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Seeking Medicine’s Moral Centre: Ethics, Bioethics, and Assisted Dying

Title: Seeking Medicine’s Moral Centre
Subtitle: Ethics, Bioethics, and Assisted Dying
Subject Classification:  Medicine and Medical Ethics, Bioethics, Science  
BIC Classification: MBDC, PSAD, JFM
BISAC Classification: MED078000, SOC002010, LAW102000
Binding: Hardback, eBook
Publication date: 16 Jan 2025
ISBN (Hardback): 978-1-80441-533-7
ISBN (eBook): 978-1-80441-534-4

 

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Description

For the first time in two millennia, the Hippocratic ethic of medical care has been supplanted by a new bioethics. The bottom-up set of injunctions to care, of the patient and for society, ha been replaced by a top-down, commercial ethic focused on patient autonomy in a limited system of medical care.

To understand this transformation, and its the effect, Seeking Medicine’s Moral Centre focuses on the issue of “medical aid in dying,” (MAiD) in Canada. Uniquely, it introduces ethnography as a tool to parse a set of academic and public articles reflecting the changing face of medical ethics from 1996 to the present. In doing so it joins the professional and the popular as a single dataset.

It is the first book to seriously critique bioethics as a medical ethic through its focus on medical aid in dying as a still contested program in care of the chronically ill and fragile.

Key audiences include journalists, medical anthropologists and sociologists; ethicists and bioethicists; medical and scientific researchers and policy makers.

Biography

Author(s):  Dr. Tom Koch is a medical geographer, historian, and ethicist. The author of 15 books and over 250 journal articles, he is an Adjunct Professor of medical geography at the University of British Columbia.

Reviews

"For 30 years Tom Koch has covered the introduction, acceptance and out of control expansion of Medical Aid in Dying (MAiD) in Canada through a series of journal, newspaper, and magazine articles. Here he combines that work to show how a bottom-up, traditional medical ethic arising within medicine and stable for two Millennia, has been exchanged for a top-down, thinly principled, bureaucratic ethic of care and, he would argue, too often non-care. This ethic focuses only on relief of an individual’s suffering, a goal we all accept, through absolute prioritisation of a right to individual autonomy, including to have medical assistance to end one’s life. It also displays ‘presentism’, looking only to the immediate present and not the past or future to seek wisdom and assess wider and more profound risks and harms of this stance, especially those to vulnerable people, Medicine and society. This book helps us to understand what has happened with MAiD in Canada, which is essential if the damage it is causing there is to be limited. It is also a vital warning to other countries, such as Australia that have adopted the MAiD model, or are considering doing so."
- Margaret Somerville, Professor of Bioethics, The University of Notre Dame, Australia. Professor Emerita Faculty of Medicine and the founding Director of the Centre for Medicine, Ethics, and Law, McGill University, Montreal.

"Seeking Medicine’s Moral Centre is timely and much needed critical appraisal of the moral landscape of contemporary medicine. With erudition and a keen eye for factual accuracy, Tom Koch retraces the ideological and cultural shift that resulted in the emergence of bioethics as the main source of moral authority in health care. Through powerful narratives and insightful analysis, Koch explores how society’s attitudes toward life, death, and disability have changed, often in ways that prioritise efficiency over compassionate care. The adoption of Medical Aid in Dying (MAiD) in Canada, Koch argues, is symptomatic of the failure of bioethics. This new ethic is a top-down imposition of a set of principles on medicine that prioritises patient autonomy without a careful consideration of the role and knowledge of practitioners. The abandonment of medicine’s patient-centred Hippocratic tradition and vocational ethic on behalf of the complex, pragmatic, principle-driven approach to address ethical conundra in medicine has proven to be detrimental to an ethics of care. A compelling read for anyone interested in reassessing the intellectual bases of bioethics."
- Professor Fabrice Jotterand, Bioethics and Medical Humanities and Director, Graduate Program in Bioethics, Medical College of Wisconsin, USA

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