Perhaps nature is simply a challenge to be addressed, overcome, and set aside.This volume is a critical exploration of natural law theory.

The legal basis of informed consent in Texas may on first examination suggest an unqualified affirmation of persons as the source of authority over themselves. This view of individuals in the practice of informed consent tends to present persons outside of any social context in general and outside of their families in particular. The actual functioning of law and medical practice in Texas, however, is far more complex. This study begins with a brief overview of the roots of Texas law (...) and public policy regarding informed consent. This surface account is then contrasted with examples drawn from the actual functioning of Texas law: Texas legislation regarding out-of-hospital do-not-resuscitate (DNR) orders. As a default approach to medical decision-making when patients lose decisional capacity and have failed to appoint a formal proxy or establish their wishes, this law establishes a defeasible presumption in favor of what the law characterizes as “qualified relatives” who can function as decision-makers for those terminal family members who lose decisional capacity. The study shows how, in the face of a general affirmation of the autonomy of individuals as if they were morally and socially isolated agents, space is nevertheless made for families to choose on behalf of their own members. The result is a multi-tier public morality, one affirming individuals as morally authoritative and the other recognizing the decisional standing of families. (shrink)

Creation of for-profit markets in organs for transplantation ignites in many deep moral repugnance. Proposals to broker organs have been denounced by the US Congress and professional groups alike. Financial incentives are believed to undermine consent, coercing the poor into selling their organs, violating human dignity, and improperly commodifying the human body; such concerns are held to trump the possibility of increasing life-sustaining transplants. While such views summarize the apparent global consensus which marks worldwide prohibition of the sale of human (...) organs, I argue that closer examination reveals significant grounds for concluding that markets would be more successful in preventing exploitation, preserving human dignity, and protecting against improper commodification than governmental bureaucratic procedures for procuring and allocating organs. (shrink)

This paper critically explores key aspects of the gulf between traditional Christian bioethics and the secular moral reflections that dominate contemporary bioethics. For example, in contrast to traditional Christian morality, the established secular bioethics judges extramarital sex acts among consenting persons, whether of the same or different sexes, as at least morally permissible, affirms sexual freedom for children to develop their own sexual identity, and holds the easy availability of abortion and infanticide as central to the liberty interests of women. (...) Secular bioethics seeks to separate children from the authority of their parents, placing children themselves as in authority to make their own judgments about appropriate lifestyle choices, including sexual behaviors. As I argue, however, absent God, there exists no standpoint outside of our own cultural sociohistorically conditioned understanding from which to communicate any deeper perspective of reality or the bioethics that such a perspective would secure. Consequently, rather than discerning moral truth, secular bioethics merely affirms its own particular cultural sociohistorically conditioned ideological perspective. It is a social and political worldview bereft of definitive moral foundation, independent moral authority, or unambiguous content. (shrink)

Organ procurement policy from the recently deceased recasts families into gatekeepers of a scarce medical resource. To the frustration of organ procurement teams, families do not always authorize organ donation. As a result, efforts to increase the number of organs available for transplantation often seek to limit the authority of families to refuse organ retrieval. For example, in some locales if a deceased family member has satisfied the legal conditions for first-person prior assent, a much looser and easier standard to (...) satisfy than informed consent, organ retrieval may proceed despite the family’s objections. Some countries have replaced voluntary consent to organ donation with forms of organ conscription. Often referred to under the misnomer “presumed consent,” such policies legalize the harvesting of organs at death, unless individuals exercise official options to opt out. As this article explores, however, there are good grounds for affirming the authority of the family to consent to or to deny organ donation on behalf of recently deceased family members, as well as to reject first-person assent and “presumed consent” policies of organ procurement. Insofar as individuals have failed clearly and competently to provide informed consent to organ donation, moral authorization for the use of the person and his body ought to be grounded on the foundational authority of the family, rather than the state’s supposed interests in obtaining organs for transplantation. (shrink)

