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Tuesday, March 12, 2019


Stephen Scher and Kasia Kozlowska. Rethinking Health Care Ethics. Palgrave Pivot/Springer, 2018. Available Open Access (free download): 

“a powerful and deeply reasoned critique of teaching and practice in contemporary bioethics, and a timely, compelling, and humane proposal for rethinking values and ethics in the care of patients.”

– Allan M. Brandt, Department of the History of Science, and former Dean of the Graduate School of Arts and Sciences, Harvard University
If Rethinking Health Care Ethics had a subtitle, it would be “Philosophical Ethics Meets the Real World.” The book identifies a gap between philosophical approaches to normative and professional ethics, especially as embodied in the American bioethics movement, and the actual world of professional practitioners, where ethical problems are encountered, and solved as best as possible, day by day, minute by minute. The book is, in effect, an extended exploration of this gap between theory and practice, and of how to address it.

An easy way of understanding the setting for the book is by relating an anecdote by the former co-editors of a major medical journal. They were working as visitors at a university-affiliated hospital, and they described (to the resident “ethicist”) “an everyday clinical decision (one of very many).” The ethicist replied, “That would take days—even weeks—for me to analyze properly.” Moreover, he added, “If the end results of [their] decision were harmful,” the two doctors “would have been unethical.” The problem, of course, is that health professionals—and virtually anyone working in any profession—need to make these decisions quickly, often immediately. And they often even make these decisions more or less automatically, without thinking. How can that be?

The book is nontechnically written in order to make it accessible to non-philosophers, ranging from undergraduate students to practicing professionals. It is potentially useful in undergraduate and graduate courses in professional ethics, in courses offered in professional schools, and for practicing professionals. The book also raises, indirectly, important questions about the limits of philosophical ethics and about how one should teach moral philosophy, and with what goals and expectations in mind.

Stephen Scher, PhD, JD (sscher@mclean.harvard.edu) is Senior Editor of the Harvard Review of Psychiatry and former Senior Editor of the American Journal of International Law. Kasia Kozlowska, MBBS, PhD, is Clinical Associate Professor of Psychiatry at the University of Sydney Medical School.

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