The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability (...) for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it. (shrink)

In this paper, we assume that organ donation policy in the United States will continue to be based on an opt-in model, requiring express consent to donate, and that families will continue to have the prerogative to make donation decisions whenever the deceased person has not recorded his or her own preferences in advance. The limited question addressed here is what should be done when a potential donor dies unexpectedly, without any recorded expression of his or her wishes at hand, (...) while a family decision is being sought. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

Moral opposition by medical professionals to participation in the process of sentencing for capital crimes, including refusals to provide medical treatment, may compromise the integrity of the legal process.

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The determinative issue in applying the insanity defense is whether the defendant experienced a legally relevant functional impairment at the time of the offense. Categorical exclusion of personality disorders from the definition of mental disease is clinically and morally arbitrary because it may lead to unfair conviction of a defendant with a personality disorder who actually experienced severe, legally relevant impairments at the time of the crime. There is no need to consider such a drastic approach in most states and (...) in the federal courts, where the sole test of insanity is whether the defendant was “unable to appreciate the wrongfulness of his conduct at the time of the offense.” This is because the only symptoms that are legally relevant in such jurisdictions are those that impair reality-testing and thereby affect the person's capacity to understand the nature and consequences of her actions. However, if the test of insanity includes a “volitional prong” (inability to control one's behavior), some way must be found to limit the scope of the defense to the core cases (involving psychotic conditions) to which it has traditionally been applied, and to prevent a shift toward a deterministic account of criminal conduct — i.e., “people can't help being who they are and doing what they do.” The best way of accomplishing this is to limit the definition of mental disease to severe disorders characterized by gross disturbances of the person's capacity to understand reality. (shrink)

In his accompanying article, Dr. Kinscherff has convincingly demonstrated why a categorical exclusion of personality disorders from the definition of “mental disease” in insanity defense adjudication is arbitrary, both conceptually and clinically. He explains his position in the context of a vignette involving a hypothetical defendant, Wilhelmina Sykes, charged with ramming her car into another car obstructing her path, causing serious injury to its driver. Dr. Kinscherff correctly points out that the determinative issue in applying the insanity defense in any (...) case, including the hypothetical case involving Ms. Sykes, is whether the defendant experienced a legally relevant functional impairment at the time of the offense. In many states — and in the hypothetical jurisdiction in which Ms. Sykes is being prosecuted — the relevant functional impairments are those that could have affected her ability “to appreciate the wrongfulness of her conduct” or “to conform her conduct to the requirements of the law. (shrink)

Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise is contingent on the number of available organs. The growing gap between the demand and supply results in unnecessary loss and diminished quality of life as well as high costs for surviving patients and health insurers. Twenty years after the enactment of the National Organ Transplantation Act, it is time to rethink the moral basis and overall design of organ transplantation policy. We propose a national plan for organ (...) transplantation insurance under which the federal government would assume responsibility for increasing the organ supply and would cover all costs associated with transplantation for patients not otherwise covered. (shrink)

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284. Unfortunately, thousands of potential (...) organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists. (shrink)

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

Obtaining informed consent has typically become a stylized ritual of presenting and signing a form, in which physicians are acting defensively and patients lack control over the content and flow of information. This leaves patients at risk both for being under-informed relative to their decisional needs and of receiving more information than they need or desire. By personalizing the process of seeking and receiving information and allowing patients to specify their desire for information in a prospective manner, we aim to (...) shift genuine control over the informational process to patients. A new paradigm of Information on Demand, such as we suggest, would also enhance legal certainty, achieve greater congruence between the information patients want and the information they receive, and promote more meaningful patient-physician interactions, a desirable outcome that has been difficult to achieve by other means. (shrink)

In an explicit attempt to reduce physician paternalism and encourage patient participation in making health care decisions, the informed consent doctrine has become a foundational precept in medical ethics and health law. The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians to respect and facilitate patient autonomy is reflected in the (...) rules that have been created to implement consent procedures, especially those requiring disclosure of relevant information.However, there are many practical impediments to patient self-determination in health care decisionmaking. Well-meaning physicians often lack the time to live up to the ideal of facilitating genuine, informed deliberation with and by their patients, and many lack the motivation or skill to do so successfully. (shrink)

This unique book clearly explains genetic and neuroimaging research on intelligence and how neuroscience findings may lead to enhancing it.

