Abstract
Pellegrino was the first to point out that principles become obligations, not merely check lists when grounding them in the nature of medical activity. The obligations that arise from the nature of the relationship provide the theoretical grounding lacking in the approach through prima facie principles. Beneficence becomes a requirement not of a system of philosophy applied to medicine, but of the nature of medicine; it encompasses the whole of the patient’s well-being.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsNotes
- 1.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship: the Need for a Better Linkage”, p. 363.
- 2.
Ibid., p. 364.
- 3.
Pellegrino E.D., “Toward a Virtue Based Normative Ethics for the Health Profession”, p. 273.
- 4.
Humorously he adds that he is “not suggesting a feeble eclecticism, a cafeteria-style ethics, that would add a spoonful of virtue here, a principle there, and a dash of consequence in another place. Nor do I suggest a formless syncretism based in egregious compromises for the sake of a unity that enervates conflicting theories. Rather, the strength of each theory must be preserved, drawn upon, and placed in dynamic equilibrium with the others in order to accommodate the intricacy, variety, and particularity of human moral acts.”
- 5.
Ibid., p. 274.
- 6.
Brody H., “The Four Principles and Narrative Ethics”, in Principles of Health Care Ethics, p. 207.
- 7.
Ibid., p. 208.
- 8.
It is interesting to note that when people have a difficult decision to take, whether of moral character or not, many find themselves speaking with others in a sense of relating all the details. Indeed many realise the importance of this and use it as a ‘tool’. Relating the same story over and over will bring out further insights which will ultimately help. In the final choice or decision.
- 9.
Ibid., p. 214.
- 10.
Churchill L.R., “‘Damaged Humanity’: The Call for a Patient-centred Medical Ethic in the Managed Care Era”, in The Influence of Edmund D. Pellegrino’s Philosophy of Medicine, p. 115.
- 11.
Indeed by focusing on the patient one is phenomenologically creating the relationship; but in the sense the aim is at the ‘end’ of the relationship. (the ‘telos’) and not on the means.
- 12.
Thomasma D.C., “Antifoundationalism and the Possibility of a Moral Philosophy of Medicine”, in The Influence of Edmund D. Pellegrino’s Philosophy of Medicine, p. 128.
- 13.
Idem.
- 14.
Cassell E.J., The Nature of Suffering, p. 28.
- 15.
Idem.
- 16.
Ibid., p. 152.
- 17.
Ibid., p. 155.
- 18.
Ibid., p. 156.
- 19.
Beauchamp. T.L., “Principlism and Its Alleged Competitors”, p. 195.
- 20.
Ibid., p. 61.
- 21.
Cassell E.J., The Nature of Suffering and the Goals of Medicine, Oxford 1991
- 22.
Heidegger, M., Being and Time, p. 33.
- 23.
Ibid., p. 60.
- 24.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship: the Need for a Better Linkage”, p. 362.
- 25.
The contract models of Veatch and Engelhardt are clear examples.
- 26.
Heidegger M., op. cit., p. 61.
- 27.
Ibid., p. 62.
- 28.
Pellegrino E.D., “Toward a Virtue Based Normative Ethics for the Health Profession”, p. 267.
- 29.
Cassell E.J., The Nature of Suffering, p. 66.
- 30.
Ibid., p. 74.
- 31.
Brody H., “The Four Principles and Narrative Ethics”, pp. 207–216.
- 32.
Heidegger M., Being and Time, p. 160.
- 33.
Ibid., p. 161.
- 34.
Ibid., p. 162.
- 35.
Ibid., p. 161.
- 36.
Ibid., p. 162.
- 37.
Ibid., p. 163.
- 38.
Beauchamp. T.L., Childress J.F., Principles of Biomedical Ethics, p. 375.
- 39.
Heidegger M., op. cit., p. 127.
- 40.
“We take pleasure and enjoy ourselves as they (man) take pleasure; we read, see, and judge about literature and art as they see and judge…..” (Idem.)
- 41.
Ibid., p. 165.
- 42.
Ibid., p. 167.
- 43.
Zaner R.M., “Experience and Moral Life: A Phenomenological Approach to Bioethics”, in A Matter of Principles?, pp. 211–236.
- 44.
Heidegger M., op. cit., p. 184.
- 45.
Cassell E.J., The Nature of Suffering, p. 66.
- 46.
Zaner R.M., “Experience and Moral Life: A Phenomenological Approach to Bioethics”, pp. 213–215.
- 47.
A similar situation is illustrated in the narrative brought our by a patient in the following case. A girl who attended the clinic regularly presented with amenorrhoea and subsequently found to be pregnant. Her first reaction was to look for an abortion. When asked and probed what was truly troubling her she found for herself that indeed she loved her boyfriend, was ready to have the baby and ready to marry him. Her problem was she was young and without finances. Moreover her greatest fear was her step-mother. It transpired that her step-mother beat her regularly and called her a prostitute. Her two step-brothers abused her sexually; a fact which the step-mother always denied—and thus the accusations. Amidst all this the father tried to maintain neutrality. Along with the mother of a close friend of hers’ we convinced her to look for a place to live, not rush into marriage and leave her stepmothers’ home. We also told her to see the parish priest and see what he thought. He actually arrived to the same conclusion. She had her baby and eventually married the father.
- 48.
Heidegger M., Being and Time, p. 182.
- 49.
Ibid., p. 183.
- 50.
Ibid., p. 185.
- 51.
Ibid., p. 186.
- 52.
Ibid., p. 187.
- 53.
Ibid., p. 195.
- 54.
