Health Care Analysis

, Volume 1, Issue 2, pp 155–162 | Cite as

Bioethical blind spots: Four flaws in the field of view of traditional bioethics

  • K. W. M. Fulford
Original Paper Analysing Ethics

Abstract

In this paper it is argued that bioethics has tended to emphasise: ‘high tech’ areas of medicine at the expense of ‘low tech’ areas such as psychiatry; problems arising in treatment at the expense of those associated with diagnosis; questions of fact at the expense of questions of value; and applied ethics at the expense of philosophical theory. The common factor linking these four ‘bioethical blind spots’ is a failute to recognise the full extent to which medicine is an ethical as well as scientific discipline. Once this is acknowledged it leads to a full-field bioethics in which the different areas are mutually complementary. In particular, it paves the way for a fruitful two-way exchange between the more abstract aspects of philosophical theory and the contingencies of day-to-day clinical work. The arguments of the paper are illustrated with recent work on the abuse of psychiatry.

Keywords

Recent Work Common Factor Scientific Discipline Clinical Work Full Extent 

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References

  1. 1.
    Hope, T. and Fulford, K. W. M. (1993). Medical education: patients, principles and practice skills. In,Principles of Health Care Ethics, ed. by R. Gillon. John Wiley and Sons, Chichester.Google Scholar
  2. 2.
    Merskey, H. (1991). ‘Ethical aspects of physical manipulation of the brain’.Psychiatric Ethics, 2nd edn, ed. by S. Bloch and P. Chodoff, pp. 185–214. Oxford University Press, Oxford.Google Scholar
  3. 3.
    Beauchamp, T. L. and Childress, J. F. (1989).Principles of Biomedical Ethics. Oxford University Press, Oxford.Google Scholar
  4. 4.
    Bloch, S. and Chodoff, P. (1991).Psychiatric Ethics, 2nd edn. Oxford University Press Oxford.Google Scholar
  5. 5.
    Kopelman, L. M. (1989). Moral problem in psychiatry. In,Medical Ethics, ed. by R. Veatch. Jones and Bartlett Publishing, Massachusetts.Google Scholar
  6. 6.
    Hope, R. A. (1990). Ethical philosophy as applied to psychiatry.Current Opinion in Psychiatry,3, 673–676.Google Scholar
  7. 7.
    Anzia, D. J. and La Puma, J. (1991). An annotated bibliography of psychiatric medical ethics.Academic Psychiatry 15, 1–7.Google Scholar
  8. 8.
    Campbell, A. V. and Higgs, R. (1982). InThat Case: Medical Ethics in Everyday Practice London, Darton, Longman and Todd.Google Scholar
  9. 9.
    Boorse, C. (1975). On the distinction between disease and illness.Philosophy and Public Affairs 5, 49–68.Google Scholar
  10. 10.
    Boorse, C. (1976). What a theory of mental health should be.Journal of Theory Social Behaviour 6, 61–84.Google Scholar
  11. 11.
    Fulford, K. W. M. (1989).Moral Theory and Medical Practice. Cambridge University Press, Cambridge.Google Scholar
  12. 12.
    Agich, G. J. (1983). Disease and value: a rejection of the value-neutrality thesis.Theoretical Medicine 4, 27–41.Google Scholar
  13. 13.
    Engelhardt, H. T. Jr. (1975). The concepts of health and disease. In,Evaluation and Explanation in the Biological Sciences, ed. by H. T. Engelhardt Jr and S. F. Spicker, D. Reidel, Dordrecht.Google Scholar
  14. 14.
    Gillon, R. (1986).Philosophical Medical Ethics. John Wiley and Sons, Chichester.Google Scholar
  15. 15.
    Hesse, M. (1980).Revolutions and Reconstructions in the Philosophy of Science. The Harvester Press, Brighton.Google Scholar
  16. 16.
    American Psychiatric Association (1980).Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association, Washington, DC.Google Scholar
  17. 17.
    Frances, A., First, M. B., Widiger, T. A., Miele, G. M., Tilly, S. H., Davis, W. W. and Pincus, H. A. (1991). An A-Z guide to DSM-IV conundrums.Journal of Abnormal Psychology 100 (3), 407–412.Google Scholar
  18. 18.
