Public appeals for organ donation to an identified individual raise serious ethical questions about the role of the media, the physician, the prospective recipient, and the donor in the procurement process.

In diesem Aufsatz stelle ich mir die Aufgabe, den Einfluß von Leibniz' Idee einer lingua characterica und eines calculus ratiocinator auf Gottlob Freges Projekt einer Begriffsschrift im groben Aufriß auf Grund begrifflicher Parallelen darzulegen.

Substitute decision-makers for severely disabled neonates who can be kept alive but who will require constant medical interventions and will die at the latest in their teens are faced with a difficult decision when trying to decide whether to keep the infant alive. By and large, the primary focus of their decision-making centers on what is in the best interests of the newborn. The best-interests criterion, in turn, is importantly conditioned by quality-of-life considerations. However, the concept of quality of life (...) is logically and ethically different for patients with a developing as opposed to a developed awareness. Unfortunately, this difference is ignored by current quality-of-life considerations, there are no quality-of-life measures that take this difference into account, and decision-making proceeds entirely without acknowledging this fact. This note outlines why this is a problem and why there is a need for a new set of tools that incorporates this distinction if the substitute decision-makers are to apply the best-interest criterion in a meaningful way. (shrink)

Es ist allgemein bekannt, daß Frege stark von Leibniz beeinflußt worden ist; jedoch behauptet Patzig (Frege, Leibniz u. d. sogenannte ,lingua characteristica universalis', in: Studia Leibnitiana, Suppl., vol. III no. 3 (1969), pp. 103-112), daß seine Leibniz-Kenntnisse nur auf indirekten Quellen fußten und im Grunde äußerst gering waren. Dieser Aufsatz soll zeigen, daß solche und ähnliche Behauptungen auf ungenügender Kenntnis von Freges Schriften beruhen.

Bolzano's position on logic and his theory of sentences-in-themselves and their analysis, as well as his position on existence statements and subjective representations show a striking and profound similarity to Frege's theory of thoughts, his analysis of propositions, representations and judgment, as well as his position on the nature of logic in general. Bolzano's theories on these points, therefore, may well have been seminal to the development of Frege's position.

The notion of cerebral death is examined in relation to those of cardiopulmonary and whole-brain death. It is argued that rather than being a new concept of death, it is merely a new criterion that leaves the old concept — death as loss of personhood — intact. The argument begins on a theoretical level with the distinction between criteria and concepts, places both into context with the notion of a conceptual framework in its relation to empirical reality, and then particularizes (...) the result to criteria for the determination of death. It is argued that the suggestion of the cerebral criterion is nothing more than an attempt to realign the concept of death with the empirical data with which it has come out of step due to new developments in the empirical field. The paper considers tutioristic objections to the criterion, and shows its compatibility with dualistic religio-metaphysical positions by considering an actual example. It also addresses briefly the ethical impact of the criterion on medical practice. (shrink)

There is a fundamental inconsistency in Western society’s treatment of non-human animals on the one hand, and of human foetuses on the other. While most Western countries allow the butchering of animals and their use in experimentation, this must occur under carefully controlled conditions that are intended to minimize their pain and suffering as much as possible. At the same time, most Western countries permit various abortion methods without similar concerns for the developing fetus. The only criteria for deciding which (...) abortion method is used centre in the stage of the pregnancy, the size of the fetus, the health of the pregnant woman and the physician’s preference. This is out of step with the underlying ethos of animal cruelty legislation, cannot be justified ethically and should be rectified by adjusting abortion methods to the capacity of the fetus to experience nociception and/or pain. (shrink)

