Four prominent views of the nature and methods of clinical ethics (especially in consultation forums) are reviewed; each is then submitted to a criticism intended to show both weaknesses and strengths. It is argued that clinical ethics needs to be responsive to the specific complexities of clinical situations. For this, the need for an expanded notion of practical reason within unique situations is emphasized, one whose aim is to facilitate decision-making on the part of those directly responsible for them and (...) consonant with their own respective moral frameworks and conceptions of what is most worthwhile. Keywords: Casuistry, clinical ethics, consultation, decision-making, dialogue, facilitator, practical reason, relationships CiteULike Connotea Del.icio.us What's this? (shrink)

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose (...) and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic; that is, there will be many casuistries not just one. Keywords: casuistry, common morality, kinetics, moral authority, moral pluralism, morphology, paradigm cases, taxonomy CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper I examine the epistemology and ethics of consensus, focusing on the ways in which decision makers use/misuse ethical expertise. The major questions I raise and tentative answers I give are the following: First, are the ‘experts’ really experts? My tentative answer is that they are bona fide experts who often represent specific interest groups. Second, is the experts' authority merely epistemological or is it also ethical? My tentative answer is that the experts' authority consists not only in (...) their command over specific matters of fact and/or value, but also in their ability to achieve ‘consensus’ about what is ‘true’/‘false’, or ‘right’/‘wrong’. Third, should the authority of expertise be limited? My tentative answer is that it should be limited in the area of facts but especially in the area of values. Persons who are ethics ‘experts’ must be particularly careful to practice an ethics of persuasion rather than an ethics of compulsion . Their role is not to force their group consensus upon decision makers' individual moral perceptions and deliberations; rather it is to help decision makers come to their own conclusions about what they ought to do. Keywords: authority of expertise, consensus, ethics committees, ethics of persuasion, NIH consensus development conferences CiteULike Connotea Del.icio.us What's this? (shrink)

Consensus is commonly identified as the goal of ethics committee deliberation, but it is not clear what is morally authoritative about consensus. Various problems with the concept of an ethics committee in a health care institution are identified. The problem of consensus is placed in the context of the debate about realism in moral epistemology, and this is shown to be of interest for ethics committees. But further difficulties, such as the fact that consensus at one level of discourse need (...) not imply consensus at another, oblige us to look more closely at the deliberative process itself. That yields two complementary methods of deliberation that have proven their worth. Finally, placing ethics committees in the context of Dewey's philosophy of social intelligence suggests that consensus should be regarded primarily as a condition rather than as the goal of inquiry. Keywords: ethics committee, consensus, moral authority CiteULike Connotea Del.icio.us What's this? (shrink)

Following a brief account of the puzzle that ethics committees present for the Western Philosophical tradition, I will examine the possibility that social contract theory can contribute to a philosophical account of these committees. Passing through classical as well as contemporary theories, particularly Rawls' recent constructivist approach, I will argue that social contract theory places severe constraints on the authority that may legitimately be granted to ethics committees. This, I conclude, speaks more about the suitability of the theory to this (...) level of analysis than about the ethics committee phenomenon itself. Keywords: ethics committees, moral consensus, social contract theory CiteULike Connotea Del.icio.us What's this? (shrink)

The multidisciplinary nature of bioethics can result in narrow sub-specialists within the field, whose work reflects the issues and concerns most relevant to their home discipline. This can result in work which is insensitive to the important ways in which particular areas of bioethics are interrelated, and which (while viable in the context of the sub-specialty) is not viable in a broader context. The narrow focus of many healthcare ethics committees on issues directly related to clinical patient care can exacerbate (...) this problem. Increasingly, issues in the clinical care of patients cannot be separated from issues in research, organizational ethics, and public policy. I argue that these problems call for a need to identify core areas for bioethics education. This is especially true for education of hospital ethics committees, which incresingly face complex cases involving concerns that fall outside traditional patient care issues. I then consider nine areas examined in detail in A Companion to Bioethics edited by Helga Kuhse and Peter Singer, as potential candidates for core areas of bioethics education. At the same time, I evaluate the range of issues examined in each area of the book, in the context of the books ability to provide an introduction to each area. (shrink)

This is the first full-length biography in more than fifty years of Immanuel Kant, one of the giants amongst the pantheon of Western philosophers as well as the one with the most powerful and broad influence on contemporary philosophy. It is well known that Kant spent his entire life in an isolated part of Prussia living the life of a typical university professor. This has given rise to the view that Kant was a pure thinker with no life of his (...) own, or at least none worth considering seriously. In this biography, Manfred Kuehn debunks that myth once and for all. Taking account of the most recent scholarship Professor Kuehn allows the reader to follow the same journey that Kant himself took in emerging as a central figure in modern philosophy. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

