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Books > Medicine > General issues > Medical ethics
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For the Patient's Good - The Restoration of Beneficence in Health Care (Hardcover)
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For the Patient's Good - The Restoration of Beneficence in Health Care (Hardcover)
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In this companion volume to their 1981 work, A Philosophical Basis
of Medical Practice, Pellegrino and Thomasma examine the principle
of beneficence and its role in the practice of medicine. Their
analysis, which is grounded in a thorough-going philosophy of
medicine, addresses a wide array of practical and ethical concerns
that are a part of health care decision-making today. Among these
issues are the withdrawing and withholding of nutrition and
hydration, competency assessment, the requirements for valid
surrogate decision-making, quality-of-life determinations, the
allocation of scarce health care resources, medical gatekeeping,
and for-profit medicine. The authors argue for the restoration of
beneficence (re-interpreted as beneficence-in-trust) to its place
as the fundamental principle of medical ethics. They maintain that
to be guided by beneficence a physician must perform a right and
good healing action which is consonant with the individual
patient's values. In order to act in the patient's best interests,
or the patient's good, the physician and patient must discern what
that good is. This knowledge is gained only through a process of
dialogue between patient and/or family and physician which respects
and honors the patient's autonomous self-understanding and choice
in the matter of treatment options. This emphasis on a dialogical
discernment of the patient's good rejects the assumption long held
in medicine that what is considered to be the medical good is
necessarily the good for this patient. In viewing autonomy as a
necessary condition of beneficence, the authors move beyond a trend
in the medical ethics literature which identifies beneficence with
paternalism. In their analysis of beneficence, the authors reject
the current emphasis on rights- and duty-based ethical systems in
favor of a virtue-based theory which is grounded in the
physician-patient relationship. This book's provocative
contributions to medical ethics will be of great interest not only
to physicians and other health professionals, but also to
ethicists, students, patients, families, and all others concerned
with the relationship of professional to patient and patient to
professional in health care today.
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