All the dimensions of politics and the health care system are designed to care for the individual. Health is a desirable end, medical care is a need.
Should religion be engaged in the dialectical discourse? As Pellegrino discusses this I'm reminded of the works of H. Tristram Engelhardt discussing the role of religion in the public square and the notion of agreement among "enemies."
Autonomy started as a negative right but has become from a right of neglect to a right to demand treatment to the extent of micromanagement at the bedside. While wanting to preserve the autonomy of the patient, we also need to consider the autonomy of the health professional.
In clinical ethics, there need to be absolutes. Without them, morality will be left to the courts.
Augustine says 'an unjust law is no law.' Today conscience clauses are under threat and the value-free doctor is the most desirable.
Pellegrino very interestingly recommends bedside clinical ethics education. It takes a socratic approach, takes it out of the abstract and into reality. It seems this approach brings the clinician into a more intimate relationship with the patient.
"Inane thinking" about the hippocratic oath that pervades bioethics today. Pellegrino says that the hippocratic oath/ethos are not the whole of medical ethics. It is a statement of morality.