Health professionals do not always have the luxury of making “right” choices. This article introduces the “devil's choice” as a metaphor to describe medical choices that arise in circumstances where all the available options are both unwanted and perverse. Using the devil's choice, the paper criticizes the principle of double effect and provides a re-interpretation of the conventional legal and ethical account of symptom relief in palliative care.

In 1982, cinemas around the world screened Sophie's Choice, a film starring Meryl Streep and Kevin Kline, adapted from the book by William Styron. The film opens with Stingo, a young journalist from the South, who arrives in New York in 1947 and rents a room in Brooklyn. Stingo is drawn into a relationship with Sophie and Nathan, the couple who live upstairs. Sophie is a Polish concentration camp survivor; Nathan is the man who saved her when she arrived in (...) America. Nathan is charismatic, schizophrenic, and violent.In one of the film's flashbacks, a German soldier imposes a terrible choice on Sophie, a young mother who arrives at Auschwitz with other prisoners from Krakow. Sophie is ordered to choose which of her two children will be sent to the ovens, and which will live. (shrink)

I have a hairstylist whose lover was very sick. I’d been seeing this stylist for ten years and we’re good friends. [His lover was] becoming an invalid, not able to get out of bed. He said “I hate to ask you this but would you mind writing a prescription to help us out?” [So] I wrote a prescription to a patient who I had never seen, and I sent it to him in the mail and I heard the next time (...) I went in to get my hair cut that it was the most beautiful experience that my stylist had ever had. It was Valentine’s Day and they had a lovely meal with champagne. And they held each other and then, you know, his partner took his pills and was released. (shrink)

I have a hairstylist whose lover was very sick. I’d been seeing this stylist for ten years and we’re good friends. [His lover was] becoming an invalid, not able to get out of bed. He said “I hate to ask you this but would you mind writing a prescription to help us out?” [So] I wrote a prescription to a patient who I had never seen, and I sent it to him in the mail and I heard the next time (...) I went in to get my hair cut that it was the most beautiful experience that my stylist had ever had. It was Valentine’s Day and they had a lovely meal with champagne. And they held each other and then, you know, his partner took his pills and was released. (shrink)

The two questions, “What is public health law?” and “How can law improve the public's health?” are perennial ones for public health law scholars. This paper proposes a framework for conceptualizing discussion and debate about the scope and opportunities for public health law within liberal democracies. Part 2 of the paper draws selectively on this framework in order to highlight some areas where law's potential role deserves greater acknowledgment and exploration.

The two questions, “What is public health law?” and “How can law improve the public’s health?”, are perennial ones for public health law scholars. They are ideological questions because perceptions about the proper boundaries of law’s role will shape perceptions of what law can do, in an operational sense, to improve health outcomes. They are also theoretical questions, in the sense that, without closing down debate about the limits of public health law, these questions can be addressed by mapping the (...) range of perspectives on how law might “go to work” for the public’s health. Finally, these are immensely practical questions. On our ability to understand the roles that law can play in public health improvement rests our capacity, as a society, to use law strategically as a policy tool. (shrink)

For the past 30 years, the Melbourne urologist Dr Rodney Syme has quietly—and more recently, not-so-quietly—assisted terminally and permanently ill people to die. This paper draws on Syme’s recent book, A Good Death: An Argument for Voluntary Euthanasia , to identify and to reflect on some important challenges to what I outline as the traditional account of law, ethics, and end of life decisions. Among the challenges Syme makes to the traditional view is his argument that physicians’ intentions are frail (...) and unfairly expose physicians to moral and legal censure. Secondly, Syme argues that physician-assisted dying (PAD) should be framed as a form of palliative care, not as a kind of safety-chute for when palliative care fails. Thirdly, Syme himself is a rare breed: a dissident doctor who has opened himself up for scrutiny and criticism, by reflecting publicly on his experiences at the edge of the law. Syme’s career illustrates that prohibition, just like legalization, is a social policy that carries social consequences. The paper acknowledges the variability and idiosyncratic nature of extra-legal physician-assisted dying, and argues that the best way forward is to attempt to weigh the social consequences of both policies. Advocates and opponents of PAD should recognize that both prohibition and legalization involve trade-offs and impose possible costs on patients and on society. (shrink)

