Philosophical Medical Ethics Research Articles

Book Reviews

Book Reviews Get access Philosophical Medical Ethics. Raanan Gillon. (189 pages, £8.50). Chichester: John Wiley and Sons, 1986, 0-471-91222-0. ALBERT H. KELLER ALBERT H. KELLER Search for other works by this author on: Oxford Academic PubMed Google Scholar Family Practice, Volume 4, Issue 4, December 1987, Pages 335–336, https://doi.org/10.1093/fampra/4.4.335-a Published: 01 December 1987

Philosophical medical ethics

Philosophical medical ethics

Philosophical medical ethics. Conclusion: the Arthur case revisited.

Throughout his British Medical Journal series of 25 articles on medical ethics, Gillon frequently used the Arthur case (which involved a British physician who faced criminal charges for allowing a Down's syndrome newborn to die) to illustrate moral arguments concerning approaches to clinical dilemmas. He returns to the Arthur case in this essay on the obligations of physicians toward all patients with Down's syndrome. Gillon asks what implications one's view of the moral permissibility of allowing infants with this handicap to die has for the care of adults with the same condition. He concludes that the issue turns on the question of personhood, in particular that of newborns. If newborns are not accorded personhood status, then allowing those with severe handicaps to die may be justified but should not be considered morally different from actively killing them.

Doctors and patients.

Gillon outlines some prima facie moral duties of physicians to patients that have emerged from his previous articles in a series on philosophical medical ethics. These duties follow from four general ethical principles--respect for autonomy, beneficence, non-maleficence, and justice--plus the self-imposed supererogatory duty of medical beneficence. From these principles the author derives such duties as providing adequate information and advice on treatment options, encouraging patient participation leading to informed decisions, maintaining competence and exposing incompetence, admitting errors, disclosing personal medico-moral standards, and acknowledging that other interests may occasionally supersede those of the individual patient. Gillon concludes that, where self interest conflicts with medical beneficence, the claim of medicine as a profession requires that the patient's interests take priority.

"The patient's interests always come first"? Doctors and society.

In one of a series of articles on philosophical medical ethics, Gillon considers the implications for medical ethics of the social context in which doctors practice. Such implications often contradict a common and absolutist medico-moral cliché that "the patient's interests always come first." He notes that moral obligations to a particular patient may at times be superseded by the social obligation to allocate health care resources justly; to pursue research to benefit future patients; and to engage in preventive medicine to benefit potential patients. Gillon also reflects on three more hidden aspects of medicine's relation with society that may conflict with the interests of the individual patient--the contribution of social factors to disease and health, social determinants of physician's attitudes, and the struggle for power between the medical profession and other social groups

On sickness and on health.

The meaning of health, its relation to illness and disease, and its aspects that are of particular importance in medical ethics are the foci of Gillon's essay, one of a series on philosophical medical ethics. He argues that the World Health Organization's definition of health--"a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity"--is too broad for use by physicians in patient care. Defining illness and disease--those components of ill health with which doctors are concerned--might help delineate the physician's role in restoring or preserving health. Gillon summarizes the realist and nominalist approaches to disease and to the question whether it is an evaluative or a value free concept. He suggests that the definition and ascription of illness are of such social importance that decisions concerning them should be made cooperatively by doctors and society.

The principle of double effect and medical ethics.

In one of a series of articles on philosophical medical ethics, Gillon examines the Roman Catholic doctrine of double effect as it applies to discussions of the moral difference between acts and omissions in patient care. The doctrine holds that, in the context of actions that have both good and bad effects, an action that has a bad effect is morally permissible if (a) the action itself is good, (b) its perpetrator's intention is solely to produce the good effect, (c) the good effect is not achieved through the bad, and (d) there is sufficient reason to permit the bad effect. Gillon concludes that, while the doctrine of double effect is unlikely to be accepted fully by non-absolutists, some of its claims are useful in deciding which clinical interventions are morally justified.

Justice and allocation of medical resources.

