Lisa H. Newton

Physician and patient: Respect for mutuality

Philosophers and physicians alike tend to discuss the physician-patient relationship in terms of physician privilege and patient autonomy, stressing the duty of the physician to respect the autonomy and the variously elaborated ‘rights’ of the patient. The authors of this article argue that such emphasis on rights was initially productive, in a ‘first generation’ of debate on medical ethical issues, but that it is now time for a second generation effort that will stress the importance of the unique experiential aspects of the physician-patient relationship — mutual trust, suffering and healing. We attempt here to initiate this second-generation discussion, presenting the first generations philosophical background, criticizing it from the perspective of clinical experience, and seeking a synthesis in the relational qualities of patient and physician interacting in a medical context.

The internal morality of the corporation

Is good morality the natural outcome of profitable business practices? The thesis explored here is one version of the recent literature on corporate culture, typified by the bestselling In Search of Excellence — that the corporation that creates a strong culture, one that best serves the customer, the product, and the employee, must also be profitable. The thesis turns out to have an historical parallel in Platos Republic (subtitled, I suppose, “In Search of Justice”). Parallel “virtues” can be worked out for state and corporation. In the end, profitability turns out not to be a necessary consequence of excellence, just as Platos “Ideal” state turned out to be mortal.

Charting shark-infested waters: Ethical dimensions of the hostile takeover

Except for a small clutch of academic shark-defenders, everyone seems to know that hostile takeovers are wrong, destructive of people and industries, and damaging to the long-term competitiveness of corporate America. But analysis of the takeover process, absent insider trading, fails to identify any injury that is not replicated elsewhere in the business system. Current suggestions for remedying the situation seem inadequate, ill-fitted to the problem, or hostile to the entire capitalist system. Could it be that it is that system as a whole, or the assumptions underlying it, that is at fault?

LIBERTY AND LAETRILE: IMPLICATIONS OF RIGHT OF ACCESS*

The whole problem of Laetrile is this: that people want to take it, but it does them no good. And in that simple fact, given that Laetrile is known as a drug, there lies a fundamental and irreconcilable conflict between the two guiding values of American life from its beginnings. The values are Liberty and Welfare: in the twentieth century they have reached an equipoise of influence and respect; and the outcome of the Laetrile controversy may be not only a sign but a determining factor in the eventual assignment of priority between them. For this reason the issue is of compelling interest to contemporary social philosophy, and analysis of the issue in the terms of the categories of that discipline may serve to indicate some of the intellectual consequences of the options before us. I happen to think that the analysis suggests the advisability of a course of action with regard to Laetrile; I will present and defend that conclusion in the latter half of the paper.

The Occupational Imperative: Engaging the Professions in Teaching Ethics

The teaching of ethics, this paper suggests, is shaped by economic and other influences from the world outside the university gates, and by the expectations we as a society hold for those who have mastered the subject. For much of American history, university graduates were expected to settle into an elite group of civic leaders, requiring for that role a rich understanding of the classical sources of ethical discussion. In the more fluid society that followed, they were expected to use the critical thinking that they had developed in ethics class to keep the society rational in a sea of conflicting claims. Now, in the anomic society of unfamiliar economic and political threats, the best way to teach ethics is through the moral sensibility that underlies it, by sending the students off campus altogether and exposing them, through internships and other experience, to the operations of the world they will soon have to join.

Greening, Root and Branch: The Forms and Limits of Environmentalism

The purpose of the paper is to examine the roots of our obligation to preserve the land and its resources, to address in some systematic way the “So what?” response to the massive documentation of environmental deterioration and the accompanying environmentalist imperatives. We will begin with an exercise in deconstruction—the parsing of an event, just one event, to extract from its account some of the problems that environmentalism has got itself into, especially in dealing with the multiple faces of American business. From that point we will be in a position to address the central project of the paper, an elaboration of an ethic for the appreciation and protection of the natural environment, ‘the land’, for short, meaning the earth, all its life, all its resources.

Educated Warfare: Adversary Relations in the Groves of Academe

Reflecting on the nature, causes, and possible resolutions of the faculty-administration adversarialism is ubiquitous on our campuses. There is no doubt that we have faculty on our campus who simply detest administrators, and we know by hearsay that there are administrators (especially Board members) who detest faculty. The climate of adversarialism does not seem to boil down, at the end, to personal likes and dislikes. There is also no doubt that there is a vast fund of mutual respect and genuine friendship among other faculty and administrators, but those bonds do not seem to end the adversary relationship, or even mitigate it. There doesn’t seem to be any institutionalization of the adversarialism, as there is, for instance, in the American judicial system. Then where does it come from, and what can be done about it? I argue that we can come to see adversarialism as good, and learn to live peacefully with it. And conclude that we probably aren’t going to do a very good job at living peacefully, but it’s still worth the effort of trying. Adversarialism is in the end no more than the inevitably fractious working out of the competition of legitimate visions in a setting where (at our best) every vision is respected and honored, but (even at our best) resources are necessary and limited.

The Concept of a Right Ordering

There can be no doubt that the dramatic increase in malpractice litigation in our time constitutes a serious social problem. Solutions to that problem do not seem to be forthcoming from medicine, which cannot guarantee that patients will always fully recover from every illness, nor do they seem to be forthcoming from law, which cannot make logical room in the corpus juris for any a priori limitations on the right to sue for damages. Nor will solutions be found, I am presently convinced, through attempts to assimilate the modes of thought appropriate to one profession into those appropriate to the other: to make lawyers somehow partners in a healing process, or to describe, or circumscribe, each facet of the physician-patient relationship in terms of legal rights, duties and responsibilities. I agree with Darrel Amundsen that the tension between lawyers and physicians drawn by the malpractice issue has certain ancient roots. But a partial resolution of our otherwise unprecedented present condition will require a fundamental reordering of specifically modern social expectations, i.e., the expectations that an individual is taught to hold toward his society — and not only with regard to the workings of law and medicine.

Hippocrates Lost, A Professional Ethic Regained: Reflections on the Death of the Hippocratic Tradition

In the present article, it is my intent to consider the morality of the Hippocratic Oath in the context of a larger discussion of bioethics. That discussion is itself so remarkable, and so contrary to the morality of the Hippocratic Oath, that I shall take its existence as the starting point for my present reflections. The existence of bioethics is remarkable because it presupposes a common ground of dialog between philosophers and physicians, a willingness on the part of both professions to contribute insights from their specialized literature and their diverse experiences to the solution (or at least the clarification) of problems that sprawl across the historic boundaries of either one. And it is contrary to the morality of the Hippocratic Oath that such willingness should be there on the part of the physicians. Those in the field tend to begin all such articles or discussions with a comment on the “recent interest in bioethics”: this odd mannerism should call our attention to the profound changes in medicine proper that have made discussions of bioethics at all possible, changes specifically in the very influence of the Hippocratic Oath on those practicing in the field.