Abstract:Respect for persons protects patients regarding their own healthcare decisions. Patient informed choice for altruism (PICA) is a proposed means for a fully autonomous patient with decisionmaking capacity to limit his or her own treatment for altruistic reasons. An altruistic decision could bond the patient with others at the end of life. We contend that PICA can also be an advance directive option. The proxy, family, and physicians must be reminded that a patient’s altruistic treatment refusal should be respected.

Letters commenting on Hardwig, J "Is There a Duty to Die?" with a reply to those letters by the author.

The prevalent ethic of patient autonomy ignores family interests in medical treatment decisions. Acknowledging these interests as legitimate forces basic changes in ethical theory and the moral practice of medicine.

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

find myself believing all sorts 0f things for which I d0 not possess evidence: that smoking cigarettes causes lung cancer, that my car keeps stalling because the carburetor needs LO be rebuilt, that mass media threaten democracy, that slums cause emotional disorders, that my irregular heart beat is premature ventricular contraction, that students} grades are not correlated with success in the ncmacadcmic world, that nuclear power plants are not safe (enough) . . . The list 0f things I believe, though (...) I have no evidence for the truth of them, is, if not infinite, virtually endless. And.. (shrink)

Most traditional epistemologists see trust and knowledge as deeply antithetical: we cannot know by trusting in the opinions of others; knowledge must be based on evidence, not mere trust. I argue that this is badly mistaken. Modern knowers cannot be independent and self-reliant. In most disciplines, those who do not trust cannot know. Trust is thus often more epistemically basic than empirical evidence or logical argument, for the evidence and the argument are available only through trust. Finally, since the reliability (...) of testimonial evidence depends on the trustworthiness of the testifier, this implies that knowledge often rests on a foundation of ethics. The rationality of many of our beliefs depends not only on our own character, but on the character of others. (shrink)

We are beginning to recognize that the prevalent ethic of patient autonomy simply will not do. Since demands for health care are virtually unlimited, giving autonomous patients the health care they want will bankrupt our health care system. We can no longer simply buy our way out of difficult questions of justice by expanding the health care pie until there is enough to satisfy the wants and needs of everyone. The requirements of justice and the needs of other patients must (...) temper the claims of autonomous patients. (shrink)

When Richard Lamm made the statement that old people have a duty to die, it was generally shouted down or ridiculed. The whole idea is just too preposterous to entertain. Or too threatening. In fact, a fairly common argument against legalizing physician-assisted suicide is that if it were legal, some people might somehow get the idea that they have a duty to die. These people could only be the victims of twisted moral reasoning or vicious social pressure. It goes without (...) saying that there is no duty to die. (shrink)

Better public health and medicine have given us a new kind of death and with it, a new fear – the fear that death will come too late and take too long. The generation that is dying now is largely unprepared for this new kind of death, for traditionally, people have always tried to avoid or postpone death. But if we are to avoid a bad death – too slow and too late – many of us with access to 21st (...) century medicine will need to develop a very new art, the art of going to meet death. We will need the wisdom to discern when our lives are over, sometimes even without medical indicators such as a terminal or chronic illness. Then we will need the skill to wrap things up, both within ourselves and with our loved ones, and finally, the courage, decisiveness and resolution to take steps to end our lives. (shrink)

Should we regard Jennifer Lackey’s ‘Creationist Teacher’ as understanding evolution, even though she does not, given her religious convictions, believe its central claims? We think this question raises a range of important and unexplored questions about the relationship between understanding, factivity and belief. Our aim will be to diagnose this case in a principled way, and in doing so, to make some progress toward appreciating what objectual understanding—i.e., understanding a subject matter or body of information—demands of us. Here is the (...) plan. After some ground clearing in §1, §2 outlines and motivates a plausible working model—moderate factivity—for characterising the sense in which objectual understanding should be regarded as factive. §3 shows how the datum that we can understand false theories can, despite initial suggestions to the contrary, be assimilated straightforwardly within the moderate factivity model. §4 highlights how the inverse kind of case to that explored in §3—viz., a variant of Lackey’s creationist teacher case—poses special problems for moderate factivity. With reference to recent work on moral understanding by Hills, §5 proposes a solution to the problem, and §6 attempts to diagnose why it is that we might originally have been led to draw the wrong conclusion. (shrink)

