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Just Healthcare beyond Individualism: Challenges for North American Bioethics

  • Solomon R. Benatar (a1)

Extract

Medical practitioners have traditionally seen themselves as part of an international community with shared and unifying scientific and ethical goals in the treatment of disease, the promotion of health, and the protection of life. This shared mission is underpinned by explicit acceptance of traditional concepts of medical morality, and by an implied link between individual human rights and the ethics of medical practice long enshrined in a range of World Medical Association (WMA) and other medical codes. These have been powerful instruments exhorting individual practitioners to promote health and to defend universal principles in order to protect their patients and the physician-patient relationship even in the face of authoritarian state coercion and imposed national ideologies and policies. There has been widespread support for this approach and this should be intensified.

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1. British Medical Association. Medicine Betrayed: The Participation of Doctors in Human Rights Abuses. London: Zed Books, 1992.

2. Grodin, MA, Annas, GJ, Glantz, LH. Medicine and human rights: a proposal for international action. Hastings Center Report 1993;23(4):812.

3. Richards, T. The World Medical Association: can hope triumph over experience? British Medical Journal 1994;308:262–6.

4. Commonwealth Medical Association. Medical Ethics and Human Rights: Report of the Commonwealth Medical Association Project on the Role of Medical Ethics in the Protection of Human Rights. Parts 1 and 2. London: British Medical Association 1994.

5. See note 1, British Medical Association 1992.

6. Crawshaw, R. Greed and the medical profession. British Medical Journal 1993;306:151.

7. See note 3, Richards, 1994.

8. Sagan, LA. The Health of Nations: True Causes of Sickness and Well Being. New York: Basic Books, 1987.

9. Desjarlais, R, Eisenberg, L, Good, B, Kleinman, A. World Mental Health: Problems and Priorities in Low Income Countries. New York: Oxford University Press, 1995.

10. Benatar, SR. Prospects for global health: lessons from tuberculosis. Thorax 1995;50:8990.

11. See note 4, Commonwealth Medical Association 1994.

12. Benatar, SR. War, or peace and development: South Africa's message for global peace and security. Medicine, Conflict and Survival 1997;13(2):125–34.

13. See note 9, Desjarlais, , Eisenberg, , Good, , Kleinman, 1995.

14. See note 10, Benatar, 1995.

15. See note 12, Benatar, (submitted) 1997.

16. Benatar, SR. Medicine and health care in South Africa. New England Journal of Medicine 1986;315:527–32.

17. Benatar, SR. Academic medicine in South Africa: past, present and future. Adler Museum Bulletin 1992;18(1):2836.

18. Benatar, SR, Van Rensburg, HCJ. Health care services in a new South Africa. Hastings Center Report 1995;25(4):1621.

19. Van Rensburg, HCJ, Benatar, SR. The legacy of apartheid in health and health care. South Afric Journal of Sociology 1993;241:99111.

20. Benatar, SR. Africa and the world. South Africa Medical Journal 1994;84:723–6.

21. Tarnas, R. The Passion of the Western Mind: Understanding the Ideas That Have Shaped Our Worl View. New York: Ballantine Books, 1991.

22. I hope that my concerns will be viewed in the context of an ongoing attempt by a physician to “stand outside his discipline and world view” and see perplexing social problems as symptorr arising in an unjust world that is undergoing profound changes–changes that are reflected i the much admired transition taking place in South Africa which, with all its turbulence, has positive message for the world. The concerns and criticisms I shall express regarding bioethic and medicine in the U.S. relate to the system within which these operate and not to the man fine colleagues in both fields whom I hold in high regard and affection, and from whom I hav received so much intellectual stimulation and friendship over the years. Having experienced th impact of being included by some in the stereotypic picture of “Apartheid medicine” in Sout Africa–perhaps an inevitable consequence of living in this society–I am aware that in taking broad view I risk offending colleagues by portraying a somewhat monolithic image of America medicine and bioethics. This is certainly not my intention and I regret any offense I may cause i my attempt to provoke greater interest in the pervasiveness of exploitation and in the symbolic and material influence of the U.S. medical and bioethics enterprises on a global scale.

23. Pellegrino, ED, Thomasma, DC. For the Patient's Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press, 1988.

24. Fox, RC. The evolution of American bioethics: a sociological perspective. In: Weisz, G, ed. Soch Science Perspectives on Medical Ethics. Dordrecht: Kluwer Academic Press, 1990:201–17.

