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Healthy RespectEthics in Health Care$

R. S. Downie, K. C. Calman, Ruth A. K. Schröck, and Malcolm Macnaughton

Print publication date: 1994

Print ISBN-13: 9780192624086

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780192624086.001.0001

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Healthy Respect

Malcolm Macnaughton

Oxford University Press


The ethical aspects of medical care have been with us for a long time but the interest in this area has become much more pronounced in recent years and now ‘medical ethics’ is a popular subject of discussion by people in all walks of life. This, in turn, has made the medical profession itself pay much more attention to the ethical aspects of health care in its widest sense.

The real stimulus to this widespread interest has been the development of new techniques and new forms of management which have addressed such basic subjects as life and death; fertilization of the egg by the sperm in a laboratory; and the experimentation on embryos which has brought into consideration in a very practical sense the questions: ‘When does human life actually begin? What moral status should be given to an embryo? What can and cannot or should or should not be done to an embryo? When does personhood occur?’ At the other end of the life cycle, developments in artificial respiration have resulted in keeping patients alive who would normally die and have given rise to the question: ‘When is a person dead?’

Health care is a bottomless pit as far as financial funding is concerned. In practical terms finance has to be limited so that there are financial restrictions on health care. This results in, for example, a restriction on the number of patients who can have renal dialysis. ‘Who then should be given priority for this treatment and what are the ethics of this?’ Problems arise in the selection of patients for dialysis. ‘What is the balance in the use of resources?’

(p.vi) The medical profession is basically pragmatic as far as health care is concerned. In general, doctors wish to develop new methods for health care that will improve the quality of the lives of the patients that they treat. They sometimes find it difficult to see why restrictions should be put on when the results are so obviously beneficial. ‘What then is meant by quality of life?’

There are a variety of ways of looking at medical care; a variety of arguments that can be advanced and other considerations to take into account which health care professionals may not always consider. At the same time the public, politicians, lawyers, theologians, and others may not always be aware of the problems the health care professional has and they also have to remember who is at ‘the sharp end’ of the decision-making. The health care professionals have a collective responsibility which, so rightly, has been pointed out in this book and this is sometimes not fully appreciated.

Medical students generally, at present, do not spend much time on the ethical aspects of medicine. When they are being taught about such subjects as in vitro fertilization, artificial insemination by donor, terminal care, brain death, renal dialysis, and priorities in care, they are involved in learning the various kinds of decision-making but seldom in their course is there a formal teaching of ethics. This book attempts to remedy this deficiency and the authors have tried to put the arguments for and against the various problems and to ask the student to think about these problems. The student is introduced to the philosophical discussion of the ‘slippery slope’ argument and the argument of consequences and the various philosophical aspects of ethics. This enables the student to obtain a ‘new look’ at some of the problems and see some of the fallacies of the arguments that are put forward. It would in fact be most valuable for all medical students to have a course in philosophy related to medicine as part of their medical course and this book attempts to fill this gap. It should be essential reading for medical students and, in addition, all those who think they know the answer to the moral problems discussed here should read this book. In addition to medical students and doctors – lawyers, politicians, and theologians and, indeed, anyone in the general public who seeks (p.vii) to have a view on these difficult aspects of medical ethics, and especially those in public life who can exert influence and perhaps even legislate, ought to read this book in order to acquaint themselves with the difficulties. This would enable them to take part in a much more rational discussion of the problems than has been the case so far. This is a most valuable book and I hope it will be widely read. (p.viii)