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The authors' credentials point to a growing focus on ethical concerns in the country's medical centers. Pellegrino is President of Catholic University of America as well as Professor of Philosophy and Biology and of Clinical Medicine at Georgetown University in Washington, D.C. Thomasma is Director, Human Values and Ethics, Center for the Health Sciences at the University of Tennessee. In their aim to develop a philosophy of medicine and a foundation for medical ethics they reflect the ""moderate realism of the Aristotelian-Thomist tradition"" with a little phenomenology and empiricism thrown in. In short, an eclectic, pragmatic approach. The problem is that, while they illuminate the issues, they arrive at no conclusions. They are duly mindful of today's currents and counter-currents: an oft-times adversarial relationship between doctor and patient; inclinations toward holistic or anti-establishment medicine in the midst of increasing bureaucratization; multiple prototypes of patients' bills of rights, rights to life, fights to die, rights to informed consent, rights to hospital ombudsmen. To avoid extreme positions or purely theoretical arguments, the authors concentrate on the practice of medicine, the dynamics of a goal-oriented relationship involving two or more people. This concentration places the moral center of medicine on the relationship between an individual supposedly endowed with expertise and someone motivated to seek health and well-being. The dynamics of that encounter and the decision-making involved then can serve as a springboard for the discussion of fundamental moral questions such as: What constitutes the good life? Is the patient's autonomy defensible when he chooses what is harmful? And so on. The authors are very good at postulating the benefits to both philosophy and medicine from opening a discussion--perhaps too good, given their penchant for summaries and restatements. One can hardly find a point of disagreement, either. To their argument for a contractual, covenant-like relationship between physician and patient, one in which each individual has responsibilities and commitments, there can hardly be a demurrer. Not a controversial or catalyzing text, then, but rather a thoughtful inquiry inviting attention and further discourse.

Pub Date: Dec. 1st, 1980
Publisher: Oxford Univ. Press