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Medical Ethics' Assault on Medical Values

Grant E. Steffen, MD
JAMA. 1984;251(21):2791-2792. doi:10.1001/jama.1984.03340450019008.
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To the Editor.—  Drs Clement and Sider claim in their article entitled "Medical Ethics' Assault Upon Medical Values" that the principle of autonomy "is an inappropriate foundation on which to build medical ethics." I think that they are wrong and that they make several errors in their argument for a clinical ethic.First, they state that "philosophic autonomy is based entirely in formal logic." This simply is not true. Autonomy is a respected and necessary principle in utilitarianism, that branch of philosophical thought most removed from formalism. John Stuart Mill, one of the most influential philosophers of the 19th century, was a utilitarian and argued vigorously for autonomy on the grounds that promoting autonomy would maximize the benefits of everyone concerned. Surely, one cannot label Mill a formalist or claim that his arguments are without content, a deficiency the authors attribute to formalism.Second, they state that observing the principle


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