The Philosophy of Medicine: Framing the Field PDF
Preview The Philosophy of Medicine: Framing the Field
THE PHILOSOPHY OF MEDICINE Framing the Field Philosophy and Medicine VOLUME 64 Founding Co-Editor Stuart F. Spicker Editor H. Tristram Engelhardt, Jr., Center for Medical Ethics and Health Policy, Baylor College of Medicine and Department of Philosophy, Rice University, Houston, Texas Editorial Board George J. Agich, Department of Bioethics, The Cleveland Clinic Foundation, Cleveland, Ohio Nicholas Capaldi, Department ofPhilosophy, University of Tulsa, Tulsa, Oklahoma Edmund L. Erde, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey Becky White, California State University, Chico, California The titles published in this series are listed at the end of this volume. THE PHILOSOPHY OF MEDICINE Framing the Field Edited by H. TRISTRAM ENGELHARDT, JR. Philosophy Department, Rice University, Baylor College of Medicine KLUWER ACADEMIC PUBLISHERS NEW YORK / BOSTON / DORDRECHT / LONDON / MOSCOW eBookISBN: 0-306-47475-1 Print ISBN: 0-7923-6223-3 '2002 Kl uwer Academic Publishers New York, Boston, Dordrecht, London, Moscow All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://www.kluweronline.com and Kluwer’s eBookstore at: http://www.ebooks.kluweronline.com STUARTFRANCIS SPICKER, Ph.D. B.A., City University of New York, Queens College, 1959 M.A., New School for Social Research, New York City, 1962 Ph.D., University of Colorado, Boulder, 1968 Professor Massachusetts College of Pharmacy and Health Sciences Boston, Massachusetts Professor Emeritus University of Connecticut Health Center Farmington, Connecticut TABLE OF CONTENTS H.TRISTRAMENGELHARDT,JR. /ThePhilosophyofMedicineand Bioethics: An Introduction to the Framing of a Field 1 SECTION ONE / THE PHILOSOPHY OF THE BODY AND BIOETHICS HENK A. M. J. TEN HAVE / Bodies of Knowledge, Philosophical Anthropology. and Philosophy of Medicine 19 MARXW.WARTOFSKY/Bodies, Body Parts, andBody Language: Reflections on Ontology and Personal Identity in Medical Practice 37 MARK J. CHERRY / Bodies and Minds in the Philosophy of Medicine: Organ Sales and the Lived Body 57 SECTION TWO / EUTHANASIA. SECULAR PRIESTS. AND THE CENTRALITY OF CHOICE THOMAS HALPER / Accommodating Death: Euthanasia in the Netherlands 81 GEORGE J. AGlCH / Why Should Anyone Listen to Ethics Consultants? 117 LORETTA M. KOPELMAN / Changing Views of Paternalism in Research: AIDS Activists Demand Change 139 SECTION THREE / FUNDAMENTAL CATEGORIES: THE MIND, EQUITY, THE STATE, AND TIME K. W. M. FULFORD /ThreeDesignationsofDisorder:Diversity, Disease. andDeterminism inPsychiatric Thought and Practice 159 BERNARD M. DICKENS / Equity and the Health Effects of Urbanization 177 THOMAS J. BOLE. III / Engelhardt on Kant’s Moral Foundations and Hegel’s Category ofthe State 195 vii viii TABLE OF CONTENTS H TRISTRAM ENGELHARDT, JR / Bole on Kant, Hegel, and Engelhardt: A Brief Reply 223 AKIO SAKAI / Epilogue: The Use of the Past 227 BIBLIOGRAPHY OF THE WORKS OF STUART FRANClS SPICKER 235 NOTESONCONTRIBUTORS 241 INDEX 243 H. TRISTRAM ENGELHARDT. JR. THE PHILOSOPHY OF MEDICINE AND BIOETHICS: AN INTRODUCTION TO THE FRAMING OF A FIELD I. AT THE ORIGINS OF A FIELD From where do new fields of scholarship arise? How do they take shape? Why do old ones reappear and gain new life? In particular, how and why in the 1970’s did the philosophy of medicine again become an important field of study? Why did philosophy become so central to the new and emerging field of bioethics? There are no simple answers to these questions. Cultural developments represent an interplay of values, institutions, science, technology, economic forces, and, most importantly, persons. In the 1960’s and early 1970’s, the number of persons who credited the importance of the philosophy of medicine and bioethics could have easily assembled in a small room. Of these, few had an apprecia- tion of the breadth of philosophical issues at stake in medicine and the biomedical sciences. Stuart Spicker did. Fields take shape in great measure because persons see their possibility and have the insight to realize them in actuality. Stuart Spicker’s vision of bioethics and the philosophy of medicine has had an enduring impact on this field. This is not to deny the role of ideas. Ideas act as final causes for fields of scholarship. They inspire scholars who call into existence the social structures within which actual scholarly dialogue can occur. There are no scholarly fields without discussions, conferences. journals, and books. There are no conferences, journals, or books without scholars to bring them into being. Organizing conferences, establishing journals, and developing book series are labors that require energy, insight, and the ability to stick with tasks over time. This has proved no less true with bioethics and the philosophy of medicine. These areas of interest formed a scholarly field united by the interest of philosophers in medicine and the biomedical sciences. It came to be appreciated that. with respect to medicine and the biomedical sciences; issues of evaluation and explanation were intertwined: a distinction between the philosophy of medicine and bioethics was not only artificial but misleading. The two areas of concern came to function as one general field of investigation with areas of special focus. This field came into existence because certain 1 H. T. Engelhardt, Jr. (ed.), The Philosophy of Medicine, 1-15. ©2000 Kluwer Academic Publishers. Printed in the Netherlands. 