One way to think about capitalism-versus-socialism is to examine the extent to which capitalist economic institutions are compatible with the fulfillment of socialist ideals. The late G. A. Cohen has urged that the two are strongly incompatible. He imagines how it would make sense for friends to organize a camping trip, distills the socialist moral principles that he sees fulfilled in the camping trip model, and observes that these principles conflict with a capitalist organization of the economy. He adds that (...) these principles are ethically attractive, so if it is feasible to organize the economy on the camping trip model, we ought to do so. This essay argues to the contrary that for all that has been said, capitalist economic arrangements might be in the set of institutional arrangements that overall would best fulfill the camping trip principles, and anyway, the principles themselves ought to be rejected, so the question whether or not a capitalist set-up might satisfy these principles should not interest us. The grounds for rejecting the camping trip principles support a form of welfarist consequentialism that denies that equality of distribution of any sort is per se ethically desirable and also denies that liberal freedoms to live as one chooses are per se morally desirable. Equality and freedom should rather be regarded as in the light of possible means (or hindrances) to advancing good for people, fairly distributed. (shrink)

Nietzsche announces his intentions to publish a “physiology of aesthetics”, namely a naturalistic explanation for how aesthetic judgements are grounded in the physiology of both the one experiencing the work, and the creator of it. But as well as the physiological reduction of aesthetic judgements, Nietzsche in many places across his oeuvre frames the apparatus of physiology, especially the prescriptive dimension of self-cultivation, in terms amenable to being treated as ‘aesthetic’. The first section will mount a (re-) defense of the (...) use of aestheticized language for discussing Nietzschean self-cultivation. The second section demonstrates an aesthetic evaluation of capacities that make possible the acquisition and removal of instinctual components, ultimately arguing for Nietzsche’s qualified indeterminism regarding the capacity for self-cultivation. The third section will assess the pres- ence of another aesthetic measure, this time in terms of envisaging one’s psycho-physiology by reference to an external spectacle. The final section discusses metaethical questions stemming from Nietzsche’s prescriptive language regarding the aestheticization of our physiology. (shrink)

This chapter contains section titled: I The Challenge Model II Challenge Versus Impact III Parameters and Limitations IV Tolerance, Neutrality, and Antipaternalism V Equality VI Resources Versus Welfare VII Conclusion Acknowledgement.

A Christian Cosmology studies the two books of God, the Bible and nature, to discern their consistent reading for our age. This volume, an expanded version of Volume 1, offers a framework of illuminating concepts of philosophy and theology, in which it develops in rich detail the author's crystallized vision. Richard Pendergast sees the world as a hierarchy of irreducible elements, the highest level being that of the Logos. From the search of ancient Greek philosophy for a unifying principle (...) and its integration with Jewish thought in the Hellenistic era, he relates the emergence of the Christian doctrine of the Trinity and its study to the present day. Using scriptural sources, he makes explicit the concept of "incosmation," preceding that of the Incarnation, and presents to us an immanent and transcendent Logos as head of the universe. (shrink)

Intellectual journal of a highly perceptive philosopher who has left civilization for contemplation in the forest. He struggles to rationally comprehend his metaphysical intuitions of the soul. He explains and advances the thought of some of his most influential predecessors: Berdyaev, Emerson, William James, Pessoa, Senancour, Thoreau and, Nietzsche.

In Achieving Our Country, Richard Rorty pauses to explain what it was like to be “a red diaper anticommunist baby” and to become a “teenage Cold War liberal.” Rorty's political allegiances were virtually unknown until the 1980s. The trouble with Rorty's “inspirational” liberalism is that, at best, it tends to become merely inspirational and sentimental, without much bite. There once was a time when the work of liberal metaphysicians and theorists was important, especially when liberalism was a novelty and (...) liberal societies were just coming into existence. Indeed, economic trends suggest that there may be a collapse of liberalism and pragmatism in America. Inspirational liberalism may be a healthy antidote to legalistic rights‐based liberalism and to the abuses of the infatuation with theorizing by postmodern cultural critics. But without pragmatic toughness and a concrete program for reform, patriotic inspirational liberalism too easily degenerates into an empty rhetorical hand waving. (shrink)

