NOTES
PREFACE
1. David L. Sackett, William M. C. Rosenberg, J. A. Muir Gray, R. Brian Haynes, and W. Scott Richardson, âEvidence-Based Medicine: What It Is and What It Isnât,â British Medical Journal 312, no. 7023 (1996): 71â72.
INTRODUCTION
1. It is important for us to clarify our use of âwell-beingâ here. Our own moral theory has a substantive account of human flourishing at its foundations, and such flourishing could equally be designated as a form of well-being. However, throughout this book, when we use the expression in italicsâwell-beingâwe mean to designate the thin, preference- and desire-satisfaction model that many medical ethicists presently use. We typically italicize the first use of the expression in a chapter, and then rely on context to make it clear which sense of âwell-beingâ we mean.
2. As we discuss further in chapter 1, Beauchamp and Childressâs enormously influential framework focuses on four principles: beneficence, nonmaleficence, justice, and autonomy. See Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed. (New York: Oxford University Press, 2013), 13â14.
3. See Ronit Y. Stahl and Ezekiel J. Emanuel, âPhysicians, Not ConscriptsâConscientious Objection in Health Care,â New England Journal of Medicine 376, no. 14 (2017): 1380â85.
4. H. Tristram Engelhardt, The Foundations of Bioethics, 2nd ed. (New York: Oxford University Press, 1996), 7.
5. A 2016 U.S. News & World Report article showed that ânearly half of U.S. physiciansâ49 percentâmeet the definition for overall burnout.â In addition, physiciansâ âsatisfaction with work-life balance is far lower than that of others: 36 percent versus 61 percent.â See Steve Sternberg, âDiagnosis: Burnout,â U.S. News & World Report, September 8, 2016. See also Tait D. Shanafelt, Omar Hasan, Lotte N. Dyrbye, Christine Sinsky, Daniel Satele, Jeff Sloan, and Colin P. West, âChanges in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population between 2011 and 2014,â Mayo Clinic Proceedings 90, no. 12 (2015): 1600â1613.
6. Michael J. Balboni and Tracy A. Balboni, Hostility to Hospitality: Spirituality and Professional Socialization within Medicine (New York: Oxford University Press, 2019).
7. As will become clear, we see two interrelated disagreements about medicine: one over whether health should be the primary and largely exclusive purpose of medicine and one over what health is.
8. Edelsteinâs translation renders the Greek well: âI will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedyâ (Îżáœ ÎŽÏÏÏ ÎŽáœČ ÏÏ
ÎŽáœČ ÏÎŹÏÏΌαÎșÎżÎœ ÎżáœÎŽÎ”Μ᜶ αጰÏÎ·ÎžÎ”áœ¶Ï ÎžÎ±ÎœÎŹÏÎčÎŒÎżÎœ ÎżáœÎŽáœČ áœÏηγΟÏÎżÎŒÎ±Îč ΟÏ
ÎŒÎČÎżÏ
Î»ÎŻÎ·Îœ ÏÎżÎčΟΎΔΠáœÎŒÎżÎŻÏÏ ÎŽáœČ ÎżÏÎŽáœČ ÎłÏ
ΜαÎčÎș᜶ ÏΔÏÏ᜞Μ ÏΞÏÏÎčÎżÎœ ÎŽÏÏÏ). Ludwig Edelstein, The Hippocratic Oath: Text, Translation, and Interpretation (Baltimore, MD: Johns Hopkins University Press, 1943), 2â3.
9. For discussion of this claim in relation to the oath itself, see T. A. Cavanaugh, Hippocratesâ Oath and Asclepiusâ Snake (New York: Oxford University Press, 2018).
10. C. S. Lewis, The Abolition of Man, or, Reflections on Education with Special Reference to the Teaching of English in the Upper Forms of Schools (San Francisco: HarperSanFrancisco, 2001), 43.
11. Gerald P. McKenney, To Relieve the Human Condition: Bioethics, Technology, and the Body (Albany, NY: State University of New York [SUNY] Press, 1997), 16. McKenney himself engages dialectically with a number of previous critics, such as Hans Jonas Leon Kass and Stanley Hauerwas, from whom we have also learned much.
12. Jeffrey P. Bishop, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying (Notre Dame, IN: University of Notre Dame Press, 2011).
13. Ibid., 9.
14. âSocial imaginaryâ is a term that Charles Taylor explores in depth in his Modern Social Imaginaries (Durham, NC: Duke University Press, 2004), 23.
15. Edmund D. Pellegrino, âThe Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions,â Journal of Medicine and Philosophy 26, no. 6 (2001): 559â79.
