The Philosophy and Practice of Medicine and Bioethics (eBook)

Warren Shibles was a Senior philosophy professor at the University of Wisconsin at Whitewater, Wisconsin and also taught courses at Tübingen, Germany. He has published 27 books, and over 180 professional journal articles.He also was a researcher in phonetics. He died in July 2007. Barbara Maier is a Senior physician, gynaecologist and obstetrician at the Women`s Hospital in Salzburg and head of the Department of Gynaecological Endocrinology and Assisted Reproduction at the University Clinic of Gynaecology and Obstetrics in Salzburg, Austria. She has been teaching ethics in medicine at the Institute for Ethics and Law at the University of Vienna since 1993. She has a Ph.D. in Philosophy, and M.D from the University of Vienna.

Contents 7
The Rationale Behind the Book 18
About the Authors 22
1 Metaphor in Medicine: The Metaphorical Method 23
1.1 Introduction 23
1.2 Types of Metaphor 26
1.2.1 Substitution 26
1.2.2 Juxtaposition 26
1.2.3 Analogy, Simile, or Comparison 26
1.2.4 Symbolism 26
1.2.5 Metonymy 26
1.2.6 Synecdoche 27
1.2.7 Synesthesia 27
1.2.8 Reversal 27
1.2.9 Personification 27
1.2.10 Oxymora or Combination of Opposites 28
1.2.11 Deviation 28
1.2.12 Metaphor-to-Myth Fallacy 28
1.3 Metaphorical Methods Should be Considered for Analysis of and Writing Research Papers 29
1.4 Case Example: A Healthcare Worker (H) Patient (P) Metaphoric: H/P Modeling in Medicine 33
1.5 H/P Models 34
1.5.1 H = P 34
1.5.2 H versus P 34
1.5.3 Not H and not P 34
1.5.4 H or P 35
1.5.5 H and P 35
1.5.6 H not P 35
1.5.7 P not H 35
1.5.8 H (verb) P 35
1.5.9 P (verb) H 35
1.5.10 H = P 35
1.5.11 H ? P 35
References 36
2 Definition 37
2.1 Where Does It Come from that We Think We Need to Define? 37
2.2 Distinction Between Types of Definition 40
References 43
3 Decision-Making: Fallacies and Other Mistakes 45
3.1 Conditions of Decision-Making 45
3.2 Frequent Causes of Irrational Medical Thinking and Decision-Making 46
3.3 Five Levels of Decision-Making in Medicine 50
3.4 Fallacies in Decision-Making 51
3.5 Mistakes 56
3.5.1 What are Mistakes? 56
3.5.2 What are Indications of Errors? 57
3.5.3 Indications that Mistakes are Often Preventable Ones 58
3.5.4 What are the Reasons for the Mistakes? 59
3.5.4.1 Questionable Medical Treatments 59
3.5.4.2 Error is Necessary 59
3.5.4.3 Uncritical Thinking (Speaking) 59
3.5.4.4 Medical Knowledge Is Lacking 59
3.5.4.5 System as a Cause of Error 59
3.5.4.6 Some Mistakes Are Not Mistakes 60
3.5.4.7 Guidelines Are Not Followed 60
3.5.4.8 Self-Caused Mistakes 60
3.5.4.9 Patient Errors 60
3.5.4.10 Lack of Sufficient Attention 60
3.5.4.11 Misdiagnosis 60
3.5.4.12 Overwork 61
3.5.4.13 Limitations of Knowledge in Medicine 61
3.5.4.14 Unfair Medical Threats of Malpractice Suits Threaten Physicians 61
3.5.4.15 Unfair Blame 61
3.5.4.16 Protocols of Good Management Are Violated 62
3.5.4.17 Unfairness of the Law 62
3.5.4.18 Negative Emotions 63
3.5.5 Case Example: Misleading Diagnosis 63
3.5.6 Personal Experiences: Mistakes 64
References 65
4 Analysis of Causation in Medicine 67
4.1 Decision-Making and Cause 68
4.2 Synonyms of Cause 70
4.3 Antonyms for Cause 71
