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Price: $90.50

Format:
Hardback 256 pp.
156 mm x 234 mm

ISBN-10:
0195043197

ISBN-13:
9780195043198

Publication date:
April 1995

Imprint: OUP US

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For the Patient's Good

The Restoration of Beneficence in Health Care

Edmund D. Pellegrino and David C. Thomasma

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 thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence (re-interpreted as beneficence-in-trust) 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 patient's values. In order to act in the patient's best interests, or the patient's 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 patient's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient's 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 duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician-patient relationship. This book's 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.

Readership : Physicians, ethicists, students of medicine and bioethics

Reviews

  • "For the Patient's Good is a superb and much needed book. . . well written and a joy to read. Pellegrino and Thomasma are, I feel, to be congratulated for having produced one of the fundamental books in the field." --Hastings Center Report
  • "Pellegrino and Thomasma. . .have provided help for any doctor who, at the end of a working day, wonders whether he or she has done good to the patients. For such doctors this is a book to be bought, read, and reread." --Journal of the Royal College of General Practitioners
  • "Elicits some fascinating case histories, legal problems, and familiar clinical dilemmas. . . .There is clear and sometimes alarming insight into American practice in general and the problems of litigation, the profit motive and self interest in particular. . . .The book is thought provoking, and the ideas proposed by the authors are worthy." --British Medical Journal
  • "It will challenge readers at all levels of knowledge in medical ethics. It is a book that one can return to time and again for fresh and revealing insights as one's own experience in ethical dilemmas matures." --The Journal of Family Practice
  • "This is not an easy book to read. Those who make the effort will find much that makes the tough going worthwhile. They may even be encouraged to build on the analysis presented by these two distinguished thinkers to solve some of the many remaining riddles and paradoxes of creating an ethic to govern the interactions of doctors and patients." --Journal of the American Medical Association
  • "The authors' well-knit argument is worth careful reading . . . . The proposals in this book can be seen as both plausible and achievable." --New England Journal of Medicine
  • "The balance between patient autonomy and physician beneficence remains a matter of dispute. Pellegrino and Thomasma, while supportive of patient autonomy, are critical of the "almost automatic" assumption made by some ethicists that autonomy, rather than beneficence, must supervene. . . . Our modern suspicion of trust born of a sometimes righteous indignation and always associated with emotional resentment, has gone too far; for this reason, For the Patient's Good is a necessary book. --Bioethics Books
  • "Much can be said for Pellegrino and Thomasma's initial steps in constructing a philosophy of medicine. First, and perhaps most important, their work offers an alternative to the hegemony of autonomy that characterizes most of American medical ethics. . . . Their work also takes into account much of the valuable philosophy of medicine currently being done in Europe and too often ignored. The history of medicine is taken seriously in their discussions of the medical profession and medical ethics, a history often overlooked by those in medical ethics. For the Patient's Good calls into question the provincialism that too often characterizes American academia and so challenges philosophers and physicians to enter into dialogue." --Bulletin of the Park Ridge Centery
  • "Pelligrino and Thomasma are arguably among the most influential authors now writing about the moral nature of physicianhood. . ."--Jonathan B. Imber, Ph.D., Texas tech University,The New England Journal of Medicine

PART I: The Delineation of Beneficence
1. Paternalism, Autonomy, and Beneficence in the Patient-Doctor Relationship
2. Limitations of Autonomy and Paternalism: Toward a Model of Beneficence
3. Why Good Rather than Rights?
4. Beneficence-in-Trust
PART II: The Implications of Beneficence for the Doctor and Patient
5. Health and Ethical Norms
6. The Good of the Patient
7. Quality of Life Judgements and Medical Indications
8. The Good Patient
9. The Good Physician
PART III: The Consequences of Beneficence
10. The Common Devotion: A Reconstruction of Medical Ethics
11. Making Decisions Under Uncertainty
12. Making Decisions for Incompetent Patients
13. The Role of Physicians, Families and Other Surrogates in Decisions Concerning Incompetent Patients
14. The Physician as Gatekeeper
15. Beneficence-in-Trust: How It Is Applied
16. A Medical Oath for the Post Hippocratic Era

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Edmund D. Pellegrino is at Georgetown University. David C. Thomasma is at Loyola University of Chicago Stritch School of Medicine.

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