The Philosophical Diseases of Medicine and their Cure: Philosophy and Ethics of Medicine, Vol. 1: Foundations

434 Pages·2004·9.359 MB·English

by  Josef Seifert (auth.)

THE PHILOSOPHICAL DISEASES OF MEDICINE AND THEIR CURE
Philosophy and Medicine
VOLUME 82
Founding Co-Editor
Stuart F. Spieker
Editor
H. Tristram Engelhardt, Jr., Department of Philosophy, Rice University, and Baylor
College ofM edicine, Houston, Texas
Associate Editor
Kevin Wm. Wildes, S.J., Department ofP hilosophy and Kennedy Institute ofE thics,
Georgetown University, Washington, D. C.
Editorial Board
George J. Agieh, Department ofB ioethics, The Cleveland Clinic Foundation,
Cleveland, Ohio
Nicholas Capaldi, Department ofP hilosophy, University of Tulsa, Tulsa,
Oklahoma
Edmund Erde, University ofM edicine and Dentistry ofN ew Jersey, Stratford,
New Jersey
Eric T. Juengst, Center for Biomedical Ethics, Case Western Reserve University,
Cleveland, Ohio
Christopher Tollefsen, Department of Philosophy, University ofS outh Carolina,
Columbia, South Carolina
Becky White, Department ofP hilosophy, California State University, Chico,
California
The titles published in this series are listed at the end oft his volume
THE PHILOSOPHICAL
DISEASES OF MEDICINE
AND THEIR CURE
PHILOSOPHY AND ETHICS OF MEDICINE,
VOL. 1: FOUNDATIONS
by
JOSEF SEIFERT
International Academy of Philosophy in the Principality of Liechtenstein (lAP) and Chile (lAP-PUC)
and
Pontificia Universidad Cat6lica de Chile, Santiago
~- Springer Science+Business Media, LLC
A C.I.P. Catalogue record for this book is available from the Library of Congress.
ISBN 978-90-481-6736-4 ISBN 978-1-4020-2871-7 (eBook)
DOI 10.1007/978-1-4020-2871-7
Printed on acid-free paper
springeronline.com
All Rights Reserved
© Springer Science+Business Media New York 2004
Originally published by Springer Netherlands
Softcover reprint of the hardcover I st edition 2004
No part of this work may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming, recording
or otherwise, without written permission from the Publisher, with the exception
of any material supplied specifically for the purpose of being entered
and executed on a computer system, for exclusive use by the purchaser of the work.
Dedicated to
My beloved children
Maria Michaela Seifert,
who is dedicating her life to philosophy and wrote her first work on
the nature and inviolable dignity ofe ach human being,
and
Gabriel Joseph Seifert,
who intends to work as a philosophically healthy physician for the
high goods entrusted to medicine;
and to my many dear friends in medicine - professors ofm edicine
and medical ethics, physicians, and nurses in all the world, who serve
the great ends ofm edicine with an unwavering commitment,
including:
Jerome Lejeune t
in commemoration oft he tenth anniversary ofh is death (1994)
Madame Jerome Lejeune
and to
Michael and Charlotte Barthel, Anna Barthel, John and Evelyn Billings,
Johannes Bonelli, Judie Brown, Sr. Anna Cappella, Fr. Fernando Chomali,
Fr. John Fleming, Petr Hach, Gonzales Herranz, Roy Joseph and
Elizabeth Heyne, Joseph Dietrich and Cynthia Heyne, Nicholas Heyne,
Thomas Hilgers, Paulina Johnson, Gudrun Lang, Birthe Lejeune,
Josef Lingenhole, DetlefLinke, Lorena Mosso, Jorge Neira, Luis Jensen,
Antun Lisee, Manfred Lutz, Marcelo Munoz, Tamas Csaky-Pallavicini,
Soledad Perez, Wanda Pohawska, M. Loreto Rodriguez, Alberto Rojas,
Pedro Rosso, Gottfried Roth, Joseph Santamaria, Philippe Schepen,