4.4 Metaphorical Models for Cause 71
4.5 Substitutions for Cause 71
4.6 Temporal Factors in Causality 71
4.7 Types of Causality 72
4.8 Summary 84
References 85
5 Ethics and Non-ethics 87
5.1 Introduction 87
5.2 A Naturalistic Theory of Ethics 91
5.3 What Is Ethics in Actual Usage? 94
5.4 Ethics and Morals: An Unethical Society 102
5.5 Value Contradictions 105
5.6 Examples of Contradictions 106
5.7 On Being Non-ethical and Anti-Inquiry 109
5.8 Brief Conclusion 111
5.9 An Ethics Text for British Medical Schools 112
5.10 Case Example: Medicine and Dysfunctional Culture (Made Available by Dr Wolf Michael Luetje, Head of the Womens Hospital Viersee in Germany) 113
5.11 Case Example: Military Medical Service as Contradictory to Medical Practice 114
5.12 Insensitivity to Killing: The Failure to be Embarrassed 117
5.13 Case Example: On Sensitivity 119
5.14 Case Example: Tsunami Disaster and Cultural Irresponsibility 120
5.15 Case Example: Culture and Family as Anti-Medicine: Female Circumcision 122
References 125
6 Medicotheology and Biotheology 133
6.1 Introduction: How Many People Have Religious Beliefs? 133
6.2 The Influence of Religion on Bioethics and Medicine 134
6.3 Church Opposition to Medicine 137
6.4 Should Medicine Be Based on Supernaturalism? 139
6.5 Science and Metaphysical Causes? 139
6.6 Case Example: Religion and Autonomy 140
6.7 Religion Versus Medicine: A Common Ground? 141
6.8 Religion as Ethics 142
6.9 Ethics Committees 143
6.10 Humanism Versus Religion 144
6.11 Absolute Religious Ethics Versus Consequentialism 145
6.12 Case Example: Deprogramming Religion in Medicine 145
6.13 Case Example: A Real Woman 146
6.14 The Person as a Soul 147
6.15 Sanctity-of-Life (Human) 147
6.16 General Observations Regarding the Value of Human Life 148
6.17 Contradictions Regarding the Sanctity-of-Life Doctrine 149
6.18 Selected Arguments from the Philosophy of Religion 150
6.19 Prayer as Medical Treatment 151
References 154
7 Emotion In Medicine 158
7.1 Introduction 158
7.2 Case Example: Non-mental Associations Provide Complexity to Cognitions 161
7.3 Emotion Is Not an Internal State 161
7.4 Emotions Can Be Changed 162
7.5 The Happy Stoics: Passionate Rational Emotion 163
7.6 Virtually All Judgments Involve Emotion 163
7.7 Emotion Can Change with Bodily Feeling 164
7.8 Emotion Is Not Passive 165
7.9 Emotions Are Unique 166
7.10 Rejection of the Release Theory of Emotions 166
7.11 Case Example: Emotion Requires Assessment 167
7.12 Negative Emotions Are Philosophical Language Fallacies 168
7.13 Some Traditional Examples of Philosophy of Language Fallacies 169
7.14 Pity 170
7.15 Hope and Humor 171
7.16 Case Example: Patients Negative Emotions 171
7.17 Can Emotions Be Reduced to Physiology? 172
7.18 How Are Diseases and Emotions Classified? 173
7.19 Case Example: Legal Recognition of Emotional Harm 174
7.20 Brief Summary of the Cognitive Theory of Emotion 175
7.21 Case Example: The Cognitions Involved in the Emotion of Interest 176
References 177
8 Enlightened Versus Normative Management: Ethics versus Morals 181
8.1 Introduction 181
8.2 Requirements for Good Management 183
8.3 Special Section on Overwork: A Failed Metaphor of the Medical System 202