In the face of the moral pluralism that results from the death of God and the abandonment of a God's eye perspective in secular philosophy, bioethics arose in a context that renders it essentially incapable of giving answers to substantive moral questions, such as concerning the permissibility of abortion, human embryonic stem cell research, euthanasia, etc. Indeed, it is only when bioethics understands its own limitations and those of secular moral philosophy in general can it better appreciate those tasks that (...) it can actually usefully perform in both the clinical and academic setting. It is the task of this paper to understand and reevaluate bioethics by understanding these limits. Academic bioethicists can analyze ideas, concepts, and claims necessary to understanding the moral questions raised in health care, assessing the arguments related to these issues, and provide an understanding of the different moral perspectives on bioethical issues. In the clinical setting, bioethicists can provide legal advice, serve as experts on IRBs, mediating disputes, facilitating decision-making and risk management, and clarifying normative issues. However, understanding this is only possible when one understands the history, genesis, and foundations of bioethics and its inability to provide a resolution to postmodern moral pluralism. (shrink)

Orthodox Christian theology gives philosophy the same role it played in the Church of the first half-millennium. This article distinguishes among nine senses of philosophy and four senses of theology in order to highlight the characteristic features of Orthodox Christian theology’s use of philosophy and philosophical reasoning. It shows why, given the metaphysics and epistemology of Orthodox Christian theology (e.g., God is recognized as fully transcendent, such thatthere is no analogia entis between created and Uncreated Being, with the result that (...) the experience of the encounter with God can only be recounted apophatically) and its sociology of knowledge (e.g., theology in the strict sense occurs primarily in monasteries, not in the academy), philosophy is regarded as not able to contribute to the development of old doctrines or the fashioning of new doctrines, but only to the clarification of doctrinal statements. As a consequence, Orthodox Christian theology has been committed to severely confining philosophy’s role in theology. (shrink)

The first section of this paper asks why the notion of consensus has recently come to the fore in the medical humanities, and suggests that the answer is a function of growing technological and professional complexity. The next two sections examine the concept of consensus analytically, citing some of the recent philosophical literature. The fourth section looks at committee deliberations and their desirable outcomes, and questions the degree to which consensus serves those outcomes. In the fifth and last section it (...) is suggested that if I am to subscribe to a consensual outcome responsibly I must be personally committed to it, and that this requires a form of knowledge I call ‘fiduciary’, in this case knowledge of the competence and trustworthiness of other participants in deliberation whose expertise may have influenced my agreement. (shrink)

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to (...) philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms. (shrink)

This is the first full-length biography in more than fifty years of Immanuel Kant, one of the giants amongst the pantheon of Western philosophers as well as the one with the most powerful and broad influence on contemporary philosophy. It is well known that Kant spent his entire life in an isolated part of Prussia living the life of a typical university professor. This has given rise to the view that Kant was a pure thinker with no life of his (...) own, or at least none worth considering seriously. In this biography, Manfred Kuehn debunks that myth once and for all. Taking account of the most recent scholarship Professor Kuehn allows the reader to follow the same journey that Kant himself took in emerging as a central figure in modern philosophy. (shrink)

This is the first full-length biography in more than fifty years of Immanuel Kant, one of the giants amongst the pantheon of Western philosophers as well as the one with the most powerful and broad influence on contemporary philosophy. It is well known that Kant spent his entire life in an isolated part of Prussia living the life of a typical university professor. This has given rise to the view that Kant was a pure thinker with no life of his (...) own, or at least none worth considering seriously. In this biography, Manfred Kuehn debunks that myth once and for all. Taking account of the most recent scholarship Professor Kuehn allows the reader to follow the same journey that Kant himself took in emerging as a central figure in modern philosophy. (shrink)

This book is a translation of a classic work of modern social and political thought. Elements of the Philosophy of Right, Hegel's last major published work, is an attempt to systematize ethical theory, natural right, the philosophy of law, political theory, and the sociology of the modern state into the framework of Hegel's philosophy of history. Hegel's work has been interpreted in radically different ways, influencing many political movements from far right to far left, and is widely perceived as central (...) to the communitarian tradition in modern ethical, social, and political thought. This edition includes extensive editorial material informing the reader of the historical background of Hegel's text, and explaining his allusions to Roman law and other sources, making use of lecture materials which have only recently become available. The new translation is literal, readable, and consistent, and will be informative and scholarly enough to serve the needs of students and specialists alike. (shrink)

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