Twenty years ago, in four papers,1 I offered a unified descriptive analysis of health, disease, and function. In recent philosophy of medicine, these papers are often treated as a standard defense of one pole on the spectrum of views about health: the extreme view that, at least at the theoretical foundation ofmodern Western medicine, health and disease are value-free scientific concepts. Theoretical health, I argued, is the absence of disease; disease is only statistically species-subnormal biological part-function; therefore, the classification of human states as healthy or diseased is an objective matter, to be read off the biological facts of nature without need of value judgments. Let us refer to this general position as “naturalism”—the opposite of normativism, the view that health judgments are or include value judgments. Following Nordenfelt (1987), let me call my specific naturalist theory the “biostatistical theory (BST),” a name emphasizing that the analysis rests on the concepts of biological function and statistical normality.2

A Rebuttal on Health

PurposeThe authors’ primary goal was to provide a comprehensive and current review of the literature surrounding ethics education for medical students. Following this review, the authors summarize the deficits in the current literature and provide recommendations for future inquiries on medi

Medical ethics education: where are we? Where should we be going? A review.

Self recognition and social awareness in the deconnected minor hemisphere.

To assess physicians' attitudes toward the use of deception in medicine, we sent a questionnaire to 407 practicing physicians. The questionnaire asked for responses to difficult ethical problems potentially resolvable by deception and asked general questions about attitudes and practices. Two hundred eleven (52%) of the physicians responded. The majority indicated a willingness to misrepresent a screening test as a diagnostic test to secure an insurance payment and to allow the wife of a patient with gonorrhea to be misled about her husband's diagnosis if that were believed necessary to ensure her treatment and preserve a marriage. One third indicated they would offer incomplete or misleading information to a patient's family if a mistake led to a patient's death. Very few physicians would deceive a mother to avoid revealing an adolescent daughter's pregnancy. When forced to make difficult ethical choices, most physicians indicated some willingness to engage in forms of deception. They appear to justify their decisions in terms of the consequences and to place a higher value on their patients' welfare and keeping patients' confidences than truth telling for its own sake.

Physicians' Attitudes Toward Using Deception to Resolve Difficult Ethical Problems

Medical ethics education, it has been said, has 'come of age' in recent years in terms of its formal inclusion in undergraduate medical curricula. This review article examines the background to its inclusion in undergraduate curricula and goes on to examine the consensus that has arisen on the design of ethics curricula, using Harden's curriculum and S.P.I.C.E.S models as templates. While there is consensus on content for undergraduate medical ethics education, there is still significant debate on learning and teaching methods. Despite the broad agreement on the need to apply adult education principles to ethics teaching, there would appear to be some tension between balancing the need for experiential learning and achieving the 'core curriculum'. There are also as yet unresolved difficulties with regards to resources for delivery, academic expertise, curriculum integration and consolidation of learning. Assessment methods also remain contentious. Although there is consensus that the ultimate goal of medical ethics, and indeed of medical education as a whole, is to create 'good doctors', the influence of the 'hidden curriculum' on students' development is only beginning to be recognized, and strategies to counteract its effects are in their infancy. The need for proper evaluation studies is recognized. It is suggested that the areas of debate appearing in the literature could be used as a starting point for evaluation studies, which would form the empirical basis of future curriculum development.

http://ethicist.kmu.edu.tw/pimages/p-55/j.1365-2923.2000.00607.pdf

Review of ethics curricula in undergraduate medical education.

1. Introduction 2. Morality 3. Application 4. Principalism 5. Malady 6. Competence 7. Consent 8. Confidentiality 9. Paternalism 10. Justification 11. Death 12. Euthanasia

Bioethics: A Return to Fundamentals

Formal teaching of ethics in the medical school curriculum has increased greatly during the past 15 years. Yet, schools vary in how much attention they give the subject, and even those that do offe...

Basic curricular goals in medical ethics.

1. Introduction 2. Morality 3. Moral disagreement 4. Particular Moral Rules and Special Duties 5. Principlism 6. Malady 7. Mental Maladies 8. What Doctors Must Know about Medical Practice 9. Adequate Information, Competence and Coercion 10. Paternalism and Its Justification 11. Death 12. Euthanasia

Bioethics: A Systematic Approach

Malady: a new treatment of disease.

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics--principlism, put forward by Beauchamp and Childress in Principles of Bioethics, and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals--are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, either the original version or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated.

K. Danner Clouser

Papers

Bioethics: A Return to Fundamentals

Basic curricular goals in medical ethics.

Bioethics: A Systematic Approach

Malady: a new treatment of disease.

Common morality versus specified principlism: reply to Richardson.