Most professions rest on the expertise of their members. Professionals are professionals primarily because they know more than most of us about something of importance to our society or to many members of it. Professionals are given power, respect, prestige, and above average incomes. If professionals are worthy of this status, it is largely because of their special knowledge and the way they use it. And if professionals have special rights and responsibilities, it is also primarily because of the social (...) positions they occupy due to their presumed expertise. (shrink)

We need to understand, and on a philosophical level, our consumer mentality. For ours is a consumer society. Yet (pace environmental philosophers) philosophers have had almost nothing to say. This paper is a start toward a normative philosophy of consumption. It explores a distinction which, if viable, has far-reaching implications — the distinction between ownership and what I call “possession.” This distinction marks two different senses in which a good or service can be mine. I argue that an approach to (...) consumption oriented around possession rather than ownership would support the conclusion that there are prudential or self-interested, not only moral or environmental, limits to rational consumption. That would be a very desirable conclusion given that we often exceed these other limits of rational consumption. (shrink)

W0mcn’s liberation, it is oftcn said, strikes closer t0 home than othcr forms of human liberation. Although basic shifts in attitudes arc required for thc liberation 0f, for example, workers 0r blacks and othcr ethnic minorities, thcsc types of liberation could bc accomplished without fundamental changes in what we call 0ur “privatc" lives or 0ur personal relationships. The liberation 0f blacks 0r workers is largely an affair 0f public roles and institutions, 21 matter 0f socialjusticc, and it is thus carried (...) 0ut relatively impcrsonally and anonymously in the marketplace and workplace, thc university and governmental institutions. Granted, if thc liberation 0f blacks and workers is t0 bc complete, I might have t0 bc willing t0 have some in my club and my suburb. Somc 0f my bcst friends might then bc blacks 0r workers, and I might even have t0 bc willing t0 have my daughter marry 0nc. Nonetheless, it might well be truc that my club and neighborhood, my friendships, and my relationship t0 my daughter could go 0n pretty much as bcforc, 0ncc "thcy” had been admitted. (shrink)

For all their differences, the “pro-choice” and the “pro-life” views of abortion are largely in agreement about one aspect of abortion decisions: where an abortion is morally legitimate, the pregnant woman should be permitted to decide whether or not to have an abortion. But I argue in this paper that if the man who will become the father of the fetus is known, if he believes that he will not be able (or permitted) to simply walk away from his biological (...) offspring, and if he does not think it would be a good idea for him to a) become a parent, b) with this woman, or c) at this time, then the woman should have an abortion. Given the life-altering moral obligations involved in raising a child, a woman should not decide to make her (sexual) partner a father without his full consent. (shrink)

A 78 year old married woman with progressive Alzheimer's disease was admitted to a local hospital with pneumonia and other medical problems. She recognized no one and had been incontinent for about a year. Despite aggressive treatment, the pneumonia failed to resolve and it seemed increasingly likely that this admission was to be for terminal care. The patient's husband (who had been taking care of her in their home) began requesting that the doctors be less aggressive in her treatment and, (...) as the days wore on, he became more and more insistent that they scale back their aggressive care. The physicians were reluctant to do so, due to the small but real chance that the patient could survive to discharge. But her husband was her only remaining family, so he was the logical proxy decisionmaker. Multiple conferences ensued, and finally a conference with a social worker revealed that the husband had recently proposed marriage to the couple's housekeeper and she had accepted. (shrink)