8.3.1 Introduction 202
8.3.2 How Many Hours Do Physicians, Nurses and Healthcare Workers Work? 203
8.3.3 Attempts to Limit the Number of Work Hours 203
8.3.4 Do Physicians and Nurses Also Cause the Problems of Overwork? 205
8.3.5 What Is the Effect of Overwork? 207
8.3.6 Overwork Harms Health of Staff 208
8.3.7 Overwork Increases Sick Leave 208
8.3.8 Overwork Causes Stress and Burnout and Addictions 209
8.3.9 Overwork and Suicide 210
8.3.10 Overwork Causes Loss of Quality of Life 210
8.3.11 Overwork Is a Cause of Negative Emotions 210
8.3.12 Overwork Causes Loss of Interest in Medical Practice 211
8.3.13 What Is the Legal Result of Overwork? 211
8.3.14 Denial that Healthcare Workers Overwork and/or that It Is Harmful 212
8.3.15 Is There Evidence for the Harm of Overwork? 213
References 216
9 Care: A Critique of the Ethics and Emotion of Care 221
9.1 Introduction 221
9.2 Care Theories 222
9.3 The Word-Field Meanings of Caring 226
9.3.1 Introduction 226
9.3.2 The Synonyms and Word-Field of the Term ''Caring.'' 227
9.4 Irrational Forms of Caring (See Also Empathy and Sympathy) 228
9.5 The Cognitive-Emotive Theory of Caring 231
9.5.1 Feeling 232
9.5.2 Caring Is a Value Cognition Causing Feeling [Caring = (Cognition > Feeling)]
9.5.3 Caring Is Based on Positive Cognitions 233
9.5.4 Emotions Can Be Changed 233
9.5.5 We Cause Our Own Emotions: Caring Is Caused by Ourselves 234
9.5.6 The Passionate Stoics: Rational Emotion, Rational Caring 235
9.5.7 Negative Emotion Changes with Feeling 235
9.5.8 Negative Emotion Is Not Passive 235
9.5.9 Each Emotion of Caring Is Unique 236
9.5.10 Rejection of the Release Theory of Caring 236
9.5.11 Judgments Generally Involve Emotion 236
9.5.12 Metaemotion 237
9.6 Caring and Negative Emotions 237
9.7 Mutuality of Caring 238
9.8 The Patients Hippocratic Oath 238
9.9 Empathy and Caring 239
9.10 Summary 241
References 243
10 Egoism and Altruism in Medicine 247
10.1 Introduction 247
10.2 Common Definition of Altruism and Egoism 247
10.3 Definitions of Altruism 248
10.4 Definitions of Egoism 248
10.5 An Analysis of the Word-Fields of Altruism and Egoism 248
10.5.1 The Word-Field of Altruism 249
10.5.2 The Word-Field of Egoism 249
10.6 Altruism Versus Egoism 250
10.7 The Problem of the Self 251
10.8 The Ethical Basis of Altruism and Egoism 252
10.8.1 General Remarks 252
10.8.2 Utilitarian Altruism 253
10.8.3 Ayn Rand's Objectivist Egoism 253
10.8.4 The Ordinary Language Basis of Altruism and Egoism 255
10.9 Altruism and Egoism as Emotions 255
10.9.1 Altruistic and Egoistic Emotions Are Not Mere Bodily Feelings 256
10.9.2 Altruism and Egoism Are Cognitions Causing Bodily Feelings [26] 256
10.9.3 The Emotions of Altruism and Egoism Can Be Changed 256
10.9.4 Altruism and Egoism Are Based on Value Cognitions 257
10.10 Sympathy 258
10.11 Selfishness 259
10.12 Rational Altruism and Egoism 261
10.13 Summary 262
References 262
11 Letting Die 264
11.1 Introduction 264
11.2 Misuse of Ethical Terms 268
11.3 Criteria for Preferential Treatment: Non-contradiction 269
11.4 Case Example: Oregon Healthcare Prioritizing 269
11.5 What About Self-Caused Illness and How to Determine? 270
