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UB PHI 237 - Christopher Boorse’s “Goals of Medicine” Cont.

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PHI 237 1st Edition Lecture 10Christopher Boorse’s “Goals of Medicine” Cont.- MAIN IDEA OF IMM – certain thing will be wrong for medical practitioners given the nature of the external morality of the societyo 1 view is that medicine is to make people home and heal them and make the whole– path-acentric fold Contrary to IMM Nature to fight pathology Disease mean broader note of pathology Path-acentric approach to medicine is that the essence of medicine dealing with pathology Pathology is the essence of help  Euthanasia, physician assistance suicide, torture, tying people tubes, organ transplants  pathologyo IMM list of prima fascia things … prima fascia wrong but all things consider accept otherV. Some Lessons from History30. Two examples: ancient contraception and Victorian Obstetrical anesthesia suggest that, whenever our medical tradition begin, doctors went way beyond promoting health from the start- Physicians have always gone beyond fighting disease by fighting contraception- Anthesistizeing pain- Contraception hasn’t been universally banned31. Contraception on demand was not universally condemned and so we can erase it from the Western medical tradition only be expelling ancient physicians who prescribed it32. Contraception on demand was not universally condemned and so we can erase it from the Western medical tradition only is expelling ancient physicians who prescribed it- Nothing in Hippocratic oath about contraception- This oath is mostly path-acentricThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- Swear by Apollo g-d of medicine and his son Asclepius- Hygeia – hygiene- Panacea – penicillin- 2nd paragraph … shouldn’t charge on passing on medical knowledge … for some people its free- 3rd paragraph … keep it from harm … Shouldn’t give out deadly drugso So physician assistant suicide is ruled out- 4th paragraph abortion is ruled out- 5th paragraph physicians cure- 6th paragraph doctors made house calls …o Shouldn’t have sex with men, women, free or slave- 7th paragraph confidentiality- 8th paragraph oath kept have fame … oath broken have infamy - When borse studied Hippocratic oath much talk about how to engage in contraception… was on howthe patient wanted it- Looks like Hippocratic practitioners and physicians participate in contraception33. Victorian obstetrical anesthesia shows that even in medicine originated in 19th century for it thenstarted doing more good than harm, anesthesia for labor achieved total acceptance at similar time- Early medicine shouldn’t be even called medicine- Medicine back then didn’t make you healthier than a placebo could34. The pain is normal, inherent in human design, either as a design default or (rather farfetched), as encouraging women not to give birth alone or according to psychoanalysis, to bond with children - Pregnancy isn’t a disease and pain of a pregnancy isn’t disease its just unwanted- Body will feel pain when you push out the baby35. So obstetrical anesthesia’s rapid acceptance as ethics is a second counterexample to any limitation ofmedicine to treating pathological conditions- Whenever you think medicine began many doctors were doing something that had nothing to dowith fighting disease and pathology … natural pain and labor- B thinks that no IMM of medicine should be path-acentricVI. Goals of Medicine36. Boorse offers two categories of goals: a) to the patient and b) knowledge promoting goals- Weak one that wont rule out anything in the patients interest- Goals of medicine to patient and other to promoting medicine37. CB adds a principle IV “using biomedical knowledge of technology in the best interests of the patient.” to B & M’s list on goods that benefit the patient, which eliminates much of their list- Principal captures the broad goals and fundamental minimal IMM - ***CORE IDEA OF BOORSE’S MINIMAL IMM IS THAT DOCTORS SHOULD USE IT IN THE BEST INTEREST OF THE PATIENT ***- Broader morality is external morality- Cant appeal to the nature of medicine- Key idea is medical knowledge is used in patients interest- Others outlawed by others external morality’s of medicine- Drs. Will not always see what is in the patients best interest because its not what the patient wantso Don’t do things in the patients best interest even when they want it- AUTONOMY OF PATIENT IS THE MOST DISCUSSED VALUEVII. Physician Unbound?39. Boorse imagines 3 responses to the physician being unbound from a focus on the pathological 39a) Retreat and reject as unethical all of physicians’ treatments on normal conditions- Contraception, flavor pains unbound39b) endorse these as ethical acts by physicians, but not as medical since they’re not health directed - Doctors allow other things of medicine- If they have the skills let them do it and practice- Not medicine but doctors can do other things39c) Accept them all as medicine embracing an IMM on the patient side only of using biomedical knowledge and technology for the patient’s benefit- Doctors asses biomedical knowledge- Do anything in the patients interest- Contraception do it … enhancement do it..40. Option irejects medical history. If b or c are accepted there are no objections from an IMM against VAE and enhancements because either are genuine medicine or something doctors can do - No objections to IMM - VAE – voluntarily active euthanasia … when the patient wants to die - Genuine medicine or something the doctors can do - B or c … take away and limit moves and IMM- PAS IS PHYSICIAN ASSISTANT SUCICIDE41. Apart from an IMM, it is usually just Catholic-inspired ethics ban on intentional killing innocent human beings that rule out voluntary active euthanasia (VAE) - Only objection to euthanasia in principle that you cant intentionally kill the innocent42. CB is skeptical of feasibility of enhancements in the short term for we don’t know how and won’t do it well and doctors can’t be trusted to improve on normality- Nothing wrong but unlikely to see in near futureVIII. Criticisms of Boorse’s“Goals of Medicine”43. It doesn’t matter that doctors have always prescribed contraception or done cosmetic surgery. That might still not be essential to medicine. Conceptual analysis may contradict CB’s claims44. An analogy might be helpful for distinguishing essence or core from


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