    Clare, A. (1979). The disease concept in psychiatry. In,Essentials of Postgraduate Psychiatry, ed. by P. Hill, R. Murray and A. Thorley. Academic Press, Grune & Stratton, New York.Google Scholar
  19. 19.
    Kendell, R. E. (1975). The concept of disease and its implications for psychiatry.British Journal of Psychiatry 127, 305–315.Google Scholar
  20. 20.
    Roth, M. and Kroll, J. (1986).The Reality of Mental Illness. Cambridge University Press, Cambridge.Google Scholar
  21. 21.
    Szasz, T. S. (1960). The myth of mental illness.American Psychologist 15, 113–118.Google Scholar
  22. 22.
    Duff, A. (1983). Mental disorder and criminal responsibility: In,Philosophy and the Criminal Law ed. by A. Duff and N. Simmonds. F. S. Verlag, Stuttgart.Google Scholar
  23. 23.
    Moore, M. S. (1984).Law and Psychiatry: Rethinking the Relationship. Cambridge University Press, Cambridge.Google Scholar
  24. 24.
    Fulford, K. W. M. (1993). Value, action, mental illness and the law. In:Criminal Law: Action, Value and Structure, ed. by K. Gardner, J. Horden and S. Shute. Oxford University Press, Oxford.Google Scholar
  25. 25.
    Williams, B. (1985).Ethics and the Limits of Philosophy. Fontana, London.Google Scholar
  26. 26.
    Seedhouse, D. (1991).Liberating Medicine. John Wiley and Sons, Chichester.Google Scholar
  27. 27.
    Hare, R. M. (1963). Descriptivism.Proceedings of the British Academy 49, 115–134. Reprinted in Hare R. M. (1972).Essays on the Moral Concepts. Macmillan, London.Google Scholar
  28. 28.
    Urmson, J. O. (1950). On grading.Mind 59, 145–169.Google Scholar
  29. 29.
    Fulford, K. W. M. (1993). Closet logics: hidden conceptual elements in the DSM and ICD classifications of mental disorders. In,Philosophical Perspectives on Psychiatric Classification, ed. by J. S. Sadler, M. Schwartz and O. Wiggins. Johns Hopkins University, Baltimore.Google Scholar
  30. 30.
    Warnock, G. J. (1967).Contemporary Moral Philosophy, Macmillan, London.Google Scholar
  31. 31.
    Toulmin, S. (1980). Agent and patient in psychiatry.International Journal of Law and Psychiatry 3, 267–278.Google Scholar
  32. 32.
    Nordenfelt, L. (1987).On the Nature of Health: An Action-theoretical Approach. D Reidel, Dordrecht.Google Scholar
  33. 33.
    Fulford, K. W. M. (1993). Thought insertion and insight: disease and illness paradigms of psychotic disorder. In,Phenomenology, Language and Schizophrenia, ed. by M. Spitzer. Springer-Verlag, Berlin.Google Scholar
  34. 34.
    Seedhouse, D. (1986).Health: The Foundations for Achievement. John Wiley and Sons, Chichester.Google Scholar
  35. 35.
    Gluzman, S. (1989).On Soviet Totalitarian Psychiatry. International Association on the Political Use of Psychiatry, Amsterdam.Google Scholar
  36. 36.
    Bloch, S. (1981). The political misuse of psychiatry in the Soviet Union.Psychiatric Ethics, 2nd edn, ed. by S. Bloch and P. Chodoff. Oxford University Press, Oxford.Google Scholar
  37. 37.
    Wing, J. K. (1978).Reasoning about Madness. Oxford University Press, Oxford.Google Scholar
  38. 38.
    Merskey, H. and Shafron, B. (1986). Political hazards in the diagnosis of sluggish schizophrenia.British Journal of Psychiatry 148, 247–256.Google Scholar
  39. 39.
    Fulford, K. W. M., Smirnoff, A. Y. U. and Snow, E. (1993). Concepts of disease and the abuse of psychiatry in the USSR.British Journal of Psychiatry 162, 801–810.Google Scholar
  40. 40.
    Fulford, K. W. M. (1990). Philosophy and medicine: the Oxford connection.British Journal of Psychiatry 157, 111–115.Google Scholar
  41. 41.
    Austin, J. L. (1956–7). A plea for excuses.Proceedings of the Aristotelian Society 57, 1–30. Reprinted in White A. R. (ed) (1968).The Philosophy of Action. Oxford University Press, Oxford.Google Scholar

Copyright information

© John Wiley & Sons, Ltd. 1993

Authors and Affiliations

  • K. W. M. Fulford
    • 1
  1. 1.Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordUK

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