25. Jonsen, AR. The birth of bioethics (special supplement). Hastings Center Report 1993;23(6):S1–S15.

26. Pellegrino, ED. The metamorphosis of medical ethics. JAMA 1993;269:1158–62.

27. Emanuel, EJ. The Ends of Human Life. Cambridge (MA): Harvard University Press, 1992.

28. Jonsen, AR. American moralism and the origin of bioethics in the United States. Journal of Medicine and Philosophy 1991;16:113–30.

29. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. 4th ed.New York: Oxford Universit Press, 1994.

30. See note 23, Pellegrino, , Thomasma, 1988.

31. Beauchamp, TL. The promise of the beneficence model for medical ethics. Journal of Con tempi rary Health Law and Policy 1990;6:145–55.

32. Pellegrino, ED. Patient and physician autonomy: conflicting rights and obligations in the physician/patient relationship. Journal of Contemporary Health Law and Policy 1994;10:4768.

33. Jonsen, AR. Is individual responsibility a sufficient basis for public confidence? Archives i Internal Medicine 1991;151:660–2.

34. Daniels, N. Just Health Care. New York: Cambridge University Press, 1985.

35. The quest for justice and community in health care: a quarter century of bioethics (speci. issue). Hastings Center Report 1994;24(3):741.

36. Buchanan, AE. Privatization and just healthcare. Bioethics 1995;9:220–39.

37. Rothman, D. Strangers at the Bedside. New York: Basic Books, 1991.

38. Siegler, M. Falling off the pedestal: what is happening to the traditional doctor-patient rek tionship? Mayo Clinic Proceedings 1993;68:461–7.

39. See note 27, Emanuel 1992.

40. Lee, PR, Etheridge, L. Clinical freedom: two lessons for the UK from US experience wit privatization of health care. Lancet 1989;1:263–5.

41. Woolhandler, D, Himmelstein, DU. Extreme risk-the new corporation proposition for phys cians. New England Journal of Medicine 1995;25:1706–8.

42. Gilbert, A. An Unequal World: The Links Between Rich and Poor Countries. 2nd ed.Edinburgh: Nelson, 1992.

43. Kennedy, PM. Preparing for the Twenty First Century. New York: Random House, 1993.

44. See note 8, Sagan, 1987.

45. Himmelstein, DU, Woolhandler, S. The National Health Program Book. Monroe (ME): Commc Courage Press, 1994.

46. Hiatt, HM. Medical Lifeboat. New York: Harper and Row, 1989.

47. See note 41, Woolhandler, , Himmelstein, 1995.

48. Reich, WT, ed. Encyclopedia of Bioethics. 2nd ed.New York: Macmillan Publ. Co., 1995.

49. See note 46, Hiatt, 1989.

50. See note 48, Reich, 1995.

51. Chapman, AR, ed. Health Care Reform: A Human Rights Approach. Washington (DC): Georgetown University Press, 1994.

52. See note 45, Himmelstein, , Woolhandler, 1994.

53. See note 46, Hiatt, 1989.

54. Howard, RE. Monitoring human rights: problems of consistency. Ethics and International Affairs 1990;4:3351.

55. Thompson, D. Hospital ethics. Cambridge Quarterly of Healthcare Ethics 1992;3:203–15.

56. Thompson, D. Ethics and Congress: From Individual Corruption to Institutional Corruption. Washington (DC): The Brookings Institution, 1995.

57. Wolf, SM. Health care reform and the future of physician ethics. Hastings Center Report 1994;24(2):2841.

58. Attfield, R. The global distribution of health care resources. Journal of Medical Ethics 1990;16:153–6.

59. Jonsen, AR. The New Medicine and the Old Ethics. Cambridge (MA): Harvard University Press, 1992.

60. See note 8, Sagan, 1987.

61. See note 9, Dejarlais, , Eisenberg, , Good, , Kleinman, 1995.

62. See note 10, Benatar, 1995.

63. See note 12, Benatar, 1997.

64. See note 9, Dejarlais, , Eisenberg, , Good, , Kleinman, 1995.

65. Jennings, B, Callahan, D, Wolf, SM. The public duties of the professions (special supplement). Hastings Center Report 1987;17(1):316.

