On Moral Medicine

In print for more than two decades, On Moral Medicine remains the definitive anthology for Christian theological reflection on medical ethics. This third edition updates and expands the earlier awardwinning volumes, providing classrooms and individuals alike with one of the finest available resources for ethics-engaged modern medicine.

Collecting a wide range of contemporary and classical essays dealing with medical ethics, this huge volu me is the finest resource available for engaging the pressin g problems posed by medical advances. '

Selected as a Choice "Outstanding Academic Book" when it was first published, On Moral Medicine remains the most comprehensive anthology on medical ethics written from a theological point of view. Collecting a wide range of contemporary and classical theological essays dealing with medical ethics, this volume is the finest resource available for engaging the pressing problems posed by medical advances.

For more than a century, the American medical profession insisted that doctors be rigorously trained in medical science and dedicated to professional ethics. Patients revered their doctors as representatives of a sacred vocation. Do we still trust doctors with the same conviction? In Trusting Doctors, Jonathan Imber attributes the development of patients' faith in doctors to the inspiration and influence of Protestant and Catholic clergymen during the nineteenth and early twentieth centuries. He explains that as the influence of clergymen waned, and as reliance on medical technology increased, patients' trust in doctors steadily declined. Trusting Doctors discusses the emphasis that Protestant clergymen placed on the physician's vocation; the focus that Catholic moralists put on specific dilemmas faced in daily medical practice; and the loss of unchallenged authority experienced by doctors after World War II, when practitioners became valued for their technical competence rather than their personal integrity. Imber shows how the clergy gradually lost their impact in defining the physician's moral character, and how vocal critics of medicine contributed to a decline in patient confidence. The author argues that as modern medicine becomes defined by specialization, rapid medical advance, profit-driven industry, and ever more anxious patients, the future for a renewed trust in doctors will be confronted by even greater challenges. Trusting Doctors provides valuable insights into the religious underpinnings of the doctor-patient relationship and raises critical questions about the ultimate place of the medical profession in American life and culture.

Today’s medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal. What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of “health care services” for the sake of the patient’s subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange. Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient’s health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics.

In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at once practically relevant and philosophically significant.

In these essays, a diverse group of ethicists draw insights from both religious and feminist scholarship in order to propose creative new approaches to the ethics of medical care. While traditional ethics emphasizes rules, justice, and fairness, the contributors to this volume embrace an "ethics of care," which regards emotional engagement in the lives of others as basic to discerning what we ought to do on their behalf. The essays reflect on the three related themes: community, narrative, and emotion. They argue for the need to understand patients and caregivers alike as moral agents who are embedded in multiple communities, who seek to attain or promote healing partly through the medium of storytelling, and who do so by cultivating good emotional habits. A thought-provoking contribution to a field that has long been dominated by an ethics of principle, Medicine and the Ethics of Care will appeal to scholars and students who want to move beyond the constraints of that traditional approach.

When his teenaged son Christopher, brain-damaged in an auto accident, developed a 106-degree fever following weeks of unconsciousness, John Campbell asked the attending physician for help. The doctor refused. Why bother? The boy's life was effectively over. Campbell refused to accept this verdict. He demanded treatment and threatened legal action. The doctor finally relented. With treatment, Christopher's temperature subsided almost immediately. Soon afterwards he regained consciousness and today he is learning to walk again. This story is one of many Wesley Smith recounts in his groundbreaking new book, The Culture of Death. Smith believes that American medicine ''is changing from a system based on the sanctity of human life into a starkly utilitarian model in which the medically defenseless are seen as having not just a 'right' but a 'duty' to die.'' Going behind the current scenes of our health care system, he shows how doctors withdraw desired care based on Futile Care Theory rather than provide it as required by the Hippocratic Oath. And how ''bioethicists'' influence policy by considering questions such as whether organs may be harvested from the terminally ill and disabled. This is a passionate, yet coolly reasoned book about the current crisis in medical ethics by an author who has made ''the new thanatology'' his consuming interest.