This paper challenges the foundational claim that the human family is no more than a social construction. It advances the position that the family is a central category of experience, being, and knowledge. Throughout, the analysis argues for the centrality of the family for human flourishing and, consequently, for the importance of sustaining family-oriented practices within social policy, such as more family-oriented approaches to consent to medical treatment. Where individually oriented approaches to medical decision-making accent an ethos of isolated personal (...) autonomy family-oriented approaches acknowledge the central social and moral reality of the family. I argue that the family ought to be appreciated as more than a mere network of personal relations and individual undertakings; the family possesses a being that is social and moral such that it realizes a particular structure of human good and sustains the necessary conditions for core areas of human flourishing. Moreover, since the family exists as a nexus of face-to-face relationships, the consent of persons, including adults, to be members of a particular family, subject to its own respective account of family sovereignty, is significantly more amply demonstrated than the consent of citizens to be under the authority of a particular state. As a result, in the face of a general Western bioethical affirmation of the autonomy of individuals, as if adults and children were morally and socially isolated agents, this paper argues that social space must nevertheless be made for families to choose on behalf of their own members. (shrink)

This study explores the ways in which adolescents, even so-called “mature minors”, lack adequate development of the intellectual, affective, and emotional capacities necessary morally to consent to medical research on their own behalf. The psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than mature adults. They lack full adult maturity and personal agency. As a result, in addition to the usual requirements for IRB approval, one or both parents, or a (...) legal guardian, should provide informed consent for minor children to participate in medical research. (shrink)

This paper defends an in principle understanding of the authority of persons over themselves and, in consequence, argues for significant limits on morally permissible state authority. It also defends an account of the limits of permissible state action that distinguishes between the ability of persons to convey authority to common projects and what may be judged virtuous, good, safe, or proper to do. In terms of organ transplantation policy, it concludes that it is morally acceptable, and should be legally permissible, (...) for individuals to sell one of their kidneys while living, pocketing the cash to use as that person sees fit to advance their own understanding of their own best interests. Morally objectionable policy proposals, I argue, are not those that encourage individuals to sell a redundant kidney while living or families to sell the organs of a recently deceased loved one, but those that seek coercively to confiscate the organs of the recently deceased. Recognizing the authority of persons over themselves, and their ability to convey moral authority to common projects, including the sale of human organs for transplantation, would shed light on the medical marketplace and clarify public policy, while increasing the efficiency and effectiveness of procuring human organs for transplantation. (shrink)

The day-to-day work of clinical ethics consultants and healthcare ethics committees can easily become overly routine. Too much routine, however, comes with a risk that morally important practices will be reduced to mere bureaucratic formalities, while practitioners become desensitized to ethically significant distinctions between cases. Clinical ethics consultation and organizational ethics must be set within the broader social and cultural context of the healthcare environment. This practice requires looking beyond mere legal compliance and the routinely false assumption that there are (...) unambiguous ethical norms that easily govern clinical ethics and hospital policy formation. Together the essays in this issue of HEC Forum challenge readers to rethink taken-for-granted assumptions regarding patient care, physician obligation, clinical ethics consultation, and organizational ethics. (shrink)

Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer onto a donated body. Response has been decidedly mixed. How should we think about the moral permissibility of head transplants? Is it a life-saving/life-enhancing opportunity that appropriately expands the boundaries of medical practice? Or, is it a bioethical morass that ought not to be attempted? For the (...) purposes of this paper, I set aside questions regarding the surgical operation’s technological plausibility so as to focus on very basic questions regarding personal identity and the morality of head transplantation. The analysis begins with an exploration of the embodiment of persons. It considers whether persons can be conceptually distinguished from all parts of their body, even if they cannot be physically separated from some parts without loss of personhood. It argues that in most cases replacing body parts with reasonably similar parts will not destroy the conditions for sustaining personhood. However, as I explore, the phenomenology of personhood is such that some physical changes may prove to be too significant to maintain personal identity successfully over time. Given such complexity and the significance of the costs involved, the moral permissibility of head transplantation likely depends on recognizing that persons may give permission to collaborate in common activities, including projects with which others deeply disagree, provided that they only utilize the services and resources of free and consenting others. (shrink)

This paper defends an in principle understanding of the authority of persons over themselves and, in consequence, argues for significant limits on morally permissible state authority. It also defends an account of the limits of permissible state action that distinguishes between the ability of persons to convey authority to common projects and what may be judged virtuous, good, safe, or proper to do. In terms of organ transplantation policy, it concludes that it is morally acceptable, and should be legally permissible, (...) for individuals to sell one of their kidneys while living, pocketing the cash to use as that person sees fit to advance their own understanding of their own best interests. Morally objectionable policy proposals, I argue, are not those that encourage individuals to sell a redundant kidney while living or families to sell the organs of a recently deceased loved one, but those that seek coercively to confiscate the organs of the recently deceased. Recognizing the authority of persons over themselves, and their ability to convey moral authority to common projects, including the sale of human organs for transplantation, would shed light on the medical marketplace and clarify public policy, while increasing the efficiency and effectiveness of procuring human organs for transplantation. (shrink)

