Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch argues that bioethics has failed to deliver on its promises.
This essay identifies two different methodological strategies used by the proponents of anarchism. In what is termed the "ontological" approach, the rationale for anarchism depends on a particular representation of human nature. That characterization of "being" determines the relation between the individual and the structures of social life. In the alternative approach, the epistemological status of "representation" is challenged, leaving human subjects without stable identities. Without the possibility of stable human representations, the foundations underlying the exercise of institutional power can (...) be challenged. This epistemological discussion is traced from Max Stirner to the twentieth-century movement known as poststructuralism. (shrink)
Earl Conee has argued that the metaphysics of personal identity is irrelevant to the morality of abortion. He claims that doing all the substantial work in abortion arguments are moral principles and they garner no support from rival metaphysics theories. Conee argues that not only can both immaterialist and materialist theories of the self posit our origins at fertilization, but positing such a beginning doesn’t even have any significant impact on the permissibility of abortion. We argue that this thesis is (...) wrong on both accounts. We do so, in part, by relying on a hylomorphic rather than a Cartesian conception of the soul. There are good reasons for believing such a soul theory can favor an earlier origin than the leading materialist accounts. We also show that the theological metaphysics of hylomorphism provide greater support for a pro-life position than the Cartesian position Conee discusses. However, we argue that even on a materialistic account of personal identity, metaphysics has substantial bearing upon the morality of early abortions. (shrink)
Transhumanists advance a "posthuman" condition in which technological and genetic enhancements will transform humankind. They are joined in this goal by bioethicists arguing for genetic selection as a means of "enhancing evolution," improving if not also the species then at least the potential lives of future individuals. The argument of both, this paper argues, is a new riff on the old eugenics tune. As ever, it is done in the name of science and its presumed knowledge base. As ever, the (...) result is destructive rather than instructive, bad faith promoted as high ideal. The paper concludes with the argument that species advancement is possible but in a manner thoroughly distinct from that advanced by either of these groups. (shrink)
Normative criteria adopted to assure just, equitable, and efficient allocation of donor organs to potential recipients has been widely praised as a model for the allocation of scarce medical resources. Because the organ transplantation program relies upon voluntary participation by potential donors, all such programs necessarily rely upon public confidence in allocation decision making protocols. Several well publicized cases have raised questions in North America about the efficacy of allocation procedures. An analysis of those cases, and the relevant technical literature, (...) suggest consistent structural deficits exist in the organ allocation process as it is applied by many individual transplantation centres. These irregularities are based upon both the failure of rank waiting as a method to guarantee just treatment and a general failure to recognize the extent to which prescriptive criteria — social values — are commonly used to screen potential organ transplant candidates. Resulting idiosyncratic determinations, and a devaluation of rank waiting as a criterion, raise fundamental questions regarding justice, fairness, and equability in the application procedure at large. To correct these structural problems in organ allocation procedures, a multicriterion model defining prescriptive criteria through the Analytic Hierarchy Process (AHP) is proposed. (shrink)
For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a (...) broader debate over fundamentals, and a different approach to bioethical debate. (shrink)
The ethical commitment to democracy requires creating the public space for a rational discourse among real alternatives by the population. In this article, I argue that the Internet fails in this task on 2 fronts. Inspired by the work of Jean Baudrillard, the work argues that the Internet reinforces a structure of passive political agents through its 1-way form of communication. The Internet is designed to deliver political text, not engage the public in dialogue about the direction of collective decision (...) making. Furthermore, the ideal of democratic politics relies on the notion of the "commons" as a real space for political activity, debate, and exchange. Virtual space cannot provide a substitute. Democratic politics must have as its premises real bodies, confronting real problems, in real space. The article concludes by arguing that the Internet is a place filled with political artifacts, largely without discourse and dialogue. As such, it has the potential to undermine democratic practice. (shrink)
In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)
Two rival paradigms permeate bioethics. One generally favors eugenics, euthanasia, assisted suicide and other methods for those with severely restricting physical and cognitive attributes. The other typically opposes these and favors instead ample support for "persons of difference" and their caring families or loved ones. In an attempt to understand the relation between these two paradigms, this article analyzes a publicly reported debate between proponents of both paradigms, bioethicist Peter Singer and lawyer Harriet McBryde Johnson. At issue, the article concludes, (...) are two distinct axiomatic sets of values resulting in not simply different styles of rhetoric but different vocabularies, in effect two different languages of ethics. (shrink)
There are in two assumptions inherent in this issue's theme, both inimical to the traditional goals of medicine and to the standards of care it proposed. First, the idea that treatment must be limited for some (but not others) on the basis of cost was born in the early literature of bioethics. Second, that there is a quantifiable and diagnostically predictable period at the “end-of-life” where treatment is “futile,” and therefore not worth supporting in a context of scarcity grew out (...) of bioethics's construction of allocative protocols in the 1990s. This paper traces the history of these ideas as constructs grounded in neither natural scarcity nor in firm diagnostic categories. Their relation to issues of care is therefore suspect. (shrink)
