The question of whether physicians or other healthcare workers are ethically entitled to strike is troubling in that it entails a conflict in obligations. This question of a conflict of obligations (and the answer to it) has wider implications for many other workers.

It is often said that because physicians and other healthcare professionals frequently play a critical role in determining the fate of their patients, they ought if at all possible to be their patient's friend. The relationship of necessity is intimate: physicians have knowledge of their patients' histories and of their bodies which under other circumstances would be reserved to the most intimate of friends, and physicians and patients meet under more or less critical situations. In this paper, I briefly examine (...) the role of the physician as “friend,” an Issue to be much more extensively explored In a book In preparation. (shrink)

In this paper, I want to try to put what has been termed the “care ethics” into a different perspective. While I will discuss primarily the use of that ethic or that term as it applies to the healthcare setting in general and to the deliberation of consultants or the function of committees more specifically, what I have to say is meant to be applicable to the problem of using a notion like “caring” as a fundamental precept in ethical decision (...) making. I will set out to examine the relationship between theoretical ethics, justice-based reasoning, and care-based reasoning and conclude by suggesting not only that all are part of a defensible solution when adjudicating individual cases, but that these three are linked and can, in fact, be mutually corrective. I will claim that using what has been called “the care ethic” alone is grossly insufficient for solving individual problems and that the term can be extremely dangerous. I will readily admit that while blindly using an approach based solely on theoretically derived principles is perhaps somewhat less dangerous, it is bound to be sterile, unsatisfying, and perhaps even cruel in individual situations. Care ethics, as I understand the concept, is basically a non- or truly an anti-intellectual kind of ethic in that it tries not only to value feeling over thought in deliberating problems of ethics, but indeed, would almost entirely substitute feeling for thought. Feeling when used to underwrite undisciplined and intuitive action without theory has no head and, therefore, no plan and no direction; theory eventuating in sterile rules and eventually resulting in action heedlessly based on such rules lacks humanity and heart. Neither one nor the other is complete in itself. There is no reason why we necessarily should be limited to choosing between these two extremes. (shrink)

The history in which bioethics developed is well reviewed in a recent book written by Al Jonsen. This superb little volume gives a concise—even if a necessarily rather subjective—account of the development of the field. A more objective history of the contemporary development of the field cannot be expected from those who helped craft it and awaits historians of the future. What I have been asked to do here is to supply my own personal impressions of the development of this (...) field as I have experienced it. What I have been asked to do here is to supply my own personal impressions of the development of this field as I have experienced it. (shrink)

This paper will discuss the role of compassion in ethics in general and in healthcare ethics in particular. My thesis is that compassion:1) as Rousseau pointed out, is a natural trait common to all higher animals ;2) can and does serve as one of the most important motivators and modulators of ethics in both theoretical and applied aspects;3) must be controlled by, and in turn control, reason if it is to serve its ethical as well as natural purposes; and4) as (...) a natural trait has survival value and, by virtue of being a natural trait, cannot be an obligation although there may very well be an obligation to do all that is necessary to nurture and not crush this sentiment. (shrink)

This paper inaugurates a new section on education, the focus of which is on education in a broader sense. The purpose is to stimulate discussion not only about techniques of education but also to initiate a dialogue concerninig more fundamental questions and issues. What are the goals of education generally and of and for ethics committees specifically? What, for an ethics committee, is “education”? What do we mean by education in this field? To function efficiently on an ethics committee, does (...) a member need specific training? Should the educational efforts of an ethics committee extend beyond the medical and nursing staff? If so, should they extend beyond the hospital and into the community? Is educating patients a legitimate function of an ethics committee? These are but a few of the questions that I hope will be debated over the years in the pages of this journal. (shrink)

Virtually all persons who have had a hand in shaping the concept of ethics committees in this country accept the principle that the individuals making up the ethics committee should represent different interests, backgrounds, and viewpoints. In other words, ethics committees are intended mainly to represent the interests of the communities they serve. However, ethics committees often also serve hospitals that are religiously based and who, not unreasonably, may insist on affirming their own institutional morality and their own peculiar way (...) of looking at some problems. Deep-seated ethical quandaries, especially in shaping policy, are often unavoidable. (shrink)

Issues of social justice have traditionally been given short shrift by American healthcare professionals, feeling that justice at the bedside is inapplicable and possibly even misplaced. However, perhaps motivated by the realization that escalating costs and maldistribution of healthcare represent an intolerable situation, an ever-growing amount of medical literature and healthcare ethics literature is turning to considerations of justice.