It is commonly believed thatgeriatric medicine generates a distinctive setof ethical problems. Implicated are such issuesas resource allocation, competence and consent,advance directives, medical futility anddeliberate death. It is also argued that itwould be unjust to allow the elderly to competewith younger populations for expensive andscarce health care resources because theelderly “have already lived,” and that treatingthem the same as these other populations woulddiminish the available resources unfairly,prolong a life of inevitably failing health andresult in increased health care expenditures.In fact, however, (...) this perception of ethicaluniqueness is mistaken. Differences in medicalconditions, demographics and aetiology shouldnot be allowed to obscure the fact that ethicalissues in geriatric medicine are essentiallythe same as those faced in any other area ofhealth care, and that the solutions that areadopted in the geriatric context must beconsistent with the ethical principles that arefollowed elsewhere. The paper argues that theroot of the mistaken perception lies in theabandonment of the Hippocratic mandate ofmedicine and in an unreflective adherence tothe belief that medical advances are inevitablybeneficial. It is suggested that a return topatient-centred medicine and the use of ethicsimpact analyses before introducing medicaladvances may be ethically appropriate. (shrink)

Browne, Gillett and Tweeddale propose that the use of non‐therapeutic elective ventilation (EV) to secure transplantable organs is ethically indefensible. Their argument centres around several propositions: that explicit patient consent for EV is essential, but since it is not included in the consent process for donation from the patient, using it constitutes assault; that inferring consent for EV from the consent to donate itself is ethically and logically indefensible; and that explicit consent from next‐of‐kin should neither be sought nor honoured (...) in view of the stress EV may cause to staff and families. This article examines their reasoning and suggests that it is fatally flawed. It argues further that in most cases of donation, not using EV may itself be unethical. (shrink)

Une propriété décisive du langage quant à la fiabilité de l'expression des pensées, est sa disposition à créer des noms propres auxquels ne correspond aucun objet. Cela n'a pas de conséquences sérieuses quand cela arrive dans la fiction que tout le monde comprend comme telle. Il n'en est pas de même quand cela arrive dans un exposé qui se prétend strictement scientifique. Un exemple particulièrement singulier est ici la formation de noms propres sur le modèle de «l'extension du concept ‘a’», (...) ainsi, «l'extension du concept d'étoile fixe». En vertu de l'article défini, cette expression semble désigner un objet. Linguistiquement parlant, cependant, il n'y a pas d'objet qui puisse être ainsi désigné. (shrink)

This chapter contains sections titled: Introduction Conceptual Issues Decision Issues Conclusion References Further reading.

At ’Opus Oxoniense’ book I, d.2, q.1, John Duns Scotus gives an argument for the existence of God that is based on the distinction between essentially and accidentally ordered efficient causes. Historically, this argument has been rejected because the claim that accidentally ordered causes require essentially ordered causes to account for the perpetuation of forms is question-begging. I argue that the critics of Scotus’s argument have failed to consider the ontology of the theory substance, accident and causation with which Scotus (...) is operating, and that once this is taken into account the traditional critique fails. (shrink)

St. Thomas’s argument for the immortality of the human soul in question 75, article 6 of his Summa Theologica has historically been rejected, most famously perhaps by Duns Scotus, who said that it was inconclusive at best and question begging at worst. This article argues that Scotus’s critique may be unfair because it rests on a mistaken understanding of what St. Thomas means by the phrase “natural desire,” and that if one unpacks the ontological assumptions that underlie St. Thomas’s reasoning (...) about the difference between sensible and intellective awareness, an argument emerges that does not suffer from the shortcomings that Scotus alleges. (shrink)

The Canadian health care system is a publicly fundedsystem based on the philosophy that health is a right,not a commodity. The implementation of thisperspective is hampered by the fact that the CanadianConstitution makes health care a matter of provincialjurisdiction, while most taxing powers lie in thehands of the federal government. Further problemsarise because of Canada's geographic nature and a moveto regionalization of provincial health careadministration. The issue is compounded byrecent developments in reproductive technologies,aboriginal health, changes in consent law, etc.