This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, (...) however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good. (shrink)

The essays in this issue of The Journal of Medicine and Philosophy explore an innovative voucher program for encouraging kidney donation. Discussions cluster around a number of central moral and political/theoretical themes: What are the direct and indirect health care costs and benefits of such a voucher system in human organs? Do vouchers lead to more effective and efficient organ procurement and allocation or contribute to greater inequalities and inefficiencies in the transplantation system? Do vouchers contribute to the inappropriate commodification (...) of human body parts? Is there a significant moral difference between such a voucher system and a market in human organs for transplantation? This paper argues that while kidney vouchers constitute a step in the right direction, fuller utilization of market-based incentives, including, but not limited to, barter exchanges, would save more lives and further reduce human suffering. (shrink)

Regional Perspectives in Bioethics" illustrates the ways in which the national and international political landscape encompasses persons from diverse and often fragmented moral communities with widely varying moral intuitions, premises, evaluations and commitments.

Regional Perspectives in Bioethics" illustrates the ways in which the national and international political landscape encompasses persons from diverse and often fragmented moral communities with widely varying moral intuitions, premises, evaluations and commitments.

This volume brings together a set of critical essays on the thought of Professor Doctor H. Tristram Engelhardt Jr., Co-Founding Editor of the Philosophy and Medicine book series. Amongst the founders of bioethics, Professor Engelhardt, looms large. Many of his books and articles have appeared in multiple languages, including Italian, Romanian, Portuguese, Spanish, and Chinese. The essays in this book focus critically on a wide swath of his work, in the process elucidating, critiquing, and/or commending the rigor and reach of (...) his thought. This volume compasses analyses of many different aspects of Engelhardt's work, including social and political philosophy, biopolitics, the philosophy of medicine, and bioethics. It brings together internationally known scholars to assess key elements of Engelhardt's work. (shrink)

Accounts of natural law moral philosophy and theology sought principles and precepts for morality, law, and other forms of social authority, whose prescriptive force was not dependent for validity on human decision, social influence, past tradition, or cultural convention, but through natural reason itself. This volume critically explores and assesses our contemporary culture wars in terms of: the possibility of natural law moral philosophy and theology to provide a unique, content-full, canonical morality; the character and nature of moral pluralism; the (...) limits of justifiable national and international policy seeking to produce and preserve human happiness, social justice, and the common good; the ways in which morality, moral epistemology, and social political reform must be set within the broader context of an appropriately philosophically and theologically anchored anthropology. This work will be of interest to philosophers, theologians, bioethicists, ethicists and political scientists. (shrink)

This article explores the limits of secular philosophy and philosophical reason. It argues that once one abandons God, philosophical reason is unable to establish any particular bioethics or understanding of morality as canonical; that is, as definitively true and binding. Philosophy simply cannot secure the truth of any particular account of the right, the good, the just, or the virtuous. Once one abandons God, all is approached as if it were without ultimate meaning. Throughout, the article explores H. Tristram Engelhardt (...) Jr’s arguments in After God: Morality and Bioethics in a Secular Age, which confronts this major intellectual and cultural crisis. As Engelhardt remind us, traditional Christianity is not a life-style choice, much less another meta-narrative that one chooses and writes for oneself. It is an encounter with God, Who changes everything. Christian bioethics must be appreciated in terms of an encounter with and an authentic experience of God, Whose commands will routinely conflict with the moral dictates of secular morality. (shrink)

With rare exception, Roman Catholic moral theologians condemn the sale of human organs for transplantation. Yet, such criticism, while rhetorically powerful, often over-simplifies complex issues. Arguments for the prohibition of a market in human organs may, therefore, depend on a single premise, or a cluster of dubious and allied premises, which when examined cannot hold. In what follows, I will examine the ways in which such arguments are configured. For example, Thomas Aquinas’(1224-1274) understandings of embodiment and moral uses of the (...) body are usually interpreted as, and cited in support of, foreclosing a market in human organs. Aquinas’ principle of totality requires that one preserve the wholeness of the human body. In approaching Aquinas’ texts, I will assume the role of a revisionist who takes seriously his core commitments, while at the same time indicating that one can further develop his understanding of the body in ways which are supportive of the sale of human organs while remaining in conformity with the author's core concerns. Such considerations will provide significant grounds for concluding that a market in human organs for transplantation appreciates the embodied nature of the human person, respects the body and its parts as personal, rather than as mere things, is consistent with acknowledging God’s dominion over our lives and bodies, and constitutes an appropriate utilization of God's gifts to us. Moreover, such a market would likely create significant opportunities charitably to help others, to enhance human dignity and to protect against the serious dehumanization of current national bureaucratic procedures for organ donation. (shrink)

Power tends to corrupt and absolute power corrupts absolutely. To be clear, I do not think that blood transfusions necessarily...

