Abstract
This commentary, while sympathetic to Thomasma and Pellegrino [15], raises three sets of questions concerning the adequacy of their view of medicine as a foundation for medical ethical decision-making. The first set of questions concerns the account of the nature of medicine presented by Thomasma and Pellegrino. It is argued that the account is not clearly univocal and that even the most important description offered requires further clarification. Questioned, secondly, is the reasoning used by Thomasma and Pellegrino to propel their movement from establishing an evaluative component in medicine to asserting an ethical dimension to medical judgment. It is argued that the authors equivocate in their presentation between the medical and moral uses of value terms. Finally, the role of the living body as a foundation for medical ethics is questioned, both in terms of the normative force such a ground can generate, and in terms of the range of duties to which this foundation must commit the profession.
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References
Boorse, C., ‘Health as a theoretical concept’,Philosophy of Science 44, (1977) 542–573.
Boorse, C., ‘On the distinction between disease and illness’,Philosophy and Public Affairs 5, (1975) 49–68.
Burns, Chester R., ‘Diseases versus healths: Some legacies in the philosophies of modern medical science’, inEvaluation and Explanation in the Biomedical Sciences, edited by Engelhardt, H. T., Jr. and Spicker, S. F., D. Reidel, Dordrecht, 1975, pp. 29–47.
Callahan, D., ‘The WHO definition of ‘Health’’,Hasting Center Studies 1, (1973) 77–87.
‘Concepts of health and disease’,Journal of Medicine and Philosophy 1, (1976). Special issue.
Engelhardt, H. T., Jr., ‘The concepts of health and disease’, inEvaluation and Explanation in the Biomedical Sciences, edited by Engelhardt, H. T., Jr. and Spicker, S. F., D. Reidel, Dordrecht, 1975, pp. 125–141.
Engelhardt, H. T., Jr., ‘Rights and responsibilities of patients and physicians’, inMedical Treatment of the Dying: Moral Issues, edited by Bayles, M. D. and High, D. M., Schenkman, Boston, 1978, pp. 9–28.
Engelhardt, H. T., Jr., ‘Doctoring the disease, treating the complaint, helping the patient: Some of the works of Hygeia and Panacea’, inKnowing and Valuing, edited by Engelhardt, H. T., Jr. and Callahan, D., Hastings Center, Hastings-on-Hudson, New York, 1980, pp. 225–249.
Engelhardt, H. T., Jr., ‘Ethical issues in diagnosis’,Metamedicine 1, (1980) 39–50.
Gorovitz, S. and MacIntyre, A., ‘Toward a theory of medical fallibility’, inScience, Ethics, and Medicine, edited by Engelhardt, H. T., Jr. and Callahan, D., Hastings Center, Hastings-on-Hudson, N.Y., 1976, pp. 248–274.
Kass, L. R., ‘Regarding the end of medicine and the pursuit of health’,The Public Interest 40, (1975) 11–42.
Pellegrino, E. D., ‘The anatomy of clinical judgments’, inClinical Judgment: A Critical Appraisal, edited by Engelhardt, H. T., Jr., Spicker, S. F., and Towers, B., D. Reidel, Dordrecht, 1979, pp. 169–194.
Szasz, T. S.,The Myth of Mental Illness (Revised Edition), Harper and Row, New York, 1974.
‘The concept of health’,Hastings Center Studies 13, (1973). Special issue.
Thomasma, D. and Pellegrino, E. D., ‘The philosophy of medicine as the source for medical ethics’, this issue.
Toulmin, S., ‘Psychic health, mental clarity, self-knowledge and other virtues’, inMental Health: Philosophical Perspectives, edited by Engelhardt, H. T., Jr. and Spicker, S. F., D. Reidel, Dordrecht, 1978, pp. 55–70.
Wartofsky, M. W., ‘The mind's eye and the hand's brain: Toward an historical epistemology of medicine’, inScience, Ethics and Medicine, edited by Engelhardt, H. T., Jr. and Callahan, D., Hastings Center, Hastings-on-Hudson, New York, 1976, pp. 167–194.
World Health Organization, ‘Preamble, Constitution of the World Health Organization’, inThe First Ten Years of the World Health Organization, WHO, Geneva, 1958, p. 459.