The most common approach to the problem of requests for futile treatment – the hospital futility policy – rests on the assumption that demands for futile treatment are both intractable and irrational. But there is another approach to the futility problem, an approach that would be dialogic, piecemeal, and case-by-case. This is the only approach that attempts to deal with both the hospital’s problem and the patient’s or family’s problem that motivates the request/demand for futile treatments. As such, it holds (...) the promise of resolving the problem of demands for futile treatment in a way that does not generate anger and ill will at the hospital staff for what will inevitably strike patients and their families as a blatant assertion of the hospital’s power. (shrink)

For Socrates, philosophy is self-examination. If the Euthyphro is still to be philosophy in this sense, it must challenge people living now. This paper offers a reading that does this. First, a better case is made for something like the kind of expertise Euthyphro claims and for his position about piety. Second, Socrates and Euthyphro embody different views about the kind of expertise that would be relevant to discovering and engendering piety. Finally, Socrates’ unorthodox conception of piety is made explicit. (...) With these features highlighted, the Euthyphro still possesses the power to provoke and challenge. (shrink)

Amid the controversies surrounding physician-assisted suicides, euthanasia, and long-term care for the elderly, a major component in the ethics of medicine is notably absent: the rights and welfare of the survivor's family, for whom serious illness and death can be emotionally and financially devastating. In this collection of eight provocative and timely essays, John Hardwig sets forth his views on the need to replace patient-centered bioethics with family-centered bioethics. Starting with a critique of the awkward language with which philosphers argue (...) the ethics of personal relationships, Hardwig goes on to present a general statement on the necessity of family-centered bioethics. He reflects on proxy decisions, the effects of elder care on the family, the financial and lifestyle consequences of long-term care, and physician-assisted suicide from the perspective of the family. His penultimate essay, "Is There a Duty to Die?" carries the idea of family-centered ethics to its logical, controversial, conclusion; comments upon this essay from Daniel Callahan, Larry Churchill, Joanne Lynn, and journalist Nat Hentoff offer differing views on this highly charged subject. As advances in medicine prolong patient's lives, the welfare of those ultimately responsible for medical care-the family-must be addressed. Hardwig's courageous and illuminating essays set forth a new direction in bioethics: one that considers the welfare of everyone concerned. (shrink)

Living out of silence, out of a fully functioning, lovingly attentive mind, and not just out of thought, out of a partially functioning mind, is requisite for depth or profundity in living or relating. A fully attentive, truly silent or meditative mind sees that there is real dualism of time and the timeless and that time and the timeless each has its own unique value. The timeless, or real silence, that which alone can make for depth in one's living and (...) relating, can be there only when, in one's awareness, time and all that is related to time, have come to an end. An examination of a wide variety of statements made by writers, both past and present, shows that these understandings are seldom there in contemporary writings, just as they were not there in writings that have come down to us from the past. 'Living beyond the One and the Many' invites readers to consider the possibility that what is presented in it can bring deep meaning to one's way of living in the world"--Publisher's description, back cover. (shrink)

Business ethics – both stockholder and stakeholder theories – makes the same mistake as the one made by the traditional ethics of medicine. The traditional ethics of medicine was a teleological ethics predicated on the assumption that the goal of medicine was to prolong life and promote better health. But, as bioethicists have made plain, these are not the only or even the overriding goals of most patients. Most of us have goals and values that limit our desire for medical (...) treatments. Similarly, the view of the stockholder in business ethics is that the stockholder has only one interest – profit. If stockholders have no other values or interests that would limit their desire for additional profit, their sole interest is in profit maximization. But investors are real people with interests and values that balance and limit their desire for profit. It would be an extremely odd individual who cared for nothing except more profit. And institutional investors are supposed to serve the interests of individual investors. Stockholders hold many stakes in the firms in which they invest. The conclusion that most stockholders have interests that would limit the pursuit of maximum profit has significant implications both for business ethics and for the management of for-profit corporations. Something like “informed consent for investors” is needed. Corporate managers, to the extent that they are to be agents of their stockholders, must not simply pursue profit maximization. They must ascertain the interests and values of their investors that limit the single-minded pursuit of profit. (shrink)

