Particularizing an Internal Morality of Physical Therapy

While the American Physical Therapy Association (APTA) has upheld a Code of Ethics since 1935, the philosophical underpinnings of physical therapy practice have yet to be robustly explicated. Theoretical work in the field of philosophy of medicine can be engaged to study physical therapy practice. Modifying the phenomenological and teleological framework of Edmund Pellegrino, a physician and prominent bioethicist, the purpose of this theoretical paper is to particularize Pellegrino’s philosophy of medicine to construct an internal morality of physical therapy. Acknowledging that the internal morality of health care professions is founded in the relationship between a patient and a health care professional, this paper analyzes the nature and telos, or end, of physical therapy through three phenomena of physical therapy –the fact of disability, the act of profession, and the act of physical therapy. This paper claims that, rather than medicine’s clinical truth of a good treatment decision, physical therapy’s clinical truth is a good process that capacitates patients. This relational approach to an internal morality robustly underpins a philosophy and ethics of physical therapy.

On Pellegrino and Thomasma’s Admission of a Dilemma and Inconsistency

Edmund Pellegrino and David Thomasma’s writings have had a worldwide impact on discourse about the philosophy of medicine, professionalism, bioethics, healthcare ethics, and patients’ rights. Given their works’ importance, it is surprising that commentators have ignored their admission of an unresolved and troubling dilemma and inconsistency in their theory. The purpose of this article is to identify and state what problems worried them and to consider possible solutions. It is argued that their dilemma stems from their concerns about how to justify professional rules restricting colleagues from performing acts they view as direct, active, and formal (intentional) killings, such as physician-assisted suicide, mercy killing, and abortion. It is further argued that their inconsistency is that they both assert and deny that professional colleagues should not use their moral or theological values to impose professional restrictions on other colleagues without adequate philosophical grounds. At risk are their arguments about the nature of an internal morality for medicine, a secular and multicultural basis for medical ethics, and a nonarbitrary way to determine what acts fall outside the ends of medicine. These are arguments they claim also apply to other healthcare professions. The article begins with a brief overview of their key positions to provide the context in which they make their admission.

Human Dignity as Concept and Lived Experience

In Evangelium vitae, Pope St. John Paul II addresses euthanasia and physician-assisted suicide by striking a balance—maintaining the inherent dignity of all persons while considering the lived experience of those struggling to see dignity amidst suffering. Subsequently, a debate about the word dignity has led to clarifications from the President’s Council on Bioethics (under President George W. Bush) regarding different uses of the word. This essay relies on the work of the council, especially an essay by Edmund Pellegrino, to provide a basis for reflecting on John Paul II’s approach to dignity in Evangelium vitae in terms of concept and lived experience. To further develop these insights, an alternative framework is proposed for thinking about dignity in the practical setting.

Edmund Pellegrino: moralidade médica e a teoria do consenso moral

Resumo Os autores apresentam e comentam as ideias de Edmund Pellegrino, bioeticista nascido em New Jersey, Estados Unidos, acerca da existência de moralidade interna à medicina, relacionada ao fim inerente à arte médica, ou seja, a cura do paciente, assim como a moralidade externa à medicina, que diz respeito a todos os outros aspectos da atividade médica cujo propósito final não seja a cura do paciente. Apresentam também os comentários de outros eticistas, contra ou a favor dos argumentos apresentados por Pellegrino, e comparam aspectos da referida moralidade externa à teoria do consenso moral desenvolvida anteriormente pelos autores.

Dualism and Its Discontents II: Philosophical Tinctures

Part II of II: This chapter explores philosophical responses to Cartesian dualism—notably Maurice Merleau-Ponty’s elaboration of phenomenology—and its relevance to medicine. With close reading of Merleau-Ponty’s Phenomenology of Perception, phenomenology’s attentiveness to lived experience and to embodiment is described. Next, discussion of the work of philosophers, clinicians, ethicists and patients—including Havi Carel, S. Kay Toombs, Richard Baron, Edmund Pellegrino, Richard Zaner, and Fredrik Svenaeus—demonstrates the influence of phenomenological perspectives in healthcare, addressing the dissociation and alienation often experienced by clinicians and patients alike. Counter-examples to the philosophical narrative presented here are then offered, demonstrating the rich complexity of philosophical enquiry. The chapter closes with a brief discussion of the poem “Soul” by David Ferry, which offers a means of approaching the age-old issue of the relationship between body, mind, and spirit. Thus the authors argue that philosophical understanding—particularly in combination with literature—offers particular insight into the challenges and possibilities of healthcare today.

HOMAGE TO EDMUND PELLEGRINO

On the 4th of July 2014, a Sattelite Symposium on Bioethics was held during The First Annual Conference and Awards Ceremony of The European Society For Person Centered Healthcare, including a simple act of homage to Dr. Edmund Pellegrino. The necessity for training in medical ethics and bioethics is increasingly well acknowledged by both medical practitioners, medical students and indeed patients. This observation led to the Spanish CEEM (Consejo Estatal de Estudiantes de Medicina, España), in co-operation with The National Conference of Deans of Faculties of Medicine of Spain (Conferencia Nacional de Decanos de las Facultades de Medicina, España) and the OMC (Organización Médica Colegial) to create a guide entitled “Ethical Recommendations for Clinical Practice.”