The Philosophical Diseases of Medicine and their Cure: Philosophy and Ethics of Medicine, Vol. 1: Foundations

ISBN-13: 9789048167364 / Angielski / Miękka / 2010 / 406 str.

Josef Seifert

Opis

At all times physicians were bound to pursue not only medical tasks, but to reflect also on the many anthropological and metaphysical aspects of their discipline, such as on the nature of life and death, of health and sickness, and above all on the vital ethical dimensions of their practice. For centuries, almost for two millennia, how ever, those who practiced medicine lived in a relatively clearly defined ethical and implicitly philosophical or religious 'world-order' within which they could safely turn to medical practice, knowing right from wrong, or at least being told what to do and what not to do. Today, however, the situation has radically changed, mainly due to three quite different reasons: First and most obviously, physicians today are faced with a tremendous development of new possibilities and techniques which allow previously unheard of medical interventions (such as cloning, cryo-conservation, ge netic interference, etc. ) which call out for ethical reflection and wise judgment but regarding which there is no legal and medical ethical tradition. Traditional medical education did not prepare physicians for coping with this new brave world of mod em medicine. Secondly, there are the deep philosophical crises and the philosophical diseases of medicine mentioned in the preface that lead to a break-down of firm and formative legal and ethical norms for medical actions.

Spis treści

1 The Nature and the Seven Goals of Medicine as Objects of a Dramatic Free Choice of the Physician Today.- 1. On the Nature of Medicine and the Physician. The Physician as Scientifically Trained Healer, as Practitioner of the ‘Art of Medicine’, as Ethicist, and as Moral Subject.- 1.1. The Physician as Scientifically Trained Healer, the Essence of Medicine as Empirical Inductive Science, and Its a priori Foundations.- 1.1.1. The Physician and the Role of Empirical Scientific Training.- 1.1.2. A Justification of Medicine as an Empirical Science against Hume’s and Popper’s Objections Raised against Induction.- 1.1.3. Immense Progress in Medicine as Experimental Science and as Scientifically Supported Medical Practice.- 1.1.4. Medicine as Practical or ‘Pragmatic’ Science and the Respective Values of Theoretical versus Practical Sciences.- 1.2. The Physician as ‘Practical Artist’ and Craftsman—and Progress in Medicine.- 1.3. On the Constitutive Role of a Philosophical Understanding of Man and Morality for Medicine as Science, and of Moral Commitments for the Physician as Practitioner.- 2. The Physician-Philosopher: Theoretical and Practical Philosophical and Ethical Aspects of Medicine.- 2.1. The Goods Medicine Is Called to Serve and the Indispensable Moral Choice of the Physician.- 2.2. The Seven Goods or’ seven Ends’ the Physician Should Serve and Respect.- 2.2.1. Medical Service to Human Life in Its Uniqueness and Specifically Personal Nature as well as in Its Right Place in the Whole Order of Goods.- 2.3. ‘Health’ as a Fundamental Goal of Medicine and as Disputed Question.- 2.3.1. The Question “What Is Human Health?” as a Philosophical and as Disputed Question.- The Nature of Health and Reductionism.- Utopian Notions of Health.- Objectivity or Subjectivity of Concepts of Health?.- 2.3.2. The Question “To Which Extent Should Health Be Promoted in Medicine?” as a Disputed Question.- 2.3.3. The Question “What Is the Place of Health in the Hierarchy of Human Goods?” as a Disputed Question.- 2.4. The Fight against Pain (Suffering) and for Pleasure and Physical and Mental Relief: Preventing, Alleviating, or Freeing from Suffering (Palliative Medicine)—Promoting Well-Being and Feeling Well.- 2.5. The Conscious Life of Man as Such and Personal Dignity.- 2.6. Integrity of the Human Bodily Form and Aesthetic Values.- 2.7. The General and Spiritual Good of Man and of His Vocation as Transcendent Goal and Guideline for Medicine.- 2.7.1. General Remarks on the Ways in Which This Transcendent Good of the Human Person Obliges the Physician.- 2.7.2. The Different Ways in Which This Transcendent Good of the Human Person Obliges the Physician.- 2.8. The Special Relationship between the Physician and the Absolute Good (God).- 2.9. The Religious Transformation of the Image of the Physician and the Goods Medicine Should Serve.- 2.10. The Remarkable World Wide Consensus on the Goods Medicine Should Serve.- 2.11. The Physician-Philosopher and the Nature of the ‘Practical’ Philosophy in Medicine with Respect to the Seven Goods.- 2.12. Conclusion of Our Reflections on the Goods Medicine Should Serve, and Theophrastus Paracelsus on the Transcendent Ends of Medicine.- 3. The Physician as Moral Agent and Further Hints at the Philosophical Diseases of Medicine and Their Cure.