Protagoras, of all the ancient philosophers, has perhaps attracted the most interest in modern times. His saying ‘Man is the measure of all things’ caused Schiller to adopt him as the patron of the Oxford pragmatists, and has generally earned him the title of the first humanist. Yet the exact delineation of his philosophcal position remains a baffling task. Neumann, writing on Die Problematik des ‘Homo-mensura’ Satzes in 1938,2 concludes that no certainty whatever can be reached on the meaning of (...) the dictum, since ‘man’, ‘measure’, and ‘things’ are all ambiguous, nor can we tell which of the three is the predicate. The time is past when it was believed that a man's philosophy could be understood apart from the events of his life and the circumstances of his age: yet in the case of Protagoras the historical method of approach has hardly been attempted, although the impact of environment was perhaps more decisive in the formation of philosophical concepts in the Greek world than anywhere else. The reality about which the Greek philosopher spoke had three aspects: it was either the one universe of physics, or the political unity, or God. For example, the book of Heracleitus Περ φσεως was divided into three chapters or logoi, About the Whole, a political, and a theological. Neither physics nor theology supplies from its own subject-matter the form in which this reality was described. (shrink)

In thc Foundations, Kant draws a distinction bctwccn action which is in accord with duty and action which is done from the motive of duty. This is 21 famous distinction, of course, and thcrc arc many interesting issues concerning it and its implications for ethical thcory. In this paper, I wish t0 focus on just 0nc noteworthy feature of K2mt’s usc of this distinction. Likc any distinction bctwccn logical compatiblcs, this 0nc yields four logically possible classes of action: (1) actions (...) which are both in accord with duty and from duty; (2) actions which arc neither from duty nor in accord with duty; (3) actions which are in accord with duty but not from duty; and (4) actions which are from duty but not in accord with duty. What intcrcsts mc about these four possibilities is that, to thc best of my knowledge, Kant never considers or even mentions the last 0f these possibilities: action from duty but not in accord with duty. This is perhaps surprising in a philosopher with Kant’s intcrcst in logic and passion for thoroughness. Onc would have thought that hc would mention this logical possibility, cvcn if only in order to discount it as not really possible. Beginning with the idea that there arc cases of action from duty but not in accord with duty, I argue in this paper that Kant could not have admitted that thcrc can be actions of this kind, for their cxistcncc un-. (shrink)

The achievements of the textile industry in Roman Britain are often underestimated as a result of the meagreness of our available evidence. The Edict on maximum prices issued by Diocletian in A.D. 301 shows that British capes commanded high prices on the markets of the Empire, and that in the late third century A.D. British rugs were the best in the world. In view of the competition from the traditional centres of rug manufacture in the East, this is an astonishing (...) achievement. (shrink)

The received translation and interpretation of many of the technical terms current in the textile industry of the Roman Empire are inaccurate, because lexicographers have either fought shy of being precise, or have thought that they recognized in the ancient world technical processes which originated at a much later date. The evidence is often equivocal or insufficient, but may still yield details that have been overlooked. The textile expression scutulatus, to take an example, deserves more attention than Blümner has devoted (...) to it. When it refers to the appearance of a garment, Lewis and Short, s.v. scutulatus, translate ‘diamond or lozenge-shaped, checkered’. It seems worth while to attempt a more precise translation, and, if possible, to estimate the significance in context of the goods so designated. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Physicians face ethical concerns about treatment decisions -- when to offer, withhold or withdraw various treatments -- and treatment decisions have been the focus of bioethics, as well. But the issues that most trouble patients and their families at the end of life are not these. To them, the end of life is a spiritual crisis. ("Spiritual" as used here has to do with the ultimate meaning and values in life. It need not involve a religion, the belief in a (...) God or in any life after death.). (shrink)