H T Engelhardt - Academia.edu (original) (raw)
Papers by H T Engelhardt
Journal of the American College of Cardiology, 1991
We are completing the most revolutionary century in the history of medicine. As we look to the ne... more We are completing the most revolutionary century in the history of medicine. As we look to the next century-in fact, to the next millennium-there is no reason to believe that medical progress will not continue in even more dramatic fashion. Yet constraints will remain, which must be acknowledged in framing ethical judgments because they define the human condition. In particular, there are circumstances that will make concerns regarding the use of resources the central issue in medical ethics: 1) medical technologic advances will likely continue to produce new, promising and expensive therapeutic and diagnostic interventions; 2) human life will continue to have a limited duration; 3) treatment will often be only partially successful, leaving some individuals with a quality of life they find unacceptable; 4) resources for health care will be limited; and 5) the moral authority of states to constrain how persons use their resources will remain limited as well. Despite often Promethean expectations, we are left with the constraints of finitude, which include the problem of rising demands on medicine in the face of limited resources. The Failures of Ethics and Implications for Medical Ethics These are the substance of ethical concerns, not just economic problems. In the future as in the past, medicine will need to place its activities and self-understanding within a moral context. Physicians will need to face the restructuring of American medicine to provide health insurance for all. The literature is already rich with new proposals (1,2). What is important is how we understand this step morally. I will first address the failures of ethics and their implications for medical ethics. For primarily moral reasons, we should abandon the rhetoric of providing the best care
Politics and the life sciences : the journal of the Association for Politics and the Life Sciences, 1988
As Arnhart acknowledges, the major intellectual challenge of the 20th century is to justify moral... more As Arnhart acknowledges, the major intellectual challenge of the 20th century is to justify moral judgments rationally and to provide moral authority for political action when individuals meet as moral strangers who do not share common moral assumptions. This is the task of a secular morality that aspires to transcend particular religious or ideological commitments. The arguments for nihilism suggest that such a task cannot be successfully completed. There are three ways one might attempt to escape the threat of nihilism. First, one might endeavor to show that the Aristotelian project to read human moral goals and the lineaments of proper political structure from the characteristics of human biology can be successful, despite the skepticism of authors who have articulated the naturalistic fallacy: from what is the case, one cannot conclude what ought to be the case. A neo-Aristotelian approach would need to derive from the biological nature of humans a proper code for human conduct and morally justified guidelines for human political action. Second, one might attempt to discover, as Kant had hoped, content in the very nature of reason. Here the “nature” at stake is not an external biological nature, but the characteristics of reason or reasoning itself. A contemporary example of the Kantian undertaking is found in Rawls' Theory of Justice (1971). The Aristotelian and Kantian traditions provide two quite different senses of “natural,” from which Western thinkers have attempted (in different ways) to establish the content of natural law and to justify moral and political rules.
Health care analysis : HCA : journal of health philosophy and policy, 2001
The challenge in maintaining patient autonomy regarding medical decision-making and confidentiali... more The challenge in maintaining patient autonomy regarding medical decision-making and confidentiality lies not only in control over information transferred to and regarding patients, but in the ambiguity of autonomy itself. Post-modernity is characterized by the recognition of not just numerous accounts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, and an element of human flourishing. In each case, it can have a different content, depending in part on whether it is given a nomological or a volitional construal. Different accounts of autonomy can lead to strikingly different understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of autonomy they themselves affirm. In the face of competing accounts of moral probity, autonomy in a secular morality and bioethics must by default be understood in terms of the ...
The Journal of medicine and philosophy, 1990
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 1999
Journal of health & social policy, 1992
1. J Health Soc Policy. 1992;4(1):27-35. Selling virtue: ethics as a profit maximizing strategy i... more 1. J Health Soc Policy. 1992;4(1):27-35. Selling virtue: ethics as a profit maximizing strategy in health care delivery. Engelhardt HT Jr, Rie MA. Center for Ethics, Medicine, and Public Issues, Baylor College of Medicine, Houston, TX 77030. ...