- 3.1. Importance of the Subject of Medicine and His Inalienable Rights as Person: Physicians, Nurses, and Other Health Professionals Are Not Mere Technicians or Instruments in the Service of Health and of the Other Goods of Medicine or of Patient Wishes but Acting Persons.- 3.2. Finding Anew Its Roots? A Word on the History and the Essential Ethical Dimension of Medicine—the Hippocratic Oath as More than an Ornament of the Medical Profession.- 3.3. Progress or Decline of Medicine with Respect to Its Value-Base and Third Philosophical-Ethical Dimension: Modern Medicine—Immense Progress or Regress behind the Age of the Medicine Man?.- 2 The Dignity of the Human Person as a ‘Universal of Medical Ethics’.- 1. Prolegomena.- 1.1. The Theoretical and Practical Significance of Understanding Human Dignity.- 1.2. Can Human Dignity Be Known to Be an Objective, Universal and Simultaneously Uniquely Individual Value?.- 1.3. Can Consensus Be Reached about Human Dignity and Can It Function as a Common Ground for Medical Ethics—as a ‘Medical Ethical Universal’?.- 1.4. The Role of Realist Phenomenological Philosophy in Showing Human Dignity to Be Truly a ‘Medical Ethical Universal’.- 1.5. The Main Theses to Be Defended in This Chapter.- 1.6. Two Ways to Know What It Is to Be a Person: Immediate Phenomenological Experience of Persons, and Intuition into the Ontological Ground that Intelligibly Underlies Experience.- 2. What Is a Person? Ontological and Axiological Understanding of the Person.- 2.1. The Person as Ultimate Individual Subject of Rational Nature.- 2.1.1. Person as a Substance.- 2.1.2. The Person as ‘Thing in Itself’.- 2.1.3. The Person as a Living Substance.- 2.1.4. Personal Individuality (Uniqueness).- 2.1.5. The Person as a Spiritual Substance and the Human Soul.- Arguments for the Existence of the Soul.- 2.1.6. The Person as an Individual Spiritual Substance in Relation to Other Persons.- 2.2. A Definition of the Person by Her ‘Inviolable’ Dignity.- 3. The Four Sources and Dimensions of Human Dignity and Their Characteristics.- 3.1. Ontological Dignity of the Human Person as Such and from the Very Beginning of Her Existence.- 3.2. Dignity of the Conscious and Rational Person and Its Levels.- 3.3. Third Source and Sort of Dignity: ‘Acquired Dignity’ and Moral Dignity.- 3.4. Fourth Source/Dimension of Dignity—Dignity as Gift/Bestowed Dignity.- 3.5. Relations between the Different Sources and Dimensions of Personal Dignity.- 4. Dignity as Object of Rational Knowledge and Answer to Some Objections against the Rational Knowability of Human Dignity.- 5. Human Dignity as a Unifying Bond among Men and Medical Professionals Worldwide.- 3 From the Morally Relevant Goals of Medicine to Medical Ethics On the Superiority of Moral Values over All Extramoral Goals of Medicine.- 1. Introductory Notes on Ethics in Its Relation to Medicine.- 2. The Ambiguity of the Notion of the Good: On the Totally New Quality of Moral Goodness and Evil in Comparison with all Other Goods and Evils.- 3. The Nature of Moral Goodness.- 3.1. Moral Values Are Objectively Good.- 3.2. Intrinsic Goodness (Value) Rather Than Being Merely Agreeable or Even Only Objectively Good for Me.- 3.3. Moral Values Are Necessarily Linked to Freedom.- 3.4. Moral Values Presuppose a Certain Morally Relevant Object or Matter (Which Can Be Grave or Light).- 3.5. Moral Values Imply a New Type of Ought Which Elucidates the ‘Absolute Sense’ in Which They Are Good.- 3.6. Moral Values Are Dependent on the Knowledge of Morally Relevant and of Moral Goods and Evils.- 3.7. Moral Values Involve Responsibility.- 3.8. Moral Conscience.- 3.9. Moral Values Deserve Praise or Blame in a New Sense.- 3.10. Moral Goodness Alone Can Constitute a Certain ‘Worthiness of Happiness ‘, Moral Evil a ‘Deserving of Pain’.- 3.11. Also Guilt and Merit, Reward and Punishment Are Essentially Related to Moral Good and Evil, and to It Alone.- 3.12. Moral Goodness Expresses in an Essentially New and Higher Sense the Idea of Value as Such (Good in a New and More Proper Sense to Which Extramoral Senses of ‘Goodness’ Are Merely Analogous).- 3.13. Moral Goodness, As Long As It Really Exists, Cannot Be Abused Like Intellectual, Aesthetic, Temperamental and Other Values.- 3.14. Moral Values Are Absolutely Speaking Good in that They Never Must Be Sacrificed for Any Other Value, because They Are (a) Incomparably Higher and (b) Should Absolutely and ‘First’ Be Sought For.- 3.15. Moral Goodness as a Source of the Value of the Person as Such: Only the Person Herself Can Be the Primary Bearer of Moral Values, Never Impersonal Beings, and also Personal Acts Can Be Morally Good Only in a Derivative Sense.- 3.15.1. Only Persons as Opposed to All Impersonal Beings Can Be Morally Good.- 3.15.2. Only the Person Herself Can Be the Primary Bearer of Moral Values—Personal Acts Can Be Morally Good Only in an Analogous Sense.