In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide arrayof practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, the allocation ofscarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence (re-interpreted as beneficence-in-trust) to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician mustperform a right and good healing action which is consonant with the individual patient's values. In order to act in the patient's best interests, or the patient's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue betweenpatient and/or family and physician which respects and honors the patient's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient's good rejects the assumption long held in medicine that what is considered to be themedical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the currentemphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician-patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also toethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today.
Author(s): Edmund D. Pellegrino; David C. Thomasma
Publisher: Oxford University Press
Year: 1988
Language: English
Pages: 240
City: New York & Oxford
Front cover
Title page
Preface
Contents
I. The Delineation of Beneficence
1. Paternalism, Autonomy, and Beneficence in the Doctor-Patient Relationship
2. Limitations of Autonomy and Paternalism: Toward a Model of Beneficence
3. Why Good Rather than Rights?
4. Beneficence-in-Trust
II. The Implications of Beneficence for the Doctor and Patient
5. Health and Ethical Norms
6. The Good of the Patient
7. Quality-of-Life Judgments and Medical Indications
8. The Good Patient
9. The Good Physician
III. The Consequences of Beneficence
10. The Common Devotion: A Reconstruction of Medical Ethics
11. Making Decisions Under Uncertainty
12. Making Decisions for Incompetent Patients
13. The Role of Physicians, Families, and Other Surrogates in Decisions Concerning Incompetent Patients
14. The Physician as Gatekeeper
15. Beneficence-in-Trust: How It Is Applied
16. A Medical Oath for the Post-Hippocratic Era
Notes
Preface
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Index
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