Increasingly, students and professionals within healthcare are faced with difficult questions and decisions: medical progress and technological innovation are widening the therapeutic scope, thereby both allowing for new, exciting possibilities but also making clinical decisions more intricate. That’s why it is no longer enough to provide healthcare students and professionals with some basics in biomedical ethics; rather, what is needed is also an accessible guide to ethical theories and practices, which does not presuppose any background or training in philosophy while at the same time not renouncing the fundamental questions at the core of the medical profession – this book aims to be exactly that ethical guide.
Increasingly, students and professionals within healthcare are faced with difficult questions and decisions: medical progress and technological innovation are widening the therapeutic scope, thereby both allowing for new, exciting possibilities but also making clinical decisions more intricate. That’s why it is no longer enough to provide healthcare students and professionals with some basics in biomedical ethics; rather, what is needed is also an accessible guide to ethical theories and practices, which does not presuppose any background or training in philosophy while at the same time not renouncing the fundamental questions at the core of the medical profession – this book aims to be exactly that ethical guide.
Ethics in Healthcare: A Philosophical Introduction
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Ethics in Healthcare: A Philosophical Introduction
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Overview
Increasingly, students and professionals within healthcare are faced with difficult questions and decisions: medical progress and technological innovation are widening the therapeutic scope, thereby both allowing for new, exciting possibilities but also making clinical decisions more intricate. That’s why it is no longer enough to provide healthcare students and professionals with some basics in biomedical ethics; rather, what is needed is also an accessible guide to ethical theories and practices, which does not presuppose any background or training in philosophy while at the same time not renouncing the fundamental questions at the core of the medical profession – this book aims to be exactly that ethical guide.
Product Details
| ISBN-13: | 9781786608710 |
|---|---|
| Publisher: | Rowman & Littlefield Publishers, Inc. |
| Publication date: | 08/30/2018 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 152 |
| File size: | 2 MB |
| Age Range: | 18 Years |
About the Author
Read an Excerpt
CHAPTER 1
Mind and World
What's the Point of Philosophy Anyway?
You may be wondering why on earth healthcare professionals should bother with ethics and philosophy. What is the point of it? Those are actually two separate questions: what's the point of philosophy and ethics in general, and what is the point of them when it comes to the healthcare context? Both are, I think, legitimate questions — so I will start by trying to provide an answer; and this will also end up giving an introduction to the subject matter of this book.
There are, I think, at least two ways of showing the importance of philosophy and philosophical questions even for those who work (or will go on to work) within healthcare; and, more in general, for those with practical or applied tasks and jobs — otherwise known as 'the real world' (as philosophers like to call, well, everything else really).
I. The first point is that empirical questions (and answers) do not exhaust all the questions worth asking (whether they may still exhaust all the answers though, at least all the meaningful ones anyway, is a more difficult issue).
II. Secondly, a lot of your work within healthcare will consist in decision making and problem solving, and many of the tools and skills that are necessary for effective decision making and problem solving are the tools of reason — they are, namely, philosophical tools and skills.
This second point is exacerbated by technological progress and automation, which at the same time reduce the manual tasks for which professionals (as in, human professionals) are required while also increasing the complexity of the decisions that human professionals have to make and the problems that they have to solve. Technological development may offer exciting new therapeutic possibilities and certainly provides overall for better healthcare, but that does not at the same time necessarily mean that it makes the working lives of healthcare professionals easier; the very opposite may actually be the case.
Each of the above two points is enough to independently show the importance of philosophy as a discipline and of philosophical questions in particular; both generally speaking and specifically for doctors and healthcare professionals. But while I will not elaborate on the second issue here, this chapter will concern itself with the first point.
Empirical Questions Are Not All the Questions Worth Asking
It is easy to show that many questions, many important questions, are not empirical questions and that the fact that they cannot be solved empirically is no reason not to ask and try to answer these questions — that, you may say, is what philosophy is for.
Try to think of what matters most to you and you will see that some if not many of the things we hold most dear are not empirical: am I going to die? Yes, you are. This is indeed pretty high on anybody's list while being, admittedly, an empirical issue — both science and experience show us the inevitability of death. Does god exist? It very likely does not, but already here it is not obvious that this question can be settled empirically. Or think about questions such as whether to have children or what career to choose: many of the great practical questions in our lives are not easily settled empirically. Not to mention ethical dilemmas: Why should one do the right thing? What's in it for me? Again, if there is an answer, it does not look to be a simple question of fact.
More philosophically, 'Why is there something rather than nothing?' is a question that most people will have posed themselves at some point during their lives and it is, according to some (notably Martin Heidegger), the most fundamental question; but it is hardly a question that we can answer empirically through scientific method or experiments.
