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The Bioethical Mandala
The Moral Structure of Health Care (part 7)

Endnotes

1. Mandala is a sanscrit word meaning wheel. It implies the "arrangement of deities or their emblems, usually in the form of a circle, emanating from a centre, expressing a pattern of energies" (Fremantle & Trungpa 1975; p. 108). Such geometrical designs were often used as keys in initiation ceremonies. Cf. Tibet's Great Yogi Milarepa translated by W.Y. Evans-Wentz, p. 132, footnote 3. Mandalas were not the exclusive province of the ancient buddhists, however, but were and are widespread throughout the cultures of both East and West. Cf. The Alchemical Mandala by Adam McLean.

2. I am indebted to Michael Walzer for this image. Cf. his interesting, though unduly egalitarian views on medicine and social welfare in Spheres of Justice, p. 86 ff.

3. Walzer, op.cit. p.87. His remarks apply in spades to the cultures of America and Australia!

4. Discourse on Method, pp. 84-85. A questionable assumption, despite its seeming self-evidence.

5. Ibid.

6. Replacing the monarchic conception of society as the extended body of the king. Cf. Discipline and Punish, especially Part Three, "Discipline" and notably the section on "Docile Bodies". Also The History of Sexuality Volume I, in particular Part Five,"Right of Death and Power over Life".

7. Thomas Szasz:The Theology of Medicine

8. Thalidomide, a drug designed to relieve unpleasant symptoms associated with pregnancy, had been exhaustively tested on animals revealing no evidence of ill-effects. However, when applied to pregnant women, the resultant horrific effects on the wellbeing of their offspring and the families themselves, not to mention the costs to the health systems of the world, have been extensively documented.

9. Of course a person may on occasions act according to ethical principles out of habit, but there are circumstances, particularly unfamiliar ones, that require an ethical decision in the defined sense. Moreover, this is not to say that all possible moral alternatives must be available, merely that, as Nozick points out (Nozick 1974, p. 263), at least one alternative be open.

10. Utilitarians have been led to the hedonistic (and untenable) position that, for an individual, simple sensual pleasure is the most valuable thing - and ultimately to the position maintained by Smart, when he allowed that the ideal future state of man would consist in the passive receipt of electronic stimulations from a postulated programmable pleasure instrument able to induce any desired kind of experience directly into the organism at the touch of a switch. Even such a committed utilitarian as Smart, while accepting such a conception as philosophically and socially desirable, nevertheless recoiled from it when it was presented as a potential personal future for him!

11. There is a vast amount of evidence that pain and pleasure are purely interpretational, subjective experiences, rather than empirical, objective sensations.

12. Machiavelli would disagree here, but utilitarians would generally not see themselves as the proponents of naked (or concealed) self-interest in the struggle for power and control of others, without consideration of the amount of suffering engendered. This is not to say that a utilitarian might not under certain circumstances employ Machiavelli's recommendations (see The Prince), but his justification for doing so would probably be that it was necessary instrumentally towards the maximisation of the satisfaction of the preferences of the majority. Utilitarianism is fundamentally democratic; Machiavelli is not.

–000–

Bibliography & Texts Consulted

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ARISTOTLE: Ethics - Penguin; London revised ed.1976 (trans:J. A. K. Thompson)
AUROBINDO Sri: The Synthesis of Yoga - Sri Aurobindo Ashram;Pondicherry 1976 (6th ed.)
AVALON A.: The Principles of Tantra - Ganesh & Co.; Madras 1986 (6th ed.)
AVALON A.:The Serpent Power - Dover; NY 1974 (7th ed.)
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DESCARTES R.: Discourse on Method - Penguin; London 1960
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EVANS-WENTZ W. Y.: The Tibetan Book of the Dead - Oxford 1960
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FOUCAULT M.: The History of Sexuality Volume 1 - Penguin; London 1976 (tr. R. Hurley)
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RUSSELL B.: Power - Unwin; London 1960
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SINNETT A.P.: Esoteric Buddhism - Wizard's Bookshelf; Minneapolis 1973 (fac. of 5th ed. 1885)
SPERRY W.L.: The Ethical Basis of Medical Practice - Hoeber; NY 1950
SZASZ T.: The Theology of Medicine - Oxford; Melbourne 1979
TAIMINI I. K.: The Science of Yoga - T.S. Publishing House; Wheaton Ill. 1961
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WALZER M.: Spheres of Justice - Blackwell; Oxford 1985
WILLIAMS B.: Problems of the Self - Cambridge 1973
ZIMMER H.: Philosophies of India - Bollingen; Princeton 1969


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