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Medicine and Moral Philosophy

Medicine and Moral Philosophy: A "Philosophy and Public Affairs" Reader

Marshall Cohen
Thomas Nagel
Thomas Scanlon
Copyright Date: 1981
Pages: 320
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  • Book Info
    Medicine and Moral Philosophy
    Book Description:

    Responding to the increased public interest in the moral aspects of medical practice, this collection of essays focuses on questions of justice and injustice in the delivery and distribution of medical care and on problems concerning the rights of patients in their relationship to doctors, medical institutions, and government.

    Originally published in 1982.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-5356-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
    (pp. vii-xii)
    M.C., T.N. and T.S.

    Recent years have witnessed a remarkable quickening of interest on the part of doctors and lawyers, private citizens and government officials in the moral questions raised by the practice of medicine and the arrangements society makes for the provision of health care. Philosophers and other theorists have taken up these questions in an increasingly important and influential literature. The present anthology, drawn from articles published over the last decade inPhilosophy &Public Affairs, is intended to make available to a wider audience what we believe are some of the most lucid and penetrating discussions of these problems.

    The first section...

  4. PART I. Conceptual Issues

    • On the Distinction between Disease and Illness
      (pp. 3-22)

      In this century a strong tendency has developed to debate social issues in psychiatric terms. Whether the topic is criminal responsibility, sexual deviance, feminism, or a host of others, claims about mental health are increasingly likely to be the focus of discussion. This growing preference for medicine over morals, which might be called thepsychiatric turn, has an obvious appeal. In the paradigm health discipline, physiological medicine, judgments of health and disease are normally uncontroversial. The idea of reaching comparable certainty about difficult ethical problems is an inviting prospect. Unfortunately our grasp of the issues that surround the psychiatric turn...

    • Human Being: The Boundaries of the Concept
      (pp. 23-48)

      Uncertainty about our ability to define the biological boundaries of human life is familiar. Currently, the most prominent issue is the definition of death—specifically whether to retain the traditional cardiopulmonary criteria for death or to adopt some version of so-called brain-death criteria. The law in some jurisdictions has already begun to permit physicians to pronounce death on a finding of “irreversible coma.” And though it is clear that transplant surgery and the development of life-support technology have given impetus to the change, a number of writers have taken pains to argue that it is perfectly sound, conceptually, to redefine...

    • Brain Death and Personal Identity
      (pp. 49-78)

      The legal and medical definition of death has recently changed in many states from cessation of heart and lung function to so-called brain death. Patients who have suffered irreversible loss of brain function but continue to breathe would have been accounted alive under previous medical practice and legal statute. They are now pronounced dead. Though the changes are sanctioned by leading medical and legal authorities, they have proceeded in a climate of some confusion, a symptom of which was a recent ruling by a Florida judge: “This lady is dead and has been dead and she is being kept alive...

  5. PART II. Health and Social Policy

    • Health-Care Needs and Distributive Justice
      (pp. 81-114)

      A theory of health-care needs should serve two central purposes. First, it should illuminate the sense in which we—at least many of us—think health care is “special,” that it should be treated differently from other social goods. Specifically, even in societies in which people tolerate (and glorify) significant and pervasive inequalities in the distribution of most social goods, many feel there are special reasons of justice for distributing health care more equally. Some societies even have institutions for doing so. To be sure, others argue it is perverse to single out health care in this way, or that...

    • Medical Progress and National Health Care
      (pp. 115-138)

      An individual s access to medical care should not be determined exclusively by his ability to pay the going price From this starting point, alternatives beckon One is the traditional system of health-care delivery within which eleemosynary and religious institutions are prominent in providing medical services to those unable to pay Before the emergence of modern medicine the poor could not expect treatment equivalent to that received by the rich, but this was a general disability of poverty, not specifically a problem of medical access Indeed, in an era when health care had little positive correlation with health outcomes and...

    • Gifts and Exchanges
      (pp. 139-158)

      Richard Titmuss is justly distinguished for his devotion to the welfare of society at large and particularly to those who have received the least of society’s benefits. He has not rested content with the moral satisfaction of advocating the good but has immersed himself in the detailed factual analysis and speculative thinking needed if good intentions are to become good deeds. The gift he has made of his talents has now found an appropriate embodiment in his latest and much-noticed study,The Gift Relationship: From Human Blood to Social Policy.² The study focuses specifically on the workings of a paticular...

