The concept of person is integral to bioethical discourse because persons are the proper subject of the moral domain. Nevertheless, the concept of person has played no role in the prevailing formulation of human death because of a purported lack of consensus concerning the essential attributes of a person. Beginning with John Locke's fundamental proposition that person is a ‘forensic term’, I argue that in Western society we do have a consensus on at least one necessary condition for personhood, and (...) that is the capacity for conscious experience. When we consider the whole brain formulation of death, and the most prominent defense of it by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, we can readily identify the flaws that grow out of the failure to define human death as the permanent loss of the capacity for conscious experience. Most fundamental among these flaws is a definition of human death that reduces persons to the capacity of the brain to regulate purely physiological functioning. Such a formulation would, in theory, apply to any member of the animal kingdom. I suggest that an appropriate concept of death should capture what it is about a particular living being that is so essential to it that the permanent loss of that thing constitutes death. What is essential to being a human being is living the life of a person, which derives from the capacity for conscious experience. (shrink)

Abstract:The specialty of psychiatry has a long-standing, virtually monolithic view that a desire to die, even a desire for a hastened death among the terminally ill, is a manifestation of mental illness. Recently, psychiatry has made significant inroads into hospice and palliative care, and in doing so brings with it the conviction that dying patients who seek to end their suffering by asserting control over the time and manner of their inevitable death should be provided with psychotherapeutic measures rather than (...) having their expressed wishes respected as though their desire for an earlier death were the rational choice of someone with decisional capacity. This article reviews and critiques this approach from the perspective of recent clinical data indicating that patients who secure and utilize a lethal prescription are generally exercising an autonomous choice unencumbered by clinical depression or other forms of incapacitating mental illness. (shrink)

Abstract:Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical (...) and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards. (shrink)

Prognostication, the process offormulating and communicating a prognosis, isno longer considered by most physicians to bean essential task in caring for patients withserious illness. Because of this fact, it isnot surprising to find that when physiciansattempt to engage in prognostication, they doit poorly. What may be surprising to thoseoutside the medical community is the extent towhich professional norms have developed whichactively discourage physicians from engaging inprognostication. This article explores thecauses of this state of affairs and thejustifications offered for it. The (...) conclusionis reached that physicians have a professionalresponsibility to competently engage inprognostication based upon the doctrine ofinformed consent, and that a failure or refusalto do so has not only potential legalramifications, but serious negativeimplications for many of the core issues inbioethics, such as the use of advancedirectives, palliative medicine, and medicalfutility. (shrink)

In a recent special supplement to the Hastings Center Report entitled “Improving End-of-Life Care—Why Has It Been So Difficult?” Robert Burt wrote the following in an essay ominously entitled “The End of Autonomy”: No one should be socially authorized to engage in conduct that directly, purposefully, and unambiguously inflicts death, whether on another person or on oneself. Decisions that indirectly lead to death should be acted upon only after a consensus is reached among many people. No single individual should be (...) socially authorized to exercise exclusive control over decisions that might lead to death, whether that individual is the dying person, the attending physician, or a family member acting as health care proxy. (shrink)

Until quite recently bioethicists have had little of depth and probity to say about the duty of healthcare professionals in general and physicians in particular to relieve pain and suffering associated with disease and/or its treatment.

In the mid to late 1980s a debate arose over the moral and legal authority of advance medical directives. At the center of this debate were two point-counterpoint law journal articles by Rebecca Dresser and Nancy Rhoden. What appeared to have the makings of an ongoing critical dialogue ended with the untimely death of Nancy Rhoden. Rebecca Dresser, however, has continued her challenge of advance directives in numerous publications, most recently in a critique of Ronald Dworkin's Life's Dominion. Like Rhoden, (...) Dworkin has been a staunch advocate of advance directives as an exercise of what has come to be referred to as prospective or precedent autonomy. In this paper I will consider a number of the issues that Dresser has repeatedly raised about the infirmities of advance directives, and suggest that it is from an understanding of and appreciation for the narrative dimension of the life of a person that advanced directives draw one of their most powerful justifications. (shrink)

Abstract:Recent contributions to the medical literature have raised yet again the issue of whether the term “terminal” is an intelligible one and whether there is a consensus view of its meaning that is sufficient to justify or even require its use in discussing end-of-life care and treatment options with patients. Following a review of the history and development of informed consent, persistent problems with the communication of prognosis and the breaking of bad news are analyzed. The author argues that candid (...) but compassionate communication between physicians and patients about prognosis is essential to informed decisions about both disease-directed (curative) and palliative therapies. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 52-53, June 2011.

