Kazimierz Szewczyk

In the article I discuss three types of non-formal curriculum: the hidden, informal and null curriculum. Their negative impact on the moral education of medical students and physicians is documented through the choice of examples from Polish medical schools and the statements of Polish physicians. I also justify the thesis that the teaching of medical ethics as ethics-as-tools is deeply rooted within the Polish moral cultural tradition. The polemic with Władysław Biegański serves as a means of showing the relation between the medical moral tradition and the belief that medical ethic is of little importance in the moral education of medical students and doctors. I also indicate that the lack of references to medical schools as moral entities within moral education condemns physicians to the solitude of their personal conscience when confronted with moral decisions. This, in turn, promotes the idea of defining this conscience in opposition to the law.

W artykule szkicuję czynniki sprzyjające przemianie kompleksowego ujęcia relacji kobieta ciężarna – płód, w dualny model tego odniesienia. W pierwszym modelu kobieta i płód są traktowani przez lekarzy jak jeden pacjent, natomiast w drugim także fazom prenatalnym ludzkiego życia przyznaje się moralny status samodzielnego pacjenta. Dualne podejście ma negatywne następstwa dla kobiet brzemiennych, sygnalizowane w tekście w polemice z Susan Mattingly. W drugiej części pracy analizuję podjętą przez Franka Chervenaka i Laurence McCullougha, teoretyczną próbę uzasadnienia statusu płodu jako pacjenta, przy jednoczesnym zachowaniu elementów kompleksowego modelu relacji kobieta ciężarna – płód. Analizy ukazują jej fiasko

W artykule w trojaki sposób dowodzę odrębności profesjonalnej etyki lekarskiej, mianowicie: 1. ukazując różnice pozycji normatywnej obowiązków w etyce profesjonalnej i ogólnej, 2. uzasadniając przynależność lekarskiej etyki profesjonalnej do modelu zapożyczenia jako typu etyki aplikacyjnej, 3. podając racje za profesjonalizmem historycznym jako etyką właściwą dla stanu lekarskiego. Odrębność profesjonalnej etyki lekarskiej stanowi ważny argument za jej umieszczeniem w planie edukacji etycznej studentów medycyny i lekarzy. W końcowej części pracy rekonstruuję rzeczywiste i postulowane relacje między etyką profesjonalną a profesjonalizmem, bioetyką akademicką i bioetyką publiczną. Celem rekonstrukcji jest wskazanie optymalnego dla edukacji etycznej miejsca etyki profesjonalnej w systemie kształcenia etycznego profesjonalistów.

In the article I prove the separateness of professional medical ethics in three ways: 1. By showing differences between the normative rank of responsibilities within general and professional ethics. 2. By justifying affiliation of professional medical ethics within the appropriation model which is a type of applied ethics characterized by its unique properties. 3. By justifying historical professionalism as the ethics that is proper for the medical profession; for this kind of ethical internalism the content of professional ethics is the sole work of medical professional organizations as well as individual doctors. In the final part of the article I reconstruct the actual and postulated relations between professional ethics and professionalism as well as between academic bioethics and public bioethics. The aim of this reconstruction is to indicate the optimal from the perspective of ethical education place of professional ethics within the ethics education system for professionalists.

W pierwszej części artykułu charakteryzuję trzy rodzaje profesjonalizmu lekarskiego: profesjonalizm tradycyjny, odnowiony i kompleksowy. Omawiam także czynniki kulturowe, ekonomiczne i aksjologiczne wpływające na ich kształtowanie się. Stawiam tezę, że profesjonalizm kompleksowy ze względu na jego skomplikowanie i arbitralne wyodrębnianie elementów składowych jest nieprzydatny w edukacji moralnej studentów i lekarzy. W części drugiej rekonstruuję wady i zalety profesjonalizmu tradycyjnego i odnowionego. Uzasadniam pogląd, że najważniejsza zaleta profesjonalizmu wynika z jego ambiwalencji moralnej. Nie traktuję więc tej dwuznaczności jako wyłącznie wady. Lekarz profesjonalista powinien mieć świadomość jasnych i ciemnych stron profesjonalizmu oraz umiejętność właściwego ich ważenia w danych okolicznościach – poszukiwania Arystotelesowskiego złotego środka. W ostatniej części argumentuję za umiarkowanie optymistycznym przekonaniem o przydatności profesjonalizmu tradycyjnego i odnowionego w moralnym formowaniu studentów medycyny i młodych lekarzy.