Beatriz Paulina Shand, Alejandro and Maritza Serani, Daniel Serrao,
Alan Shewmon, Anton Svajger t,William F. Sullivan, Paulina Taboada,
Nicholas Tonti-Filippini, Sergio Valenzuela and Pamela del Carmen
Silva Crespo, Patricio Ventura, Raul Ventura, Dieter Walch, Albert Wick,
Tom Watts, Nikolaus Zwicky-Aeberhard
TABLE OF CONTENTS
PREFACE AND ACKNOWLEDGMENTS xvii
INTRODUCTION xxvii
CHAPTER 1
THE NATURE AND THE SEVEN GOALS OF MEDICINE AS OBJECTS OF A
DRAMATIC FREE CHOICE OF THE PHYSICIAN TODAY
1. On the Nature of Medicine and the Physician. The Physician as
Scientifically Trained Healer, as Practitioner ofthe 'Art of
Medicine', as Ethicist, and as Moral Subject
1.1. The Physician as Scientifically Trained Healer, the Essence of
Medicine as Empirical Inductive Science, and Its a priori
Foundations
1.1.1. The Physician and the Role of Empirical Scientific Training
1.1.2. A Justification of Medicine as an Empirical Science against Hume's
and Popper's Objections Raised against Induction 2
1.1.3. Immense Progress in Medicine as Experimental Science and as
Scientifically Supported Medical Practice 25
1.1.4. Medicine as Practical or 'Pragmatic' Science and the Respective
Values of Theoretical versus Practical Sciences 32
1.2. The Physician as 'Practical Artist' and Craftsman-and Progress in
Medicine 36
1.3. On the Constitutive Role of a Philosophical Understanding of Man
and Morality for Medicine as Science, and of Moral Commitments
for the Physician as Practitioner 38
2. The Physician-Philosopher: Theoretical and Practical Philosophical
and Ethical Aspects of Medicine 39
2.1. The Goods Medicine Is Called to Serve and the Indispensable Moral
Choice of the Physician 39
2.2. The Seven Goods or 'Seven Ends' the Physician Should Serve and
Respect 44
2.2.1. Medical Service to Human Life in Its Uniqueness and Specifically
Personal Nature as well as in Its Right Place in the Whole Order of
Goods 45
2.3. 'Health' as a Fundamental Goal of Medicine and as Disputed
Question 52
2.3.1. The Question "What Is Human Health?" as a Philosophical and as
Disputed Question 52
Vll
viii TABLE OF CONTENTS
The Nature of Health and Reductionism 54
Utopian Notions of Health 54
Objectivity or Subjectivity of Concepts of Health? 56
2.3.2. The Question "To Which Extent Should Health Be Promoted in
Medicine?" as a Disputed Question 57
2.3.3. The Question "What Is the Place of Health in the Hierarchy of
Human Goods?" as a Disputed Question 57
2.4. The Fight against Pain (Suffering) and for Pleasure and Physical and
Mental Relief: Preventing, Alleviating, or Freeing from Suffering
(Palliative Medicine)-Promoting Well-Being and Feeling Well 58
2.5. The Conscious Life of Man as Such and Personal Dignity 61
2.6. Integrity of the Human Bodily Form and Aesthetic Values 68
2.7. The General and Spiritual Good of Man and of His Vocation as
Transcendent Goal and Guideline for Medicine 69
2.7.l. General Remarks on the Ways in Which This Transcendent Good of
the Human Person Obliges the Physician 69
2.7.2. The Different Ways in Which This Transcendent Good of the
Human Person Obliges the Physician 71
2.8. The Special Relationship between the Physician and the Absolute
Good (God) 72
2.9. The Religious Transformation of the Image of the Physician and the
Goods Medicine Should Serve 76
2.10. The Remarkable World Wide Consensus on the Goods Medicine
Should Serve 79
2.11. The Physician-Philosopher and the Nature of the 'Practical'
