Respice...prospice: Philosophy, ethics and medical care- past, present, and future.

Respice, adspice, prospice: (Latin) Look to the past, and the present, in order to gauge the future In an accompanying interview, Prof. Edmund Pellegrino reflects upon a life in medicine and bioethics, and offers his perspectives on the current and future state of these fields. Professor Pellegrino reiterates his oft-cited view of the inextricability of philosophy, ethics and the humanities in science and clinical medicine. This intertwinement must be acknowledged and regarded in any consideration of the nature and extent of the myriad possibilities and problems that can and will arise in medicine, and in the moral decisions mandated by its circumstances. Philosophy, Ethics and Humanities in Medicine (PEHM) responds to these realities by providing a forum for deep discussion of the philosophical bases of science and medicine, so as to attempt to depict 1) the intensity and complexity of the intersection of philosophy and ethics; 2) how this intersection is revealed in research and therapeutics, and 3) how philosophical premises might ground ethical analyses and approaches that are necessary for sound medical care. Simply put, the vision and mission of PEHM is to generate thought and reflection upon the richness of the situations and relationships that are intrinsic to medicine. The notion of philosophy, ethics and humanities in medicine is important, as it communicates an appreciation for ethics and humanitarian concern(s) as essential to each and all of the dimensions that contribute to and constitute medicine as a profession and practice. The papers appearing in PEHM illustrate this, and also seek to inform, educate, and at times, provoke debate and controversy. This year has seen a fine complement of papers: some re-examining longstanding questions and constructs of medicine [1-3]; others focusing upon issues that reveal the shifting exigencies and contingencies of healthcare in an evermore technololgic and globalized world culture [4-10], and still others that look to philosophy and history to portend the potential constructs, contexts and concerns that will establish the ethical landscape of medicine in years to come [11-14] Certain papers remain the focus of discourse and dialectic for some time as the issues they raise seethe anew in the crucible of professional, public and/or political conversation. To be sure, this has been the case with Prof. Thomas Papadimos’ essay “Healthcare Access as a Right not a Privilege: A Construct of Western Thought” [15], that has stimulated ongoing deliberation and debate upon putative right to medical care, the relationship of ethics to policy, and the assertion of Aristotelian philosophical claims to healthcare-as-right. Each and all of these themes are relevant and controversial in light of recent healthcare reforms and the changing climate of healthcare provision. There is some question as to whether Aristotle actually endorsed healthcare as a right, and Prof. Pellegrino (working with the staff of the National Reference Center for Bioethics Literature at the Kennedy Institute for Ethics at Georgetown University) has raised this point by noting specific citations from Annas, Long, Miller, Schofield, et al. [16] The reader is recommended to this work (vide infra), as both commentary upon the ongoing discussion of the issue at hand and Prof. Papadimos’ paper. Pellegrino calls for “...broader conversation...about the whether any classical foundation exists for the right to healthcare”, and recently, John K. Hall and Mark V. Boswell have asserted that while physicians and, might I add, patients may like to think of healthcare as a human right, ethics and law do not provide clear support for this position [17]. As these authors note, there is little to support the provision and goodness of medical care beyond the moral premises of the traditional physician-patient relationship. In examining and directing the fiduciary nature and power of this relationship, we may return to Aristotle: for while he may not have explicitly described healthcare as a right, he most Correspondence: [email protected] Potomac Institute for Policy Studies 901 N. Stuart St. Suite 900 Arlington, VA 22203, USA Full list of author information is available at the end of the article Giordano Philosophy, Ethics, and Humanities in Medicine 2010, 5:17 http://www.peh-med.com/content/5/1/17