In somewhat similar terms we could think of questions about the finite or infinite nature of time and space; think of those deep questions from our childhood about what's beyond the end of the universe or what was before the beginning of it.
The same goes for epistemological questions about whether we can ever know the external world or be sure that it — or anything really — does actually exist: recall Rene Descartes' cogito ergo sum, according to which the only thing that we cannot doubt is our own existence as thinking beings; as minds, that is, rather than bodies. So we can't even be sure of the existence of our own body, according to Descartes, let alone the rest of the universe.
But we don't even need to go to these great depths of fundamentality to encounter nonempirical questions: if you were asked to point your index finger at your mind, in which direction would you point? You may plausibly answer that you would point towards your head for the simple reason that the mind is either identical with the brain, or anyway somewhat dependent on or connected to the brain (or at least more generally to our body anyway).
These are plausible answers that are the object of much debate within philosophy; but again here the point is not what the correct answer is but what kind of question we are asking and what kinds of answers would be legitimate or appropriate ones in the first place — and the suggestion we are looking at is that what the mind is and what its relation to the brain consists of are not purely empirical questions that can be settled through scientific method alone.
CASE STUDY I: The Nervous Patient
More specifically to the healthcare profession: suppose you have a patient who would rather not undergo a minor operation and risk serious health consequences that could be easily avoided through this minor procedure. What is the right thing to do in this case? Is it best to simply passively accept the patient's wish — after all, consent, as we will see later on (chapter 6 of this book is indeed dedicated to consent within healthcare), is a fundamental requirement within healthcare? Or should one at least try to convince the patient by providing much more information and detail about the trivial nature of the procedure and the serious consequences of not intervening? Alternatively, should one put pressure on the patient or even try to coerce the patient into the procedure (say the patient is still very young or, on the other hand, senile)?
The point here goes beyond what is the best medical and ethical approach to this and countless other difficult cases that healthcare professionals face every day. Some of these cases may be easier to solve than others: in the one above, for example, it seems that providing more information would be the least that the doctor should do while coercion would appear to be going too far (except maybe for extreme circumstances that will have to do with the patient's state of mind). So this case is possibly not even that intractable — as opposed to, say, a case of breaking patient confidentiality in the hope of saving someone else's life.
Still, the point is not how easy or difficult these dilemmas are; the point is rather that the questions that need to be answered to decide what to do in such a case are not purely empirical questions: there are, it is obvious, medical considerations that are crucial to such a decision; but — and that is the main point here — answering all the relevant medical questions will still not tell you what to do in such a case; which is to say: purely medical questions, in the above case, do not exhaust all the relevant questions.
And this is really, in a nutshell, my answer to our initial question: not all the questions and problems that healthcare professionals will have to address will be medical or, in broader terms, empirical ones; and that is why it is important — indeed, crucial — that healthcare professionals (and this also applies well beyond healthcare) engage with ethical and philosophical questions too. Basically, without those skills you will not be able to get the job done — it is as simple as that.
What other relevant questions are there, in such a case, beyond medical (and other empirical) questions? Here's one: when it comes to a patient's health, should we listen only to the doctor's expert opinion or also to the patient's wishes? This is not a medical question; neither is it another kind of empirical question, even though there is at least one sense in which answers to this question may be or become empirical: if they become the object of legislation.
If it is stipulated by law that the patient's wishes have to be taken into account, for example, then there would be an empirical answer to our question: namely, the law. Still, even in this particular — legal — sense of empirical questions and answers, the issue is unresolved: namely, what justifies a piece of legislation? What makes it a good law or one that it would be wrong to disobey?
Here, again, we may have to appeal to ethical considerations in order to justify legislation, which would again allow room for nonempirical questions (alternatively, one may just say that a law is just as long as it has been approved following appropriate procedures — say, voted in by a democratically elected parliament; but again it is easy to see here that some of these further issues are not easily resolved empirically, just think of the adjective 'appropriate' and the adverb 'democratically' above).
The basic point is, then, that there are questions that are not purely empirical and that are at the same time crucial to our decisions and to the problems that we face in real life: above we have identified at least two kinds of such questions, both of which are broadly philosophical. Some of these philosophical questions are purely theoretical; others are of a practical nature because they have more directly to do with deciding what to do.
Indeed, this will be a good way of thinking of philosophy and ethics — and philosophical and ethical questions — throughout: not as something distinct but rather in terms of ethical questions being one kind of philosophical question, the practical kind.
