Lebel, Robert Roger

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The Linacre QuarterlyVolume 43 | Number 1 Article 122-1-1976[Book Review of ] Ethics of Health Care, edited byLaurence R. TancrediRobert Roger LebelFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationLebel, Robert Roger (1976) "[Book Review of] Ethics of Health Care, edited by Laurence R. Tancredi," The Linacre Quarterly: Vol. 43:No. 1, Article 12.Available at: http://epublications.marquette.edu/lnq/vol43/iss1/12Ethics of Health Care Laurence R. Tancredi, Editor National A cadem y of S cien ces, In stitute of M edicin e. 1974, 313 p. , $6.00 (paper). The papers of the Academy's Conference on Health Care and Changing Values (27-29 Novem-ber 1973) are published in this volume. Six sections correspond to the six sectional meetings of the conference: conceptual foun-dations, governmental decision-making, consumer evaluation of health care, professional values, care settings, and problems of the chronically ill and aged. Medical doctors, ethicians, economists, so-ciologists, consumer advocates and others participated. Albert Jonsen and Andre Hel-legers set the tone for the discus-sion by laying out the conceptual foundations for reflection. Tradi-tional medical ethics codes have two components: pragmatic direc-tions (etiquette) and exhorta tions to virtue (morality). Of these, the latter may be more embarrassing, but is also more important. A theory of virtue is one of the three foundations of any ethical study. The second foundation is a theory of duty . In medical ethics, as opposed to any other species of ethics, this has centered on the integrity of the human organism and that of the provider/ patient relationship; pub I i c discussion continues to focus here. Only since medicine has come to be institutionalized has the need for the third foundation been noticed with some urgency: a theory of the common good. Medical care has ceased to be a 54 simple matter of the provider/ patient relationship. We have be-gun to appreciate that our actions extend in time and significance beyond the person and problem at hand, to society at large. Com-mitment of extraordinary tech-nological resources to the care of one person is an expense inevita-bly undertaken by the entire so-ciety .. . because of the structure of health care delivery and fund-ing. Consequently, Jonsen and Hel-legers urge the importance of deepening our reflection on this third pedestal of medical ethics. They disavow any ready answers to the thorny problems that arise in such a discussion. But this must be the advancing edge of our thinking. The ethicist is not one who provides answers; rather he assists in laying out the road map, in finding the paths for ade-quately dealing with the complex questions. The nine other essays, and their accompanying com men -taries, show concern congruent with the kind of contribution em-phasized by J onsen and Hellegers . They make a valiant effort, but the thinking inevitably seems to gravitate back to familiar terri-tory, namely the physician/ pa-tient relationship. Kenneth Arrow, discussing gov-ernment decision-making and the preciousness of life, struck this recurring theme early in the con-Linacre Quarterly ference. When the arguments are laid out, it seems best to opt for maximum freedom of choice in the patient. Among other things, this depends on communicating all the pertinent information and encouraging participation in deci-sion-making. This of course de-parts from the time-honored tra-dition of the physician (expert) making the decisions for the pa-tient (client). Here we find a changing theory of duty: our con-temporary frame of mind gives high priority to the rights to know and to choose. (Perhaps the para-digmatic area in which this has become evident is genetic coun-seling. ) John S. Wellington, M.D., pro-vided an acute analysis of the changing values and methods of selection for medical school appli-cants. He concluded that methods have changed more than values; medical schools still tend to admit those who will maintain the pro-fessional status quo . There are no revolutions in sight. Several authors addressed the matter of fee-for·service vs . the health maintenance organizations (HMO's). They opted almost al-ways for plurality, for keeping both systems operative. Whether this would foster consumer free-dom of choice or perpetuate con-fusion remains to be seen; the question continues to elicit con-siderable polarization. Senator Edward M. Kennedy has been a vocal critic of the situation in American health care, pressing for congressional involvement in a complete revamping of the system under federal auspices. For the most part, the essays are well written. A notable excep-tion is that dealing with the chronically ill and aged. Jerome Kaplan's prose is so difficult that his ideas get lost in the reader's frustration. Ethics of Health Care is a val-uable book for its exposition of, and creative thinking about, the important questions it addresses. Reviewed by: Robert Roger Lebel, S.J. Kennedy Fellow in Medicine, Law & Ethics University of Wisconsin Madison, Wisconsin Premeditated Man: Bioethics and the Control of Future Human Life Richard M. Restak The Viking Press. N ew York. 1975, XVlll + 202 p. , $8.95 Is there a common ethical f ram e w 0 r k that encompasses cloning, psychosurgery, and sperm banking - indeed, that encom-passes all areas of biomedical 'eth-February, 1976 ics? Restak believes that such a framework consists of the sci-entist's enormous power to alter the course of social evolution. He believes that the bioethicist 55 

[Book Review of] \u3cem\u3eEthics of Health Care\u3c/em\u3e, edited by Laurence R. Tancredi

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[Book Review of] \u3cem\u3eEthics of Health Care\u3c/em\u3e, edited by Laurence R. Tancredi

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