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Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, traditions, and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers.
In a clear and elegant style, T. M. Scanlon reframes current philosophical debates as he explores the moral permissibility of an action. Permissibility may seem to depend on the agent’s reasons for performing an action. For example, there seems to be an important moral difference between tactical bombing and a campaign by terrorists—even if the same number of non-combatants are killed—and this difference may seem to lie in the agents’ respective aims. However, Scanlon argues that the apparent dependence of permissibility on the agent’s reasons in such cases is merely a failure to distinguish between two kinds of moral assessment: assessment of the permissibility of an action and assessment of the way an agent decided what to do. Distinguishing between these two forms of assessment leads Scanlon to an important distinction between the permissibility of an action and its meaning: the significance for others of the agent’s willingness to act in this way. An action’s meaning depends on the agent’s reasons for performing it in a way that its permissibility does not. Blame, he argues, is a response to the meaning of an action rather than its permissibility. This analysis leads to a novel account of the conditions of moral responsibility and to important conclusions about the ethics of blame.
“The big issues of medical ethics are more in the news than ever before. And yet they remain as stubborn and often as incendiary as ever. This book claims that in an effort to deal with the issues, mainstream philosophers have arbitrarily omitted many ethically relevant features in order to reduce the central problems to more tractable technical puzzles. The most gratuitous omissions have been the patient’s point of view on the problem; the patient’s ordinary life, which provides the wider context for his point of view; and the ordinary language and concepts by which the patient tries to make sense of the problem.
The need for a global ethics has its origin in the human situation as such (i.e. in the fact of hominisation that has dismissed us from the natural security of animal instincts and thrown us into the state of freedom) and especially in the present situation of humankind that is characterised by an extreme increase of external challenges to our co-responsability, brought about by the results of natural science, technology, politics and economy, and – as it appears – lacking internal resources of ethical reason. The present book tries to show that the transcentendal-pragmatic approach to discourse ethics can reconstruct the genesis of this situation and provide a rational response to the external challenges to and the internal deficits of global ethics. (Peeters 2001)
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