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Tony Coady explores the challenges that morality poses to politics. He confronts the complex intellectual tradition known as realism, which seems to deny any relevance of morality to politics, especially international politics. He argues that, although realism has many serious faults, it has lessons to teach us: in particular, it cautions us against the dangers of moralism in thinking about politics and particularly foreign affairs. Morality must not be confused with moralism: Coady characterizes various forms of moralism and sketches their distorting influence on a realistic political morality. He seeks to restore the concept of ideals to an important place in philosophical discussion, and to give it a particular pertinence in the discussion of politics. He deals with the fashionable idea of “dirty hands,” according to which good politics will necessarily involve some degree of moral taint or corruption. Finally, he examines the controversial issue of the role of lying and deception in politics. Along the way Coady offers illuminating discussion of historical and current political controversies. This lucid book will provoke and stimulate anyone interested in the interface of morality and politics.
D. D. Raphael provides a critical account of the moral philosophy of Adam Smith, presented in his first book, The Theory of Moral Sentiments. Whilst it does not have the same prominence in its field as his work on economics, The Wealth of Nations, Smith’s writing on ethics is of continuing importance and interest today, especially for its theory of conscience. Smith sees the origin of conscience in the sympathetic and antipathetic feelings of spectators. As spectators of the actions of other people, we can imagine how we would feel in their situation. If we would share their motives, we approve of their action. If not, we disapprove. When we ourselves take an action, we know from experience what spectators would feel, approval or disapproval. That knowledge forms conscience, an imagined impartial spectator who tells us whether an action is right or wrong. In describing the content of moral judgment, Smith is much influenced by Stoic ethics, with an emphasis on self-command, but he voices criticism as well as praise. His own position is a combination of Stoic and Christian values. There is a substantial difference between the first five editions of the Moral Sentiments and the sixth. Failure to take account of this has led some commentators to mistaken views about the supposed youthful idealism of the Moral Sentiments as contrasted with the mature realism of The Wealth of Nations. A further source of error has been the supposition that Smith treats sympathy as the motive of moral action, as contrasted with the supposedly universal motive of self-interest in The Wealth of Nations.
David Ellison’s book is an investigation into the historical origins and textual practice of European literary Modernism. Ellison’s study traces the origins of Modernism to the emergence of early German Romanticism from the philosophy of Immanuel Kant, and emphasizes how the passage from Romanticism to Modernism can be followed in the gradual transition from the sublime to the uncanny. Arguing that what we call High Modernism cannot be reduced to a religion of beauty, an experimentation with narrative form, or even a reflection on time and consciousness, Ellison demonstrates that Modernist textuality is characterized by the intersection, overlapping, and crossing of aesthetic and ethical issues. Beauty and morality relate to each other as antagonists struggling for dominance within the related fields of philosophy and theory on the one hand (Kant, Kierkegaard, Nietzsche, Freud) and imaginative literature on the other (Baudelaire, Proust, Gide, Conrad, Woolf, Kafka).
Marc A. Rodwin draws on his own experience as a health lawyer–and his research in health ethics, law, and policy–to reveal how financial conflicts of interest can and do negatively affect the quality of patient care. He shows that the problem has become worse over the last century and provides many actual examples of how doctors’ decisions are influenced by financial considerations. We learn how two California physicians, for example, resumed referrals to Pasadena General Hospital only after the hospital started paying $70 per patient (their referrals grew from 14 in one month to 82 in the next). As Rodwin writes, incentives such as this can inhibit a doctor from taking action when a hospital fails to provide proper service, and may also lead to the unnecessary hospitalization of patients. We also learn of a Wyeth-Ayerst Labs promotion in which physicians who started patients on INDERAL (a drug for high blood pressure, angina, and migraines) received 1000 mileage points on American Airlines for each patient (studies show that promotions such as this have a direct effect on a doctor’s choice of drug). Rodwin reveals why the medical community has failed to regulate conflicts of interest: peer review has little authority, state licensing boards are usually ignorant of abuses, and the AMA code of ethics has historically been recommended rather than required. He examines what can be learned from the way society has coped with the conflicts of interest of other professionals –lawyers, government officials, and businessmen–all of which are held to higher standards of accountability than doctors. And he recommends that efforts be made to prohibit and regulate certain kinds of activity (such as kickbacks and self-referrals), to monitor and regulate conduct, and to provide penalties for improper conduct. Our failure to face physicians’ conflicts of interest has distorted the way medicine is practiced, compromised the loyalty of doctors to patients, and harmed society, the integrity of the medical profession, and patients. For those concerned with the quality of health care or medical ethics, Medicine, Money and Morals is a provocative look into the current health care crisis and a powerful prescription for change.
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