Court-ordered caesarean sections against the explicit wishes of the pregnant woman have been criticised as violations of the woman9s fundamental right to autonomy and to the inviolability of the person--particularly, so it is argued, because the fetus in utero is not yet a person. This paper examines the logic of this position and argues that once the fetus has passed a certain stage of neurological development it is a person, and that then the whole issue becomes one of balancing of (...) rights: the right-to-life of the fetal person against the right to autonomy and inviolability of the woman; and that the fetal right usually wins. (shrink)

The current global shortage of organs has prompted aseries of proposals for improving organ retrievalrates. They include preferred recipient status forregistered organ donors, payment for organs, presumedconsent and required response. This paper examinesthe tenability of these proposals and points out theirshortcomings. Taking the Canadian situation as anexample, it argues further that the shortage isexacerbated by unethical and essentially illegalretrieval protocols that flout the law of informedconsent. It is suggested that before any redrafting oflaws and regulations is undertaken, these protocolsshould be (...) revised. (shrink)

It is generally assumed that allocation problems in a socialized health care system result from limited resources and too much demand. Attempts at solutions have therefore centered in increasing efficiency, using evidence-based decision-making and on developing ways of balancing competing demands within the existing resource limitation. This article suggests that some of the difficulties in macro-allocation decision-making may result from the use of conflicting ethical perspectives by decision-makers. It presents evidence from a preliminary Canadian study to this effect.

To date, over 5,000 applications have been filed with United States Patent Office for patents on human genes. More than 1,500 of these applications have been granted. Other jurisdictions are experiencing a similar rush to mine and protect genomic gold. This paper argues that although many jurisdictions allow the patenting of human genes, this is ethically indefensible and amounts to an unjustified appropriation of a general human heritage. Economic and legal arguments in favour of patenting are considered and rejected. Reference (...) is made to the Wellcome Trust Consortium's initiative and the Merck Gene Index Project, which place patented genetic information into the public domain. (shrink)

Sex selection, which refers to the attempt to choose or control the sex of a child prior to its birth, has become the subject of increasing ethical scrutiny and many jurisdictions have criminalized it except for serious sex-linked diseases or conditions that cannot easily be ameliorated or remedied. This paper argues that such a blanket prohibition is ethically unwarranted because it is based on a flawed understanding of the difference between sexist values and mere sex-oriented preferences. It distinguishes between ethics (...) and public policy, and suggests a way of allowing preference-based sex selection as a matter of public policy without permitting value-based sex selection. It further argues that medically-based sex selection should be publicly funded but that preference-base sex selection should not be paid for by society, and that the prohibition against value-based sex selection should be enforced through legislation that controls the licensing of health care facilities and through disciplinary procedures against health care professionals. (shrink)

Many countries encourage immigration, yet almost without exception they impose medical conditions on the admissibility of prospective immigrants. This paper examines the ethical defensibility of this practice. It argues that the neighbourhood principle, which states that we owe a greater duty to neighbours than to strangers, when properly understood, extends to all human beings, that economic and safety considerations play only a limited role in ethically underwriting an exclusionary policy, and that medical immigration criteria should be harmonized with treatment eligibility (...) criteria for citizens of the relevant countries themselves. (shrink)