In one of a series of short articles on philosophical medical ethics, Gillon examines the principle of justice as it applies to adjudicating competing claims for the distribution of scarce medical resources. He describes Aristotle's theory of justice--with its demands of formal equity, impartiality, and fairness--and then considers various substantive criteria that have been proposed to justify choosing among competing candidates for scarce resources. In the absence of an acceptable way to give consistent moral priority to any of the criteria, he concludes, practical systems should be set up to resolve conflicts by taking into account the fundamental moral values of respect for autonomy, beneficence, and nonmaleficence while incorporating Aristotle's formal principle of justice.

Beneficence: doing good for others.

Gillon's essay on beneficence is one in a series of British Medical Journal articles on philosophical medical ethics. The duty of beneficence, or doing good for others, figures more prominently in medicine than in most other professions. As important as beneficence is in the physician patient relationship, however, it must be tempered by respect for the patient's autonomy; by the duty of nonmaleficence, or of doing no harm; and by a concern for justice, especially in the allocation of scarce medical resources.

Paternalism and medical ethics.

In one of a series of articles on philosophical medical ethics, Gillon considers various moral arguments in support of medical paternalism. He maintains that the utilitarian principle of maximizing happiness by improving health, minimizing suffering, and prolonging life is not promoted by granting physicians the authority to deceive patients or to make decisions for them in areas of moral and subjective choice. If one wants to do good for a patient, one generally needs to find out what the patient wants one to do. Gillon concludes that many utilitarians agree with deontologists that respect for autonomy is required if human welfare really is to be maximized.

Philosophical medical ethics

Partial table of contents: An Introduction to Philosophical Medical Ethics: The Arthur Case. Medical Oaths, Declarations, and Codes. Deontological Foundations for Medical Ethics? Conscience, Good Character, Integrity, and to Hell with Philosophical Medical Ethics? Ita s All Too Subjectivea a : Scepticism about the Possibility or Use of Philosophical Medical Ethics. To What Do We Have Moral Obligations and Why (I)? Rights. Autonomy and the Principle of Respect for Autonomy. Paternalism and Medical Ethics. Beneficence: Doing Good for Others. Justice and Medical Ethics. Justice and Allocation of Medical Resources. Telling the Truth and Medical Ethics. Confidentiality. Consent. Where Respect for Autonomy Is not the Answer. On Sickness and on Health.

Philosophical medical ethics. Rights.

In one of a series of articles on philosophical medical ethics, Gillon examines problems associated with the term "rights." He focuses on the distinction between legal and institutional rights on the one hand and moral rights on the other, and then on the distinction between universal moral rights possessed by all human beings and those moral rights that arise as a result of prior actions or special social relationships. Finally, he discusses the distinction between rights that impose moral obligations on others to act and rights that require others to refrain from acting.

Philosophical medical ethics

Philosophical medical ethics

"It's all too subjective": scepticism about the possibility or use of philosophical medical ethics.

In one of a series of articles on philosophical medical ethics, Gillon rebuts the argument that moral claims are essentially different from scientific claims because scientific claims are objective and confirmable or refutable, while moral claims are subjective, unconfirmable, irrefutable, and their differences incapable of resolution. He contends that there is widespread agreement about many moral principles, that moral disagreement may arise from the use of ambiguous terminology, and that progress toward resolution may be accomplished by analysis of the logical validity and consistency of the arguments.

Conscience, good character, integrity, and to hell with philosophical medical ethics?

Gillon, in one of a series of articles on philosophical medical ethics, rebuts the contention of many physicians that philosophical medical ethics is irrelevant to medical education and practice. His opponents hold that the ethical education of the physician is accomplished by the development of conscience, good character, and integrity in conjunction with medical skills. Gillon argues that accepting these virtues as sufficient in themselves, without requiring any philosophical analysis of the moral assumptions and objectives of medical practice, is akin to specifying a syllabus for therapeutics while claiming that a knowledge of pharmacology is unnecessary.

Medical oaths, declarations, and codes.