11.6 The Hippocratic Oath: Pacifism in Medicine? 273
11.7 Should We Kill X to Save Y? The Numbers Game 276
11.8 Allowing Death = Killing = Murder 281
11.9 Letting-Die and the Samaritan 283
11.10 Albert Schweitzer on Reverence for Life 286
11.11 Negative Emotions Kill and Let Die 289
11.12 Lack of Organs for Transplantation as a Form of Letting Die 289
11.13 Suicide and Euthanasia 289
11.14 Conclusion 292
References 293
12 A Critique of Autonomy and Patient Responsibility 299
12.1 Introduction 299
12.2 Criticisms of the Principle of Autonomy 300
12.3 Patient Responsibility and a Patient Code of Ethics 309
12.4 Patients Duties 311
12.5 Case Report: Patient and Legal Irresponsibility 313
References 313
13 Philosophy and Ethics of the Body 317
13.1 Introduction 317
13.2 Definition of Philosophy and Body 318
13.3 The Scientific Method: Medicine as a Science 319
13.4 A Naturalistic Ethics of the Body 320
13.5 The Value of Life in Terms of the Body 321
13.6 The Mind 323
13.7 The Self as a Language Construct 323
13.8 The Un-philosophical Body 325
13.9 Outward Physical Appearances: Beauty 326
13.10 The Face 327
13.11 The Body as a Whole and Body Parts: Organs and Transplantation Medicine 328
13.12 Reproduction of Bodies? 329
13.13 Leib: Living to the Full 329
13.14 The Philosophical Body: The Body as an Aesthetic Whole 330
13.15 Summary of the Ethics of the Body 331
References 331
14 Organ Donation: Mandatory Organ Donation Declaration 334
14.1 How Many People Need Organs? 334
14.2 Death Requirement 336
14.3 Opposition to Organ Donation 337
14.4 Support of Organ Donation 338
14.5 Presumed Organ Donation 339
14.6 Family Approval as an Adverse Policy 341
14.7 Recommendations for Obtaining Organs for Transplantation 342
14.7.1 Lottery 342
14.7.2 The Economic Incentive Approach 343
14.7.3 Irresponsible Lifestyles and Organ Preference 343
14.7.4 Mandatory Organ Donation Declaration 346
References 348
15 Embryonic Stem Cell Research: A Question of Beliefs? 351
15.1 Introduction 351
15.2 Definitions and Clarifications of Morals and Ethics 352
15.3 Facts and Beliefs About Stem Cells 353
15.3.1 What We Already Know About Stem Cells 353
15.3.2 The Promise of Stem Cell Research in General 355
15.4 The Controversy About What an Embryo Is 356
15.4.1 Definitions 356
15.4.2 Embryonic Development in Its Context 357
15.4.3 The Moral Status Ascribed to an Embryo 357
15.4.4 Life Is Not Just Life: When Is a Human a Human? 358
15.5 Ethical Issues in Stem Cell Research 359
15.5.1 How to Perform an Ethical Examination? 359
15.5.2 Inquiry into Language 360
15.5.3 The Abortion Argument All Over Again? 361
15.5.4 Adult Stem Cell Research-an Alternative to Embryonic Stem Cell Research? Other Alternatives? 362
15.5.5 IVF ''Left Over'' Embryos Versus ''Created for Research'' Embryos 362
15.5.6 Public Funding? 363
15.5.7 The Ethical Challenge of Research 365
15.6 Conclusions: Humaine Medicine Medicine for Suffering People 366
References 366
16 The Philosophy of Prevention 371
16.1 Introduction 371
16.2 An Analysis of Prevention 372
16.3 Unethical Behavior and Irresponsible Lifestyles 376
16.4 Lifestyle as Philosophical and Critical Thinking 377
16.5 Areas of Prevention 378