This paper considers how we can conceptualize a “global response” to chronic, non-communicable diseases (NCDs) – including cardiovascular disease, cancer, diabetes, and tobacco-related diseases. These diseases are the leading cause of death and disability in developed countries, and also in developing countries outside sub-Saharan Africa. The paper reviews emerging and proposed initiatives for global NCD governance, explains why NCDs merit a global response, and the ways in which global initiatives ultimately benefit national health outcomes. As the global response to NCDs (...) matures, and the number of initiatives and partnerships increases, it will become increasingly important to map their respective contributions, and to evaluate progress overall. It is not yet clear what institutional mechanism, if any, will rise above the sea of surrounding initiatives to play this global role. This paper therefore aims to provide a conceptual map for making sense of what individual initiatives contribute to global governance. This map also draws attention to the distinctively “global” public health functions that a global response to NCDs should seek to discharge. (shrink)

Judging by their contribution to the global burden of death and disability, chronic, non-communicable diseases are the most serious health challenge facing the world today. The statistics tell a frightening story. Over 35 million people died from chronic diseases in 2005 — principally cardiovascular disease, cancer, and chronic respiratory disease. Driven by population growth and population ageing, deaths from non-communicable diseases are expected to increase by 17% over the period 2005-2015, accounting for 69% of global deaths by 2030.Cardiovascular disease, the (...) leading cause of death in all regions except sub-Saharan Africa, is estimated to rise from 17.1 million deaths to 23.4 million deaths. Cancer deaths will increase from 7.4 million to 11.8 million over the same period. Due to population growth, mergers and acquisitions, and the marketing of global cigarette brands in developing countries, deaths from tobacco will rise from 5.4 million per year, through 6.4 million, to 8.3 million by 2030. These figures include a doubling in tobacco deaths in low- and middle-income countries from 3.4 million to 6.8 million lives annually. By 2015, smoking will cause 50% more deaths than HIV/AIDS. (shrink)

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing (...) in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice. (shrink)

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. Writing (...) in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice. (shrink)

The first of five commentaries on “Bloomberg's Health Legacy: Urban Innovator or Meddling Nanny?” from the September‐October 2013.

A Spirituality of Resistance addresses the challenges of creating a spiritual life in the midst of unprecedented environmental crisis. In the end, Gottlieb finds that only through striving to protect the earth and all its inhabitants can one find authentic personal and spiritual peace.

Name der Zeitschrift: Philologus Jahrgang: 160 Heft: 2 Seiten: 197-216.

Unter Berücksichtigung von Ishiguros Gegenargumenten untersucht dieser Aufsatz erneut die traditionelle Interpretation von Leibniz' These, daß es keine kausale Wechselwirkung zwischen den Substanzen gebe und daß die kausalen Erklärungen für die Eigenschaften einer Substanz völlig in ihrer Natur lägen. Ishiguros Argumente benutzen die Unterscheidung zwischen dem Begriff einer Substanz und ihrer Natur, und in der Tat kann die Philosophie von Leibniz ohne diese Unterscheidung nicht voll gewürdigt werden. Aber sie lassen nicht erkennen, daß für Leibniz keine eindeutige Entsprechung zwischen ihnen (...) besteht. Sie lassen nicht erkennen, daß die kausale Erklärung für die Eigenschaften einer Substanz nicht völlig in ihrer eigenen Natur liegt. Die traditionelle Interpretation der prästabilierten Harmonie wird von allem, was Leibniz sagt, unterstützt und sollte wieder zur Geltung kommen. (shrink)

We propose that the fine discrete movements of the tongue as used in speech are what account for the extreme lateralization in humans, and that handedness is a mere byproduct of tongue use. With regard to syntax, we support the Armstrong et al. (1995) proposition that syntax derives directly from gestural motor movements as opposed to facial expressions.

Moral theories may differ not only in the substantive moral principles they assert, but also in their concept of a person or moral agent. Thus, for example, Utilitarianism stresses the ability of a human being to calculate rationally the profit and loss which attend particular actions; and Aristotle bases his Nichomachean Ethics on a moral psychology tied to the notion of harmonious self-development.

