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June 1, 1984

Medical Ethics' Assault on Medical Values-Reply

Author Affiliations

University of Rochester Medical Center School of Medicine and Dentistry Rochester, NY

JAMA. 1984;251(21):2792-2793. doi:10.1001/jama.1984.03340450019010

In Reply.—  All three letters share incorrect assumptions about our position and misunderstandings of ethical theory.

  1. Churchill and Cross confuse political choice with philosophic autonomy. Value theory is not the same as political ideology, nor do the social conventions of the last two decades reflect the complexity of the citizen's life. Steffen also confuses Mill's political writing with his ethical theory. Mill's universal ethical principle is utility, and on that he is a formalist, as modern interpreters such as D. H. Hodgson1 indicate. Mill himself was too smart to make autonomy a universal ethical principle. He saw it as limited and as a tool for achieving the utility principle. However, medical ethicists have associated his name with autonomy ethics in their confusion of politics for ethics.

  2. It makes no sense to separate experience into subjective or objective components and do no such thing ourselves. But Churchill and