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July 20, 1984

Medical Ethics-Reply

Author Affiliations

University of Rochester School of Medicine and Dentistry Rochester, NY

JAMA. 1984;252(3):345-346. doi:10.1001/jama.1984.03350030019013

In Reply.—  It is difficult in a short article for physicians to do full justice to all the intricacies of philosophic ethics and the medical ethics that is deduced from it. The best approach is to look at possible conceptual moves. We argue that the predominant intellectual move is "autonomy ethics," by whatever name an individual ethicist calls it. This may be anathema to ordinary language philosophy, but in the world of practice, operations count more than names.For Culver and Gert,1 paternalism always involves violating a moral rule. They also want to consider some violations "justified." They employ the notion that an irrational action is defined as harming oneself without an adequate reason. Reasons, which are not "motives" in their system, make otherwise irrational acts rational (we could substitute "cognitively demonstrated" or "intellectually proved"). Finally, "competent patients should make their own medical decisions" (p 49) and the "consent