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      Ontology of doctor and patient relationship and bioethics: from Aristotle’s teleology to Pellegrino’s philosophy of medicine

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          Abstract

          Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle’s practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.

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          Principles of Biomedical Ethics

          Tom L. Beauchamp, James F. Childress (2019)
          Principles of Biomedical Ethics provides a highly original, practical, and insightful guide to morality in the health professions. Acclaimed authors Tom L. Beauchamp and James F. Childress thoroughly develop and advocate for four principles that lie at the core of moral reasoning in health care: respect for autonomy, nonmaleficence, beneficence, and justice. Drawing from contemporary research--and integrating detailed case studies and vivid real-life examples and scenarios--they demonstrate how these prima facie principles can be expanded to apply to various conflicts and dilemmas, from how to deliver bad news to whether or not to withhold or withdraw life-sustaining treatments.<br> <br> Ideal for courses in biomedical ethics, bioethics, and health care ethics, the text is enhanced by hundreds of annotated citations and a substantial introduction that clarifies key terms and concepts.<br>
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            The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions.

            E D Pellegrino (2001)
            The moral authority for professional ethics in medicine customarily rests in some source 'external' to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, 'internal' morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship.
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              The impossibility of a morality internal to medicine.

              W Veatch (2001)
              After distinguishing two different meanings of the notion of a 'morality internal to medicine' and considering a hypothetical case of a society that relied on its surgeons to 'eunuchize' priest/cantors to permit them to play an important religious/cultural role, this paper examines three reasons why morality cannot be derived from reflection on the ends of the practice of medicine: (1) there exist many medical roles and these have different ends or purposes, (2) even within any given medical role, there exists multiple, sometimes conflicting ends, and, most critically, (3) the ends of any practice such as medicine must come from outside the practice, that is, from the basic ends or purposes of human living. The paper concludes by considering whether these ends external to medicine are universally part of the moral reality or whether they are socially constructed. The paper argues that, even if various cultural accounts of the common, universal morality are 'socially constructed,' they may, nevertheless, be reflections, however, imperfect, of a more universal common morality that should be thought of as real. Therefore, the morality of medicine must come from a more fundamental morality external to medicine. That external morality will be socially constructed, but may nevertheless reflect an underlying common morality.
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                Author and article information

                Contributors
                Nuno Ribeiro Ferreira:
                ORCID: http://orcid.org/0000-0002-5998-3086
                nunoribferreira@gmail.com
                Journal
                Journal ID (nlm-ta): Med Health Care Philos
                Journal ID (iso-abbrev): Med Health Care Philos
                Title: Medicine, Health Care, and Philosophy
                Publisher: Springer Netherlands (Dordrecht )
                ISSN (Print): 1386-7423
                ISSN (Electronic): 1572-8633
                Publication date (Electronic): 27 November 2024
                Publication date PMC-release: 27 November 2024
                Publication date (Print): 2025
                Volume: 28
                Issue: 1
                Pages: 113-119
                Affiliations
                [1 ]Bioethics Centre, Faculty of Medicine, University of Porto, ( https://ror.org/043pwc612) Alameda Prof. Hernâni Monteiro, Porto, 4200-319 Portugal
                [2 ]Faculty of Human Sciences, Catholic University of Portugal (UCP), ( https://ror.org/03b9snr86) Palma de Cima Campus, Lisboa, 1649-023 Portugal
                Author information
                http://orcid.org/0000-0002-5998-3086
                http://orcid.org/0000-0002-0874-689X
                http://orcid.org/0000-0002-1377-9899
                Article
                Publisher ID: 10239
                DOI: 10.1007/s11019-024-10239-2
                PMC ID: 11805858
                PubMed ID: 39601903
                SO-VID: a0bca308-b11b-4dbf-9bfe-33245c5013f0
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date accepted : 10 November 2024
                Funding
                Funded by: Universidade do Porto
                Open Access :

                Open access funding provided by FCT|FCCN (b-on).

                Categories
                Subject: Scientific Contribution
                Custom metadata
                issue-copyright-statement © Springer Nature B.V. 2025

                ScienceOpen disciplines: Medicine
                Keywords: ontology,philosophy of medicine,bioethics,doctor-patient relationship
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: ontology, philosophy of medicine, bioethics, doctor-patient relationship

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