Philosophy in Medicine with Respect to the Seven Goods 80
2.12. Conclusion of Our Reflections on the Goods Medicine Should Serve,
and Theophrastus Paracelsus on the Transcendent Ends of Medicine 81
3. The Physician as Moral Agent and Further Hints at the Philosophical
Diseases of Medicine and Their Cure 82
3.l. Importance of the Subject of Medicine and His Inalienable Rights as
Person: Physicians, Nurses, and Other Health Professionals Are Not
Mere Technicians or Instruments in the Service of Health and ofthe
Other Goods of Medicine or of Patient Wishes but Acting Persons 82
3.2. Finding Anew Its Roots? A Word on the History and the Essential
Ethical Dimension of Medicine-the Hippocratic Oath as More than
an Ornament of the Medical Profession 84
3.3. Progress or Decline of Medicine with Respect to Its Value-Base and
Third Philosophical-Ethical Dimension: Modem Medicine-
Immense Progress or Regress behind the Age of the Medicine Man? 85
TABLE OF CONTENTS ix
CHAPTER 2
THE DIGNITY OF THE HUMAN PERSON AS A 'UNIVERSAL OF MEDICAL ETHICS' 89
1. Prolegomena 89
1.1. The Theoretical and Practical Significance of Understanding Human
Dignity 90
1.2. Can Human Dignity Be Known to Be an Objective, Universal and
Simultaneously Uniquely Individual Value? 93
1.3. Can Consensus Be Reached about Human Dignity and Can It
Function as a Common Ground for Medical Ethics-as a 'Medical
Ethical Universal '? 94
1.4. The Role of Realist Phenomenological Philosophy in Showing
Human Dignity to Be Truly a 'Medical Ethical Universal' 96
1.5. The Main Theses to Be Defended in This Chapter 99
1.6. Two Ways to Know What It Is to Be a Person: Immediate
Phenomenological Experience of Persons, and Intuition into the
Ontological Ground that Intelligibly Underlies Experience 99
2. What Is a Person? Ontological and Axiological Understanding
of the Person 100
2.1. The Person as Ultimate Individual Subject of Rational Nature 100
2.1.1. Person as a Substance 101
2.1.2. The Person as 'Thing in Itself 102
2.1.3. The Person as a Living Substance 103
2.1.4. Personal Individuality (Uniqueness) 104
2.1.5. The Person as a Spiritual Substance and the Human Soul 104
Arguments for the Existence of the Soul 105
2.1.6. The Person as an Individual Spiritual Substance in Relation to Other
Persons 113
2.2. A Definition of the Person by Her 'Inviolable' Dignity 114
3. The Four Sources and Dimensions of Human Dignity and Their
Characteristics 115
3.1. Ontological Dignity of the Human Person as Such and from the Very
Beginning of Her Existence 115
3.2. Dignity of the Conscious and Rational Person and Its Levels 121
3.3. Third Source and Sort of Dignity: 'Acquired Dignity' and Moral
Dignity 126
3.4. Fourth SourcelDimension of Dignity-Dignity as GiftlBestowed
Dignity 128
3.5. Relations between the Different Sources and Dimensions of Personal
Dignity 132
x TABLE OF CONTENTS
4. Dignity as Object of Rational Knowledge and Answer to Some
Objections against the Rational Knowability of Human Dignity 134
5. Human Dignity as a Unifying Bond among Men and Medical
Professionals Worldwide 136
CHAPTER 3
FROM THE MORALLY RELEVANT GOALS OF MEDICINE TO MEDICAL Enncs
On the Superiority ofM oral Values over All Extramoral Goals ofM edicine 139
1. Introductory Notes on Ethics in Its Relation to Medicine 139
2. The Ambiguity of the Notion of the Good: On the Totally New
Quality of Moral Goodness and Evil in Comparison with all Other
Goods and Evils 149
3. The Nature of Moral Goodness 151
