Institute for Ethics and Society, University of Notre Dame Australia, 104 Broadway, P.O. Box 944, Broadway, NSW, 2007, Australia.
Theor Med Bioeth. 2019 Jun;40(3):243-251. doi: 10.1007/s11017-019-09487-8.
There has been significant debate about whether the moral norms of medical practice arise from some feature or set of features internal to the discipline of medicine. In this article, I analyze Edmund Pellegrino's conception of the internal morality of medicine, and situate it in the context of Alasdair MacIntyre's influential account of "practice." Building upon MacIntyre, Pellegrino argued that medicine is a social practice with its own unique goals-namely, the medical, human, and spiritual good of the patient-and that the moral norms that govern medical practice are derived from these goals. After providing an overview of Pellegrino's work, I discuss some forceful objections to his theory-specifically, that it is too rigid and incapable of entering into dialogue with contemporary values systems; that it is dependent on an external conception of human flourishing; and that it is incompatible with the rapidly changing nature of modern medicine. In the final section of this article, I consider how theorists working in the Hippocratic tradition might respond to these objections against ethical essentialism by drawing upon MacIntyre's historico-cultural method as well as what he calls Aristotle's "metaphysical biology."
关于医学实践的道德规范是否源自医学学科内部的某些特征或特征集合，一直存在着激烈的争论。在本文中，我分析了埃德蒙·佩莱格里诺（Edmund Pellegrino）对医学内部道德的理解，并将其置于阿拉斯代尔·麦金泰尔（Alasdair MacIntyre）有影响力的“实践”论述背景下。佩莱格里诺在麦金泰尔的基础上提出，医学是一种具有自身独特目标的社会实践，即患者的医学、人类和精神利益，而规范医学实践的道德规范则源自这些目标。在概述了佩莱格里诺的工作之后，我讨论了对他的理论的一些有力反对意见，特别是认为它过于僵化，无法与当代价值体系进行对话；它依赖于对人类繁荣的外部概念；以及它与现代医学的快速变化性质不兼容。在本文的最后一节，我考虑了希波克拉底传统的理论家如何通过借鉴麦金泰尔的历史文化方法以及他所称的亚里士多德的“形而上学生物学”来回应这些对伦理本质主义的反对意见。
