{"title":"Futility and the varieties of medical judgment.","authors":"D P Sulmasy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the \"circumspect\" view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine-an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.</p>","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1-2","pages":"63-78"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20077620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"FUTILITY AND THE VARIETIES OF MEDICAL JUDGMENT","authors":"D. Sulmasy","doi":"10.1023/A:1005749217702","DOIUrl":"https://doi.org/10.1023/A:1005749217702","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"63-78"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/A:1005749217702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57094154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The influence of Edmund D. Pellegrino's Philosophy of Medicine.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1-2","pages":"1-215"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20095897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"EDMUND D. PELLEGRINO FESTSCHRIFT","authors":"David C. Thomasma","doi":"10.1007/978-94-017-3364-9_1","DOIUrl":"https://doi.org/10.1007/978-94-017-3364-9_1","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51042704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"FINDING AN APPROPRIATE ETHIC IN A WORLD OF MORAL ACQUAINTANCES","authors":"E. Loewy","doi":"10.1007/978-94-017-3364-9_7","DOIUrl":"https://doi.org/10.1007/978-94-017-3364-9_7","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"79-97"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51042743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ANTIFOUNDATIONALISM AND THE POSSIBILITY OF A MORAL PHILOSOPHY OF MEDICINE","authors":"D. Thomasma","doi":"10.1007/978-94-017-3364-9_10","DOIUrl":"https://doi.org/10.1007/978-94-017-3364-9_10","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"127-143"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51042727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why bioethics needs the philosophy of medicine: some implications of reflection on concepts of health and disease.","authors":"G Khushf","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the \"science\" of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderate of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice.</p>","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1-2","pages":"145-63"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20078086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The crisis of virtue: arming for the cultural wars and Pellegrino at the limes.","authors":"H T Engelhardt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of medicine and the philosophical grounding of medical ethics that has framed the contemporary field of bioethics in the expectation, of the rational justification of a universal content-full morality. However, this attempt at rational justification has failed, leaving a plurality of bioethics and the inability to secure the canonical account of virtue and character which Pellegrino has sought. This failure is integral to a Western Christian error regarding the nature of virtue.</p>","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1-2","pages":"165-72"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20078088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"EDMUND D. PELLEGRINO's PHILOSOPHY OF FAMILY PRACTICE","authors":"H. Brody","doi":"10.1023/A:1005728614068","DOIUrl":"https://doi.org/10.1023/A:1005728614068","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"7-20"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/A:1005728614068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57092994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A DIALOGUE BETWEEN VIRTUE ETHICS AND CARE ETHICS","authors":"P. Benner","doi":"10.1023/A:1005797100864","DOIUrl":"https://doi.org/10.1023/A:1005797100864","url":null,"abstract":"","PeriodicalId":77444,"journal":{"name":"Theoretical medicine","volume":"18 1","pages":"47-61"},"PeriodicalIF":0.0,"publicationDate":"1997-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/A:1005797100864","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57096395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}