- 3.15.3. Moral Goodness Makes the Person as Such Good in a Deeper Sense Compared with Which all Other Meanings of the Goodness of the Person Are Just Analogous.- 3.16. Moral Values Are the Absolute and Highest Good for the Person: Moral Values Belong to the Unum Necessarium and the ‘Three Modes of Participation in Values’ Account for Three Ways in Which Moral Values Are the Highest Objective Goods for Persons.- 3.17. Moral Values Are Goods ‘in the Unrestricted Sense’ by Being Pure Perfections.- a. Transcendentals.- b. Pure Perfections.- 3.18. Moral Values Are Unconditionally Good because They Are Never Just ‘Means’ towards Ends (Happiness). They Are Dominated by a Principle of Dueness and Appropriateness and Arise ‘on the Back’ of Acts (a Critique of Eudemonism).- 3.19. Link of Morality to Religion and to God.- 3.20. Moral Values Constitute the Most Direct Link between Morality and Religious Spirituality: Distinction between Philosophical and Theological Assertions.- 3.21. The Unity of Moral Values.- 3.21.1. ‘One Moral Value’—Goodness.- 3.21.2. ‘No Division of Labor’ in the Moral Life.- 3.21.3. ‘Existential Moral Unity’.- 3.21.4. The Unity of the ‘Root’ of All Moral Goodness: the ‘Oneness of Virtue’.- 3.22. The Superiority of Moral Values over All Others and the Crucial Importance of This Insight Expounded in This Chapter for Medical Ethics.- 3.23. Moral Values Are Characterized as ‘Goodness without Qualification’—Its Relationship to Happiness and to the Supreme Good.- 4. Concluding Remarks.- 4 The Freedom of Choice for or against the Basic Goods and Ends of Medicine Physicians, Nurses, and Other Health Professionals as Agents in the Drama of Freedom.- 1. Towards a Metaphysics and Epistemology of Freedom.- 1.1. Freedom in the Strong Metaphysical Sense Is Absolutely Inseparable from Personhood.- 1.2. A Metaphysical Detour for Those Readers Who Are Interested in the Ultimate Foundations of Medical Ethics: Some Elements of a Metaphysics of Human Freedom and Answers to Objections against the Existence of Human Freedom.- 1.3. The Nature and Real Existence of Human Freedom Can Be Known with Indubitable Certitude.- 1.4. Some Metaphysical Difficulties and Apories in Admitting Human Freedom and Another Metaphysical Side-Trip to Support Additional Evidence of the Truth of Our Knowledge that We Are Free.- 1.5. Did Neurological Evidence Refute Freedom?.- 1.6. Is Freedom Self-Creation?.- 1.7. Freedom and Its Conditions: Individual Being, Cognition, and Value.- 2. Ethics, Freedom, and Motivation: the Drama of the Physician’s Freedom Can Only Be Understood in the Light of the Free Choice of the End and Not Only of the Means.- 2.1. Categories of the ‘Good’.- 2.2. The Drama of Human Freedom Can Only Be Understood in the Light of the Free Choice of the End and Not Only of the Means: Categories of the ‘Good’ as Explanation of This Choice.- 3. Being Free Is Not Restricted to the Sphere of Action but Encompasses Many Spheres of Human Willing.- 3.1. Different Levels of Human Freedom—Actual and Superactual, Direct and Indirect Freedom, Affective Responses, Other Gifts and Cooperative Freedom.- 4. Cooperative Freedom and the Affective Dimension of the Gift of Self as an Important Element of Medical Ethics.- 5. Concluding Remarks on the Fundamental Moral Choices in Medicine.- 5 Rational Justification of an Objective and Publicly Acceptable Bioethics A Critique of Ethical Relativism, Skepticism, and Nihilism and an Answer to Engelhardt.- 1. Short Summary of the Results Gained in the Preceding Chapters and of the Problems to Be Treated in Chapter 5.- 2. The Philosophical Plague and Aids of Medicine to Be Discussed in this Chapter and Their Cure.- 3. Are Truth and Goodness Relative?.- 3.1. Relativism, Skepticism, and Their Consequences—a Radical Philosophical Plague of Medicine.- 3.2. The Evident Falsity and the Internal Contradictions of General Relativism and Skepticism.- 3.3. Critique of Ethical Relativism and Skepticism.- 3.3.1. Actual Contradictions of Ethical Relativism and Skepticism.- 3.3.2. Inevitable and Inherent Contradiction in Ethical Relativism and Skepticism.- 3.3.3. Critique of Emotivist Ethical Relativism.- 3.3.4. Critique of Positivist Forms of Ethical Agnosticism.- 3.3.5. Immediate Evidence of Morally Good and Evil and of Other Values—Value-Seeing (Wertsehen) as a Method of Ethics.- 3.3.6. Refutation of the Argument for Ethical Skepticism or Relativism from a Lack of Ethical Consensus—Broad Ethical Consensus Also with Atheists.- 3.3.7. Arguments against Ethical Relativism from the Observation that Many Apparently Moral Disagreements Are Disagreements on Facts, Not on Values.- 3.3.8. Two Arguments against Ethical Agnosticism and Relativism Which Are Insufficient in Themselves but Constitute Additional Reasons against Ethical Subjectivism: Evaluation of Desires and Coherence.- 3.3.9. Is There a Conflict between Intuitive Ethical Knowledge and Ethical Argumentation?.