Biomedical subjects
Publications and source records attributed to Diego Gracia.
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During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics.
The discussions of these past twenty years have significantly improved our knowledge about the foundation of bioethics and the meaning of the four bioethical principles with concern to at least three different points: that they are organised hierarchically, and therefore not "prima facie" of the same level; that they have exceptions, and consequently lack of absolute character; and that they are neither strictly deontological nor purely teleological. The only absolute principle of moral life can be the abstract and unconcrete respect of human beings. But when determining the material content of this respect, principles become contingent and relative. Therefore, moral reasoning must have necessarily no less than three moments, one absolute but merely formal, namely respect for all human beings, and the other two relative and material. The first material moment is comprised of the four bioethical principles, divided into two levels, one private, including the principles of autonomy and beneficence, and the other one public, including those of nonmaleficence and justice. The second material moment deals with specific cases, and requires analysis of their context, including their circumstances and consequences. Only when following these steps, and therefore balancing principlism and contextualism, can moral reasoning be correct and complete.
Today the Western world harbors, at least, three very different ethical traditions, each with its own characteristics: the Anglo-Saxon, the Northern (or Central) European, and the Mediterranean. Because modern bioethics made its appearance in the Anglo-American culture, Europeans in general, and Mediterraneans in particular, have attempted not simply to "import" or "translate" bioethics, but rather to "recreate" or "remake" the discipline according to their own cultural and ethical traditions. In my presentation, I would like to explain the peculiarities of Mediterranean bioethics, analyzing the following seven points: First, how they think bioethics should be philosophically founded; Second, the Mediterranean ethics of virtue and the doctor-patient relationship; Third, the relationship between Ethics and Law; Fourth, Health Care Systems and Ethics, Fifth, the problems concerning patient rights; Sixth, ethics by Committees; and finally, some general conclusions.
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During the last decades, an important debate about professions in general, and particularly about the medical profession, has taken place. The classic idea that professionals do have a "special mora lity", different from the common morality, which among other things give them legal impunity, came to a head. This causes a great deal of confusion among the professionals, incapable of reacting and redefining precisely their own identity. Some new concepts, like that of "internal morality" of professional activities, made the debate more difficult and confusing. On the other hand, the everyday more powerful influence of free market forces in the health care economy, has made that some decisions taken by health care managers would be considered by physicians as opposed to their professional duties and incompatible with them. This has been the origin of a debate about what is called in North America "New Professionalism". This debate deals with basic questions about the health care professional's identity at the beginning of this new Century.
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