2 H. TRISTRAM ENGELHARDT, JR. people saw its importance and were willing to labor patiently to estab- lish a full-fledged field of academic pursuit. At the end of the 1960’s and the beginning of the 1970’s, confer- ences had begun to recognize puzzles of a philosophical sort about medicine. First, there was a cultural hunger to locate medicine within larger cultural concerns. This was driven by the increasing salience of medicine itself. In every developed country, health care was claiming a larger portion of the gross domestic product. The promise of new tech- nologies also threatened seemingly novel moral and public policy puzzles. If the law deserved a philosophy of law, medicine seemed to deserve something like a philosophy of medicine. Although that term was hardly used in the 1960’s (Szumowski, 1949), philosophy of medicine had a history that reached to the beginning of the 19th century (Berlinghieri, 1801). Second. new technologies such as critical care units and organ transplantation pressed for clarity about issues such as determining when death occurs. Third, old moral problems became more acute because the technologies that occasioned thein had become safer and more tempting: for example, abortion became associated with fewer risks of morbidity and mortality, and there was the promise of ever more effec- tive prenatal diagnosis and selective destruction of fetuses. Fourth, there appeared to be purely philosophical issues such as the nature of disease and illness that were addressed by neither the philosophy of medicine nor even the philosophy of biology. There were these and many other issues of evaluation and explanation associated with medicine that have since given birth to sustained philosophical reflection and analysis. Few philosophers seemed to notice them. Or if they noticed them, they were not yet sure how to name them or whether to place them within an independent field. There was even a resistance to taking the philosophy of medicine and bioethics seriously as fields for philosophical exploration (Engelhardt and Spicker, 1975, pp. 211-234). Philosophers were disinclined to entertain this area of scholarship. It appeared to them to involve “only” issues of application. Physicians were resistant to the view that philoso- phers could contribute to the understanding of their profession. Actual clinical experience alone was taken to provide the appropriate insight into medical moral matters. Then things began to change. in great measure because of the insight, intelligence, and energies of a small number of individuals such as Andre Hellegers, Director of the Kennedy Center, Willard Gaylin and Daniel Callahan, President and Director of THE PHILOSOPHY OF MEDICINE AND BIOETHICS 3 the Hastings Center, Chester Burns, Director of the Institute for Medical Humanities, and Edmund D. Pellegrino, Chairman of the Institute of Human Values in Medicine. In 1971, the Hastings Center Report came into print. Then in 1976 the Journal ofMedicine and Philosophy pub- lished its first issue under the editorship of Edmund Pellegrino and with the support of the Society for Health and Human Values. From the Kennedy Institute through Warren Reich, the Encyclopedia of Bioethics appeared in 1978 (Reich, 1978). There were other institutions and pub- lications that framed the field. Among them must surely be counted the book series within which this volume appears: Philosophy and Medicine. For a quarter of a century and for over sixty volumes, the series had Stuart F. Spicker (1937–) as its co-editor. Though mentioned only in passing in Jonsen’s excellent study of the birth of bioethics (Jonsen,1998), the re-emergence of interest in the philosophy of medicine had a signifi- cant impact on the philosophical character of the field of bioethics. In the above-mentioned list of founding fathers of the new field, only Callahan and Spicker are philosophers sensu stricto. Spicker is one of the few who at the beginning of the 1970’s recog- nized the importance of the philosophy of medicine in its own right and its significance for bioethics in particular. When he first turned to bringing the energies of philosophy to medicine and the biomedical sciences, one could find few individuals at professional philosophical meetings to take this project seriously. Yet, Stuart Spicker recognized that philosophers had to be brought to engage the field of medicine. In the absence of philosophy’s discipline, the bioethics that was emerging would be conceptually shallow and important issues would be inadequately addressed. Spicker recognized that medicine, the biomedical sciences. and bioethics would not be appropriately treated unless serious philo- sophical scholarship addressed the foundations of bioethics and the philosophy of medicine. In addition. he correctly saw that such exami- nations needed a substantial vehicle for their expression. Stuart Spicker was convinced that there must be scholarly conferences to produce a literature and then there must be vehicles for its publication. This insight led to the establishment of the Philosophy and Medicine series. Stuart F. Spicker joined in launching the Philosophy and Medicine series in a period when the term “bioethics” had just been coined.¹ There was little anticipation of the breadth and depth of the intellec- tual interest that would come to support this area of scholarship. There was much foment about the dehumanizing character of technology and
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