Respecting autonomy in difficult medical settings: a questionnaire study in Japan

Some people in Japan are still comfortable with the paternalistic role of doctors, but others wish that their own decisions would receive a greater amount of respect. A total of 747 students of universities and colleges and 114 parents of these students participated in a questionnaire survey. Most of the participants thought that autonomy should be respected in situations involving death with dignity and euthanasia, whereas it should not be respected in attempted suicide and involuntary admission of individuals with mental illness. A cluster analysis revealed that the participants could be divided into the following groups: aid in dying advocates (n=577), complete libertarians (n=109), protectors of the mentally ill (n=90), complete paternalists (n=29), and questionables (n=27). The assertion of independence score of the Scale for Independent and Interdependent Construal of the Self showed a significant difference among the 5 clusters. These findings suggest that the traditional paternalistic relationship between doctor and patient is undergoing a gradual transformation in Japan.

Beyond medical ethics: new directions for philosophy and medicine

A unique relationship exists between physicians and philosophers -- one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages -- a sense of how medicine has adapted to the social, cultural, and ethical needs of each period. This perspective, while emphasizing medicine as science, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology, and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary.

Why we need a theory of suffering, and lots of other theories as well: commentary

In the first section of his article, "The Role of Suffering and Community in Clinical Ethics," Erich Loewy sketches a theory of suffering. His conviction is that clinical medical ethics is not clearly rooted in theory and is inadequately grounded because of this. While acknowledging the merits of virtue ethics and casuistry, Loewy quickly dispenses with them, as contenders for this theoretical basis. Kantianism and utilitarianism are likewise rejected as "a universally acceptable grounding for ethics." In their place, Loewy proposes that "a deeper and more universal grounding can be found in the capacity of sentient beings to suffer." It is on this capacity to suffer that he builds his hierarchies of moral value, including primary, secondary, and symbolic worth. This theory of suffering should be welcomed. It promises to expand our awareness of clinical experience, and moral life generally, away from autonomy, utility, or virtue orientations toward attention to suffering and our response to it. Such a theory can give us a revitalized language to probe the issues of medical ethics. This should lead us to a careful reading of Loewy's larger work on which this article is based. Yet my enthusiasm is tempered by Loewy's noncritical acceptance of a peculiar, yet pervasive, understanding of the role and use of theory in ethics....

Intersections of Western biomedical ethics and world culture: problematic and possibility

... What emerges from the intersection of systems of medical ethics across cultural lines is a recognition of the need for and the possibility of some form of metacultural ethic that can ameliorate cultural relativism. In medical ethics, all ethical positions are not of equal moral status -- regardless of how tightly bound they may be to a particular culture; for example, consider the nearly universal approbation for cooperative efforts of physicians who oppose the use of nuclear weapons and the condemnation of physicians who torture or experiment with prisoners of war. Even if violations of patient rights are tolerated in certain social and cultural settings, they are not tolerable in any common ethic of medicine. Growing recognition of the moral rights of patients, their special vulnerability as sick persons, and their dependency on the physician's knowledge constitute the empirical foundation of a morally defensible ethic of medicine. Those cultural systems that violate such norms cannot be given equal moral standing with systems that respect these norms, not because the cultural systems that support human and patients' rights are per se superior but because the protection of human rights is grounded in something more fundamental than culture -- the deference owed to all human beings qua human beings. This is a norm by which every culture may be judged....