Among the most significant findings of SUPPORT was that 50% of ICU patients suffered from moderate to severe pain during the last days of life. At the time of its publication late in 1995, SUPPORT was merely the latest in a long series of articles in the medical literature documenting the widespread and significant undertreatment of pain, beginning with a 1973 study of hospital inpatients. Much has been written about the phenomenon of undertreated pain and inadequate care of patients at (...) the end of life, and many positive suggestions for reform of clinical education and clinical practice have been iterated and reiterated in the two decades separating the studies. Proposals for modifying clinician behaviors in this aspect of patient care have tended to focus on particular barriers to effective pain management and palliative care. (shrink)

(2013). Distinguishing Difficult Patients From Difficult Maladies. The American Journal of Bioethics: Vol. 13, No. 4, pp. 24-26. doi: 10.1080/15265161.2013.767957.

In the mid to late 1980s a debate arose over the moral and legal authority of advance medical directives. At the center of this debate were two point-counterpoint law journal articles by Rebecca Dresser and Nancy Rhoden. What appeared to have the makings of an ongoing critical dialogue ended with the untimely death of Nancy Rhoden. Rebecca Dresser, however, has continued her challenge of advance directives in numerous publications, most recently in a critique of Ronald Dworkin's Life's Dominion. Like Rhoden, (...) Dworkin has been a staunch advocate of advance directives as an exercise of what has come to be referred to as prospective or precedent autonomy. In this paper I will consider a number of the issues that Dresser has repeatedly raised about the infirmities of advance directives, and suggest that it is from an understanding of and appreciation for the narrative dimension of the life of a person that advanced directives draw one of their most powerful justifications. (shrink)

Charles Dickens began one of his many great works of literature with this seemingly paradoxical, self-contradictory statement. Reflecting on a jury verdict in Northern California in June of 2001, in the context of what has transpired during the decade of the 1990s with regard to the care of dying patients, observations in the genre of Dickens come readily to mind. In 1991, two of the most compelling books on the subject of pain, medicine, and society were published: Eric Cassell's The (...) Nature of Suffering and the Goals of Medicine and David Morris's The Culture of Pain. Both works unflinchingly recognized and explored the implications of the vast clinical literature documenting the failure of modern medicine to respond compassionately and effectively to what had by then become an epidemic of undertreated pain. (shrink)

When one considers the protracted and continuing struggle of the citizens of Oregon to include physician-assisted suicide among the panoply of measures available to dying patients and the physicians who care for them, the depth and breadth of the issue becomes inescapable. The potential intractability of the dispute is illustrated by the very fact, noted in the preceding parenthetical phrase, that consensus eludes us on even the most basic of semantic points—how we are to most aptly characterize the conduct in (...) question? The case featured in this issue's The Caduceus in Court must be examined as the latest battle in a long war of attrition waged by opponents of physician-assisted suicide against the Oregon Death with Dignity Act. After briefly reviewing that history, I will then consider the details of Oregon v. Ashcroft and the implications of the litigation not only for the care of dying patients but also for the regulation of medical practice in the United States and, more broadly still, the search for resolution of serious medical disputes in a democratic society. (shrink)

A decision by the Supreme Court of California in the case Conservatorship of Wendland, issued in August 2001, forces us once again to confront the all-too-common situation in which an individual has, on multiple occasions, expressed strongly held personal convictions about life-sustaining interventions but failed to incorporate those convictions into a formal advance directive. Many courts have recognized that lay citizens do not consistently resort to written legal formalities in their day-to-day lives, and reasonable accommodation must be made to this (...) fundamental fact about human nature. However, a small but apparently growing minority of courts adamantly insist on either formal written directives or prescience and prophetic precision on the part of the patient before a surrogate can direct the withdrawal of life-sustaining treatment. The chronology of cases that comprise this minority position in American medical jurisprudence raise important ethical issues. (shrink)

In the regime of Anglo-American tort law, every person has a responsibility to comport him- or herself with “due care” in going about day-to-day activities so as not to imperil the health, safety, or general welfare of others. The gold standard for determining what constitutes due care in any particular situation is what a reasonable person, similarly situated, would do. Determinations of due care are necessarily fact specific. Nevertheless, the general objective is to strike an appropriate balance between an unrealistically (...) high standard of caution and one that fails to take into account the known or foreseeable risks of any human endeavor. The same standard applies to individuals regardless of their age, gender, race, and level of education or economic status. The standard also applies to fictional “persons” such as corporations. The usual or prevailing custom and practice in an industry or occupation may provide relevant evidence of what constitutes “due care” in the activities common to it, but that evidence can be effectively overcome or rebutted by competent, credible evidence that the custom and practice either diverges from what it has been asserted to be or that the custom and practice is itself unsafe or otherwise poses an unreasonable risk of harm to others. Until quite recently, a singular exception to this general principle of tort law was made for the medical profession. We will consider this exception in the next section. (shrink)

