For the Patient's Good: The Restoration of Beneficence in Health Care.
For the Patient's Good is a superb and much needed book. Until now a disciplined approach to (and an argument for) the inclusion of beneficence as a moral imperative has been lacking in medical ethics, even though Engelhardt in his brilliant book The Foundations of Bioethics includes beneficence as the necessary (but not morally binding) content of medical ethics. This point of view, unfortunately, leaves us in a hole: If benevolence is volitional and not a moral imperative, it assumes a nonbinding and, therefore, ethically supererogatory role. Beneficence, moreover, assumes an almost aesthetic quality; it is "nice" like the "niceness" of a Mozart symphony or, perhaps, of raspberry sherbet. Inevitably one is left with an ethic of stark individualism devoid of any sense of community. Such an ethic, when it comes to dealing with our fellow-creatures (let alone our fellow-creatures in a medical setting) leaves one unfulfilled.
As Pellegrino and Thomasma clearly recognize, beneficence is more than merely a desirable requirement of medical practice. They ground beneficence not only in the historical facts of medical obligation but also, and perhaps more important, in the broader requirements of general ethics which, if it is to function in civilized society, must transcend an ethic of mutual nonharm.
The authors most carefully steer between the Scylla of autonomy and the Charybdis of paternalism. This is, most certainly, not an easy course to steer. An extreme respect for autonomy easily leads to...
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