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September 1986

The New Medical Ethics: A Second Opinion-Reply

Author Affiliations

Rochester, NY

Arch Intern Med. 1986;146(9):1863-1865. doi:10.1001/archinte.1986.00360210261050

—By raising profoundly consequential questions, Dr Kanoti's critique is a welcome addition to the dialogue surrounding our editorial. His charges that we create a "straw man," present a "superficial argument" which is not "well nuanced," make assertions with "no evidence" while using "emotive language," however, do not advance serious discussion. The "straw man" of the new ethics has been constructed by the ethicists themselves in asserting patient choice (autonomy) as the basis of or primary good of medical ethics. This claim has yet to be established by other than a priori reasoning. It is repeatedly asserted that emphasis on autonomy simply supplies a missing ingredient, or fills a gap in historic Hippocratic ethics. Physicians should know better; the two are incommensurable. Either, as we contend, there are ethical criteria by which to judge the goodness or badness of choices, whether those of physicians or patients, in which case autonomy

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