Colleen D. Clements

Patients' ethical obligation for their health.

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicines basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.

Systems ethics and the history of medical ethics

This paper reviews the current conclusions in medical ethics which have followed the 1969–1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thiking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. A methodology for a Systems Ethics analysis of cases is presented and illustrated by the case of a physician-assisted suicide. The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and “political correctness” in medical ethics.

Physician as Body Mechanic—Patient as Scrap Metal: What’s Wrong with the Analogy

It is not often that I find myself in such consistent disagreement with a presentation as I have with Michael D. Bayles’ “Physician as Body Mechanic.” My disagreement ranges from the basic infrastructure of the analogy to the heuristic value of using it. Unfortunately, I find the disagreement fundamental and total.