Dieser Beitrag geht von dem Standpunkt aus, daß das menschliche Genom nicht als Privateigentum der jeweils betroffenen Person, sondern als Gemeingut der Menschheit anzusehen ist. Es wird weiter dargestellt, daß die Genomforschung selbst sowie die Anwendung der durch sie entwickelten Handlungsmöglichkeiten sowohl positive als auch negative Aspekte hat. Angesichts ihres Potentials zum Guten wäre es jedoch verfehlt, aufgrund von meist religiös basierten oder kurzsichtigen tutioristischen Bedenken, die nur auf die Möglichkeit eines Mißbrauchs des so erworbenen Wissens ausgerichtet sind, die Forschung (...) selbst oder die Weiterentwicklung und Anwendung des errungenen Wissens vollständig zu unterbinden. Andererseits wäre es jedoch auch verfehlt, auf die Einsicht und den guten Willen der Forscher allein zu bauen, oder gar die Forschung und die Entwicklung des damit verbundenen Wissenstransfers sich selbst steuern zu lassen, da ein solcher Standpunkt das Erbgut der Menschheit der Willkür eines unkontrollierbaren Prozesses aussetzen würde, der allzu leicht den skrupellosen Interessen einer voreingenommenen und nur am eigenen Vorteil interessierten Minderheit anheim fallen könnte. Es wäre daher angemessen, der Forschung klare Grenzen zu setzen und den Wissenstransfer durch entsprechende Regeln strengen Kontrollen zu unterwerfen. Es gäbe hierbei verschiedene Möglichkeiten, angemessene Regeln zu entwickeln und Kontrollen einzuschalten: z.B. durch die koordinierte Entwicklung diesbezüglicher nationaler Gesetze, deren Einhaltung dann den jeweiligen Ländern als nationale Pflicht zukommen würde; durch das Abschließen von internationalen Abkommen, deren Einhaltung von internationalen Gremien überprüft werden könnte; durch die Entwicklung angemessener Regeln seitens der internationalen wissenschaftlichen und medizinischen Gemeinschaft, welche dann die Einhaltung dieser Regeln als Bedingung zur Teilnahme am internationalen wissenschaftlichen Austausch machen könnte; usw. Der vorliegende Beitrag unterwirft diese und ähnliche Vorschläge einer kurzen kritischen Analyse und gelangt zu dem Schluß, daß Regulierung und Kontrolle nur insoweit vertretbar sind, als sie auf ethische Grundprinzipien zurückgeführt werden können und damit auf ethischer Basis beruhen. Die diesbezüglichen ethischen Grundprinzipien werden identifiziert und auf die vorliegende Problematik angewandt. Ferner wird der Schluß nahegelegt, daß eine ethisch basierte Regulierung allein nicht zur angemessenen Kontrolle genügt, sondern daß es auch einer international akkreditierten Instanz bedarf, welche über genügend Mittel verfügt, um die Befolgung dieser ethisch basierten Regeln zu überprüfen und, falls erforderlich, durch angemessene Maßnahmen zu erzwingen. (shrink)

Die weltweite Praxis der Vergabe von Patenten auf Gene, die isoliert und von ihren natürlichen Gegebenheiten gereinigt worden sind, wird auf die Behauptung gestützt, dass diese Gene neu, nicht offensichtlich und nützlich sind. Während die Behauptungen von Nicht-Offensichtlichkeit und Nützlichkeit unbestreitbar sind, beruht die Behauptung von Neuheit auf einer rechtlichen Fiktion und enthält einen fundamentalen logischen Fehler. Darüber hinaus stellt das Argument, das diese Fiktion unterstützt, etwas als res nullius dar, was doch tatsächlich res communis ist. Die gängige Praxis sanktioniert (...) demnach eine ungerechtfertigte Aneignung und involviert eine fundamentale Verletzung des Begriffs des Rechtsanspruchs. Im Lichte der entgegenstehenden Gründe kann diese Verletzung auch nicht unter Berufung auf wirtschaftliche Notwendigkeiten gerettet werden. Im Unterschied dazu trifft die hier vorgetragene Kritik nicht Patentansprüche für künstliche Gene oder genetisch modifizierte Lebensformen, die daher anerkannt werden sollten. Mögliche Implikationen im Hinblick auf ein genetisch modifiziertes menschliches Genom werden kurz erörtert. The worldwide practice of granting patents on genes that have been isolated and purified from their natural occurrences is based on the claim that these genes are novel, non-obvious and have utility. While the claims of non-obviousness and utility are indisputable, the claim of novelty rests on a legal fiction and involves a fundamental logical error. Moreover, the argument in support of the fiction portrays as res nullius what in fact is res communis . Current practice therefore constitutes the legal sanction of an unjustified appropriation, and involves a fundamental violation of the notion of entitlement. In light of evidence to the contrary, this violation cannot be saved by an appeal to economic necessity. By contrast, patent claims for artificial genes or genetically modified life-forms are not subject to such a critique and should be granted. Possible implications with respect to a genetically modified human genome are briefly considered. (shrink)