Set in the context of the current interest among Analytic philosophers in the “epistemology of disagreement,” this paper explores the meta-philosophical problem of philosophical incommensurability. Motivated by Nietzsche’s provocative remark about philosophy as prejudices and desires of the heart “sifted and made abstract,” the paper first outlines the contours of the problem and then traces it through a series of examples. Drawing largely on the tradition of phenomenology and philosophical hermeneutics, a broadly Continental response to this formidable problem is suggested. (...) Disagreement cannot be understood simply in terms of epistemological strategy, but needs to be regarded in a fundamentally hermeneutical light. (shrink)

Most individuals realise that we have a moral obligation to avoid the evils of war. But this realization raises a host of difficult questions when we, as responsible individuals, witness harrowing injustices such as ""ethnic cleansing"" in Bosnia or starvation in Somalia. With millions of lives at stake, is war ever justified? And, if so, for what purpose? In this book, Richard J. Regan confronts these controversial questions by first considering the basic principles of just-war theory and then applying (...) those principles to historical and ongoing conflicts. Part One presents two opposing viewpoints: first, that war is not subject to moral norms and, second, that war is never morally permissible. The author rejects both perspectives, and moves to define the principles of just-war theory. He evaluates the roles of the president, Congress and, most importantly, the UN Security Council in determining when long-term US military involvement is justified. The moral limits of war conduct and the moral problem of using, or threatening to use, nuclear weapons are also discussed. On the just cause to wage war, Regan argues that defense of nations and nationals - whether in self-defense or in defense of others - remains the ""only"" classical cause that in the modern world would justify resorting to war. With respect to military intervention in secessionist and revolutionary wars, he contends that such intervention might be justified, but that prudence dictates extreme caution. In considering acceptable war conduct, Regan elaborates the specific principle of discrimination and proportionality; he maintains that civilians uninvolved in the enemy's war should not be directly targeted and that the costs of military action must be proportionate to the anticipated benefits of destroying military targets. The second part of the book presents case studies of eight historical wars - World War I, the Vietnam War, the Falklands War, the revolution and civil war in Nicaragua, the civil war in El Salvador, the Gulf War, the intervention in Somalia, and the Bosnian War - and poses several provocative questions about each. It invites readers and students to apply just-war principles to complex war-related situations and to understand the factual contingencies involved in moral judgements about war decisions. The book should be of particular interest to students of the moral issues of international relations and to readers interested more generally in philosophy, theology and political science. (shrink)

"A fascinating and timely treatment of the objectivism versus relativism debates occurring in philosophy of science, literary theory, the social sciences, ...

In her recent, provocative essay “What Is the Point of Equality?”, Elizabeth Anderson argues against a common ideal of egalitarian justice that she calls “ luck egalitarianism” and in favor of an approach she calls “democratic equality.”1 According to the luck egalitarian, the aim of justice as equality is to eliminate so far as is possible the impact on people’s lives of bad luck that falls on them through no fault or choice of their own. In the ideal luck egalitarian (...) society, there are no inequalities in people’s life prospects except those that arise through processes of voluntary choice or faulty conduct, for which the agents involved can reasonably be held responsible. Anderson asserts that the adherents of luck egalitarianism, which can be elaborated in many different ways, include John Roemer, Erik Rakowski, Thomas Nagel, Ronald Dworkin, Gerald Cohen, Richard Arneson, and Philippe Van Parijs.2 In contrast, according to the democratic equality conception, justice as equality requires an end to oppressive social relationships. In the ideal society of democratic equality, the social conditions of everyone’s freedom are secured, each stands to every other in a relationship of fundamental equality, including equal respect, and all have real freedom to participate in democratic self-government. (shrink)

This volume is devoted St. Thomas's commentary on the Physics. In the Physics, Aristotle delves into what makes things what they are. In commenting on this fundamental text of Aristotelian philosophy, St. Thomas takes Aristotle's thoughts and deepens them.