66. White, KL. The Task of Medicine. Menlo Park (CA): The Kaiser Family Foundation, 1988.

67. Maclntyre, A. Why is the search for the foundations of ethics so frustrating? Hastings Center Report 1979;10(4):1622.

68. Rachels, J. Can ethics provide answers? Hastings Center Report 1980;10(3):32–9.

69. Macer, D. Bioethics for the People by the People. Christchurch: Eubios Ethics Institute, 1994.

70. See note 23, Pellegrino, , Thomasma, 1988.

71. See note 24, Fox, 1990.

72. Thomasma, DC, Pellegrino, ED. Autonomy and trust in the clinical encounter: reflections from a theological perspective. In: McKenny, GP, Sandler, JR, eds. Theological Analogies of the Clinical Encounter. Dordrecht: Kluwer Academic Publishing, 1994:6984.

73. Sherwin, S. No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press, 1992.

74. Pellegrino, ED, Mazzarella, P, Corsi, P, eds. Transcultural Dimensions in Medical Ethics. (MD): Frederick, 1992.

75. Clouser, KD, Gert, B. A critique of principlism. Journal of Medicine and Philosophy 1991;15:219–36.

76. Jonsen, AR. Casuistry and clinical ethics. Theoretical Medicine 1986;7:6574.

77. Kleinman, A. Anthropology of medicine. In: Reich, WT, ed. Encyclopedia of Bioethics. New York, Macmillan Publ. Co., 1995:1667–72.

78. ten Have, H, Kimsma, G. Changing conceptions of medical ethics. In: Jensen, UJ, Mooney, G, eds. Changing Values in Medical and Health Care Decision Making. New York: Wiley, 1990.

79. Weisz, G, ed. Social Science Perspectives on Medical Ethics. Dordrecht: Kluwer Academic Publishing, 1990.

80. Hoffmaster, B. The forms and limits of bioethics. Social Science and Medicine 1994;39:1155–64.

81. Hill, T. The cultural and philosophical foundations of normative medical ethics. Social Science and Medicine 1994;39:1149–54.

82. Wikler, D. Bioethics in health policy: what methodology? In: Principles of Medical Biology, vol 1A. (CT): JAI Press, 1994:23–6.

83. Del Vecchio-Good, MJ. Cultural studies of biomedicine: an agenda for research. Social Science and Medicine 1995;41 (4):461–73.

84. See note 67, Maclntyre, 1979.

85. See note 68, Rachels, 1980.

86. See note 72, Thomasma, , Pellegrino, 1994.

87. See note 77, Kleinman, 1995.

88. See note 79, Weisz, 1990.

89. See note 80, Hoffmaster, 1994.

90. See note 81, Hill, 1994.

91. See note 73, Sherwin, 1992.

92. See note 74, Pellegrino, , Mazzarella, , Corsi, 1992.

93. See note 83, Del Vecchio-Good, 1995.

94. See note 75, Clouser, , Gert, 1991.

95. See note 76, Jonsen, 1986.

96. See note 78, Have, ten, Kimsma, 1990.

97. See note 82, Wikler, 1994.

98. Minow, M. Making All the Differences: Inclusion, Exclusion, and American Law. Ithaca (NY): Cornell University Press, 1990.

99. Charlesworth, M. Bioethics in a Liberal Society. Cambridge: Cambridge University Press, 1993.

100. See note 54, Howard, 1990.

101. See note 51, Chapman, 1994.

102. See note 51, Chapman, 1994.

103. Blumenthal, D. Health care reform-past and future. New England Journal of Medicine 1995;332:465–8.

104. See note 54, Howard, 1990.

105. Ethics, Khushf G., politics and health care reform. Journal of Medicine and Philosophy 1995;19(5):397405.

106. Rosenblum, N, ed. Liberalism and the Moral Life. Cambridge (MA): Harvard University Press, 1989.

107. Douard, J. Health care allocation: a deflationary account. In: Humber, JM, Almeda, RF, eds. Biomedical Ethics Reviews. Totowa (NJ): Humana Press, 1994:123–44.

108. Mulhall, S, Swift, A. Liberals and Communitarians. Oxford: Blackwell, 1992.

109. Etzioni, A. The Spirit of Community. New York: Crown Publishers, 1993.

110. Daly, M. Communitarianism: A New Public Ethics. Belmont (CA): Wadsworth, 1994.

111. Benhabib, S. Situating the Self: Gender, Community, and Postmodernism Contemporary Ethics. New York: Routledge, 1992.

