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    Bioethical Mandala: part 1 | part 2 | part 3 | part 4 | part 5 | part 6 | Notes & Bibliography

    The Bioethical Mandala
    A Reflection on the Moral Structure of Health Care (part 4)

    What justifies Medical Intervention?

    Medical intervention is able to be justified in terms of the perception of disease, or departure from ideal standards of bodily wellbeing. It may also be justified by the perception that intervention may be able to bring about a cure for the condition of disease; it may be further justified by the patient's consent to have relevant medical treatment for the problem. All of these points, singly or in any combination routinely justify medical intervention in an amazing range of cases, from drug addiction to unorthodox sexuality, from fluoridation of the water supply to compulsory vaccination for travel to remote spots rife with foreign diseases.

    Moreover, the fact that a person should have consented to treatment is regularly thought by professionals to justify intervention should other priorities present themselves, such as the perceived need for experimental subjects, or even tryouts for junior practitioners. This is especially the case in the high-pressure hospital environments, where calmly considered decisions are not usually the rule. These justifications are more pragmatic than moral.

    Major Ethical Positions

    Ethics generally deals with the delineation of contextual boundaries for a schedule of appropriate moral behaviour. It seeks to determine the best, or perhaps the most harmonious ways of fulfilling our needs, within a context of social interaction that must take into account the interests of others. Ethical standards seek to govern our consideration of how best to achieve the highest degree of personal and social fulfilment; they set out to map pathways to the attainment of a general flourishing within the structured web of relationships that constitute our world. Such standards very much concern themselves with what we as moral entities ought and ought not to do to each other, to the human and nonhuman parts of the world with which we interact and which may be perceived to have interests, or even rights – and, finally, what we may actually do to ourselves.

    This sort of appropriate behaviour may be contextually defined as action sourced in the ethical deliberation over projected outcomes; it presupposes the taking of one or more conscious decisions to abide by moral standards accepted as binding, at least in principle. Decisions taken in the light of such standards yield acts which are to some degree in accordance or otherwise with the relevant interests of an agent and his or her field of action, however extended. (Conversely, behaviour which is automatic, thoughtless, or wholly determined by circumstances may not be truly described as ethical, for ethics demands that its choices be open.)(9) Inappropriate, or unethical, action is the consequence of an agent's deliberate decision not to abide by relevant standards.

    The polar positions that have been taken in general ethics, the strictly utilitarian - seeking to maximise happiness and satisfaction and to minimise pain for the greatest number - and the Kantian, rights-based stance, declaring in its simplest form that all rational beings should be treated as ends-in-themselves rather than mere means, have presented a minefield of inconsistency in the day-to-day practice of health care.

    Intense Debate

    Problems associated with these traditional ethical stances, especially regarding the technological, institutional overshadowing of the caring relationship, have generated intense debate. A sort of compromise has arisen between the two, based on some conception of human rights, but entailing the recognition, attribution and balancing of relevant interests: those of clients (mainly patients, but also their relatives, employers, insurers and so on) the carers (usually medical practitioners and their associates) and those of such relevant social institutions as community health service bureaucracies, hospitals, insurance companies, the national health and other governmental institutions financed by taxpayers.

    Phenomenological positions that have recently emerged under the influence of the Continental philosophers (Nietzsche, Foucault, Merleau-Ponty and others) seem most nearly to relate, if somewhat uncomfortably, to the recognition, assignment and balancing of relevant interests, based on an existential conception of the self as lived body, intimately constructed by and within its relationships.

    This article goes on to consider the utilitarian and the rights-based ethical positions, and the implications of harmony and wellbeing.

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    Bioethical Mandala: part 1 | part 2 | part 3 | part 4 | part 5 | part 6 | Notes & Bibliography

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