- 3.3.10. Some Excellent Arguments against Purely Consequentialist Ethics Based on a Purely Intersubjective Hermeneutical Objectivism, Which Cannot Overcome Ethical Relativism.- 3.3.11. Arguments against an Ethical Relativism Based on the Alleged Relative and Relational Character of All Values—A New Use of the Distinction between Three Categories of Goodness (of Positive Importance).- 3.3.12. Intrinsic Value and Affirmability of the Person.- 4. Is an Objective Rational Bioethics Possible in Our Pluralistic Society? Engelhardt’s Negative Reply to the Second and Third Questions Posed Above and the Need to Return to Things Themselves.- 4.1. The First Reason of Engelhardt’s Allegation of the Incapacity of Philosophical Moral Reasoning: the ‘Private Character’ of Moral Commitments and the Ambiguity of This Claim.- 4.2. Does Every Claim of Rational Ethical Knowledge either Beg the Question or Lead to an Infinite Regress?—Critique of Engelhardt’s Second Reason to Reject Philosophical Ethical Objectivism.- 4.3. Natural Ethical Knowledge or Total Value Blindness of Secular Society.- 4.4. Does Engelhardt Have any Theory of Error? On the Inner Distinction between Ethical Knowledge and Ethical Errors, and between Ethical Theories and Immediate Ethical Cognitions as Ground of Rejecting Skeptical Conclusions from Ethical Dissent in Society.- 5. Is There a Publicly Acceptable Content-full Bioethics?.- 5.1. Ambiguities in the Term ‘Canonical’ and the Distinction between Epistemological and Metaphysical Ethical Skepticism.- 5.2. Ambiguities Regarding the ‘Political Ethics’ and the Relationship between Truth, Private Morality, and Public Ethics.- 5.3. The Need for Phenomenology in the Clarification and Objective Foundation of Content-full Ethical Intuitions.- 5.4. Critique of Engelhardt’s Christian ‘Fideism’ and of His Divorcing Religion from Reason—Ambiguities in His Use of the Term ‘Rationalism’ and Some Reflections on the Relations between Reason and Faith in Ethics.- 5.5. On the Indispensability of Looking for the Foundation of Bioethics in Objective Values.- 5.6. Can We Derive an Ought From an Is? Another Objection against an Objective Bioethics in a Pluralistic Society.- 5.7. Does a Publicly Acceptable Bioethics Today Require a Utilitarian Basis? On the Irreducibility of Moral Values to Means for the Morally Relevant Values Which Are the Results of Moral Actions.- 5.8. Does a Modern Bioethics in a Pluralist Society Require the Abandonment of’ speciecism’, as Singer Postulates? On the Dignity of the Human Person as a Unique Objective Value—the Untenability of Regarding the Insistence on Human Dignity as a Mere’ speciecism’.- 6 Are there absolute moral obligations towards finite goods? A Critique of ‘Teleological Ethics’ and of the Destruction of Bioethics Through Consequentialism On the Invertebratitis of Medical Ethics and its Cure.- 1. Introduction.- 1.1. The Denial of Intrinsically Wrong and Evil Acts as Ethical Invertebratitis.- 1.2. Some Bearing of Our Previous Discussion on the Morally Intrinsic Character of Right and Wrong Actions—Beyond the False Alternative: Kant or Utilitarian Consequentialism.- 2. The Main Theses of a ‘Teleological’ Foundation of Moral Norms.- 3. Immanent Critique of ‘Consequentialist Ethics’: Its Contents and Implications, Contradictions, and Silent Admissions.- 3.1. The General and Specific Consequences of Consequentialist Ethics (Güterabwägungsethik) for Medical Ethics.- 3.2. Immanent Critique Properly Speaking of the Position of ‘Teleological Ethics’.- 4. Transcendent Critique of a ‘Purely Teleological’ Ethics.- 4.1. Positive Insights Contained in Purely Teleological Ethics.- 4.1.1. Serious Difficulties for an Ethics of Moral Absolutes, Which Seem to Speak for Purely Teleological Ethics.- 4.1.2. Is There a Legitimate ‘Personalistic Teleologism’ Which Is Opposed to ‘Teleological’ Consequentialism?.- 4.2. Critique of the Central Thesis that No Finite Good Could Ground Absolute Imperatives in the Moral Sense of the Term.- 4.2.1. Absolutely Required Inner Responses to Non-Absolute Goods.- 4.2.2. A Radical Equivocation of ‘Absolute’ at the Root of the Chief Argument of Teleological Ethics.- 4.3. Are There Intrinsically Good or Evil Acts?.- 4.4. On the Possible More Moderate (Third) Thesis of Consequentialist Teleologism: Only External Actions Which Are Directed towards Finite Goods Are Not Intrinsically Good or Evil.- 4.4.1. The Third Possible Thesis of Consequentialist Teleologism Denies the Unity of Man.- 4.4.2. Teleological Ethics Must Admit at Least One Important Exception to Its Principles: Moral Values. An Internal Contradiction and the Denial of Moral Facts.- 4.4.3. The Abuse of the Distinctions ‘Moral-Premoral’ and ‘Ontic versus Moral’ Goods and Evils.- 4.5. Critique of the Depersonalization of Morality Implied in the Allegedly Personalistic Ethical Teleologism.- Epilogue.- Index of Personal Names.