112. Buchanan, AE. Assessing the communitarian critique of liberalism. Ethics 1989;99:852–82.

113. See note 27, Emanuel, 1992.

114. See note 112, Buchanan, 1989.

115. Howard, RE, Donnelly, J. Human dignity, human rights, and political regimes. American Political Science Review 1986;80:801–7.

116. See note 112, Buchanan 1989.

117. See note 106. Rosenblum 1989.

118. Gutmann, A, Thompson, DF. Moral conflict and political consensus. Ethics 1990;101:6488.

119. Gutman, A. The challenge of multiculturalism in political ethics. Philosophy and Public Affairs 1993;22:171206.

120. Walzer, M. The communitarian critique of liberalism. Political Theory 1990;18:623.

121. See note 112, Buchanan, 1989.

122. See note 108, Mulhall, , Swift, 1992.

123. See note 115, Howard, , Donnelly, 1986.

124. Mitchell, N, Howard, RE, Donnelly, J. Liberalism, human rights, and human dignity. American Political Science Review 1987;81:921–7.

125. Hoffman, S. The crisis of liberal internationalism. Foreign Policy 1985;98:159–77.

126. Kung, H. Global Responsibility: In Search of a New World Ethic. New York: Continuum, 1993.

127. Attfield, R, Wilkins, B, eds. International Justice and the Third World. London: Routledge, 1992.

128. Shue, H. Basic Rights: Subsistence, Affluence and US Foreign Policy. Princeton (NJ): Princeton University Press, 1980.

129. Gardels, N. The post-Atlantic capitalist order. New Perspectives Quarterly 1993;Spring:2–3.

130. Misgeld, D. Human rights and education: conclusions from some Latin American experiences. Journal of Moral Education 1994;23:239–50.

131. See note 4, Commonwealth Medical Association 1994.

132. See note 12, Benatar, 1997.

133. Galbraith, JK. The Culture of Contentment. Boston: Houghton Mifflin, 1992.

134. Bethke-Elshtain, J. Democracy on Trial. New York: Basic Books, 1995.

135. Farmer, P. On suffering and structural violence: a view from below. Daedalus 1996;125:261–83.

136. Ray, JL. Global Politics, 4th ed.Boston: Houghton Mifflin, 1992.

137. Donnelly, J. Universal Human Rights in Theory and Practice. Ithaca (NY): Cornell University Press, 1989.

138. Ericson, EL. The Free Mind Through the Ages. New York: Frederick Ungar, Publ. Co., 1985.

139. American Association for the Advancement of Science. Committee on Science in the Promotion of Human Welfare. Science and human welfare. Science 1960;132:6873.

140. National Academy of Sciences. Responsible Science: Ensuring the Integrity of the Research Process, vol. 1. Washington (DC): National Academy Press, 1992.

141. The Toronto Resolution. Formulated at a workshop on ethical considerations in scholarship and science. Toronto: University of Toronto, 1991.

142. Rayner, M. Turning a Blind Eye? Medical Accountability and the Prevention of Torture in South Africa. Washington (DC): American Academy for the Advancement of Science, 1987.

143. Stover, E. Thex Open Secret: Torture and the Medical Profession in Chile. Washington (DC): American Academy for the Advancement of Science, 1987.

144. Douglas, M. How Institutions Think. Syracuse (NY): Syracuse University Press, 1986.

145. See note 127, Attfield, , Wilkins, 1992.

146. See note 128, Shue, 1980.

147. See note 137, Donnelly, 1989.

148. Nardin, T, Maple, DR, eds. Traditions of International Ethics. Cambridge: Cambridge University Press, 1992.

149. Beitz, CR. Political Theory and International Relations. Princeton (NJ): Princeton University Press, 1979.

150. Wipfler, WL. Human rights violations and US foreign assistance: the Latin American connection. In: Brown, PG, Maclean, D, eds. Human Rights and US Foreign Policy. Lexington (MA): Lexington Books, 1979.

151. See note 104, Khushf, 1995.

152. Symposium on the role of philosophers in the development of public policy. Ethics 1987;07:775–91.

153. Noble, CE. Ethics and experts. Hastings Center Report 1982;12(4):78.

154. Seedhouse, D. Why bioethicists have nothing useful to say about health care rationing. Journal of Medical Ethicss 1995;21:288–91.

