Ethics and the Metaphysics of Medicine
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From Basic Bioethics

Ethics and the Metaphysics of Medicine

Reflections on Health and Beneficence

By Kenneth A. Richman

Explores the philosophical and practical ethical implications of a definition of health as a state that allows us to reach our goals.





Explores the philosophical and practical ethical implications of a definition of health as a state that allows us to reach our goals.

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery.

"Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education.


$6.75 S | £5.99 ISBN: 9780262182386 232 pp. | 9 in x 6 in


  • Kenneth Richman's remarkable book brings a unique depth of scholarship to the task of illumunating the much overused concept of patient-centered care. The Richman-Budson theory of health, setting individual patients' goals in the context of the traditional medical focus on biological functioning, is a must for medical educators.

    K.W.M. Fulford

    Professor of Philosophy and Mental Health, University of Warwick, and Honorary Consultant Psychiatrist, University of Oxford

  • This is a book well worth reading! Like few authors in the field, Richman situates his bioethics within a broader analysis of issues in the philosophy and metaphysics of medicine. This is an important and substantive contribution to contemporary scholarship.

    H. Tristram Engelhardt, Jr.

    Department of Philosophy, Rice University, Professor Emeritus, Baylor College of Medicine

  • This book was a joy to read. It takes the reader on a grand tour of most of the important problems in the philosophy of medicine and bioethics. It is clear, well-written, comprehensive, thought-provoking, and illuminating. Though I am well versed in these subjects, I learned a great deal from reading this book.

    David B. Resnik

    Brody School of Medicine, East Carolina University