Handbook of Bioethics: (eBook)

TABLE OF CONTENTS 6
INTRODUCTION: TAKING STOCK OF BIOETHICS FROM A PHILOSOPHICAL PERSPECTIVE 8
SECTION I THE EMERGENCE OF BIOETHICS 37
THE HISTORY OF BIOETHICS AS A DISCIPLINE 38
SECTION II BIOETHICAL THEORY 60
PRINCIPLES AND PRINCIPLISM 62
CASUISTRY 82
VIRTUE THEORY IN PHILOSOPHY OF MEDICINE 96
COMMON MORALITY 128
FEMINIST APPROACHES TO BIOETHICS 150
FOUR NARRATIVE APPROACHES TO BIOETHICS 170
PHILOSOPHY OF MEDICINE AND MEDICAL ETHICS: A PHENOMENOLOGICAL PERSPECTIVE 190
SECTION III CORE CONCEPTS IN CLINICAL ETHICS 211
THE LOGIC OF HEALTH CONCEPTS 212
PHYSICIANS AND PATIENTS IN RELATION: CLINICAL INTERPRETATION AND DIALOGUES OF TRUST 230
INFORMED CONSENT 258
PHILOSOPHICAL CHALLENGES TO THE USE OF ADVANCE DIRECTIVES 298
ETHICS COMMITTEES AND CASE CONSULTATION: THEORY AND PRACTICE 322
SECTION IV THE PUBLIC POLICY CONTEXT 343
THE ETHICS OF CONTROLLED CLINICAL TRIALS 344
ETHICAL ISSUES IN THE USE OF COST EFFECTIVENESS ANALYSIS FOR THE PRIORITIZATION OF HEALTH RESOURCES 360
SIC ET NON: SOME DISPUTED QUESTIONS IN REPRODUCTIVE ETHICS 388
TESTING GENES AND CONSTRUCTING HUMANS – ETHICS AND GENETICS 422
SECTION V FOUNDATIONS OF THE HEALTH PROFESSIONS 447
DEATH, DYING, EUTHANASIA, AND PALLIATIVE CARE: PERSPECTIVES FROM PHILOSOPHY OF MEDICINE AND ETHICS 448
PHILOSOPHICAL ISSUES IN PSYCHIATRY 480
NURSING ETHICS 496
GEROETHICS 514
ETHICS AND PHILOSOPHY OF PUBLIC HEALTH 532
NOTES ON CONTRIBUTORS 556
INDEX 560
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THE LOGIC OF HEALTH CONCEPTS (p.205)

I. INTRODUCTION

It is often maintained that health is one of the major goals of medicine or even the goal of medicine. This idea has been eloquently formulated by the American philosophers of medicine Edmund Pellegrino and David Thomasma in their book A Philosophical Basis of Medical Practice (1981, p. 26):

Medicine is an activity whose essence lies in the clinical event, which demands that scientific and other knowledge be particularised in the lived reality of a particular human for the purpose of attaining health or curing illness through the direct manipulation of the body and in a value-laden decision matrix.

Although some other goals of medicine exist, such as saving lives and advancing quality of life, health is still taken to be the central goal of medicine and health care in general. However, the formidable task of interpreting the nature of health remains. What more specifically is health? To what more precise goal shall we direct our efforts in medicine and health care?

These questions are not simply academic. They are of great practical and thereby ethical concern. The consequences for health care diverge considerably, not least in economic but also in social and educational terms, if health is understood as people’s happiness with life, or their fitness and ability to work, or just the absence of obvious pathology in their bodies and minds. There are adherents of all these ideas in the modern theoretical discussion on health.

One of the major problems in this discussion is to establish the relation between the notion of disease and that of health. Are the two notions directly linked, so that health is the total absence of disease, or is there a much looser connection? Is health something over and above the absence of disease? Is health even compatible with the existence of disease? We seem to have varying intuitions in this regard. We seem also inclined to interpret health slightly differently in different contexts.

In this paper I will attempt to disentangle such issues by presenting, in some detail, two prominent theories of health (a biostatistical theory of health, BST, and a holistic theory of health, HTH) and try to assess these using two criteria for assessment, viz. their usefulness in medical practice and in public health contexts. My general conclusion will be that the holistic theory, HTH, is the more plausible theory of health.

II. TWO FUNDAMENTAL APPROACHES TO HEALTH CONCEPTS

Contemporary philosophy of health is very much focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive.

Moreover, a disease in a human being can be discovered, according to this line of thought, through ordinary inspection and through the use of scientifically validated procedures without invoking any normative evaluations of the person’s body or mind. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe this person.