16. McKenney, To Relieve the Human Condition: Bioethics, 16.
17. See Edmund D. Pellegrino, The Philosophy of Medicine Reborn: A Pellegrino Reader, ed. H. Tristram Engelhardt Jr. and Fabrice Jotterand (Notre Dame, IN: University of Notre Dame Press, 2008); Leon R. Kass, âRegarding the End of Medicine and the Pursuit of Health,â Public Interest 4 (1975): 11â 42; Alasdair MacIntyre, After Virtue: A Study in Moral Theology, 3rd ed. (Notre Dame, IN: University of Notre Dame Press, 2007), 194. See also John Keownâs assessment of John Finnis: âA New Father for the Law and Ethics of Medicine,â in Robert P. George and John Keown, Reason, Morality, and Law: The Philosophy of John Finnis (Oxford: Oxford University Press, 2014), 290â307.
18. See MacIntyre, After Virtue, 222.
CHAPTER ONEThe Way of Medicine
1. Alasdair MacIntyre, After Virtue: A Study in Moral Theory, 3rd ed. (Notre Dame, IN: University of Notre Dame Press, 2007), 187.
2. For more on the difference between experiencing oneâs work as a job versus as a calling, see Robert N. Bellah, William M. Sullivan, Richard Madsen, Ann Swindler, and Steven M. Tipton, Habits of the Heart: Individualism and Commitment in American Life (Berkeley: University of California Press, 1985); Amy Wrzesniewski, Clark McCauler, Paul Rozin, and Barry Schwartz, âJobs, Careers, and Callings: Peopleâs Relations to Their Work,â Journal of Research in Personality 31, no. 1 (1997): 21â33; and Douglas T. Hall and Dawn E. Chandler, âPsychological Success: When the Career Is a Calling,â Journal of Organizational Behavior 26, no. 2 (2005): 155â76.
3. Aristotle, Nicomachean Ethics, trans. David Ross (New York: Oxford University Press, 2009), 1094a10.
4. For an introduction to debates about whether medicine has an intrinsic telos and an internal morality, see the collection of papers on the subject in the Journal of Medicine and Philosophy 26, no. 6 (2001).
5. See Jean Bethke Elshtain, âWhy Science Cannot Stand Alone,â Theoretical Medicine and Bioethics 29, no. 3 (2008): 161â69.
6. See Paul A. Lombardo, Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck v. Bell (Baltimore, MD: Johns Hopkins University Press, 2010).
7. Aristotle, Nicomachean Ethics, 1094b25.
8. See, particularly, Leon Kass, âRegarding the End of Medicine and the Pursuit of Health,â Public Interest 40 (1975): 11â42. See also Luke Gormally, âThe Good of Health and the Ends of Medicine,â in Holder Zaborowski, Natural Moral Law in Contemporary Society (Washington, DC: Catholic University of America Press, 2010), 264â84. Gormally argues for views of both health and medicine very similar to ours.
9. See Christopher Boorse, âHealth as a Theoretical Concept,â Philosophy of Science 44 (1977): 542â73. Some proponents of an objective account, such as Boorse, further understand health as merely the absence of disease. In contrast, we claim that health is a positive quality and is, in this important sense, prior to disease. Disease is knowable because it causes a diminishment of health, but health is knowable apart from any disease. Whatâs more, health can be diminished even in the absence of disease, as when a person becomes unhealthy as a consequence of inactivity. Therefore, the opposite of health is not disease but ill healthâthe privation or absence of health.
10. For a discussion of evaluative concepts of health and disease see Jacob Stegenga, Care and Cure: An Introduction to Philosophy of Medicine (Chicago: University of Chicago Press, 2018), chaps. 1 and 2.
11. These syndromes include conditions such as chronic fatigue and fibromyalgia. See Jiwon Helen Shin, John D. Yoon, Kenneth A. Rasinski, Harold G. Koenig, Keith G. Meador, and Farr A. Curlin, âA Spiritual Problem? Primary Care Physiciansâ and Psychiatristsâ Interpretations of Medically Unexplained Symptoms,â Journal of General Internal Medicine 28, no. 3 (2013): 392â98.
12. Because humans are ever incomplete, to be human is to be disabled and dependent in significant measure, even if that dependence and disability are not socially conspicuous.
13. Gerald P. McKenny, To Relieve the Human Condition: Bioethics, Technology, and the Body (Albany, NY: State University of New York [SUNY] Press, 1997).
14. Some have interpreted Kass as disregarding mental health. He was at pains to distinguish pursuit of happiness from pursuit of health, but in our view, his account of the well-working of the organ...