The Forms and Limits of Medical Ethics

As medical ethics has evolved over the past several decades, it has come to be regarded as a domain of applied ethics, that is, the application of a rationally based, philosophical theory to moral problems in health care. But an array of difficulties arise in the attempt to apply general moral theories or norms to concrete problems, difficulties that expose the incompleteness and indeterminacy of philosophical moral theory. The doubtful ability of applied ethics to be practically helpful has led to the development of two main competitors. One is the attempt to reprise and rehabilitate the tradition of moral casuistry, which focuses on the analysis of specific cases rather than on the defense and application of theories and norms. The second is the search for moral insight and guidance in narratives or stories. These alternatives suffer from some of the same difficulties that plague applied ethics, however. Another trend in medical ethics rejects the theoretical preoccupation of applied ethics in favour of contextualism—an insistence on situating moral problems in institutional and organizational structures and in social and cultural backgrounds. Social science investigations of medical ethics pay attention to the former, while feminist critiques of medical ethics are concerned with exposing and eradicating cultural biases against women. Contemporary work in medical ethics is diverse, but these manifold approaches hold out the promise of improving our understanding of morality as a truly practical enterprise

Understanding Judicial Discretion

The main aim of this paper is to clarify the dispute over judicial discretion by distinguishing the different senses in which claims about judicial discretion can be understood and by examining the arguments for these various interpretations. Three different levels of dispute need to be recognized. The first concerns whether judges actually do exercise discretion, the second involves whether judges are entitled to exercise discretion, and the third is about the proper institutional role of judges. In this context, the views of Dworkin, Raz, Perry, Greenawalt, and Sartorius are examined. Finally, it is suggested that a resolution of the judicial discretion controversy requires a satisfactory theory of the justification of judicial decisions

Family Medicine as a Social Science

The branch of clinical medicine most likely to qualify as a social science is family medicine. Whether family medicine is a social science is addressed in four steps. First, the nature of family medicine is outlined. Second, the extent to which social science knowledge is used in family practice is discussed. Third, the extent to which family medicine can qualify as a social science is considered with respect to an orthodox model of the social sciences, that is, one that emphasizes affinities between the natural and social sciences. Finally, the same question is addressed with respect to an unorthodox model of the social sciences, that is, one that stresses the evaluative nature of the social sciences