O\u27Rourke, Kevin

English

epublications@Marquette

The Linacre QuarterlyVolume 53 | Number 2 Article 145-1-1986[Book Review of ] Ideal, Fact, and Medicine, byCharles J. DoughertyKevin O'RourkeFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationO'Rourke, Kevin (1986) "[Book Review of] Ideal, Fact, and Medicine, by Charles J. Dougherty," The Linacre Quarterly: Vol. 53 : No. 2 ,Article 14.Available at: http://epublications.marquette.edu/lnq/vol53/iss2/14a patient to accept the reality of a co nditi o n, a co mpetent jud gment may be difficult. Beauchamp and McCullough recogn ize that rationality or ab ilit y to understand a situation does not mea n that a patien t can make a competent dec ision. The authors c hallenge the notion that the physician must a lways act in the best interes ts of the patient and they hold that third party interests ma y be pro moted at t he expe nse of the patient in so me cases. They would allow psychological a nd e moti o nal conseque nces of treatment to justify withholding beneficial trea tme nts from infan ts, for insta nce. But the reasons they give for upholding third-party inte rests are quite vague, abstract. form a l and difficult to apply in concrete circumstances. They ho ld tha t the pa ti ent' s interes ts only impose a primajacie dut y that can be overridden when so d o ing brings about a grea ter good. Determining when one can promote third part y interests is done by weighing va rious harms and benefits, which is essentiall y a co nseq uen tialist ana lys is. The funda mental problem with this met hod o logy is that one never knows what harms and benefit s are to be includ ed and one ne ve r knows when to stop sea rc hing for vlllues to be weighed. Whe n they urge that patient interests either be upheld or overridden, the authors invoke benefice nce, but they neve r sho w why there is a clear dut y to act bene fi cently as beneficence cou ld plausibly compel action in another direction. They invoke the " best interests" standa rd either to warrant or prohibit paternalist ic action, but they ne ve r give pers uasive reasons why this purely formal standard requires their reco mmended action. This book was quite dissatisfying because it relies so lely on abstract and formal principles. The authors almost seem fearful of esta bli s hing concrete, binding moral norms for medical practice, and one suspects that they want medical-ethical norms to be purely formal so that these norms ca n be used to permit or prohibit whatever they desire. There is no discuss ion of basic human goods or the virtues, which is ve ry peculiar for a work in medical ethics. They seem to assume that justice will be achieved by merely acting beneficentl y or by protecting autonomy, however they a re defined. The formalit y and abstractness of contemporary ethics should be a matter of concern, as we now see a campaign to legali ze euthanasia brea king upon our co untry. There is virtually no mention of the dut y to trea t patients, and only occasionally is there any mention made ofa "therapeutic privilege". They fail to consider the nature of medical treatme nts and the conditions of patients to show how those impinge upon the moral character of judgments. This book seems to be an endorsement of the pure and contentless patient autonomy model which all but obliterates ethical duties and obligations of hea lth care providers. If it is true that thi s model is gaining do minance in our country, then it might be necessary to take measures to protect the duti es and obligations of physicia ns to proVi de care and trea tment for medically vulnerable persons. -Rev, Robert Barry, ,O,P" Ph,D , National Endowment for the Humanities Fellow Washington , D ,C. I deal, Fact, and Medicine by Charles J. Dougherty Ne>!' York: Universill' of America Press. 1985. 202 pp. "It might be said by some tha t thi s whole work is far too relativistic, that it accepts too easily the claim that there are other significant moral alternatives, and that it therefore provides no absolute foundation for the choice of these idea ls and the associated ethical May, 1986 85 th eory. In res ponse. I a dmitt o a good degree of re lat iv is m" (p. 172). With these words. the aut ho r. a professo r o f ethi cs a t Creighton Univers it y in Oma ha. Ne braska. prese nts us with a succ inct rcv iew of his anal ys is of ethi ca l theo ry as applied to pro blem a reas of medical ethi cs . bas in g h is ethical an a lysis up o n a synthes is of the th o ught o f the Englis h em oto vists and the large ly subj ect ive Ka nti a n id ea l of perso na l autonom y. Dougherty s tresses instru cti o n o f va lues as the ba sis o f mo ra lit y a nd sta tes that ethi cs s hould refine and clarify mora l in structi o ns. When discussing medica l researc h. Dougherty ex presses shock and horror at the human research protoco ls carried o ut by the Naz i medi ca l expe rim enters (p . 143) . After desc ribing so me o f the horrors perpetrat ed during the seco nd World War. Doughert y ri ghtl y points out that the ideo logv w hich allowed such experiments deve lo ped well before the seco nd World War. But. iro nica lly . w hen assigning ca uses fo r the Naz is' abuse of human right s. Doughert y fail s to li st the type o f re lat iv isti c ethica l theory w hi ch he es po uses. The best pa rt of the book is a stud y of the e thica l and lega l respons ib ili t ies of hos pitals. Most of the signifi cant lega l decisions in rega rd to hospi tal care are prese nt ed and a ve ry c lear li st of patient rig ht s and hospi tal duti es is afforded. In thi s secti o n especia lly. D o ughert y di splays a co mprehens ive view of the va lues and act ions which wo uld im prove inst itutional health ca re. -Rev. Kevin O' Rourke. O.P. Director Center for Health Care Ethics SI. I.ouis University Medical Center Ethicsfrom a TheocentricPerspective, Vol.} Theology and Ethics by James M. Gustafson Chicago: Ulli" ersill ' o( Chicago Press, 1983. 345 PI'- $ 10.95. Ethics from a Theocentric Perspective, Vol. 2 Ethics and Theology by James M. Gustafson Chicago: Unilwsill ' o( Chicago Press. 1984. 3261'1'- $25. These two works complement each other. The first develo ps a theocentric perspective; the second sets out to exp lore the ques tion. What diffe rence does a theocentric persp ecti ve make to the interpreta tion of moralit y" Together they constitute an intriguing and thought-provoking study. While the work of an y Christian et hici st or moral theo logian presupposes ce rtain theological positions. it is rare to find these e laborated systematically and at length. A serious reader is compelled to grapple w ith man y of the most basic religious issues and 86 Linacre Quarterly 

[Book Review of] \u3cem\u3eIdeal, Fact, and Medicine\u3c/em\u3e, by Charles J. Dougherty

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=3589&amp;context=lnq

[Book Review of] \u3cem\u3eIdeal, Fact, and Medicine\u3c/em\u3e, by Charles J. Dougherty

Abstract

Similar works

Full text

Available Versions

epublications@Marquette