On many occasions, care givers are faced with problems in which “drastic” types of treatment seem clearly inappropriate but “lesser” interventions still appear to be advisable, if not indeed mandatory. In the hospital setting, examples are frequent: the demented elderly patient, still very much capable of brief social interactions and still able to enjoy at least limited life, who although clearly not a candidate for coronary bypass surgery is, nevertheless, a patient in whom an intercurrent pneumonia deserves treatment; the severely (...) retarded youngster in whom appendectomy seems clearly warranted but for whom long-term dialysis seems ill-advised. The examples are legion, and their variety defies an easy, stereotypical solution. Why, one may ask, is the treatment of intercurrent pneumonia or operating on an acute appendix “clearly indicated” while coronary bypass and long-term dialysis “clearly” are not? The reactions of care givers in the past have often consisted of attempts to give half-hearted treatment or to treat fully even against their better judgment. The lack of conceptual guidelines that might help sort out such problems has inevitably led either to an inflexible absolutism in which all possible treatment to sustain life or no treatment at all is given or has resulted in a pathetic attempt to act but act minimally with the hope that such actions will be ineffective. (shrink)

The paper by Dr. Myles Sheehan “Why Doctors Hate Medical Ethics” highlights some of the problems of teaching ethics to an extremely weary group of house officers who may look at ethics as a waste of time, as a requirement that must be overcome, or as “a lot of crap” Although Dr. Shee-han's paper offers a number of interesting and valuable insights, it really fails to say why residents hate the teaching of medical ethics any more than they may hate (...) any other conference which, inevitably, intrudes on their time. In this response, I do not so much want to take issue with Sheehan's paper as to comment and to offer some of my own experiences teaching ethics. To do so, I am fully aware, may be regarded as matching anecdote with anecdote, a tiresome and ultimately futile process. (shrink)

Bd. 1-2. Medizinische Schriften.--Bd. 3. Philosophische Schriften.--Bd. 4. Theologische, religionsphilosophische und sozialpolitische Schriften.--Bd. 5. Pansophische, magische und gabalische Schriften.

From time to time medical ethicists bemoan the loss of a religious perspective in medical ethics. The discipline had its origins in the thinking of explicitly religious thinkers such as Paul Ramsey and Joseph Fletcher. Furthermore, many of those who contributed to the early development of the discipline had training in theology. One thinks of Daniel Callahan, Richard McCormick, Albert Jonsen, Sam. Banks. As the discipline becomes more and more self-reflective, with attention being paid to methodological and conditional concerns, it (...) is only natural that the roots are due for a reexamination. The time has therefore come for some reassessment. The first steps here are taken in the form of a dialogue between the coauthors to clarify authentic contributions and weed out unauthentic ones. (shrink)

Der Jesuit Erich Przywara (1889-1972) und Gertrud von le Fort (1876-1971) lernten sich Mitte der 1920-er Jahre kennen, zur Zeit der Konversion le Forts zum katholischen Glauben. Seither standen sie in einem durchgehenden, wenn auch losen Briefwechsel, vor allem in den beiden Jahrzehnten nach dem Zweiten Weltkrieg. Die von Manfred Lochbrunner herausgegebene Korrespondenz ist das berührende Dokument einer freundschaftlichen Beziehung zwischen der angesehenen Dichterin und dem nicht minder bedeutenden Religionsphilosophen und Theologen mit eigenen dichterischen Ambitionen. In einem Einführungsessay werden (...) die wesentlichen Briefinhalte kurz vorgestellt. Anmerkungen kommentieren den Text der Briefe. Abgerundet wird die Edition durch drei biographische Exkurse zu nahestehenden Personen und Anhänge, etwa zu gegenseitigen Widmungen, sowie ein Literaturverzeichnis"-- Back cover. (shrink)