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For the Patients Good: The Restoration of Beneficence in Health Care
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In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thoroughgoing philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decisionmaking today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decisionmaking, qualityoflife determinations, the allocation of scarce health care resources, medical gatekeeping, and forprofit medicine. The authors argue for the restoration of beneficence (reinterpreted as beneficenceintrust) to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patients values. In order to act in the patients best interests, or the patients good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patients autonomous selfunderstanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patients good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights and dutybased ethical systems in favor of a virtuebased theory which is grounded in the physicianpatient relationship. This books provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today.
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