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Rethinking Health Care Ethics

  • Book
  • Open Access
  • © 2018

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  • Offers a radical departure from the dominant paradigm of “principled decision making” and other theory-driven approaches to clinical ethics
  • Presents an alternative approach by exploring ethical issues in a clinically comprehensible and useful manner
  • Explains to practitioners why they typically perceive bioethics as disengaged from clinical practice and their own experience
  • Offers broad appeal for current clinicians; medical students and other professional trainees; patients and their families; experts in bioethics, philosophy, and law

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About this book

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience andperceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.

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Table of contents (11 chapters)


“There is much to admire about Scher and Kozlowska’s approach, and much to aspire to in their vision of the future of health care ethics. The book is smoothly written and easy to read; it is provocative without being abrasive. It is a valuable counterweight to overly formal, technical approaches to medical ethics.” (Samuel Reis‑Dennis, Monash Bioethics Review, April 18, 2020)

“There are many reasons to recommend Scher and Kozlowska’s text. It presents an excellent case for rethinking the way that health care ethics is taught to health practitioners. It is well written, thoughtful, brief, and freely available via open access online, which should give it wide appeal and make it eminently suitable as a teaching text. … the authors are making a potentially significant contribution to an ecological turn away from merely instrumental and toward truly humane health care practice.” (Patrick Daly, Theoretical Medicine and Bioethics, Vol. 40, August 07, 2019)

“These authors provide a comprehensive review of social science literature and an exploration of how the rise of bioethics in the US and the European response to bioethics culminated in the Universal Declaration on Bioethics and Human Rights. … Scher and Kozlowska's goal is the empowerment of clinicians to respect their moral thinking when addressing health care dilemmas. Summing Up: Recommended. Advanced undergraduates through faculty and professionals.” (B. A. D'Anna, Choice, Vol. 56 (11), July, 2019)

“The book is a lucid critique of healthcare ethics as a [distinct] subject; a critique that naturally leads into constructive suggestions for an alternative pedagogy. The book should be of high interest to teachers in healthcare ethics, to ethicists, and to anyone who finds that ethics often is presented in ways that make us estranged from ourselves. What most impresses me in this book is its trust in the human. The foundation of ethics is in the human self, not in moral theory.” (Pär Segerdahl, The Ethics Blog,, October, 03, 2018)

“Individual moral experience as fundamental … . highly persuasive in its logic and practical orientation … .” (Amir Muzur, European Journal of Bioethics, Vol. 9 (2), 2018)

Rethinking Health Care Ethics is a fine example of the power of interdisciplinary work, particularly the role of the social sciences and their relationship to philosophy. It no less focuses on how to make that helpful to the clinicians who have to make the hard decisions. The book brings a valuable set of insights to important issues.” (Daniel Callahan, co-founder and President Emeritus, The Hastings Center)

“This practically useful, important book takes on the intricate and confusing problem created by bioethics when applied not in policy but in clinical practice. In lieu of the bioethical principles and methods that clinicians frequently find irrelevant and unhelpful, the authors present an alternative clinical framing that enables them to develop an entire pedagogy for clinical bioethics. This is hugely ambitious, and readers will agree and disagree about different recommendations. The authors have nevertheless engaged an extraordinarily difficult subjectwith original thinking and practical proposals. Best of all this is a very human form of clinical training and intervention that turns on the moral cultivation of the individual and her or his growing acquaintance with clinical experience. The authors seek to empower clinicians, and I believe they succeed.” (Arthur Kleinman, MD, author of The Illness Narratives, What Really Matters, and Patients and Healers in the Context of Culture)

“Health care ethics has typically been taught in the classroom, not the clinic. The actual ethical thinking of clinicians has been less investigated and is less well understood. Rethinking Health Care Ethics addresses this deficit by giving educators and clinicians a new way of thinking about ethics; a way that is accessible and relevant and not dependent on applying complex philosophical theories. In addition to being an intelligent exposé of the limits of bioethics, the book provides a pathway for students and clinicians to integrate ethical thinking into clinical practice from the get-go. I strongly recommend this book to all health care educators and clinicians.” (Merrilyn Walton, MSW, PhD, Professor of Medical Education, Faculty of Medicine, University of Sydney)

“In this superbly written book the authors draw on materials from philosophy and the social sciences to elaborate a model of ethical discourse for clinical health care whose central feature is the recognition and development of each trainee's and each clinician’s own moral thinking, based in the self and reflecting a person's entire life experience. From this core insight, and with many vignettes drawn from their own clinical experience, the authors also elaborate an approach both to formal classroom teaching and to less formal teaching in clinical settings that amounts, in effect, to a full program for teaching clinical ethics. I warmly recommend this groundbreaking book as a highly useful resource for teachers, trainees, and health care professionals interested in clinical ethics as an inherent part of compassionate, effective, and safe health care.” (Per Olav Vandvik, MD, Professor of Evidence-Based Practice and Shared Decision-Making, University of Oslo) 

“Scher and Kozlowska offer a powerful and deeply reasoned critique of teaching and practice in contemporary bioethics. In its place, they offer a timely, compelling, and humane proposal for rethinking values and ethics in the care of patients.” (Allan M. Brandt, Harvard University)

Authors and Affiliations

  • McLean Hospital, Department of Psychiatry, Harvard Medical School, Boston, USA

    Stephen Scher

  • The Children’s Hospital at Westmead, Disciplines of Child & Adolescent Health, and of Psychiatry, University of Sydney Medical School, Sydney, Australia

    Kasia Kozlowska

About the authors

Stephen Scher is Senior Editor, Harvard Review of Psychiatry, and Lecturer in Psychiatry, McLean Hospital/Harvard Medical School, USA, and University of Sydney Medical School, Australia. He recently stepped down as Senior Editor of the American Journal of International Law.

Kasia Kozlowska is a child and adolescent psychiatrist at The Children’s Hospital at Westmead and Clinical Associate Professor at the University of Sydney Medical School, Australia.

Bibliographic Information

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