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.

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

Actions that go 'beyond the call of duty' are a common though not commonplace part of everyday life - in heroism, self-sacrifice, mercy, volunteering, or simply in small deeds of generosity and consideration. Almost universally they enjoy a high and often unique esteem and significance, and are regarded as, somehow, peculiarly good. Yet it is not easy to explain how - for if duty exhausts the moral life there is no scope to praise supererogatory acts, and if the consequentialist is (...) right there are no grounds for awarding them a special status. However, despite the distinctiveness of supererogation and the difficulty of accounting for it, philosophers have paid surprisingly little attention to the concept, and until now no thorough and systematic treatment of it has been proposed. This is what David Heyd offers in this book. His study will stimulate philosophers to recognise the importance of this rather neglected topic, and to take a fresh critical look at their theories in the light of its singular importance. (shrink)

Actions that go 'beyond the call of duty' are a common though not commonplace part of everyday life - in heroism, self-sacrifice, mercy, volunteering, or simply in small deeds of generosity and consideration. Almost universally they enjoy a high and often unique esteem and significance, and are regarded as, somehow, peculiarly good. Yet it is not easy to explain how - for if duty exhausts the moral life there is no scope to praise supererogatory acts, and if the consequentialist is (...) right there are no grounds for awarding them a special status. However, despite the distinctiveness of supererogation and the difficulty of accounting for it, philosophers have paid surprisingly little attention to the concept, and until now no thorough and systematic treatment of it has been proposed. This is what David Heyd offers in this book. His study will stimulate philosophers to recognise the importance of this rather neglected topic, and to take a fresh critical look at their theories in the light of its singular importance. (shrink)

The adversary professions--law, business, and government, among others--typically claim a moral permission to violate persons in ways that, if not for the professional role, would be morally wrong. Lawyers advance bad ends and deceive, business managers exploit and despoil, public officials enforce unjust laws, and doctors keep confidences that, if disclosed, would prevent harm. Ethics for Adversaries is a philosophical inquiry into arguments that are offered to defend seemingly wrongful actions performed by those who occupy what Montaigne called "necessary offices."Applbaum (...) begins by examining the career of Charles-Henri Sanson, who is appointed executioner of Paris by Louis XVI and serves the punitive needs of the ancien régime for decades. Come the French Revolution, the King's Executioner becomes the king's executioner, and he ministers with professional detachment to each defeated political faction throughout the Terror and its aftermath. By exploring one extraordinary role and the arguments that can be offered in its defense, Applbaum raises unsettling doubts about arguments in defense of less sanguinary professions and their practices.To justify harmful acts, adversaries appeal to arguments about the rules of the game, fair play, consent, the social construction of actions and actors, good outcomes in equilibrium, and the legitimate authority of institutions. Applbaum concludes that these arguments are weaker than supposed and do not morally justify much of the violation that professionals and public officials inflict. Institutions and the roles they create ordinarily cannot mint moral permissions to do what otherwise would be morally prohibited. (shrink)

The central thesis of this paper is that cost-containment challenges to an Ideal Advocate model of the physician-patient relationship can be met under proper circumstances. More specifically, it is possible for physicians to constrain costs while still making clinical decisions that are free from considerations of the physician's own interests and are uninfluenced by judgements about the patient's worth. But what is required is a closed distributive system, in which savings of resources at one point are applied to others' care (...) of higher priority and a just system, that is, a system whose distributive priorities are consistent with relevant principles of justice under moderate scarcity. The historical context of the argument and a stopgap, palliative, step are also developed. (shrink)

Health care reform proposals threaten to exacerbate tensions physicians already face in trying to balance traditional duties to individual patients against increasing pressure to serve broader societal and institutional goals. To cope with reform, medical ethics must clarify physicians' moral obligations, change existing ethical codes, and develop an ethics of institutions.