Abstract
Whenever there is the possibility of interaction among persons, there are questions about how those persons ought to act.1 The study of ethics may be described as the study of how persons ought to act. Since health care consists of interactions among persons, the practice of health care is inextricable from ethical issues.
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Notes
More strictly, we should say that any interaction involving sentient beings brings in questions about our obligations to those beings. The issue about our obligations to nonhuman animals is a large and important one, but cannot be included in the limited space in this book. See bibliography for books that deal with this issue.
This will be discussed in more detail below in the section on “Rights and Obligations.”
Sometimes the grumbling is really an expression of a sort of legal positivism (“We will do what the law requires us to do”). C.f. the section on rights in this chapter.
The claim was popularized by certain anthropologists, in particular, Margaret Mead. A part of a recent controversy about her work was about the validity of her claim that moral beliefs are culture-relative.
The terms “moral” and “ethical” will be used interchangeably in this book.
See following section, “Utilitarian Theory.”
Sometimes, justification is given based on evolutionary theory.
That is, the belief that “survival of the fittest” implies a competition among individuals in a species. But it should be noted that even classical evolutionary theory makes claims not only about survival of individuals, but also about survival of the species. Sometimes individual survival seems to be sacrificed for the survival of the species or other individuals. (The author begs the indulgence of those sophisticated in both ethics and evolutionary theory. The objection here is admittedly oversimplified.)
Immanuel Kant, Foundations of the Metaphysics of Morals. Trans. by Lewis White Beck. (Indianapolis: Bobbs-Merrill, 1959).
The ascription of a “will,” not the sort of thing that can be observed, is the sort of thing that empiricists would avoid.
Kant, op. cit.
Bruno Bettelheim, The Informed Heart (London, 1961), Chapter 6. As quoted in Jonathan Glover, Causing Death and Saving Lives (New York: Penguin, 1977) p. 58.
Thus, a dog can be taught to walk on two legs, but because the dog is “designed” to walk on fours it will be neither healthy nor happy if it continually walks on two legs.
This is reportage, not recommendation. We note that the Pope recently (January 1984) reiterated the classical Church natural law position on sexual matters—sex outside of marriage is a “moral disorder,” masturbation and homosexuality are also “grave moral disorders.” Notice the interesting concept of a “moral disorder”—is it a disorder in the medical sense—an illness?
Thus, the Catholic Church has been quite “permissive” on withdrawing certain life-sustaining treatments on the grounds that the use of extraordinary means is not obligatory since extraordinary means are “above and beyond” the natural order.
This may not hold true for the physician who may have special duties arising from his role as a professional and arising from his contract with the patient.
Thomas Hobbes, Leviathan (Parts I and II) (Indianapolis: Bobbs-Merrill, 1958).
Hobbes, p. 108.
Ibid., p. 107.
On the one hand, this was a very radical notion (and Hobbes got in a great deal of trouble for it)—for it claims that government is put into place by the governed and has obligations towards them. This was written during the time of absolute monarchies. On the other hand, it is conservative in the sense that it justifies a minimalist government—one that has an obligation to protect the liberties of the governed, but no obligation to do anything more for them.
The reader might find it interesting to reexamine the section on “self-interest” above.
John Rawls, A Theory of Justice (Cambridge, Mass: Belknap Press, 1971). Rawls presents a very full discussion of this view.
In regard to medical ethics, the last becomes important when we deal with the issue of drug-testing and drug sales of untested or dangerous drugs to other countries.
In theory. In conservative practice there may be inconsistencies, for example, in the demand that aggressive treatment be given to defective neonates. (See Chapter 4, “Euthanasia,” and see section on abortion in Chapter 3, “Personhood and the Right to Life.”)
Though there have been attempts to claim that these rights are derivative negative rights because good health, nutrition, etc., are necessary in order for any person to have a real opportunity to exercise his primary rights to pursue liberty, happiness, etc.
Cf. Rawls, p. 25.
Bibliography
Dworkin, Ronald. Taking Rights Seriously. Cambridge, Mass.: Harvard University Press, 1977
Haworth, Lawrence. Autonomy. New Haven: Yale University Press, 1986.
Hobbes, Thomas. Leviathan (Parts I and II). Indianapolis: Bobbs-Merrill, 1958.
Kant, Immanuel. Foundations of the Metaphysics of Morals. Trans. Lewis White Beck. Indianapolis: Bobbs-Merrill, 1959.
McCloskey, H.J. Rights. The Philosophical Quarterly, 15, 1965: p. 123.
Melden, A. I. (Ed.). Human Rights. Belmont: Wadsworth, 1970.
Mill, John Stuart. Essential Works of John Stuart Mill. Ed. Max Lerner. New York: Bantam, 1961.
Nozick, Robert. Anarchy, State, and Utopia. New York: Basic Books, 1974.
Rawls, John. A Theory of Justice. Cambridge, Mass.: Belknap Press, 1971.
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Kantor, J.E. (1989). Introduction and Philosophical Theories. In: Medical Ethics for Physicians-in-Training. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1672-3_1
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