For over 20 years the medical literature has carefully documented the undertreatment of all types of pain by physicians. During this same period, as the field of bioethics came of age, the phenomenon of undertreated pain received almost no attention from the bioethics literature. This article takes bioethicists to task for failing to recognize the undertreatment of pain as a major ethical, and not merely a clinical, failing of the medical profession. The nature and extent of the problem of undertreated (...) pain is examined, as well as possible reasons for its disregard by bioethicists. The factors contributing to undertreated pain in the clinical setting are considered, as well as the hazards posed by recent failures to address ethically questionable clinical practices. Finally, suggestions are offered for refocusing the attention of bioethicists to this significant problem. (shrink)

In his professional life, Richard Posner is addressed as “Your Honor,” inasmuch as he is Chief Judge of the U.S. Court of Appeals for the Seventh Circuit. He is also a senior lecturer at the University of Chicago Law School. Finally, he is a prolific author of books and articles in scholarly journals in which he expounds at length and with copious footnotes his particular views of jurisprudence and public policy. One of his frequent intellectual adversaries, legal philosopher Ronald Dworkin, (...) wryly described Judge Posner as “the lazy judge who writes a book before breakfast, decides several cases before noon, teaches all afternoon at the Chicago Law School, and performs brain surgery after dinner.”. (shrink)

In his professional life, Richard Posner is addressed as inasmuch as he is Chief Judge of the U.S. Court of Appeals for the Seventh Circuit. He is also a senior lecturer at the University of Chicago Law School. Finally, he is a prolific author of books and articles in scholarly journals in which he expounds at length and with copious footnotes his particular views of jurisprudence and public policy. One of his frequent intellectual adversaries, legal philosopher Ronald Dworkin, wryly described (...) Judge Posner as. (shrink)

Anyone with so much as a passing familiarity with bioethics knows how significantly and persistently the law has insinuated itself into healthcare and the process of bioethical decisionmaking. Viewed from the insular perspective of traditional medical practice and medical ethics, it is not surprising that the of the patientlimitshavoc” wreaked by law upon the landscape of medical practice, painted by a lawyer, stands in stark contrast to an earlier and much more sympathetic account offered by Columbia University historian and medical (...) humanities professor David J. Rothman in his 1991 book StrangersattheBedside, the informative subtitle of which is AHistoryofHowLawandBioethicsTransformedMedicalDecisionMaking. (shrink)

This book provides a richly interdisciplinary assessment of the thought and work of Bryan Norton, one of most innovative and influential environmental philosophers of the past thirty years. In landmark works such as Toward Unity Among Environmentalists and Sustainability: A Philosophy of Adaptive Ecosystem Management, Norton charted a new and highly productive course for an applied environmental philosophy, one fully engaged with the natural and social sciences as well as the management professions. A Sustainable Philosophy gathers together a distinguished group (...) of scholars and professionals from a wide array of fields to engage Norton’s work and its legacy for our shared environmental future. A study in the power of intellectual legacy and the real-world influence of philosophy, the book will be of great interest scholars and students in environmental philosophy, public policy and management, and environmental and sustainability studies. By considering the value and impact of Norton’s body of work it will also chart a course for the next generation of pragmatic environmental philosophers and sustainability scholars grappling with questions of environmental value, knowledge, and practice in a rapidly changing world. (shrink)