Bulletin of the American College of Surgeons, 1993
To be human is to frame projects in the face of ineradicable limitations. The beginning of sound ... more To be human is to frame projects in the face of ineradicable limitations. The beginning of sound health care policy is the recognition that one must accept some risks of death, suffering, and disability, and that one should forgo attempting to prevent death, suffering, and disability when the costs are high and the likelihood of success low. Sound health care policy requires recognizing the extreme burdens that would be incurred if one truly attempted to save lives at all costs. Framing realistic health care policy also requires taking account of the circumstance that being rich is positively correlated with living longer, and that the secular moral authority of the state to remedy this circumstance is limited. After 15 years of an all-encompassing health care system, Canada still had striking differences between the life expectancies of highest-earning and lowest-earning citizens. The second challenge for secular health care policy is: To what extent may the state forbid individual...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 1991
Theoretical medicine
Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of... more Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of medicine and the philosophical grounding of medical ethics that has framed the contemporary field of bioethics in the expectation, of the rational justification of a universal content-full morality. However, this attempt at rational justification has failed, leaving a plurality of bioethics and the inability to secure the canonical account of virtue and character which Pellegrino has sought. This failure is integral to a Western Christian error regarding the nature of virtue.
Southern medical journal, 1993
A survey of 200 outpatients using an anonymous, self-administered questionnaire revealed that 18%... more A survey of 200 outpatients using an anonymous, self-administered questionnaire revealed that 18% had already completed an advance directive. Only 5% had received information concerning advance directives from their physicians. Eighty-seven percent stated they would not be offended if, on admission to the hospital, they were to be asked whether they had completed a living will. Eighty-eight percent would view such a policy as showing evidence of positive concern by the hospital on their behalf. Only 2% consistently gave a negative response to a proposed policy of hospitals providing information concerning advance directives on admission, and a similar percentage was totally opposed to their use. Of those who had completed an advance directive, 50% had secured the only copy in a safety deposit box. This information, as well as the Patient Self-Determination Act of 1990, which will as of December 1, 1991 require hospitals to provide patients with information about advance directives, ...
The Journal of clinical ethics, 1993
The New England journal of medicine, Jan 5, 1984
The Hastings Center report
... In separate essays, Engelhardt and Jennings discuss the problem of bioethical discourse in a ... more ... In separate essays, Engelhardt and Jennings discuss the problem of bioethical discourse in a pluralistic society where there is profound disagreement over themorality of abortion, euthanasia, embryo research, and other issues. ...
The Hastings Center report, 1975
Bulletin of the history of medicine, 1975
Clio medica (Amsterdam, Netherlands), 1975
Journal of Medicine and Philosophy, 1981
Journal of Medicine and Philosophy, 1979
Journal of the American College of Cardiology, 1991
We are completing the most revolutionary century in the history of medicine. As we look to the ne... more We are completing the most revolutionary century in the history of medicine. As we look to the next century-in fact, to the next millennium-there is no reason to believe that medical progress will not continue in even more dramatic fashion. Yet constraints will remain, which must be acknowledged in framing ethical judgments because they define the human condition. In particular, there are circumstances that will make concerns regarding the use of resources the central issue in medical ethics: 1) medical technologic advances will likely continue to produce new, promising and expensive therapeutic and diagnostic interventions; 2) human life will continue to have a limited duration; 3) treatment will often be only partially successful, leaving some individuals with a quality of life they find unacceptable; 4) resources for health care will be limited; and 5) the moral authority of states to constrain how persons use their resources will remain limited as well. Despite often Promethean expectations, we are left with the constraints of finitude, which include the problem of rising demands on medicine in the face of limited resources. The Failures of Ethics and Implications for Medical Ethics These are the substance of ethical concerns, not just economic problems. In the future as in the past, medicine will need to place its activities and self-understanding within a moral context. Physicians will need to face the restructuring of American medicine to provide health insurance for all. The literature is already rich with new proposals (1,2). What is important is how we understand this step morally. I will first address the failures of ethics and their implications for medical ethics. For primarily moral reasons, we should abandon the rhetoric of providing the best care
Politics and the life sciences : the journal of the Association for Politics and the Life Sciences, 1988
As Arnhart acknowledges, the major intellectual challenge of the 20th century is to justify moral... more As Arnhart acknowledges, the major intellectual challenge of the 20th century is to justify moral judgments rationally and to provide moral authority for political action when individuals meet as moral strangers who do not share common moral assumptions. This is the task of a secular morality that aspires to transcend particular religious or ideological commitments. The arguments for nihilism suggest that such a task cannot be successfully completed. There are three ways one might attempt to escape the threat of nihilism. First, one might endeavor to show that the Aristotelian project to read human moral goals and the lineaments of proper political structure from the characteristics of human biology can be successful, despite the skepticism of authors who have articulated the naturalistic fallacy: from what is the case, one cannot conclude what ought to be the case. A neo-Aristotelian approach would need to derive from the biological nature of humans a proper code for human conduct and morally justified guidelines for human political action. Second, one might attempt to discover, as Kant had hoped, content in the very nature of reason. Here the “nature” at stake is not an external biological nature, but the characteristics of reason or reasoning itself. A contemporary example of the Kantian undertaking is found in Rawls' Theory of Justice (1971). The Aristotelian and Kantian traditions provide two quite different senses of “natural,” from which Western thinkers have attempted (in different ways) to establish the content of natural law and to justify moral and political rules.