155. See note 36, Buchanan, 1995.

156. Sharp, JS. The role and development of Volkekunde in South Africa. Journal of Southern African Studies 1981;8:1636.

157. Scheper-Hughes, N. Three proposals for a critically applied medical anthropology. Social Science and Medicine 1990;30:189–97.

158. D'Andrade, R. Objectivity and militancy: a debate, moral models in anthropology. Current Anthropology 1995;36:399408.

159. Scheper-Hughes, N. Objectivity and militancy: a debate, the primacy of the ethical: proposals for a militant anthropology. Current Anthropology 1995;36:409–20.

160. Crappanzano, V, Friedman, J, Harris, M et al. , Comments: objectivity and militancy: a debate. Current Anthropology 1995;36:420–40..

161. Agich, GJ. Clinic ethics: a role theoretic outlook. Social Science and Medicine 1990;30:389–99.

162. See note 27, Emanuel, 1992.

163. See note 99, Charlesworth, 1993.

164. Levine, R. Ethics and the Regulation of Clinical Research. 2nd ed.New Haven: Yale University Press, 1988.

165. Relman, AR. The health care industry: where is it taking us? New England Journal of Medicine 1991;325:854–9.

166. Kassirer, J. Managed care and the morality of the market-place. New England Journal of Medicine 1995;333:50–2.

167. See note 6, Crawshaw, 1993.

168. See note 51, Chapman, 1994.

169. See note 65, Jennings, , Callahan, , Wolf, 1987.

170. See note 66, White, 1988.

171. See note 165, Relman, 1991.

172. See note 166, Kassirer, 1995.

173. Lyons, JPThe American medical doctor in the current milieu: a matter of trust. Perspectives in Biology and Medicine 1994;37(3):442–59.

174. Annas, GJ. Reforming the debate on health care reform by replacing our metaphors. New England Journal of Medicine 1995;332:744–7.

175. Adson, MA. An endangered ethic-the capacity for caring. Mayo Clinic Proceedings 1995;70:496–500.

176. Trust and ethics in medical care: patients and their doctors. Journal of the Royal Society of Medicine 1994;87(Suppl. 22).

177. See note 51, Chapman, 1994.

178. See note 59, Jonsen, 1992.

179. See note 165, Relman, 1991.

180. See note 174, Annas, 1995.

181. See note 175, Adson, 1995.

182. Betrayal of the NHS (editorial). The Lancet 1995;346:651.

183. Pollock, K. The NHS goes bankrupt. 77a? Lancet 1995;346:683–4.

184. See note 18, Benatar, 1995.

185. See note 36, Buchanan, 1995.

186. See note 78, Have, ten, Kimsma, 1990.

187. See note 79, Weisz, 1990.

188. See note 80, Hoffmaster, 1994.

189. See note 81, Hill, 1994.

190. See note 82, Wikler, 1994.

191. See note 83, Del Vecchio-Good, 1995.

192. See note 106, Rosenblum, 1989.

193. See note 108, Mulhall, , Swift, 1992.

194. See note 109, Etzioni, 1993.

195. See note 110, Daly, 1994.

196. See note 112, Buchanan, 1989.

197. See note 118, Gutmann, , Thompson, 1990.

198. See note 120, Walzer, 1990.

199. See note 98, Minow, 1990.

200. See note 55, Thompson, 1992.

201. See note 56, Thompson, 1995.

202. See note 174, Annas, 1995.

203. See note 124, Hoffman, 1995.

204. Commission on Global Governance. Our Global Neighborhood. New York: Oxford University Press, 1995.

205. U.S. Congress, Office of Technology Assessment. In: Office of Technology Assessment. U.S. Public Policy-Background Paper. Washington (DC): U.S. Government Printing Office, 1993. OTA–BP–BBS–105.

206. Declaration of Ixtapa. In: Bankowski, Z, Bryant, JH, eds. Poverty, Vulnerability, and the Value of Human Life. A Global Agenda for Bioethics. Geneva: CIOMS, 1994:vii–xi.

207. Benatar, SR. The importance of medical ethics as an international endeavor. World Medical Journal 1995;41:20–5.

208. Gaylin, W. Knowing good and doing good. Hastings Center Report 1994;24(3):3641.

Just Healthcare beyond Individualism: Challenges for North American Bioethics

  • Solomon R. Benatar (a1)

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