Secular bioethicists do not speak from a place of distinction, but from within particular culturally, socially, and historically conditioned standpoints. As partisans of moral and ideological agendas, they bring their own biases, prejudices, and worldviews to their roles as ethical consultants, social advocates, and academics, attempting rhetorically to sway others and shift policy to a preferred point of view. Their pronouncements represent just one voice among others, even when delivered with strident rhetoric, in an educated and knowing tone, from within (...) institutional positions of power. This essay argues that, given the hegemony of progressive secular bioethics, traditional Christians routinely face epistemic injustice within medicine. That is, Christian knowledge regarding moral reality is all too often demeaned or dismissed, unless such norms can be translated into and defended within a secular ethos. Given such systemic bias, I argue, Christians also experience significant moral distress: they are fully aware of their moral obligations and what they ought to do, but institutionalized power structures make it nearly impossible to so act. But, Christian physicians are not mere technicians, obliged to provide whatever patients request from the list of legally available treatments. That antireligious critics seek to remove the rights of Christian physicians to limit how they practice medicine, where they do not offer or refer for abortion, euthanasia, physician-assisted suicide, and other inappropriate forms of care, is unjustified and prejudicial, singling out Christians, and other religious groups, for singular treatment. Regardless of what the law requires or institutional policy demands, however, Christians are obliged to submit to God in all things. As a result, they may at times find themselves required to engage in acts of civil disobedience. (shrink)

The TRUTH is announced to creation by the Holy Spirit, the Spirit of Truth. Here, when the consciousness rises above “the double bound of space and time” and enters into eternity, here at this moment of annunciation, the One Who announces the Truth and the Truth Announced coincide completely. In the appearance of the Spirit of Truth, i.e., in the light of Tabor, the form and the content of the Truth are one (Florensky, 1997, p. 106).

Mark J. Cherry; Searching for the Truly Human: Standing at the Precipice of a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies in Medical Moralit.

Mark J. Cherry; The Body for Charity, Profit and Holiness: Commerce in Human Body Parts, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume.

This chapter explores the experiential reality of the family and its role in securing human well-being. I argue that the family is an epistemic category as well as an ontological category: it reveals the being of the phenomenological life-world in ways that are necessary for adequately appreciating the embodiment of human health and well-being. Without the family, there are significant areas of human flourishing about which one can neither know nor experience. The family uncovers categories of moral duties and virtues (...) central to the creation and maintenance of core areas of human well-being. Familial interactions, for example, routinely demonstrate significant forms of altruistic behavior and other-directed personal costs at levels that are atypical of nonfamilial relationships. Moreover, significant cross-cultural sociobiological data support the conclusion that family life provides social, emotional, adaptive, and financial advantages, as well as the development of affective autonomy, increased longevity, improved physical and psychological health. Conversely, traumatic changes to family life, such as the death of a spouse, are well-documented as negatively impacting personal stability, life-expectancy, and overall well-being. In short, to focus unduly on the individual in isolation from the family is to diminish this rich and significant category of human good and well-being. (shrink)

This volume brings together a set of conceptual, moral, and cultural concerns carefully to assess a significant public policy issue: the development and proliferation of sex robots. Critics argue, for example, that sex robots present a clear risk to real persons as well as a degradation of society. They claim that the prevalence of sex robots will increase sexual violence, immorally objectify women, encourage pedophilia, reinforce negative body image stereotypes, increase forms of sexual dysfunction, and pass on sexually transmitted disease. (...) Proponents judge robotic sexual companionship as just another step in the exploration of human erotic desire. Sex robots, and similar technology, such as virtual reality pornography and other forms of “digi-sexuality,” are appreciated as providing autonomy affirming companionship, sexual release for the lonely, and a relatively harmless outlet for sexual fantasies that avoids the use of human prostitutes and thus reduces sexual victimization. As these chapters explore, to secure normative claims about sexual activity with artificial humanoids, one will need first to understand what the meaning of the morality of sexual activity can be as well as the significance of various practices with robotic partners on such cardinal social institutions as the family and the relationship between the sexes. One will also need to consider in terms of which ranking of human goods, right-making conditions, social outcomes, or personal virtues we ought to evaluate the significance of sexual relations with robots that look like women, men and children. Without such analysis, it will be unclear whether sex robots ought to be appreciated as a social evil that will further degrade moral culture, a positive technological innovation that will help preserve human dignity, or a more or less harmless pastime. (shrink)

Mark J. Cherry; Foundations of the Culture Wars: Compassion, Love, and Human Dignity, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 7.

Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients (1) to preserve the patient's best interests and (2) to restore the patient's autonomy. Such arguments specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighted against other factors. Varying by jurisdiction, legal statutes usually require, in addition, at least (3) that there exists the threat of harm to self or others. In this paper, I argue against embracing the first (...) two elements of this prevailing view. I also argue for a very restricted reading of the third element, based on the moral limits of permissible state action. (shrink)

This issue of The Journal of Medicine and Philosophy brings together an international group of scholars from Hong Kong, Mainland China, and North America, critically to explore whole-body/head transplantation. The proposed procedure raises significant philosophical, ethical, and social/political questions. For example, assuming transplant is successful, who survives the surgery? Does personal identity necessarily follow the head? The contributors to this special thematic issue explore the nature and ground of personal identity, what it would mean to preserve personal identity, given such (...) a significant set of physical changes, as well as the morality of such a procedure. As the authors make clear, careful conceptual philosophical analysis is essential for understanding whether whole-body/head transplantation is a life-saving/life-enhancing technological innovation, or a bioethical morass that should not be attempted. How we come to terms with such conceptual and moral concerns will have a significant impact on the future of medicine and medical technological innovation. (shrink)

In After God: Morality & Bioethics in a Secular Age, Professor H. Tristram Engelhardt, Jr. argues that the now dominant intellectual culture of the West actively shuns any transcendent point of orientation, such as an appeal to God or to a God’s eye perspective on reality. Instead, it seeks to frame its understanding of reality and morality, and thus its bioethics, without reference to any foundation outside of particular human concerns. This article explores the implications of living in a secular (...) culture that eschews any appeal to a fully objective perspective on reality. Drawing on Engelhardt’s analysis, it argues that absent access to a binding moral standpoint that is not already conditioned by a particular society, culture, or place in history, all moral and bioethical commitments are merely contingent, subject to particular human interests, aesthetic inclinations, personal intuitions, idiosyncratic choices, and political objectives. (shrink)

Sex matters. How men and women regard sex and bond sexually powerfully shapes the lifeworld. Sex is one of the major forces that influence a society and its background taken-for-granted norms. This chapter explores the ways in which the now dominant Western secular culture has generally deflated and demoralized the significance of sexual activity. Differences in preferred sexual activities are, according to this secular culture, to be appreciated as morally neutral lifestyle choices provided that they are consensual and affirm the (...) “dignity” of the parties involved. As I argue, the dominant secular culture seeks to place consensual sexual acts, of which the use of sex robots is just one additional example, beyond moral judgment, further isolating individuals from the rich social connections of traditional family life, thereby transforming the family and advancing the secularization of society. (shrink)

Death has become banal. It is devoid of meaning, if not simply surd. Yet, not even the very best of medicine can cure death. Most will suffer, except perhaps those who die suddenly while very young...

Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational (...) appeal to central values, such as “human dignity” and “self-determination”, or through “sola scriptura” biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the right, the good, the just, and the virtuous; namely, the holy. (shrink)

The goal of my comments regarding the case study of Eve Hyde — presented in the introduction of this symposium — is not first and foremost to resolve the conflict between individual autonomy and medical paternalism regarding non-consensual psychiatric treatment. Instead, the goal is to step back far enough from what is generally accepted as the morally appropriate basis for non-consensual psychiatric treatment, including involuntary hospitalization and medication, and to ask very basic questions about when patients may permissibly be treated (...) without their consent. My goal, in short, is Socratic — to explore aspects of what we take for granted in order better to determine whether we ought to take them for granted. Commentators routinely urge that it is morally permissible forcibly to treat psychiatric patients, such as Eve Hyde, in order to preserve the patient’s best interests and restore the patient’s autonomy. Such arguments typically specify duties of beneficence toward others, while appreciating personal autonomy as a positive value to be weighed against other factors. (shrink)