Health care analysis : HCA : journal of health philosophy and policy, 2001
The challenge in maintaining patient autonomy regarding medical decision-making and confidentiali... more The challenge in maintaining patient autonomy regarding medical decision-making and confidentiality lies not only in control over information transferred to and regarding patients, but in the ambiguity of autonomy itself. Post-modernity is characterized by the recognition of not just numerous accounts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, and an element of human flourishing. In each case, it can have a different content, depending in part on whether it is given a nomological or a volitional construal. Different accounts of autonomy can lead to strikingly different understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of autonomy they themselves affirm. In the face of competing accounts of moral probity, autonomy in a secular morality and bioethics must by default be understood in terms of the ...
The Journal of medicine and philosophy, 1990
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 1999
Journal of health & social policy, 1992
1. J Health Soc Policy. 1992;4(1):27-35. Selling virtue: ethics as a profit maximizing strategy i... more 1. J Health Soc Policy. 1992;4(1):27-35. Selling virtue: ethics as a profit maximizing strategy in health care delivery. Engelhardt HT Jr, Rie MA. Center for Ethics, Medicine, and Public Issues, Baylor College of Medicine, Houston, TX 77030. ...
Bulletin of the American College of Surgeons, 1993
To be human is to frame projects in the face of ineradicable limitations. The beginning of sound ... more To be human is to frame projects in the face of ineradicable limitations. The beginning of sound health care policy is the recognition that one must accept some risks of death, suffering, and disability, and that one should forgo attempting to prevent death, suffering, and disability when the costs are high and the likelihood of success low. Sound health care policy requires recognizing the extreme burdens that would be incurred if one truly attempted to save lives at all costs. Framing realistic health care policy also requires taking account of the circumstance that being rich is positively correlated with living longer, and that the secular moral authority of the state to remedy this circumstance is limited. After 15 years of an all-encompassing health care system, Canada still had striking differences between the life expectancies of highest-earning and lowest-earning citizens. The second challenge for secular health care policy is: To what extent may the state forbid individual...
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 1991
Theoretical medicine
Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of... more Edmund Pellegrino's work has been crucial to the renaissance of interest in the philosophy of medicine and the philosophical grounding of medical ethics that has framed the contemporary field of bioethics in the expectation, of the rational justification of a universal content-full morality. However, this attempt at rational justification has failed, leaving a plurality of bioethics and the inability to secure the canonical account of virtue and character which Pellegrino has sought. This failure is integral to a Western Christian error regarding the nature of virtue.
Southern medical journal, 1993
A survey of 200 outpatients using an anonymous, self-administered questionnaire revealed that 18%... more A survey of 200 outpatients using an anonymous, self-administered questionnaire revealed that 18% had already completed an advance directive. Only 5% had received information concerning advance directives from their physicians. Eighty-seven percent stated they would not be offended if, on admission to the hospital, they were to be asked whether they had completed a living will. Eighty-eight percent would view such a policy as showing evidence of positive concern by the hospital on their behalf. Only 2% consistently gave a negative response to a proposed policy of hospitals providing information concerning advance directives on admission, and a similar percentage was totally opposed to their use. Of those who had completed an advance directive, 50% had secured the only copy in a safety deposit box. This information, as well as the Patient Self-Determination Act of 1990, which will as of December 1, 1991 require hospitals to provide patients with information about advance directives, ...
The Journal of clinical ethics, 1993
The New England journal of medicine, Jan 5, 1984
The Hastings Center report
... In separate essays, Engelhardt and Jennings discuss the problem of bioethical discourse in a ... more ... In separate essays, Engelhardt and Jennings discuss the problem of bioethical discourse in a pluralistic society where there is profound disagreement over themorality of abortion, euthanasia, embryo research, and other issues. ...
The Hastings Center report, 1975
Bulletin of the history of medicine, 1975
Clio medica (Amsterdam, Netherlands), 1975
Journal of Medicine and Philosophy, 1981
Journal of Medicine and Philosophy, 1979