In the first part of my paper, drawing on the works by David Heyd, I argue that, in the choices related to procreation, an autonomous decision of the woman involved should play the key role. In the relation between a healthcare professional, on the one hand, and a pregnant patient, or a patient who intends to become pregnant, on the other – the former is ethically obliged to provide proper help in the decision-making process that should nevertheless be founded on the ethical ideal of a morally good person. The decision should also be informed by the conception of a morally good person endorsed by the woman . In the second part of my paper, I refer to the conception of the sanctity of human life, developed by Ronald Dworkin, to claim that, in a complex medical model, the tendency to equate the fetus with bodily organs should be curtailed as far as the relation between the pregnant woman and the fetus is concerned. The idea of the sanctity of life also serves as the ground on which what I call a ‘procreation epic’ is based. The suggested epic, viewed as a general philosophical framework for the healthcare and reproductive medicine policy, is considered relevant to democratic societies

The article begins by giving explaining the domination in biomedical experimentation of research leading to the production and implementation of new medicines. The description of these factors serves as an introduction to the fundamental section of the article that discusses the specific features of clinical tests during phase I of oncological therapy. They include above all such elements as the choice of human subjects from among the terminally ill and the non-therapeutic character of the experiments with an accompanying small statistical background of significant effects. The above features are the basic source of ethical dilemmas connected with phase I tests. In the article the following four most important factors have been analyzed: 1. the practical impossibility of obtaining an informed consent of the human subject for participating in the test, 2. the blurring of the border between therapy and experiment, leading to the treatment of phase I experiments as especially valuable though non-cost-effective therapeutic procedures, 3. the blurring of the distinction between a physician-therapist and a physician-researcher, 4. the tendency on the part of physicians and patients to treat phase I experiments as a way to avoid difficult conversations and decisions after all therapeutic options have been exhausted.

The article begins by clarifying the terms that are related above all to rationing itself and its most important forms: market and non-market economic rationing and non-economic rationing.Subsequent parts of the article deal with open non-market economic rationing; I argue that such rationing is necessary due to the irreducible divergence between supply and demand for health services. Moreover, I attempt to show that rationing is morally desirable and just, and that the decision to implement it requires social consensus. I maintain that a one-level system of health services is morally superior to mixed, multi-level models.

In the paper, after defining the necessary terms, I consider the following issues: 1. the process of bestowing the status of moral subjects on infants that started in the 1970s; 2. therapeutic strategies applied to these patients; 3. difficulties in classifying infants as critically ill patients; 4. problems in establishing a proxy to make decisions on their behalf; and 5. the criteria for such decisions, proposing a division of these guidelines into separative and integrative. The former serve to transfer the decision-making power to entities that are distinct from the whole health care system and fulfill directive and supervisory functions with respect to it; the latter combine in the decision process all of the components that are necessary to its operation - they decide what is in the best interests of the patient.

Kazimierz Szewczyk René Dubos, his new Hippocratic medicine, and the theology of the Earth Diametros 9 In the article I first present a sketch of René Dubos’ academic career. Then I reconstruct his philosophy of medicine and present the foundations of his ecologism, his theology of the Earth. I show that Dubos’ philosophy of medicine includes the following elements:1. A dynamic and adaptational notion of health and illness, according to which health is the ability of an individual to act in a modified environment, and illness, which is a disturbance of systemic equilibrium, is the beginning of a return to health, that is, the establishment of a new homeostasis.2. A model of human nature treated as a product of genetic and cultural adaptation to the environment, which combines a dynamic Promethean element with a proneness to injury.3. An anti-reductionist model of health care that is adapted to man’s nature and to the dynamic and adaptational vision of health, which Dubos usually calls new Hippocratic medicine.In the last part of the article I justify the thesis that the theology of the Earth constitutes an extension of the new Hippocratic medicine to the whole living supersystem of our planet