On the Teleological Structure of Medicine: A Phenomenological Contribution
This dissertation has two parts, each of which contains three chapters. Part I recapitulates Pellegrino's philosophy of medicine and Part II answers Robert Veatch's critique of Pellegrino's position.Chapter One presents Edmund Pellegrino's phenomenology of the clinical encounter: the practice of medicine comes about in response to the need for healing generated by the experience of illness; accordingly, persons who are ill (patients) and persons who profess to heal (physicians) come together for the sake of healing. Chapter Two shows that Pellegrino blends physician beneficence with patient autonomy by tracing medical morality back to the deliberations that shape the clinical encounter. Persons become patients when they seek help from physicians to answer the questions raised by illness: What is wrong? What can be done? What should be done? Physicians have the expertise required to answer the first two questions, but Pellegrino argues that physicians must come to appreciate the patient's good before they help patients determine what should be done. Chapter Three unpacks Pellegrino's complex and hierarchically structured description of the patient's good. Chapter Four asks whether a technically competent physician can practice medicine in the manner described by Pellegrino. Robert Veatch thinks not. In a pluralist society, patients and physicians do not have common values; so they cannot deliberate together. Chapter Five addresses Veatch's view of the patient-physician relationship. Theorized within the frame of pluralism, this relationship becomes a forum for conflict, which Veatch resolves by reducing the physician to the role of a technician who takes directions from the patient. Chapter Six draws on the work of S. Kay Toombs and Drew Leder to clarify Pellegrino's basic claim that illness establishes both the origin (arche) and the end (telos) of medicine. Not only does Veatch ignore the moral significance of illness emphasized by Pellegrino, but Veatch also denies Pellegrino's insight that medical ethics should respond to the patient's need to trust the physician. In sum, the contrast between Veatch and Pellegrino highlights Pellegrino's contribution to medical ethics. His phenomenology of the clinical encounter displays the teleological structure of medicine.
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