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UB PHI 237 - Exam 2 Study Guide

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PHI 237 1st EditionExam # 2 Study GuideBoorse Goals of Medicine- Main question: Is medicine only promoting health or other things as well … is medicine pathocentric?o Centered on a disease or sometimeo Concerned with more than health and fighting diseaseo Medicine about fighting disease?o What should physicians do?- Concept – Internal Morality of Medicineo Concept that the special requirements / rules of what medical professionals can / cant do  like could of conductso Goals of medicine  set parameters of IMMo Prohibited rule out  Euthanasia, PAS- If goal of medicine rue out health not contrary to it like obstetric anesthesia- Boorse thinks that he ahs reasons to be skeptical o Gives 2 reasons to be skeptical of IMM 1) Physician and medicine are ambiguous  (physician defined as being engaged and practicing medical care) (medicine defined as promoting health) 2) Historical examples: show that medicine was always about more than promoting health - 2 main exampleso Distribution and prescription of contraception in ancient society … ancient contraceptiono Victorian era using obstetric anesthesia in women in laboro *** Pain is not a disease***- Leaves us with:o Medicine not connected to fighting disease Medicine is just about fighting disease but physicians do more than it  Boorse views he considers: Pelligrinoo Clinical medicine has 1 goal: healing and promoting health and fighting diseaseo Problems w/ view: What about informed consent? If medicine just concerned with promoting health and fighting disease at all costs not concerned with patient autonomyo What about beneficent treatment? Hospice  not about curing disease, all about making death comfortable & people will die with dignity … important part of caring for them Miller and Brodyo Have view that IMM is not fixed but evoultioanry Boundaries change over time, shift, fix and adapt What are goals of medicine and physician goals  change over times New goals emerge or reinterpreting goals we heard before New aims or old goals reinterpreted Boorse problems with those viewso Says what accounts on their views  accounts for shift, evolution change?o Changes in external morality Patient autonomy not taken seriously Dr. in the driver seat Now with patient autonomy, patient respected and patient is in the driver seato *Shift in autonomy* Shift in knowledge- Only thing is shift in external morality, generally taking peoples autonomy / rights more seriously  Boorse responds  But then it seems as though what’s really changed is external morality, not internal o Have only shown in general taken rights and autonomy more seriously due to shift in ourpractice, attitude, and understanding Problems of Pellegrino viewo Boorse introduces it and criticizes it  Miller and Brody not one IMM but Boorse skeptical of IMM from first placeo No need to have shift in IMM Boorse engages in dialogue with them  their view interpreted Boorse surveys answers what people give him and interact with other people o Doesn’t accept Pellegrino because the guest miller and Brody brings in Their point of view and criticize it Hippocratic Oath  Don’t have sex with patients because of doctors role … needs to have extra requirements / possibilitieso Special code of morality to practice of medicine Finally a view Boorse comes close to endorsing  Veech’s View  Is that there is no IMM, impossible to beo 3 problems: 1. Different / same medical roles have different purposes- Like nurse give medicine / makes stay in hospital comfortable  2. Sometimes conflicting ends within a single role doctors concerned with - i. Prolonging life- ii. Curing disease- iii. Relieving suffering- iiii. Preventing diseaseo These are goals a physician might make - Dr. concerned with prolonging life but also concerned with ending sufferingo Give up end or goal to pursue another 1 o Sometimes have conflict and cant have all of them 3. Medicine ends or goals originate in external human goals- Reason why dr. have goals because general goals without differenceo Therefore external goals people have  Ex) distribution of contraception concerned with facility treatment in general o Boorse agrees with veech  Goals of medicine Miller and Brody  8 different goals of views of medicineo Boorse says look at this list Boorse thinks list is a good enough sketch and compatible of physicians engagingin torture, anabatic steroids, sex with patients Boorse: Goals of medicine 2 general categorieso 1. **ALSO KNOWN AS PATERNALISM ** Goals pertain to patient  use biomedical technology and knowledge in the best interest of the patient Concerned with what treatments to give, drugs to give, surgeries to perform o 2. Knowledge to related goals: informed consent, patient autonomy Consulting inform patient of option and state of disease; patient shift consentingto the same thing they are aware ofo Prior to 1950, 60, 70  concerned with issue 1 and lead to paternalism  Dr. relationship to patient  like child relationship to parent  As parent you know what is best for child Patients font know what best since I am a doctor I am going to do it... Strong emphasis on relationship of goals Issue 1  Bourse doesn’t seem to recognize that these 2 goals come into conflict o Do not give resources of what dr. should o when these go into conflict Ex) dr. found out patient has cancer if dr. tells patient and patient will jump out of window and kill self and easily come to conflict Issue 2  historical parts and contraception and anesthesia just because physicians always gave contraception  this isn’t idea to medicine o Physician being more than physician  maybe totally accidental and indicate  bourse argument isn’t very good  Dr. involved in doing something good  Issue 3  May be medicine more pathocentric than Bourse o People 1  plastic surgery and contraceptiono People 2  do surgery  Core of medicine for fighting diseases Issue 4  respond to Bourse as Minimal Internal Morality of Medicineo Because of goals dr. have  dr. could be allowed to be refused and do certain things  Neither required to but can opt outo If pathocentric core doctor can opt out  If dr. doesn’t want to perform abortion he opts out and can opt out if doesn’t relate to exactly fighting diseases - Life threatening pregnancies


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