Professor Spicker's two-pronged attack on welfare seems to presuppose the Kantian distinction between morality and prudence. His prudential critique rests on a massively oversimplified and somewhat offensive view of the causes of poverty. His moral premise is unsupported, and inconsistent with his demand for a state-funded investment in education. His article provides an excellent illustration of the anti-realist and Utopian nature of the ideology of the new right.

Ethics: The Heart of Health Care - a classic ethics text in medical, health and nursing studies - is recommended around the globe for its straightforward introduction to ethical analysis. In this new edition David Seedhouse demonstrates tangibly and graphically how ethics and health care are inextricably bound together, and creates a firm theoretical basis for practical decision-making. He not only clarifies ethics but, with the aid of the acclaimed Ethical Grid, teaches an essential practical skill which can be productively (...) applied in day-to-day health care. This edition, which is even more readable than the first, includes additional case studies and teaching exercises, contains new material on ethical theory and offers two further decision-making tools - The Rings of Uncertainty and the Autonomy Test. The engaging new introduction reveals the genesis of the Ethical Grid, illuminates the intent and argument of the first edition, and explains why the book is needed today as much as ever. Intended for all who work in health care or health studies - indeed for anyone with an interest in health issues - this is a highly original, innovative and accessible work on a subject traditionally regarded as lofty and obscure. It clarifies a wide variety of complex ethical issues and will give the reader fresh inspiration and renewed confidence in dealing with the demands of modern health work. (shrink)

Liberating Medicine David Seedhouse Unit for the Study of Health Care Ethics, Department of General Practice, University of Liverpool, UK Amid the increasing debate about the practice of medicine and the delivery of health care lie certain fundamental questions: What is the purpose of medicine? What is the role of the medical profession? and Where should the limits of medical intervention be set? In a world of rapid scientific and technological advance, public expectations place increasing demands on the doctor’s skills, (...) and the scope of medical practice needs constantly to be redefined. Yet few guidelines exist on how to go about this. Liberating Medicine is designed to help doctors and health care professionals to understand the role, scope and purpose of their work, by showing that through heightened recognition of possible goals and potential limits, doctors will be more free to select the most beneficial targets for their health work, to plan their strategies for care freely within their practice, and to be able to liberate more fulfilling potentials in those for whom they care. Although rooted in theoretical analysis the book is essentially practical. It contains teaching exercises, a model which can be used to show doctors how close to the limits of practice they are, and a workable checklist for use in interactions with individual patients. All those involved in the study and practice of medicine—but particularly medical students and their teachers—will find this a thought-provoking, stimulating and innovative guide to the philosophical principles of medicine and how these can be applied to everyday practice. Other Related Books Health: The Foundations for Achievement David Seedhouse September 1986 Ethics: The Heart of Health Care David Seedhouse July 1988 Changing Ideas in Health Care Edited by David Seedhouse and Alan Cribb June 1989 Philosophical Medical Ethics Raanan Gillon October 1986. (shrink)

Many clinicians believe that allowing costs to influence clinical decisions is unethical. They are mistaken in this belief, because it cannot be ethical to ignore the adverse consequences upon others of the decisions you make, which is what 'costs' represent. There are, however, some important ethical issues in deciding what costs to count, and how to count them. But these dilemmas are equally strong with respect to what benefits to count and how to count them, some of which expose ethically (...) untenable assumptions about such widely-used clinical criteria as survival rates. One of the advantages of systematic cost-effectiveness analysis is that it exposes these hidden assumptions, and requires explicit judgements to be made about which ethical position is appropriate in a particular policy context. This should have the important incidental benefit of improving the accountability of policy-makers to the community they are serving. (shrink)

I cannot be certain what people have in mind when they wish to expose medical students to ethics, but if what I have said so far is sound, then they ought not to mean moral philosophy alone. The moral life of medicine and the moral life in general have certainly given rise to rules of thumb, guidelines and principles which summarise our sentiments about interactions within that life. However, the substance of that life is human vulnerability and our responses to (...) it. This is not to say that the theories found in moral philosophy are not a rich terrain for intellectual ingenuity, they are, but there is no reason whatever to believe that their study sharpens moral sensitivity.Sensitivity to human vulnerability is the dimension which medical ethics education should seek to explore. One reason is that medical practice is at the hard edge of moral practice, and the character of the practitioners is one of our major concerns as consumers of health care.My conclusion is easy enough to state. Many have started the business of medical ethics on the assumption that moral philosophy has an applied correlate. This has proven to be a chimera. Let's have the courage to admit that a promising research project has petered out and start to look for a more plausible one. Perhaps we could start by looking for good narratives of suffering, of living under adversity, and of caring for the suffering. (shrink)

Assessments of health care needs are embedded in contracts for health services. Such contracts are the formal link between the identification of health care needs and the purchasing of services to satisfy those needs. They are a central part of the procedural relationship between the British health service (NHS) and the satisfaction of human needs. To evaluate contracts it is necessary to investigate this relationship. A number of headings under which it may be possible to begin to evaluate contracts are (...) described, and the potential of a ‘universalist’ approach to interrogate contract-based decision-making is briefly discussed. (shrink)

Two answers to the question ‘how can we allocate health care resources fairly?’ are introduced and discussed. Both utilitarian and egalitarian approaches are found relevant, but both exhibit considerable theoretical and practical difficulties. Neither seems capable of solving the problem on its own. It is suggested that, for practical purposes, a version of Rawls' famous thought experiment might provide at least some enlightenment about which theoretical approach should be used to address the question.