This book explores medicine, ethics, and the challenge of moral diversity in health care. It explores how a health professional's moral beliefs and values influence the care he or she provides. It focuses on the need for a physician's wisdom, goals to guide patient care, and respect for conscience and integrity. The book culminates in a framework for practical wisdom in medicine that reflects the importance of integration (of an individual's beliefs, values, reasoning, actions, and identity), moral dialogue, humility, and professionals' obligations to patients, themselves, and society.

The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics. Clinical research ethics has been a longstanding area of study, dating back to the aftermath of the Nazi death-camp doctors and the Tuskegee syphilis study. Most ethical regulations and institutions (such as Institutiional Review Boards) have developed in response to those past abuses, including the stress on obtaining informed consent from the subject. Richardson points out that that these ethical regulations do not address one of the key dilemmas faced by medical researchers -- whether or not they have obligations towards subjects who need care not directly related to the purpose of the study, termed "ancillary care obligations." Does a researcher testing an HIV vaccine in Africa have an obligation to provide anti-retrovirals to those who become HIV positive during the trial? Should a researcher studying a volunteer's brain scan, who sees a possible tumor, do more than simply refer him or her to a specialist? While most would agree that some special obligation does exist in these cases, what is the basis of this obligation, and what are its limits? Richardson's analysis of those key questions and the development of his own position are at the heart of this book, which will appeal to bioethicists studying research ethics, to policy makers, and to political and moral philosophers interested in the obligations of beneficence, one of the key issues in moral theory. " 'Philosophy recovers itself,' wrote John Dewey, 'when it ceases to be a device for dealing with the problems of philosophers and becomes a method, cultivated by philosophers, for dealing with the problems of men.' Henry Richardson confronts a problem in the ethics of medical research that is often (as his many real-life examples show) a matter of life and death. The problem is unexplored and quite difficult: Richardson finds he must craft new theory to deal with it. The theory he creates shows how we become morally entangled with others without intending to, as we enter into intimacies with them. This theory of moral entanglement is a genuine discovery in philosophy, with application across a wide range of human relationships. Since the theory was designed for medical researchers it also provides a bespoke ethical framework, as well as specific guidance, for researchers in the field. This book shows practical philosophy at its best: inspired by real problems, responding with powerful solutions." -- Leif Wenar, Chair of Ethics, King's College London "A medical researcher investigating transmission of malaria may find that a subject has another disease. Does the researcher have an obligation to devote some of the team's resources to treating this disease? The traditional principles of research ethics do not ask much less answer this important question. In this theoretically and practically rich book, Henry Richardson seeks to provide an answer and to identify issues that need further exploration. He argues that "ancillary care obligations" are explained by "moral entanglement" and cannot be justified by traditional principles of justice or the duty to rescue. He is admirably soft-hearted and tough-minded in combining his long demonstrated philosophical acuity with a deep knowledge of the problems on the ground. Richardson's book is characterized by great generosity towards those who need help, towards the problems faced by researchers, and towards the scholarly community - even those with whom he disagrees." - Alan Wertheimer, Senior Research Scholar, Department of Bioethics, National Institutes of Health "In this important book, Henry Richardson sculpts a new path for research ethics, one that focuses on ethical obligations of ancillary-care in clinical trials and medical research, particularly in developing countries, but with relevance throughout the world. In Moral Entanglements, Richardson extends the reach of his analysis both deep within and outside the research itself, recognizing the broader moral backdrop relevant for society-wide judgments of justice, and the special relationships that exist within the medical research context, about what is or is not owed research participants in situations of medical need. Rather than leave such important decisions up to the vagaries of politics or ad hoc assessments, this book sets out a comprehensive theoretical framework with principles to guide such decisions in the everyday lives of both medical researchers and research participants. This book significantly contributes to the ethics of ancillary-care in medical and public health research and judiciously enlightens questions and potential resolutions to these vital global and domestic problems." - Jennifer Prah Ruger, Associate Professor, Yale Schools of Public Health and Medicine