A practical, down-to-earth guide to Vasubandhu's classic work "Thirty Verses of Consciousness Only" that can transform modern life and change how you see the world. In this down-to-earth book, Ben Connelly sure-handedly guides us through the intricacies of Yogacara and the richness of the "Thirty Verses." Dedicating a chapter of the book to each line of the poem, he lets us thoroughly lose ourselves in its depths. His warm and wise voice unpacks and contextualizes its wisdom, showing us how we (...) can apply its ancient insights to our own modern lives, to create a life of engaged peace, harmony, compassion, and joy. In fourth-century India one of the great geniuses of Buddhism, Vasubandhu, sought to reconcile the diverse ideas and forms of Buddhism practiced at the time and demonstrate how they could be effectively integrated into a single system. This was the Yogacara movement, and it continues to have great influence in modern Tibetan and Zen Buddhism. "Thirty Verses on Consciousness Only," or "Trimshika," is the most concise, comprehensive, and accessible work by this revered figure. Vasubandhu's "Thirty Verses" lay out a path of practice that integrates the most powerful of Buddhism's psychological and mystical possibilities: Early Buddhism's practices for shedding afflictive emotional habit and the Mahayana emphasis on shedding divisive concepts, the path of individual liberation and the path of freeing all beings, the path to nirvana and the path of enlightenment as the very ground of being right now. Although Yogacara has a reputation for being extremely complex, the "Thirty Verses" distills the principles of these traditions to their most practical forms, and this book follows that sense of focus; it goes to the heart of the matter--how do we alleviate suffering through shedding our emotional knots and our sense of alienation? This is a great introduction to a philosophy, a master, and a work whose influence reverberates throughout modern Buddhism. (shrink)

This book explores the key motif of the religious Other in devotional (bhakti) literatures and practices from across the Indian subcontinent. The primary aim of this book is to reconsider and challenge inherited notions of the bhakta's or devotee's Other and unmask processes of representation that involve adoption, appropriation, and rejection of different social and religious agents. The book considers the ways in which bhakti might be conceived as having an inter-regional impact--as a force, discourse, network, mythology, ethic--while critically engaging (...) with extant scholarly narratives about what bhakti is and tracing when and how those narratives have been used. The sheer diversity of South Asia's devotional traditions renders them an especially rich resource for examining social and religious fault lines, thereby furthering scholarly understanding of how communalism and sectarianism originate and develop on local or regional levels, with wider geographic implications. Bringing together studies from a subcontinent-wide variety of linguistic, geographical, and historical frames for the first time, this book will be an important contribution to the literature on bhakti, and it will be of interest to scholars of South Asian Religion and Asian Religion. (shrink)

It is increasingly clear that law and its enforcement in Victorian Britain were quite effective in tackling formative industrial problems concerning pollution and broader threats to nature. What is unclear is the political philosophy, if any, underlying this historic achievement. A prevalent view is that early ‘environmental’ law lacked any philosophical underpinning. The article revisits this issue with reference to Dicey’s analysis of 19th century ‘law-making public opinion’. Dicey identified three broad streams of seminal opinion that, he argued, shaped laws (...) as the century unfolded. The early part of the century was dominated by ‘Old Toryism’, including the romantic conservatism associated with Samuel Taylor Coleridge. This then gave ground to ‘Benthamism’ which in turn ceded dominance to ‘collectivism’. Whilst Dicey ignored laws relating to the environment, I argue that this is not because these presented a particular difficulty for his thesis. Indeed, all three seams of ‘law-making opinion’ converged around the legal protection of nature to offer a rich and diverse philosophical foundation for environmental law. (shrink)

This chapter discusses nine ways to bias open‐source artificial general intelligence (AGI) toward friendliness. There is no way to guarantee that advanced AGI, once created and released into the world, will behave according to human ethical standards. The primary objective of the chapter is to suggest some potential ways to do so. First it discusses an engineer the capability to acquire integrated ethical knowledge, and provides rich ethical interaction and instruction, respecting developmental stages. The chapter creates stable, hierarchy‐dominated goal (...) systems, and ensures that the early stages of recursive self‐improvement occur relatively slowly and with rich human involvement. It tightly links AGI with the Global Brain, and focuses on foster deep, consensus‐building interactions and commensurability between divergent viewpoints. The chapter creates a mutually supportive community of AGIs, and encourages measured co‐advancement of AGI software and AGI ethics theory. Finally it develops advanced AGI sooner. (shrink)

Among the areas of knowledge that the method of reflective equilibrium (RE) has been applied to is that of logical validity. According to RE in logic, we come to be justified in believing a (deductive) logical theory in virtue of establishing some state of equilibrium between our initial judgements over the validity of specific (natural language) arguments and the logical principles which constitute our logical theory. Unfortunately, however, while relatively popular, RE with regards to logical theorizing is underspecified. In particular, (...) it’s unclear what constitute: (1) the relevant logical “data”, (2) logical theories, so that they can be suitably tested, and (3) the mechanisms under which such theories are tested. Considering the various options for how to interpret the position, we argue that in order to be workable the advocate of RE about logic must embrace what we call an _operationalised_, _wide_ and _communal_ version of RE with a _rich_ understanding of logical theories. Fortunately for the advocate of RE, there is an available account of logic’s epistemology which possesses just these properties, _logical predictivism_. However, equally unfortunately, logical predictivism commits the advocate of RE to certain further claims that they have historically been weary of holding. Consequently, it is unclear whether RE about logic itself is a viable proposal, or rather a similar but distinct epistemology of logic. (shrink)