O autorze

Josef Seifert, geb. 1945. Dr. Dr. phil. habil., Dr. h.c., o. Prof., Rektor Intern. Akad. f. Phil. im Fürstentum Liechtenstein und an der PUC (Chile). (seit 1986, 2004)

Blurb

This book deals with the essential philosophical/ethical dimension that concerns the ends and goods entrusted to medicine. It shows that medicine cannot be reduced to its scientific and technical aspects and that the constitutive philosophical aspects of medicine presently are in a state of crisis.

Medicine, besides being a scientifically based art of diagnosing and curing infirmities of many kinds, also possesses an essential philosophical and ethical dimension. It turns into anti-medicine if it no longer stands in the service of those goods and ends that are entrusted to it. Their nature is in no way known by natural science but can be clarified by philosophy. Consequently, medicine suffers from philosophical diseases of different degrees of gravity if its theory and practice are based on errors about its proper ends. The cure from the life-threatening philosophical diseases of medicine lies in a critique of philosophical mistakes that influence the theory and practice of medicine and in an understanding and practical implementation of those ethically relevant goods that constitute its true ends. At a time when these goods are by no means universally recognized or embodied in laws of medicine, some basic philosophical understanding of them and of the foundations of medical ethics is urgently required. The purpose of this volume is to provide this largely neglected part of general and medical education.