There is at present a divide in the geographical literature between those interested in distributive justice as a social value and those who seek to implement distributive plans on the basis of efficiency of resource use. The former are 'social geographers' interested in equity as a social value, and the latter are 'practical' economic and locational geographers. This divide mirrors one existing elsewhere in social science between Rawlsian liberalism and utilitarian planners. Here we argue that equality and efficiency are related (...) values that cannot be separated easily in the analysis of practical problems. Data on the distribution of transplantable human organs are considered in a practical consideration of this approach. The case-study suggests that inequality of distribution appears to effect adversely the general organ supply. Stated positively, the data suggest that, to the extent that equality of service is an objective, that goal may positively impact on organ supply. More generally, the conclusion argues for a conjoining of theoretical and practical geographical approaches where a scarce resource must be allocated across a dispersed population. (shrink)
Bioethics, and indeed much ethicalwriting generally, makes its point throughnarratives. The religious parable no less thanthe medical teaching case uses a simple storyto describe appropriate action or theapplication of a critical principle. Whilepowerful, the telling story has limits. In thispaper the authors describe a simple teachingcase on ``end-of-life'' decision making that wasill received by its audience. The authors ill-receivedexample, involving the disconnection ofventilation in a patient with ALS (Lou Gherig'sDisease) was critiqued by audience members withlong-term experience as ventilation users. Inthis (...) case, the supposedly simple narrative ofthe presenters conflicted with the lifehistories of the audience. The lessons of thisstory, and the conflict that resulted, speakcritically to the limits of simple teachingcases as well as the strengths of narrativeanalysis as a tool for the exploration ofbioethical case histories. (shrink)
This article raises the question of whether or not a "neutral" stance can be found from which to engage in philosophical counseling. By drawing on the debate between absolutism and relativism, it is argued that no such neutral ground exists. The foundational premises of the transcendentalist tradition involve different assumptions than those of the materialist and relativist traditions. Such a distinction goes back to the earliest days of philosophy and today the new profession of philosophical counseling must address the multiplicity (...) of assumptions upon which philosophic discourse can be built. The paper concludes with a call for philosophical counseling to move beyond the focus on Socrates, and to embrace a wide variety of different positions within its domain. (shrink)
Consensus is the holy grail of bioethics, the lynch pin of the assumption that well informed, well intentioned people may reach generally acceptable positions on ethically contentious issues. It has been especially important in bioethics, where advancing technology has assured an increasing field of complex medical dilemmas. This paper results on the use of a multicriterion decision making system (MCDM) analyzing group process in an attempt to better define hospital policy. In a pilot program at The Hospital for Sick Children, (...) Toronto, a series of small scale focus groups was constituted to examine criteria defining organ transplant eligibility. Criteria were organized hierarchically using the Analytic Hierarchy Process, an MCDM approach, and the resulting data was analyzed using Expert Choice 9.0, software designed to facilitate AHP analysis. Qualitative and quantitative analysis map barriers to practical consensus in a way not previously possible. (shrink)
In recent years geographic interest has focused increasingly on the moral and ethical dimensions of social constructions. Much of this work has followed the direction taken by moral philosophers whose principled approach has been applied to a range of ethically or morally problematic contexts. The challenge has been to apply a geographic perspective to an ethical dilemma that seems intractable at the level of ethical principle. This paper uses a geographic perspective to consider in a concrete fashion a current bioethical (...) concern: defining who will or will not be eligible for an organ transplant. Methodologically, it uses the analytic hierarchy process, a multicriterion decision making approach, and Q-analysis to analyze the resulting data. Long known by geographers, Q-analysis presents a methodology for the analysis of relations between two sets of criteria, in this case focus groups and their responses to a hierarchy of criteria. The result is a topology that not only presents but also explains the moral reasoning of members of a diverse set of focus groups constituted at a Canadian hospital to consider the question of organ transplant eligibility. (shrink)
US court decisions guaranteeing life-sustaining care to anencephalic infants have been viewed with disfavor, and sometimes disbelief, by some ethicists who do not believe in the necessity of life-sustaining support for those without cognitive abilities or an independently sustainable future. The distance between these two views – one legal and inclusive, the other medical and specific – seems unbridgeable. This paper reports on a program using multicriterion decision making to define and describe persons in a way which both acknowledges the (...) differences perceived by many as well as those commonalities insisted on in U.S. court decisions. It does this through application of the Analytic Hierarchy Process to a hierarchy of humanness criteria, and secondarily through reference to that concept''s subset, personhood. (shrink)
Bioethics promises a considered, unprejudicial approach to areas of medical decision-making. It does this, in theory, from the perspective of moral philosophy. But the promise of fairly considered, insightful commentary fails when word choices used in ethical arguments are prejudicial, foreclosing rather than opening an area of moral discourse. The problem is illustrated through an analysis of the language of The Royal Society Expert Panel Report: End of Life Decision Making advocating medical termination.
Artificial neural networks have weaknesses as models of cognition. A conventional neural network has limitations of computational power. The localist representation is at least equal to its competition. We contend that locally connected neural networks are perfectly capable of storing and retrieving the individual features, but the process of reconstruction must be otherwise explained. We support the localist position but propose a “hybrid” model that can begin to explain cognition in anatomically plausible terms.
What is the relationship between a visual percept and the underlying neuronal activity in parts of the brain? This manifesto reviews the theoretical framework of Crick and Kochfor answering these questions based on the neuroanatomy and physiology of mammalian cortex and associated subcortical structures. This evidence suggests that primates are not directly aware of neural activity in primary visual cortex, although they may be aware of such activity in extrastriate cortical areas. Psychophysical evidence in humans supporting this hypothesis is discussed.