In the second of a series of articles on philosophical medical ethics, Gillon briefly describes the World Medical Association's declarations on medical ethics, including the Declaration of Geneva, the international code of medical ethics adopted in London in 1949, and the Declarations of Helsinki, Lisbon, Sydney, Oslo, Tokyo, Hawaii, and Venice. Raising the question whether British physicians should be bound by these declarations, rather than by the code of ethics of the General Medical Council which has legal jurisdiction over them, he contends that law is too fluid to serve as a foundation for ethics. He plans to discuss the fundamental underpinnings of medical ethics in subsequent articles.

An introduction to philosophical medical ethics: the Arthur case.

The application of moral theory to decisions involving medical ethics is illustrated by the 1981 case in which a British pediatrician, Dr. Leonard Arthur, was acquitted of attempted murder for prescribing dihydrocodeine and "nursing care only" for a Down's syndrome newborn after the child had been rejected by his mother. Gillon outlines the moral arguments of the "prosecution" and the "defense," and then categorizes their various premises in accordance with concepts of normative ethical theory.

Philosophy and Medicine Series. H. Tristram Engelhardt, Jr. , Stuart F. SpickerPhilosophy and Medicine Series. Vol. 1: Explanation and Evaluation in the Biomedical Sciences. H. Tristram Engelhardt, Jr. , Stuart F. SpickerPhilosophy and Medicine Series. Vol. 2: Philosophical Dimensions of the Neuro-Medical Sciences. Stuart F. Spicker , H. Tristram Engelhardt, Jr.Philosophy and Medicine Series. Vol. 3: Philosophical Medical Ethics: Its

Previous articleNext article No AccessBook ReviewsPhilosophy and Medicine Series. H. Tristram Engelhardt, Jr. , Stuart F. Spicker Philosophy and Medicine Series. Vol. 1: Explanation and Evaluation in the Biomedical Sciences. H. Tristram Engelhardt, Jr. , Stuart F. Spicker Philosophy and Medicine Series. Vol. 2: Philosophical Dimensions of the Neuro-Medical Sciences. Stuart F. Spicker , H. Tristram Engelhardt, Jr. Philosophy and Medicine Series. Vol. 3: Philosophical Medical Ethics: Its Nature and Significance. Stuart F. Spicker , H. Tristram Engelhardt, Jr. Philosophy and Medicine Series. Vol. 4. Mental Health: Philosophical Perspectives. H. Tristram Engelhardt, Jr. , Stuart F. Spicker Philosophy and Medicine Series. Vol. 5: Mental Illness: Law and Public Policy. Baruch A. Brody , H. Tristram Engelhardt, Jr. Philosophy and Medicine Series. Vol. 6: Clinical Judgment: A Critical Appraisal. H. Tristram Engelhardt, Jr. , Stuart F. Spicker , Bernard Towers Philosophy and Medicine Series. Vol. 7. Organism, Medicine, and Metaphysics. Stuart F. Spicker John C. MoskopJohn C. Moskop Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Ethics Volume 92, Number 2Jan., 1982 Article DOIhttps://doi.org/10.1086/292349 Views: 8Total views on this site Copyright 1982 The University of ChicagoPDF download Crossref reports no articles citing this article.

Stuart F. Spicker and H. Tristram EnglehardtJr. (eds.) Philosophical Medical Ethics: Its Nature and Significance. Philosophy and Medicine. Vol. 3. Dordrecht, Holland and Boston: D. Reidel Publishing Company, 1977, 252 pp., $19.50.

Stuart F. Spicker and H. Tristram EnglehardtJr. (eds.) Philosophical Medical Ethics: Its Nature and Significance. Philosophy and Medicine. Vol. 3. Dordrecht, Holland and Boston: D. Reidel Publishing Company, 1977, 252 pp., $19.50. - Volume 46 Issue 2

Philosophical Medical Ethics: Its Nature and Significance. Edited by S. F. Spicker and H. Tristram EngelhardtJr. (Pp. 252; $19.50.) D. Reidel: Boston. 1977.

Philosophical Medical Ethics: Its Nature and Significance. Edited by S. F. Spicker and H. Tristram EngelhardtJr. (Pp. 252; $19.50.) D. Reidel: Boston. 1977.