16.5.1 Education: The Greatest Preventative of Disorder 378
16.5.2 Cancer Prevention 378
16.5.3 AIDS 381
16.5.4 Alzheimer's Disease (AD) 381
16.5.5 Lack of Exercise: The Obvious Escapes Us 382
16.5.6 Sexually Transmitted Disease (STD) 382
16.5.7 Longevity 383
16.5.8 Death and Disease 384
16.5.9 Hand-Washing: The Obvious Escapes Us Again 385
16.5.10 Drugs and Toxins 385
16.6 Hidden Prevention Possibilities 387
16.7 Summary 394
References 394
17 Ethics Counseling: Philosophy of Medicine Counseling Instead of Medical Ethics Counseling 399
17.1 Introduction 399
17.2 What is Ethics Counseling (EC)? 402
17.2.1 Task Force on Standards of Bioethics Consultation (USA) 402
17.2.2 Basic Ethical Principles in European Bioethics and Biolaw 404
17.2.2.1 Autonomy [38] (See also Chapter 12) 406
17.2.2.2 Dignity 407
17.2.2.3 Integrity [60] and Narrative Analysis 409
17.2.2.4 Vulnerability [76] 411
17.2.2.5 Solidarity and Social Responsibility [76] 411
17.3 Criticism of Bioethical Principlism 412
17.4 Case Method of Clinical Ethics 417
17.5 Holistic Philosophy of Medicine 421
17.6 Brief Description of Deweys Pragmatism and Naturalistic Ethics 424
17.7 Humanism Contains Many of the Elements of Contemporary Definitions of Philosophical Practice (PP) 425
17.8 The Present Definitions and Methods of Philosophical Counseling (PC) are Too Restrictive 426
17.9 Philosophical Counseling or Philosophical Practice (PP) 428
17.10 A Proposal to Change the Title of Philosophical Practice to Philosophy Education 430
17.11 The Philosophy Practitioner and Emotion 431
17.12 Summary 433
References 433
18 Medical Language: The Ordinary Language Approach 443
18.1 Introduction 443
18.2 Formal Logic as a Pseudo-Logical Failure 447
18.3 Formal Logic is Irrelevant to Thought, Reason and Emotion 449
18.4 Formal Logic as Irrelevant to Ethics or Bioethics 451
18.5 Formal Logic as Formal Fallacy 451
18.6 Formal Logic as a Fallacy of Abstractionism 451
18.7 The Arrogance of Logicians 452
18.8 Formal Logic Reduces Language to Mathematics 452
18.9 Formal Logic as a Faulty View of Meaning 453
18.10 Propositions: A Pseudo-Logical Term 454
18.11 Formal Logic as Dogmatism and Misuse of Symbols 455
18.12 Formal Logic Misuses the Term Truth 456
18.13 The Useless Syllogism 457
18.14 Formal Logic is Not Philosophy 457
18.15 The Primacy of Ordinary Language and Pragmatism 458
18.16 Formal Logic Excludes Metaphor and Creative Language 459
References 461
19 A Critique of Evidence-Based Medicine (EBM): Evidence-Based Medicine and Philosophy-Based Medicine 468
19.1 Does EBM Really Meet the Challenge of Modern Medicine? 468
19.2 What Is the View of Evidence in EBM Is It Left Undefined? 471
19.3 EBM as Statistics 472
19.4 EBM Often Investigates the Obvious and Trivial 473
19.5 EBM Bears the Risk of Overgeneralization 474
19.6 EBM Is Often Unintelligibly Complex 474
19.7 EBM Is Often Too Abstractionistic 475
19.8 EBM as Appeal to Authority Fallacy 475
19.9 EBM and the Individual Case and Context 476
19.10 Uncritical Use of EBM and Clinical Experience 477
19.11 EBM Often Excludes Relevant Causes and Variables 478
19.12 EBM Has Limited Self-Criticism 480
19.13 EBM and Psychiatry 480
19.14 EBM and Human Emotions 481