3.1. Moral Values Are Objectively Good 151
3.2. Intrinsic Goodness 01alue) Rather Than Being Merely Agreeable or
Even Only Objectively Goodfor Me 152
3.3. Moral Values Are Necessarily Linked to Freedom 153
3.4. Moral Values Presuppose a Certain Morally Relevant Object or
Matter (Which Can Be Grave or Light) 153
3.5. Moral Values Imply a New Type of Ought Which Elucidates the
'Absolute Sense' in Which They Are Good 155
3.6. Moral Values Are Dependent on the Knowledge of Morally Relevant
and of Moral Goods and Evils 156
3.7. Moral Values Involve Responsibility 157
3.8. Moral Conscience 158
3.9. Moral Values Deserve Praise or Blame in a New Sense 160
3.10. Moral Goodness Alone Can Constitute a Certain 'Worthiness of
Happiness', Moral Evil a 'Deserving of Pain' 160
3.11. Also Guilt and Merit, Reward and Punishment Are Essentially
Related to Moral Good and Evil, and to It Alone 161
3.12. Moral Goodness Expresses in an Essentially New and Higher Sense
the Idea of Value as Such (Good in a New and More Proper Sense to
Which Extramoral Senses of 'Goodness' Are Merely Analogous) 162
3.13. Moral Goodness, As Long As It Really Exists, Cannot Be Abused
Like Intellectual, Aesthetic, Temperamental and Other Values 164
3.14. Moral Values Are Absolutely Speaking Good in that They Never
Must Be Sacrificed for Any Other Value, because They Are (a)
Incomparably Higher and (b) Should Absolutely and 'First' Be
Sought For· 165
TABLE OF CONTENTS xi
3.15. Moral Goodness as a Source of the Value of the Person as Such:
Only the Person Herself Can Be the Primary Bearer of Moral Values,
Never Impersonal Beings, and also Personal Acts Can Be Morally
Good Only in a Derivative Sense 166
3.15.1. Only Persons as Opposed to All Impersonal Beings Can Be Morally
Good 166
3.15.2. Only the Person Herself Can Be the Primary Bearer of Moral
Values-Personal Acts Can Be Morally Good Only in an Analogous
Sense 167
3.15.3. Moral Goodness Makes the Person as Such Good in a Deeper Sense
Compared with Which all Other Meanings of the Goodness of the
Person Are Just Analogous 167
3.16. Moral Values Are the Absolute and Highest Good for the Person:
Moral Values Belong to the Unum Necessarium and the 'Three
Modes of Participation in Values' Account for Three Ways in Which
Moral Values Are the Highest Objective Goods for Persons 169
3.17. Moral Values Are Goods 'in the Unrestricted Sense' by Being Pure
Perfections 172
a. Transcendentals 173
b. Pure Perfections 174
3.18. Moral Values Are Unconditionally Good because They Are Never
Just 'Means' towards Ends (Happiness). They Are Dominated by a
Principle of Dueness and Appropriateness and Arise 'on the Back' of
Acts (a Critique ofEudemonism) 176
3.19. Link of Morality to Religion and to God 177
3.20. Moral Values Constitute the Most Direct Link between Morality and
Religious Spirituality: Distinction between Philosophical and
Theological Assertions 178
3.21. The Unity of Moral Values 180
3.21.1. 'One Moral Value'-Goodness 180
3.21.2. 'No Division of Labor' in the Moral Life 180
3.21.3. 'Existential Moral Unity' 181
3.21.4. The Unity ofthe 'Root' of All Moral Goodness: the 'Oneness of
Virtue' 181
3.22. The Superiority of Moral Values over All Others and the Crucial
Importance of This Insight Expounded in This Chapter for Medical
Ethics 181
3.23. Moral Values Are Characterized as 'Goodness without
Qualification' -Its Relationship to Happiness and to the Supreme
Good 182
4. Concluding Remarks 185