this article: For the Patient's Good: The Restoration of Beneficence in Health Care. By Edmund D. Pellegrino and David C. Thomasma.

This paper is a short review of Roger Crisp's book Reasons and the Good.

Preference utilitarians are concerned to maximize the autonomous choices of individuals; for this reason, they argue that nurses ought to advocate for those patients who desire assistance with ending their lives. This approach prompts us to consider, then, the moral validity of nursing involvement in measures intended to end the lives of patients. In this article, the terms of preference utilitarianism are set out and considered in order to determine whether this approach offers sufficient philosophical support for sanctioning a role (...) for nursing in euthanasia. Ultimately, it is found that preference utilitarianism is lacking in this respect, as well as in its fitness for guiding nursing activity in general. In particular, it is found that nurses are required to exchange a handmaiden relationship with the medical profession for an equally undignified relationship with patients. If nursing involvement in measures intended to end the lives of patients is to find sufficient philosophical support, then we need to look elsewhere. (shrink)

John Rist surveys the history of ethics from Plato to the present and offers a vigorous defence of an ethical theory based on a revised version of Platonic realism. In a wide-ranging discussion he examines well-known alternatives to Platonism, in particular Epicurus, Hobbes, Hume and Kant as well as contemporary 'practical reasoners', and argues that most post-Enlightenment theories of morality depend on an abandoned Christian metaphysic and are unintelligible without such grounding. He also argues that contemporary choice-based theories, whether they (...) take a strictly ethical or more obviously political form, are ultimately arbitrary in nature. His lively and accessible 2001 study is informed by a powerful sense of philosophical history, and will be of interest to both students and scholars of ethics. (shrink)

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief (...) sketch is offered of its application to the social practice of nursing. (shrink)

In an earlier article, it was found that the terms of preference utilitarianism are insufficiently sound for guiding nursing activity in general, including in relation to nursing involvement in euthanasia. In this article, I shall examine the terms of a more traditional philosophical approach in order to determine the moral legitimacy, or otherwise, of nursing engagement in measures intended to end the lives of patients. In attempting this task, nursing practice is considered in light of what I shall call a (...) ‘nursing‐as‐healing‐praxis’ approach which includes an account of the moral purpose of nursing and the virtues necessary for realizing that purpose. Ultimately, it is concluded that the terms of this approach rule out the involvement of nurses in euthanasia such that if euthanasia can be justified at all, those outside the nursing profession must provide for its administration. (shrink)

This paper analyses the question what other healthcare professions should learn from nursing ethics, e.g. what should medical ethics learn from nursing ethics. I first analyse and reject all strong versions of the claim that nursing ethics is unique, because nursing is a unique practice. I then move to the question of whether the link between nursing ethics and nursing theory can be a model for other areas of healthcare ethics. I provide an analysis of the possibility of creating a (...) theory of medicine and find that there cannot be a theory of medicine, and I argue briefly that this finding is also applicable to nursing. If there cannot be a theory of nursing, this entails that nursing ethics cannot be justifiably based on such a theory. In the final section, I then analyse the success of nursing ethics in resisting certain of the vices of Anglo‐American analytic ethics, in particular the reductionism and individualism that characterizes much of healthcare ethics. I conclude that other healthcare ethics could usefully learn from this aspect of nursing ethics. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on care has been at (...) the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

Happiness, then, is the best, noblest, and most pleasant thing in the world.'In the Nicomachean Ethics Aristotle's guiding question is: what is the best thing for a human being? His answer is happiness, but he means, not something we feel, but rather a specially good kind of life. Happiness is made up of activities in which we use the best human capacities, both ones that contribute to our flourishing as members of a community, and ones that allow us to engage (...) in god-like contemplation. Contemporary ethical writings on the role and importance of the moral virtues such as courage and justice have drawn inspiration from this work, which also contains important discussions on responsibility for actions, on the nature of practical reasoning, and on friendship and its role in the best life. This new edition retains David Ross's justly admired translation while updating certain key terms. It also includes a valuable introduction to this seminal work, and notes designed to elucidate Aristotle's arguments. (shrink)