The Metamorphosis of Medical Ethics: A 30-Year Retrospective
Pellegrino, Edmund D.
JAMA. 1993 Mar 3; 269(9): 1158-1162.
...Medical ethics is now increasingly a branch of moral philosophy, more and more responsive to shifts in philosophical opinion and fashion. The results for the conceptual structure of medical ethics are both salubrious and problematic, presenting a task of great difficulty and significance. For the following reasons, I wish to examine this metamorphosis in conceptual framework. First, the solutions we seek to the practical problems of moral choice depend entirely on the conceptual framework we use to define what we think right or wrong, good or bad. Medical ethics, like medicine itself, is a fusion of theory and practice. The theory may seem remote and abstract at times; nevertheless, it guides our reasoning. Even the most practical among us must resort ultimately to some philosophical construct, unless he or she is content to leave moral decisions entirely to intuition or visceral preferences. Moreover, physicians must recognize how powerfully philosophers and philosophical theory have been reshaping medical ethics. We cannot -- and should not -- return to the days when medical ethics was defined solely by the profession. Nor can we leave the enterprise entirely to philosophers or jurists who, after all, bring their own conceptual apparatus to bear on the questions they discuss. Finally, physicians must be aware of the philosophical arguments on which their own colleagues draw when they promulgate drastic changes in our moral tradition. Current proposals for moral legitimation -- such as physician-assisted suicide, voluntary and even involuntary and nonvoluntary euthanasia, health care rationing, the buying and selling of organs for transplantation, or the renting of uterus, ova, and sperm -- each has a rationalization deeply rooted in some conceptual shift in moral theory.
Assisted Suicide; Autonomy; Beneficence; Bioethical Issues; Bioethics; Caring; Casuistry; Clinical Ethics; Codes of Ethics; Communication; Deontological Ethics; Education; Ethical Theory; Ethics; Euthanasia; Health; Health Care; Historical Aspects; Health Care Rationing; Interdisciplinary Communication; Justice; Medical Ethics; Medicine; Moral Obligations; Philosophy; Physicians; Principle-Based Ethics; Sperm; Suicide; Teleological Ethics; Transplantation; Uterus; Values; Virtues;
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