19.15 EBM and Ethics 481
19.16 EBM Depersonalizes 481
19.17 EBM Text Reviews 482
19.17.1 Evidence-Based Spirituality 482
19.17.2 EBM and Practical Medicine 482
19.17.3 Evidence-Based Nursing 482
19.17.4 EBM and Logic 483
19.17.5 EBM and Gender Medicine 483
19.18 EBM and Rational Medicine 484
19.19 EBM, Psychosomatics and Philosophy 485
19.20 EBM and the Problem of the Placebo 486
19.21 Philosophy of Medicine Based Medicine Instead of Only Evidence Based Medicine 494
References 496
20 Lying in Medicine 502
20.1 Introduction 502
20.2 Definitions of Lying 503
20.3 A New Theory of Lying 503
20.4 Self-Lie 504
20.5 Consequences of Lying 505
20.6 Logic of Flattery: Beneficial Lying 508
20.7 Hypocrisy 508
References 509
21 The Rhetoric of Death and Dying 511
21.1 Definitions of Death 511
21.1.1 General Definitions 512
21.1.2 Medical-Psychological Definitions of Death 512
21.1.3 Death and Abortion 512
21.2 Death: The Literature 513
21.2.1 The Poet's View 513
21.2.2 Wittgenstein on Death 516
21.2.2.1 Death as a Language-Game [15] 516
21.2.2.2 The Question: What is Death? 519
21.2.2.3 Death is not a Thought or Concept 519
21.2.2.4 The Epistemological Primacy of Language 520
21.2.2.5 The Death of Mentalistic Meaning 521
21.2.2.6 There is no Non-linguistic Knowledge of Death 521
21.2.2.7 Language-Games Again and Again 522
21.2.2.8 What Death is Not 522
21.2.2.9 Imagery and Sensation 523
21.2.2.10 Can We Imagine Death? 523
21.2.2.11 Illustrations 524
21.3 Dying 524
21.3.1 The Cognitive-Emotive Theory 524
21.3.2 The Cognitive-Emotive Theory of Grief and Bereavement 526
21.4 Philosophy of Religion 528
21.4.1 Views in Theology 528
21.4.2 Old Testament 528
21.4.3 New Testament 529
21.5 Humanism 530
21.6 The Rhetoric of Death Using the Metaphorical Method 531
21.6.1 Introduction to the Metaphorical Method 531
21.6.2 Rhetorical Techniques for the Exploration of the Concept 533
21.6.2.1 Abstraction (Fallacy) 533
21.6.2.2 All-Statements or None-Statements (Also ''Always'' and ''Never'' Statements) 534
21.6.2.3 Allegory (cf., Symbol) 534
21.6.2.4 Ambiguity 534
21.6.2.5 Analogy and Simile (cf., Category-Mistake, Simile) 534
21.6.2.6 Behavioral Metaphor 535
21.6.2.7 Category-Mistakes (cf., Context Deviation) 535
21.6.2.8 Grammatical Term Metaphors 536
21.6.2.9 Circularity 536
21.6.2.10 Connotation (cf., Free Association) 537
21.6.2.11 Context Deviation (cf., Category-Mistake) 537
21.6.2.12 Contradiction Humor (cf., Poetic Metaphor) 537
21.6.2.13 Defense Mechanisms 539
21.6.2.14 Deviation 539
21.6.2.15 Euphemism 539
21.6.2.16 Free Association (cf., Connotation) 539
21.6.2.17 Hopelessness 539
21.6.2.18 Irony 540
21.6.2.19 Juxtaposition 540
21.6.2.20 Metaphor and Metaphorization 540
21.6.2.21 Metonymy 541
21.6.2.22 Personification 541
21.6.2.23 Poetic Metaphor 541
21.6.2.24 Probability 542
21.6.2.25 (Faulty) Questions and Riddles 543
21.6.2.26 Reduction to Absurdity 543
21.6.2.27 Rejuvenate Metaphors 543
21.6.2.28 Reversal Humor 543
21.6.2.29 Substitution 543
21.6.2.30 Tension Metaphors 543
21.6.2.31 Uselessness 544
21.6.2.32 Therapeutic Metaphor 544
21.7 Death and Medical Profession 544
21.8 Final Personal Remarks 545
References 545
Index 550