This unique anthology brings together readings from the works of the most significant post-Leninist Marxist thinkers. The selections reflect the diversity and high intellectual accomplishment of twentieth-century Marxism and show how these theorists have transformed traditional Marxism's general philosophical orientation, interpretation of historical materialism, models of socialist political practice, and conception of human liberation. The writings reveal the evolution of a sophisticated and democratic Marxism with a theoretical emphasis on class consciousness and subjectivity, a resistance to all forms of domination--including (...) sexism--and a belief in the political power of consciousness-raising. The selections include the work of forerunners Karl Korsch, George Lukacs, and Antonio Gramsci; figures from the 1930s, including Max Horkheimer, Theodor Adorno, and Wilhelm Reich; post-war and New Left thinkers Jean-Paul Sartre, Andre Gorz, Herbert Marcuse, and Jurgen Habermas; and contemporary socialist-feminists Sheila Rowbotham, Juliet Mitchell, Barbara Ehrenreich, Heidi Hartmann, and Ann Ferguson. Gottlieb places the readings in historical and theoretical context, providing a clear and insightful account of the intellectual problems and historical events that gave rise to the Western Marxism, and describing how it both anticipated and influenced contemporary radical movements. Each selection is prefaced by a biographical sketch and the book concludes with a bibliography suggesting further research. (shrink)

First Published in 1997. Routledge is an imprint of Taylor & Francis, an informa company.

The environmental crisis creates an unprecedented moral predicament: how to be a good person when our collective and individual actions contribute to immeasurable devastation and suffering. Drawing on an extraordinary range of sources from philosophy, political theory, global religion, ecology, and contemporary spirituality, Roger S. Gottlieb explores the ethical ambiguities, challenges, and opportunities we face. Engagingly written, intellectually rigorous, and forcefully argued, this volume investigates the moral value of nature; the possibility of an 'ecological' democracy; how we treat animals; (...) the demands and limits of individual responsibility and collective political change; contemporary ambiguities of rationality; and how to face environmental despair. In Morality and the Environmental Crisis, Gottlieb combines compassion for the difficulties of contemporary moral life with an unflinching ethical commitment to awareness and action. (shrink)

This anthology brings together new essays by leading figures in contemporary philosophy, scholars whose work is well known not only to the entire community of academic philosophy, but to many in the associated fields of sociology, women's studies, literary theory, and political science. Defining for the first time the boundaries and accomplishments of a body of work deeply critical of both the philosophical and the social dimensions of domination, the collection draws on diverse traditions and social movements. These include feminism, (...) critical theory, Marxism, deconstruction, democratic socialism, theories of race and ethnicity, deep ecology, and politicized spirituality. The contributors use these resources to comprehend and indict the present social order and to help us imagine a more just, liberating, and fulfilling society. In his lucid Introduction, Roger S. Gottlieb describes the formative contexts, achievements, and dilemmas of radical philosophy. Essays in Part I, Tradition, challenge the pretensions of philosophy in epistemology, ethics, and the theory of human nature. These articles unveil the social oppression hidden behind self-proclaimed attempts at Grand and Unbiased Philosophical Reason. In Part II, Counter-Tradition, the contributors engage with today's dominant critical perspectives and show how multi-faceted, rich, and sometimes confusing these perspectives are. Their topics include issues of exploitation, democracy, and justice; the current status of Marxism; the impact of deep ecology on radical theory; and some dilemmas faced by cultural feminism. Part III, Politics, addresses questions about contemporary North American political and cultural life. The essaysexamine relations among varying types of oppression, the experience of community and communities, the possibilities of fundamental political change, and the representation of difference in popular culture. (shrink)

Can Marxism still serve the American left? "History and Subjectivity" answers this question by synthesizing the conflict perspectives of traditional Marxism, Western and neo-Marxism, socialist-feminism, and various minority political movements into a comprehensive and original social theory. Roger Gottlieb argues convincingly that a properly transformed Marxism must understand how socialisation processes and political structures and experiences have joined the mode of production as socially primary. Drawing on resources from Marxist philosophy, political economy, feminism, Western Marxism, and from detailed historical (...) studies of racism, sexism, anti-Semitism, and the American left, Gottlieb has produced a sweeping synthesis of existing Marxist thought and an original and compelling social theory. In this edition, Roger Gottlieb has added a new introduction addressing the central questions that have emerged since the book's first publication. These include the effect on Marxist theory of the fall of communism, the theoretical challenge of postmodernism, the environmental crisis, and the rise of modern spiritual movements. The book is challenging and complex, yet clearly written and accessible to advanced undergraduate and graduate students. It will provoke a strong response from any scholar concerned with the present status and future possibilities of Marxist theory. (shrink)

This book gathers a variety of illuminating essays by an internationally known scholar of religion and ecology. New writings on technology, facing death, and an intellectual autobiography continue Gottlieb’s unique ability to connect collective struggles for a just and caring society with personal strivings for wisdom and compassion.