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


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.


Bibliography & Texts Consulted

ABRAM M.B.: Making Health Care Decisions - Commission for the Study of Ethical Problems; Washington 1982
ACKRILL J. L.: Aristotle The Philosopher - Clarendon; Oxford 1981
AGEHANANDA BHARATI: The Tantric Tradition - London 1965
ARISTOTLE: De Anima - Penguin; London 1986 (trans: H. Lawson-Tancred)
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.)
AYER A. J.: Philosophy in the Twentieth Century - Unwin; London 1984
BIRCH & ABRECHT: Genetics and the Quality of Life - Pergamon; Sydney 1975
DARLING S.: Crosscurrents: Philosophy in the Nineties - Flinders; Adelaide 1992
DASGUPTA S. N.: Yoga Philosophy - Motilal Banarsidas; Delhi 1930
DESCARTES R.: Discourse on Method - Penguin; London 1960
DHARGYEY G.N.: Kalacakra Tantra - Lib. Tibetan Works & Archives; Dharmsala India 1985
DIPROSE & FENNELL: Cartographies - Allen & Unwin; Sydney 1991
EVANS-WENTZ W. Y.: The Tibetan Book of the Dead - Oxford 1960
FOUCAULT M.: Discipline and Punish - Penguin; London 1991 (tr. A. Sheridan)
FOUCAULT M.: The History of Sexuality Volume 1 - Penguin; London 1976 (tr. R. Hurley)
FREEMANTLE & TRUNGPA: The Tibetan Book of the Dead - Shambhala; Boston 1975
HUME D.: Enquiries concerning the Human Understanding & c. - Oxford 1955
IRWIN T.: Classical Thought - OPUS; Oxford 1989
JOHNSON L.: A Morally Deep World - ANU; Canberra 1989
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KANE & MINDI: Resonance Therapy - Last Chance Publishing Co.; Yeovil 1987
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LEOPOLD A.: A Sand County Almanac - OUP; London1948
LODO Lama: Bardo Teachings - Snow Lion; NY 1987
LUCRETIUS: The Nature of the Universe - Penguin; London 1951 (tr: R.E.Latham)
MARGUTTI V.M.: Acupuncture, Biodynamic Energies and Homeopathy - Jain; New Delhi 1986
MCLEAN A.: The Alchemical Mandala - Phanes; Grand Rapids, Michigan 1989
MOTOYAMA H.: Theories of the Chakras - Quest; Wheaton Ill. 1981
NAGEL T.: The View From Nowhere - OUP; NY 1986
NEITZSCHE F.: Ecce Homo - Vintage; NY 1989 (tr. W. Kaufmann)
NEITZSCHE F.: On The Genealogy Of Morals - Vintage; NY 1989 (tr. Hollingdale & Kaufmann)
NEITZSCHE F.: Thus Spoke Zarathustra - Penguin; London 1961 (tr. R. J. Hollingdale)
NORMAN R.: The Moral Philosophers - OUP; Oxford 1983
PASSMORE J.: Man's Responsibility for Nature - Duckworth; London 1980 (2nd ed.)
PERLS, HEFFERLINE & GOODMAN: Gestalt Therapy - Pelican; London 1973
PLATO: The Republic - Penguin; London ( 2nd ed. revised 1987; trans: D. Lee)
RAJNEESH Bhagwan Shree: Tantra, The Supreme Understanding - Rajneesh Foundation; Poona 1975
RAMACHARAKA Yogi: Advanced Course in Yogi Philosophy - Fowler; London 1960
RAMSEY P.: The Patient as Person - Yale; London 1970
RAWLS : A Theory Of Justice - OUP; Oxford 1973
RUSSELL B.: Power - Unwin; London 1960
RUSSELL B.: The Conquest of Happiness - Unwin; London 1961
SINGER P.: Animal Liberation - Random House; NY 1990 (2nd ed.)
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
VEATCH R.M.: Death, Dying and the Biological Revolution - Yale; NY 1989
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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