    • Altruism and Commerce: A Defense of Titmuss against Arrow
      (pp. 159-167)

      Kenneth Arrow’s discussion¹ ofThe Gift Relationshipby Richard Titmuss² is to be welcomed because it draws attention to this remarkable book. Ostensibly, the book is a comparison of voluntary and commercial means of obtaining blood for medical purposes, but by means of this comparison Titmuss succeeds, as Arrow says, in raising “the largest descriptive and normative questions about the social order in a highly specific and richly factual context” (p. 158). Although Arrow praises the endeavor, he is not very keen on what Titmuss actually says about these issues. I wish to defend Titmuss against some of Arrow’s criticisms....

    • The Recombinant DNA Debate
      (pp. 168-186)

      The debate over recombinant DNA research is a unique event, perhaps a turning point, in the history of science. For the first time in modern history there has been widespread public discussion about whether and how a promising though potentially dangerous line of research shall be pursued. At root the debate is a moral debate and, like most such debates, requires proper assessment of the facts at crucial stages in the argument. A good deal of the controversy over recombinant DNA research arises because some of the facts simply are not yet known. There are many empirical questions we would...

    • An Alternative Policy for Obtaining Cadaver Organs for Transplantation
      (pp. 187-198)

      Two moral principles have been basic to the legal decisions concerning the rights and duties toward the newly dead They are the duty to give decent burial and the denial to anyone of a right to ownership of the dead body for commercial profit (for example, a body cannot be sold as security for the payment of a debt) ¹ The next-of-kin—rather than the church (as was the case earlier in the West) or the state—have come to bear the primary responsibility for providing decent burial

      The familial duty to give decent burial has come to be understood...

  6. PART III. Medical Paternalism

    • Paternalistic Behavior
      (pp. 201-213)

      Discussions of paternalism are often marred by the failure to consider the wide variety of paternalistic acts Thus Gerald Dworkin in his article “Paternalism” says “By paternalism I shall understand roughly the interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests, or values of the person being coerced”¹ All Dworkin s examples are of laws or regulations which he considers paternalistic Though he does recognize that there is such a thing as “parental paternalism” he simply assumes that it will always involve the parent’s attempt “to restrict the child’s freedom...

    • Medical Paternalism
      (pp. 214-234)

      There is evidence to show that among physicians in this country the medical paternalist model is a dominant way of conceiving the physician-patient relationship I contend that the practice of withholding the truth from the patient or his family, a particular form of medical paternalism, is not adequately supported by the arguments advanced to justify it Beyond the issue of telling patients the truth is the dis tinction between “ordinary” and “extraordinary” therapeutic measures, a distinction which, I argue, both expresses and helps to perpetuate the dominance of the medical paternalist model

      There are two main types of arguments against...

    • The Contractual Argument for Withholding Medical Information
      (pp. 235-242)

      Paternalistic grounds for justifying presumptively wrongful treatment of competent adults are widely looked upon as suspect. Allen Buchanan, in an instructive and generally careful essay, has shown that the presence of paternalistic attitudes and paternalistic treatment is not uncommon in physicians’ dealings with their patients.¹ In particular he contends that “the practice of withholding the truth from the patient or his family, a particular form of medical paternalism, is not adequately supported by the arguments advanced to justify it” (p. 214). Buchanan distinguishes two types of arguments which may be advanced against paternalism. The first sort would appeal to a...

  7. PART IV. Euthanasia

    • Voluntary Euthanasia and the Inalienable Right to Life
      (pp. 245-275)

      It is surprising that in this bicentennial period we have not yet heard an argument that seems to bolster the case of opponents of voluntary euthanasia. The argument derives from an interpretation of Thomas Jefferson’s famous words that all men “are endowed by their Creator with certain unalienable Rights, that among these are Life …,” and from similar passages in the writings of other founding fathers. To kill another person even with his consent or at his considered request, it might well be claimed, is to infringe his “Right to Life,” a right the founders clearly held to be incapable...

    • Euthanasia
      (pp. 276-303)

      The widely usedShorter Oxford English Dictionarygives three meanings for the word “euthanasia”: the first, “a quiet and easy death”; the second, “the means of procuring this”; and the third, “the action of inducing a quiet and easy death.” It is a curious fact that no one of the three gives an adequate definition of the word as it is usually understood. For “euthanasia” means much more than a quiet and easy death, or the means of procuring it, or the action of inducing it. The definition specifies only the manner of the death, and if this were all...

  8. Back Matter
    (pp. 304-308)