Amherst Magazine

What They Are Reading

The Amherst courses taught by Jyl Gentzler, associate professor of philosophy, include Philosophy 23s: Health Care Ethics. Here she recommends books on that topical subject.

A couple years ago, I took the opportunity of a year-long sabbatical to pursue a latent interest in what I then regarded as medical ethics. I became a fellow in medical ethics at Harvard Medical School, where I met weekly with physicians, nurses, a state representative, an AIDS activist, attorneys, and one other academic to discuss ethical problems that physicians faced (this was, after all, Harvard Medical School). Almost immediately, it became clear that the ethical problems seen by physicians in the Harvard system looked very different from the perspectives of the nurses, attorneys, and political activists in the room, indeed from the perspective of the physician who worked in an emergency room at a state hospital outside of the Harvard system. For an academic like me who had little personal experience with the health care system but lots of tools for thinking about other people's experiences, this rich clashing of points of view was invaluable. Philosophy has a tendency toward abstraction, and the solutions that philosophers propose to hypothetical ethical problems are often inadequate because the theory and the proposed solutions are uninformed by the detail of the complex problems that people face in their daily lives. The inside perspective on the American health care system that is provided by those in the nursing profession is invaluable and too rarely noticed.

An excellent corrective to that oversight is Suzanne Gordon, Life Support: Three Nurses on the Front Lines (Back Bay Books, 1997).

The apparently irresolvable conflict between the values of different people, particularly between the values of members of different cultures, has convinced many people of the truth of moral relativism—the philosophical view that what is right for me is simply a function of my beliefs about what is right, and what is right for you is simply a function of what you believe is right. We hear about the way that other people behave in various situations, and because we cannot imagine ourselves behaving the same way in those situations, we conclude that their values must be fundamentally different from our own. Our commitment to being tolerant and nonjudgmental then leads us to a kind of relativism: since their views deserve the same respect as mine, what's right for them must be different from what is right for me. But, again and again, I have discovered that an initial appearance of conflict between the basic values of myself and others is challenged when I learn more about the concrete, complex details of the actual situations that other people face. When I learn about these details, it is no longer clear to me that my behavior would be so different from theirs if I were in their shoes. While some would argue that a commitment to moral relativism is needed to encourage the tolerance that is necessary for a multicultural society to thrive, I have become convinced that information about the actual challenges that other people face in their everyday lives and about the similarity of their basic goals with our own is necessary to inspire the empathy that helps us to overcome our indifference to their needs. Two particularly rewarding accounts of the concrete, daily challenges that different Americans have faced in their efforts to access health care are Laurie Kaye Abraham, Mama Might Be Better Off Dead: The Failure of Health Care in Urban America (Chicago, 1993), and Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, her American Doctors, and the Collision of Two Cultures (Farrar, Straus, and Giroux, 1997).

An illuminating critique of moral relativism is Michele Moody-Adams, Fieldwork in Familiar Places: Morality, Culture, and Philosophy (Harvard, 1997).

Health Care Ethics is exciting because it crosses so many disciplines—philosophy, sociology, economics, political science, and biology, to name a few. For this same reason, it can be a bit daunting for someone who attempts to make sense of it all. How, for example, can we assess the moral implications of the so-called "genetic revolution" without a Ph.D. in molecular biology? One sane and nuanced discussion of the biology and philosophy of human genetics is Philip Kitcher, The Lives to Come: The Genetic Revolution and Human Possibilities (Simon and Schuster, 1997).

I originally came to philosophy because I found that it helped me to think more clearly and effectively about the difficult conceptual puzzles that everyday life poses. A very nice introduction to the basic conceptual questions that arise when thinking about health care is Bernard Gert, Charles M. Culver, and K. Danner Clouser, Bioethics: A Return to Fundamentals (Oxford, 1997).

On the particularly difficult questions of justice that arise in a health care context—questions like, "Just how much and what sort of health care does a just society provide its members?" and "Whose needs should be met when everyone's needs cannot be met?"—I recommend Norman Daniels, Just Health Care (Cambridge, 1985).

Justice seems to require us to take the perspective of an impartial observer who gives equal weight to the interests of all those affected by a particular decision. Often this perspective seems to clash with the perspective that most of us take in our daily lives when interacting with family, friends, patients, students, clients, and professional colleagues, where ties of love, commitment, friendship, and professional responsibilities seem not only to permit, but to demand, that we treat people unequally. Two recent books that helped me to understand how both impartiality and partiality are important parts of our moral lives are: Hilde Lindemann Nelson and James Lindemann Nelson, The Patient in the Family: An Ethics of Medicine and Families (Routledge, 1995), and Eva Feder Kittay, Love's Labor: Essays on Women, Equality, and Dependency (Routledge, 1999).