Internal Morality Of Medicine Research Articles

Integrity and Conscience in Medical Ethics: A Ciceronian Perspective.

In his work on medical ethics, Lauris Kaldjian identifies conscience with integrity. However, there are competing notions of integrity that may guide the conscience. This paper addresses debates over conscientious refusals by considering Cicero's account of integrity, a conception previously not discussed in the context of this debate. Cicero offers a framework for understanding integrity and conscience for the physician that is an alternative to Alasdair MacIntyre's notion of the completely unified life, an idea appropriated by Kaldjian in his argument that there can be no clean distinction between personal, private, practical reasoning and moral decision-making. Cicero's account rejects the modern-individualist idea of the autonomous self living a wholly compartmentalized life. It agrees with Kaldjian's stress on flexible decision-making, the internal morality of medicine, the importance of virtues, and the need to accommodate pluralism. However, Ciceronian integrity is better suited than the MacIntyreian account to our present liberal order. It offers a place for the "moral hero" while recognizing that the vast majority of moral agents will be "progressors" who lack the consistency of the moral hero's fully integrated life. The inclusion of both types of individuals in the medical field may offset the potentially harmful tendencies to which each is prone.

Body Modification Practices and the Medical Monopoly

The state currently grants the medical profession a monopolistic entitlement on the legal use of medical technology. As physicians are duty bound to not expose people to medically unnecessary harm, individuals who wish to engage in Body Modification Practices are effectively precluded from doing so as only physicians are legally entitled to use medical technology. In this article, I argue this is incompatible with respect for persons. Abolishing the medical monopoly allows us to meet the demands of respect for persons by granting access to technology, whilst still upholding physicians’ right to refuse to provide requested services and thereby determine the boundaries of their profession according to what they consider to be the internal morality of medicine.

Why Physicians Ought to Lie for Their Patients

Sometimes physicians lie to third-party payers in order to grant their patients treatment they would otherwise not receive. This strategy, commonly known as gaming the system, is generally condemned for three reasons. First, it may hurt the patient for the sake of whom gaming was intended. Second, it may hurt other patients. Third, it offends contractual and distributive justice. Hence, gaming is considered to be immoral behavior. This article is an attempt to show that, on the contrary, gaming may sometimes be a physician's duty. Under specific circumstances, gaming may be necessary from the viewpoint of the internal morality of medicine. Moreover, the objections against gaming are examples of what we call the idealistic fallacy, that is, the fallacy of passing judgments in a nonideal world according to ideal standards. Hence, the objections are inconclusive. Gaming is sometimes justified, and may even be required in the name of beneficence.

Ethicians, ethicists and the goals of clinical ethics consultation

We believe that clinical ethics consultation (CEC) has as its goal the delivery of healthcare in a manner consistent with the moral rules and the moral ideals. Towards this end, CEC pursues the instrumental ends of clarifying the limits of acceptable ethical disagreement and facilitating a choice among ethically acceptable alternatives. In pursuing these ends, healthcare ethics consultation (HEC) and CEC services confront three broad categories of questions: (1) questions of professional duty; (2) questions of law; and (3) questions of general morality. Professional duty questions concern what has been referred to as the "internal morality of medicine", and include questions such as the medical legitimacy of the goal(s) being pursued, or the acceptability of the means being employed. Questions of law concern themselves with what the law requires, permits or prohibits. Questions of general morality include all those not falling within the scope of the above categories. We submit that this has implications for the organization and structure of consultation services and HEC and for the methodology and processes employed in CEC. Thus: (1) questions of professional duty should be addressed only by physician members (whom we would distinguish by employing the term "ethicians") of the HEC or CEC service. The only role for non-ethicians under these circumstances would be in helping to resolve disagreements between/among professionals; (2) questions of law, in contrast, should be addressed only by the attorney member(s) of the HEC or CEC service; (3) questions of general morality may be addressed by the entire membership of the HEC or CEC service.

The Internal Morality of Medicine in the Contexts of Implicit Religion and Spirituality

The internal morality of medicine is the moral framework that entails the duties and virtues of physicians in their curing, healing and caring for the sick. It is claimed in this essay that when medicine is practiced as a secular vocation, as opposed to that of a business or a job, it meets the criteria of implicit religion and spirituality. Specifically, it is argued that spirituality is evident, relevant and important as an ingredient of the internal morality of medicine when the latter is practiced as a vocation. Spirituality may manifest in the committed professional activities and attitudes of physicians on behalf of the health of patients and of the larger community, and particularly in the process of discerning what is the best interest of patients in the context of a holistic healing approach to their clinical condition. It may also lessen the likelihood of erroneous overvaluation of patients’ self-determination, as if it were equivalent to dignity, while facilitating the consideration of patients’ communal connectedness. Therefore spirituality in medicine may enhance the quality of health care, and thereby benefit both the patients and those who affect, and who are affected by, their lives, health, dying and death.

The internal morality of medicine: an evolutionary perspective.

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of 'the common morality' to medicine or whether some of these norms are 'internal' or 'proper' to medicine. In this article we describe and defend an evolutionary perspective on 'the internal morality of medicine' that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these goals. This perspective is developed by means of a critical examination of the 'essentialist' conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp.

Cosmetic surgery and the internal morality of medicine.

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures—liposuction, breast augmentation, eyelid surgery, and facelift—443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.