Here it is important not to mix up two different distinctions that we have made so far: on the one hand, we have started with a distinction between empirical and nonempirical (philosophical, if you like) questions; and now we have introduced the distinction between practical questions and theoretical questions. As it should be clear from our discussion so far, those are two different distinctions and, importantly, theoretical questions are not necessarily empirical and practical questions may also be empirical ones; indeed, here all combinations are possible.
There are theoretical questions of an empirical nature — a lot of questions within the basic natural sciences will belong to this group; and there are, as we have seen, theoretical questions that are not empirical, as the fundamental questions about existence or knowledge that we have discussed above. Similarly, there are practical questions that are not empirical, as the questions of ethics and moral philosophy.
There are also practical questions that are empirical though: suppose you are driving your friend home and you ask whether you should turn right or left at the next junction. That is a practical question: you want to know what to do there and then; but it is an empirical question too. Given what you are trying to achieve — driving your friend home — there will be better and worse answers to that question just as there will be shorter or longer routes (or more or less scenic routes, or ones with more or less traffic, or whatever).
We should keep these two distinctions separate then. Interestingly enough, medicine and healthcare transcend both of these two distinctions: the clinical nature of medical practice means that it is a practical as much as a theoretical discipline; and, as we have just seen, empirical questions and answers do not exhaust all the issues that are relevant in order to decide what to do as a doctor or other healthcare professional.
A side conceptual note before we move on: in thinking about the distinction between the theoretical and the practical, we should also say something about the concepts of medicine and healthcare, as our understanding and use of these concepts may very well depend on the practical-theoretical distinction. One could imagine, namely, the following two alternatives: on the one hand, medicine could be understood as one component of healthcare, which would then be the broader concept that also includes practices which are not necessarily medical ones: while probably nurses should count as being within medicine, it would not be implausible to think of care homes or also a lot of social work as, say, a nonmedical part of healthcare. But there is an alternative to this view of things: namely, that medicine is the theoretical head, if you like, and healthcare its practical arm. These distinctions may appear to be just another conceptual game but they could end up having significant implications to the way in which our health systems are organized.
Necessity and Objectivity
What does it mean that a question is or isn't empirical? It seems that we have been assuming a distinction, here, which could itself be taken to be controversial. In a basic and premature sense, we could say the following — and indeed something along these lines has been guiding us so far: empirical questions are those questions which science can at least hope to give an answer to.
This should not be taken to mean that these questions have already been answered by science nor that they have been answered correctly nor that they will ever be answered correctly by science; more modestly, it should for now be taken to mean that empirical questions are those that it is appropriate for science to try to answer — whether or not science will actually ever provide a satisfactory (true?) answer would then not be crucial to the empirical nature of the question.
If you are asking yourself how a question could ever be an empirical question if science will never manage to answer it (or answer it correctly), then it may be helpful to reflect upon the fact that science — as a human endeavour — is a limited enterprise in the basic sense that humans are cognitively limited in time, space, and capacities: that basically means that there may be questions which — in theory — are available for science to give an answer to but we will never get around to give or find the answer because of our limited cognitive capacities as humans.
Here again we should not confuse the attempt to make such a distinction between empirical and nonempirical questions and to ground it on what science can or cannot appropriately try to answer with the ability to neatly sort questions either under the 'empirical' heading or under the 'nonempirical' heading. This second task represents a further difficulty and there will be questions of which it will be hard to say where they belong and over which people will genuinely disagree.
CASE STUDY II: The Existence of God
Think of the following question: does god exist? Remember, the point here is not to answer the question but merely to establish whether this question is an empirical one. This last point is important because we could imagine quite a few possibilities:
A) god exists and the question of its existence is an empirical question;
B) god exists and the question of its existence is not an empirical question;
C) god does not exist and the question of its existence is an empirical question;
D) god does not exist and the question of its existence is not an empirical question.
There are probably more alternatives than the four above (agnosticism, for example — or the meaninglessness of the question) but I will stick to the ones above for now.
It is probably fair to say that most if not all monotheistic religions hold (B) rather than (A) and take it to be very important — indeed, all-important — that (B) rather than (A) is the case. Here we can't go into any theological detail but the basic point is that the existence of god is supposed to be necessary rather than contingent, so the standard religious claim will not be merely that: god exists; it will rather be the stronger claim that: god necessarily exists.
It is consistent with the former claim but not with the latter claim that god may have not existed — that's the crucial difference and that's the reason why most if not all religions go for the latter rather than the former; and indeed god would provide even less explanation than it may do now within religious worldviews if its existence were a mere fact of empirical contingence; god could not, for example — to go back to a question we have already mentioned — even begin to answer the question of why being rather than nothing if its very existence was contingent.
(Continues…)
Excerpted from "Ethics in Healthcare"
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Copyright © 2018 Ezio Di Nucci.
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