Ibid., p. 196.
- 55.
Ibid., pp. 196–199.
- 56.
Ibid., 193.
- 57.
Svenaeus, F. The hermeneutics of medicine and the phenomenology of health. Linkoping: The Tema Institute, Linkoping University, 1999.
- 58.
Svenaeus, F. Illness as unhomelike being-in-the-world: Heidegger and the phenomenology of medicine. Medicine, Health Care and Philosophy, 2011, 14, pp. 333–343
- 59.
Tyreman, S. The happy genius of my household: phenomenological and poetic journeys into health and illness. Medicine, Health Care and Philosophy, 14, pp 301–311.
- 60.
Ahlzen, R. Illness as unhomelike being-in-the-world? Phenomenology and medical practice. Medicine, Health Care and Philosophy, 2011, 14, pp. 323–331
- 61.
Pellegrino, E.D., “Being ill and being healed: some reflections on the grounding of medical morality”, Annual health Conference of the New York Academy of Medicine, the Patient and the Health Care Professional: The Changing Pattern of their Relations (Conference held at the Academy, April 24 and 25, 1980).
- 62.
Heidegger M., op. cit., p. 179.
- 63.
Ibid., p. 180.
- 64.
Zaner R.M., “Experience and Moral Life: A Phenomenological Approach to Bioethics”, pp. 224–230.
- 65.
Ibid., p. 224.
- 66.
Ibid., p. 225.
- 67.
Ibid., p. 226.
- 68.
Cassell E.J., The Nature of Suffering, p. 68.
- 69.
Zaner. R., op. cit., p. 226.
- 70.
Ibid., p. 227.
- 71.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship.: the Need for a Better Linkage”, p. 356.
- 72.
Zaner R., op. cit., p. 228.
- 73.
Ibid., p. 229.
- 74.
Cassell E.J., The Nature of Suffering, p. 69.
- 75.
Ibid., p. 70.
- 76.
Beauchamp. T.L., Faden R., A History and Theory of Informed Consent, p. 238.
- 77.
Ibid., p. 54.
- 78.
Ibid., p. 55.
- 79.
Ibid., p. 58.
- 80.
Zaner R.M., “Experience and Moral Life: A Phenomenological Approach to Bioethics”, p. 229.
- 81.
Heidegger M., Being and Time, p. 33.
- 82.
Ibid., p. 42.
- 83.
Ibid., p. 239.
- 84.
Ibid., p. 308.
- 85.
Cassell E.J., The Nature of Suffering, p. 62.
- 86.
Ibid., p. 63.
- 87.
Heidegger M., op. cit., p. 313.
- 88.
Leder, D., “Toward A Hermeneutical Bioethics”, p. 241.
- 89.
Heidegger M., Being and Time, p. 194.
- 90.
Leder D., op. cit., p. 242.
- 91.
Heidegger, M. op. cit., p. 195.
- 92.
Leder D., op. cit., p. 242.
- 93.
Ibid., p. 243.
- 94.
Ibid., p. 244.
- 95.
Ibid., p. 245.
- 96.
Ibid., p. 249.
- 97.
Ibid., p. 250.
- 98.
Ibid., p. 252.
- 99.
Ibid., p. 253.
- 100.
Ibid., p. 255.
- 101.
Ibid., p. 256.
- 102.
Ibid., p. 257.
- 103.
Mallia, P., Ten Have, H. Applying theological development to bioethics issues such as genetic screening, Ethics Med, 2005, 21(2): 95–107
- 104.
Heidegger M., op. cit., p. 195.
- 105.
Charon R., “Narrative Contributions to Medical Ethics. Recognition,
Formulation, Interpretation, and Validation in the Practice of the Ethicist”, in U.S. Bioethics, p. 260.
- 106.
Zaner R.M., “Experience and Moral Life: A Phenomenological
Approach to Bioethics”, p. 231.
- 107.
Charon R., op. cit., pp. 260–283.
Brody H., “The Four Principles and Narrative”, pp. 207–215.
- 108.
Zaner R.M., op. cit., p. 230.
Pellegrino E.D., “The Four Principles and the Doctor-Patient Relationship.: the Need for a Better Linkage”, p. 364.
- 109.
Hjelle L.A., Ziegler D.J., Personality Theories, 2nd ed., McGraw-Hill International Editions, 1987, p. 406.
- 110.
Zaner R.M., “Experience and Moral Life: A Phenomenological Approach to Bioethics”, p. 230.
- 111.
Cassell E.J., The Nature of Suffering, p. 183.
- 112.
Ibid., p. 184.
- 113.
Ibid., p. 82.
- 114.
Ibid., p. 83.
- 115.
Ibid., p. 84.
- 116.
Ibid., p. 88.
- 117.
Ibid., p. 91.
- 118.
Ibid., p. 95.
- 119.
Ibid., p. 97.
- 120.
Ibid., p. 99.
- 121.
Ibid., p. 98.
- 122.
Ibid., p. 101.
- 123.
Ibid., p. 102.
- 124.
Cassell E.J., The Nature of Suffering, p. 108.
- 125.
Ibid., p. 111.
- 126.
Ibid., p. 122.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2013 The Author(s)
About this chapter
Cite this chapter
Mallia, P. (2013). Principles as a Consequence of the Relationship. In: The Nature of the Doctor-Patient Relationship. SpringerBriefs in Ethics, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4939-9_4
Download citation
DOI: https://doi.org/10.1007/978-94-007-4939-9_4
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-4938-2
Online ISBN: 978-94-007-4939-9
eBook Packages: MedicineMedicine (R0)