What is sovereignty? Often taken for granted or seen as the ideology of European states vying for supremacy and conquest, the concept of sovereignty remains underexamined both in the history of its practices and in its aesthetic and intellectual underpinnings. Using global intellectual history as a bridge between approaches, periods, and areas, The Scaffolding of Sovereignty deploys a comparative and theoretically rich conception of sovereignty to reconsider the different schemes on which it has been based or renewed, the public (...) stages on which it is erected or destroyed, and the images and ideas on which it rests. The essays in The Scaffolding of Sovereignty reveal that sovereignty has always been supported, complemented, and enforced by a complex aesthetic and intellectual scaffolding. This collection takes a multidisciplinary approach to investigating the concept on a global scale, ranging from an account of a Manchu emperor building a mosque to a discussion of the continuing power of Lenin's corpse, from an analysis of the death of kings in classical Greek tragedy to an exploration of the imagery of "the people" in the Age of Revolutions. Across seventeen chapters that closely study specific historical regimes and conflicts, the book's contributors examine intersections of authority, power, theatricality, science and medicine, jurisdiction, rulership, human rights, scholarship, religious and popular ideas, and international legal thought that support or undermine different instances of sovereign power and its representations. (shrink)

While it seems unlikely that any method of guaranteeing human-friendliness on the part of advanced Artificial General Intelligence systems will be possible, this doesn’t mean the only alternatives are throttling AGI development to safeguard humanity, or plunging recklessly into the complete unknown. Without denying the presence of a certain irreducible uncertainty in such matters, it is still sensible to explore ways of biasing the odds in a favorable way, such that newly created AI systems are significantly more likely than not (...) to be Friendly. Several potential methods of effecting such biasing are explored here, with a particular but non-exclusive focus on those that are relevant to open-source AGI projects, and with illustrative examples drawn from the OpenCog open-source AGI project. Issues regarding the relative safety of open versus closed approaches to AGI are discussed and then nine techniques for biasing AGIs in favor of Friendliness are presented: 1. Engineer the capability to acquire integrated ethical knowledge.2. Provide rich ethical interaction and instruction, respecting developmental stages.3. Develop stable, hierarchical goal systems.4. Ensure that the early stages of recursive self-improvement occur relatively slowly and with rich human involvement.5. Tightly link AGI with the Global Brain.6. Foster deep, consensus-building interactions between divergent viewpoints.7. Create a mutually supportive community of AGIs.8. Encourage measured co-advancement of AGI software and AGI ethics theory.9. Develop advanced AGI sooner not later. In conclusion, and related to the final point, we advise the serious co-evolution of functional AGI systems and AGI-related ethical theory as soon as possible, before we have so much technical infrastructure that parties relatively unconcerned with ethics are able to rush ahead with brute force approaches to AGI development. (shrink)

Lucid, learned, and incomparably rich in thought and detail, Art Without Borders is a monumental accomplishment, on par with the artistic achievements ...

Since the ages of the Old Testament, the Homeric myths, the tragedies of Sophocles and the ensuing theological speculations of the Christian millennium, the theme of loneliness has dominated and haunted the Western world. In this wide-ranging book, philosopher Ben Lazare Mijuskovic returns us to our rich philosophical past on the nature of consciousness, lived experience, and the pining for a meaningful existence that contemporary social science has displaced in its tendency toward material reduction. Engaging key metaphysical discussions on (...) causality, space, time, subjectivity, the mind body-problem, personal identity, freedom, religion, and transcendence in ancient, scholastic, modern, and contemporary philosophy, he highlights the phenomenology of loneliness that lies at the very core of being human. In challenging psychoanalytic and neuroscientific paradigms, Mijuskovic argues that isolative existence and self-consciousness is not so much of a problem of unconscious conflict or the need for psychopharmacology as it is the loss of a sense of personal intimacy. The issue of the criteria of "personal identity" in relation to loneliness has long engaged and consumed the interest of theologians, ethicists, philosophers, novelists and psychologists. This book will be of great interests to academics and students of the humanities, and all those with an interest in the philosophy of loneliness.. (shrink)