Health care, human worth and the limits of the particular

Journal of Medical Ethics

Volumn 23, Issue 5, 1997, Pages 310-314

  Cherry, Christopher ^a  

^a UNIVERSITY OF KENT   (United Kingdom)

Author keywords

Absolute worth; Abstraction of separateness; Detraction from identity; Instrumental value; Personal and impersonal

Indexed keywords

ARTICLE; HEALTH CARE; HEALTH CARE SYSTEM; IDENTITY; INDIVIDUALITY; MEDICAL ETHICS; MORALITY;

EID: 0030665374     PISSN: 03066800     EISSN: None     Source Type: Journal    
DOI: 10.1136/jme.23.5.310     Document Type: Article

References (13)

1. See, for instance, Empathy and the Practice of Medicine, eds Spiro H, Curnen MGM, Peschel E and St James D, Yale University Press, New Haven, 1994; and the special section on compassion in Cambridge Quarterly of Healthcare Ethics 1995; 4: 476-87.
2. See, for instance, Empathy and the Practice of Medicine, eds Spiro H, Curnen MGM, Peschel E and St James D, Yale University Press, New Haven, 1994; and the special section on compassion in Cambridge Quarterly of Healthcare Ethics 1995; 4: 476-87.
3. Harris J. The value of life. London: Routledge, 1985: 9.
4. Warnock M. Bioethics: the danger of rhetoric. Philosophical Quarterly 1983; 33: 241.
5. My idea is very unlike Kant's. He and others who believe in the ultimate value of persons, and talk in this connection of Respect and Dignity, believe that there are properties, such as rationality, which human beings must possess to join the person club. I have no use here for this notion of "person".
6. Guardian Weekend 1996 Feb 3.
7. I am aware that I leave much unsaid. Some of the issues involved are examined by John Harris in his criticisms of Anne Maclean's The elimination of morality, London: Routledge, 1993, in his The elimination of morality Journal of Medical Ethics 1995; 21: 220-4. Both Maclean and Harris seem to me to confuse (though in different ways) questions about humankind with ones about individual human beings, justification with description, and determinacy of description with indeterminacy.
8. I am aware that I leave much unsaid. Some of the issues involved are examined by John Harris in his criticisms of Anne Maclean's The elimination of morality, London: Routledge, 1993, in his The elimination of morality Journal of Medical Ethics 1995; 21: 220-4. Both Maclean and Harris seem to me to confuse (though in different ways) questions about humankind with ones about individual human beings, justification with description, and determinacy of description with indeterminacy.
9. Williams A. Economics, QALYs and medical ethics: a health economist's perspective. Fifth world congress on ethics and medicine, Imperial College, London, Sept 1993: 1-2.
10. It is unclear how extensively or consistently QALYs are currently applied at micro-or macro-level in our own or others' health services. Even so, they represent the most developed attempt so far to measure benefits from health care with a view to ranking them in league tables for rationing purposes. Some of the broad-brushed objections are interesting in ways which go far beyond the issues to which they are addressed. For they attach great ethical significance to the difference between moral and natural evil, between doing bad things and bad things happening. It is one thing to plan where distress shall and shall not fall, and another to let it fall where it will, as nature takes its course. Planning it should mean, of course, that there will be less of it anyway; but this can't have much force against someone who makes the distinction between act and event fundamental.
11. Rhodes R. Love thy patient: justice, caring, and the doctor-patient relationship. Cambridge Quarterly of Healthcare Ethics 1995; 4: 445. A recent example of a self-lacerating doctor is found in The inhumanity of medicine, British Medical Journal 1994; 309: 1671-2.
12. Rhodes R. Love thy patient: justice, caring, and the doctor-patient relationship. Cambridge Quarterly of Healthcare Ethics 1995; 4: 445. A recent example of a self-lacerating doctor is found in The inhumanity of medicine, British Medical Journal 1994; 309: 1671-2.
13. The discussion of the last page or two raises a number of far more general points. One is that a fairly familiar distinction between caring for and caring about cannot accommodate my own which is (very crudely) one about different applications of the former and their respective conditions. Another is the extent to which many people care not just about being made better or made to feel better but also about who makes this happen, and why - about sources and agents of delivery as well as, and to a degree irrespective of, outcomes. They want, however obscurely, to know why it should be thought worthwhile to try and make them - indeed, anyone - better, and ultimately how the centralised system of care in which they find themselves can be seen to retain links with the root impulse to relieve suffering which must somehow be its original inspiration. This concern - a further and related point - is one determination of a more general Humean concern with natural and artificial virtue. How on earth can the latter be grounded, as it must be, in the former? And of course the parallel does not stop there. The values that only artifice can bring, like justice and its management, are always purchased at some cost to natural partiality. (See my Nature, artifice and moral approbation. Journal of the Aristotelian Society 1976; L:265-82.)