Weaving together a diverse range of scholarly-activist intersectional voices from around the world, Critical Animal Studies and Activism: International Perspectives on Total Liberation and Intersectionality co-edited by Anthony J. Nocella II and Richard J. White makes a powerful contribution to knowledge and understanding. It is essential reading for environmentalists, animal advocates, social justice organizers, policy-makers, social change-makers, and indeed for all those who care about the future of this planet. This book spans many scholar disciplines and activist social movements, (...) and provides new insights to fundamental debates surrounding inter-species justice, liberation, and democracy. This critical theory for total liberation book expands the understanding of one struggle one fight: for human freedom, for animal rights, and for the liberation of the earth herself. Rooted in a radical praxis, the book argues that those in academia that claim critical animal studies, need to hit the streets with the protesters and the protesters need to join the theoretical conversations. Theory and practice and not binaries, but two pieces of a larger goal. Read this book and use its arguments to take the fight to smash capitalism, oppression, and domination in all its forms! (shrink)

What is the good for human persons? If I am trying to lead the best possible life I could lead, not the morally best life, but the life that is best for me, what exactly am I seeking?This phrasing of the question I will be pursuing may sound tendentious, so some explanation is needed. What is good for one person, we ordinarily suppose, can conflict with what is good for other persons and with what is required by morality. A prudent (...) person seeks her own good efficiently; she selects the best available means to her good. If we call the value that a person seeks when she is being prudent “prudential value,” then an alternative rendering of the question to be addressed in this essay is “What is prudential value?” We can also say that an individual flourishes or has a life high in well-being when her life is high in prudential value. Of course, these common-sense appearances that the good for an individual, the good for other persons, and the requirements of morality often are in conflict might be deceiving. For all that I have said here, the correct theory of individual good might yield the result that sacrificing oneself for the sake of other people or for the sake of a morally worthy cause can never occur, because helping others and being moral always maximize one's own good. But this would be the surprising result of a theory, not something we should presuppose at the start of inquiry. When a friend has a baby and I express a conventional wish that the child have a good life, I mean a life that is good for the child, not a life that merely helps others or merely respects the constraints of morality. After all, a life that is altruistic and perfectly moral, we suppose, could be a life that is pure hell for the person who lives it—a succession of horrible headaches marked by no achievements or attainments of anything worthwhile and ending in agonizing death at a young age. So the question remains, what constitutes a life that is good for the person who is living it? (shrink)

The development of a defensible and fecund notion of emergence has been dogged by a number of threshold issues neatly highlighted in a recent paper by Jaegwon Kim. We argue that physicalist assumptions confuse and vitiate the whole project. In particular, his contention that emergence entails supervenience is contradicted by his own argument that the ‘microstructure’ of an object belongs to the whole object, not to its constituents. And his argument against the possibility of downward causation is question-begging and makes (...) false assumptions about causal sufficiency. We argue, on the contrary, for a rejection of the deeply entrenched assumption, shared by physicalists and Cartesians alike, that what basically exists are things (entities, substances). Our best physics tells us that there are no basic particulars, only fields in process. We need an ontology which gives priority to organization, which is inherently relational. Reflection upon the fact that all biological creatures are far-from-equilibrium systems, whose very persistence depend upon their interactions with their environment, reveals incoherence in the notion of an ‘emergence base’. (shrink)

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All humans have an equal basic moral status. They possess the same fundamental rights, and the comparable interests of each person should count the same in calculations that determine social policy. Neither supposed racial differences, nor skin color, sex, sexual orientation, ethnicity, intelligence, nor any other differences among humans negate their fundamental equal worth and dignity. These platitudes are virtually universally affirmed. A white supremacist racist or an admirer of Adolf Hitler who denies them is rightly regarded as beyond the (...) pale of civilized dialogue. However, a very simple line of argument developed by Peter Singer challenges our understanding of these platitudes and forces us to rethink the basis and nature of the moral equality of all humans. What I call the “Singer Problem” arises if one accepts that the morally significant cognitive capacities that are relevant to the determination of the fundamental moral status of a being vary from individual to individual by degree. The problem is to specify a moral principle determining fundamental moral status that assigns a superior status to humans compared to other animals on the basis of the superior cognitive capacities of humans but also assigns all human persons an equal fundamental moral status regardless of their differing cognitive capacities. More broadly posed, the problem is to specify moral principles that yield intuitively satisfactory implications for the treatment of human individuals and other individual animals given that cognitive capacities differ across species and individuals. A search for a resolution of the Singer problem leads to disappointing results. (shrink)

Richard J. Bernstein is Vera List Professor of Philosophy at the New School for Social Research. The Essays: Philosophy, History, and Critique.