This study examines some of the moral and theological convictions that created tensions for early Christians who affirmed that the government's sword is ordained by God for a fallen world but also that Christians should not exercise it at least in warfare. Three important moral pressures toward Christian participation in war were (1) the recognition of prevention or removal of harm as a requirement of neighbor-love, (2) the related sense of responsibility, fault, and guilt for omissions, and (3) the generalization (...) test proposed by Celsus, who asked Christians to consider what would happen if everyone did what they were doing, i.e., refrained from military service. Along with many other factors, these ideas contributed to the legitimation of Christian participation in war. But this legitimation itself created additional tensions, particularly because of the requirements to "turn the other cheek," to "go the second mile," etc. In order to lessen these tensions, the Church and its theologians developed several interrelated distinctions that could reduce the scope or strength of the radical demands: higher/lower; for oneself/ for others; inner/outer; and private/public. (shrink)
"A very good book indeed: there is scarcely an issue anyone has thought to raise about the topic which Childress fails to treat with sensitivity and good judgement....Future discussions of paternalism in health care will have to come to terms with the contentions of this book, which must be reckoned the best existing treatment of its subject."--Ethics. "A clear, scholarly and balanced analysis....This is a book I can recommend to physicians, ethicists, students of both fields, and to those most (...) affected--the patients themselves."--Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Humanities, Georgetown University Medical Center. (shrink)
: Moral frameworks for evaluating non-donation strategies to increase the supply of cadaveric human organs for transplantation and ways to overcome barriers to organ donation are explored. Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices. From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible but then turn out to be ineffective and perhaps (...) even counterproductive because of inadequate attention to these rich and complex features of human body parts. Excessively rationalistic policies neglect deep beliefs, symbols, sentiments, and emotions and the like, and that deficiency marks many actual and proposed policies. In addition, policies are often too individualistic and too legalistic. (shrink)
This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as "mercy killing" and some decisions not to treat incompetent (...) patients. Keywords: illegal actions, mercy killing, non-treatment of incompetent patients, civil disobedience, conscientious objection, evasive non-compliance, moral justification and disobedience, dissent in health care CiteULike Connotea Del.icio.us What's this? (shrink)
: Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.
The U.S. regulations for the protection of humans in biomedical and behavioral research were "born in scandal and reared in protectionism." This paper discusses the evolution of these regulations and the gaps that still persist in the ongoing effort to strike a balance between protecting vulnerable populations from research risks and providing all individuals and groups with an equal opportunity to benefit from research. In particular, this paper focuses on racial, social, and economic inequities in the selection of research participants; (...) the exclusion and underrepresentation of the elderly in research, and controversies about U.S. clinical trials conducted in developing countries. (shrink)
This paper analyzes nonviolent resistance and direct action, as seen by its practitioners and theoreticians, from the standpoint of trust and risk-taking. After an examination of the nature of trust, the author indicates how it can illuminate what selected figures such as Gandhi and King have claimed about nonviolence. He offers this analysis not as a defense but as a way of understanding nonviolence that can serve as a starting point for further discussion.
Do pacifists and proponents of justified violence share a starting point? Whether or not just war theory contains an embedded presumption against violence is an important and disputed question. Substantively it is important not only because it has implications for the possibility of dialogue among Christians of different persuasions but also because the belief that the tradition advances no moral reservations about the use of force may have the effect of lowering the moral barriers against the resort to war. Conceptually (...) it is important because it reflects a fundamental methodological disagreement concerning the meaning and resolution of conflicts among moral duties. (shrink)
This paper analyzes some issues that emerge in attempts to distinguish and relate "moral" and "nonmora1' action-guides. It examines one material criterion (otherregardingness) and three formal criteria (universalizability, prescriptivity, and overridingness) and considers whether they constitute necessary and/or sufficient conditions of "morality." It treats these criteria in relation to ideals and prudential, political, and religious considerations. Furthermore, it contends that the classification of action-guides as moral or nonmoral should not prejudge their respective weights or replace substantive moral debate. The formal (...) and material criteria may determine what counts as morality, not how much morality counts. (shrink)
This is an extremely thorough revision of the leading textbook of bioethics. The authors have made many improvements in style, organization, argument and content. These changes reflect advances in the bioethics literature over the past five years. The most dramatic expansions of the text are in the comprehensiveness with which the authors treat different currents in ethical theory and the greater breadth and depth of their discussion of public policy and public health issues. In every chapter, readers will find new (...) material and refinements of old discussions. This is evident in the many new sections on topics like communitarianism, ethics of care, relationship-based accounts, casuistry, case-based reasoning, principle-based common-morality theories, the justification of assistance in dying, rationing through priorities in the health care budget, and virtues in professional roles. The most extensive revisions are in chapters 1, 2 and 8. (shrink)
In the latest edition of Principles of Biomedical Ethics , Tom Beauchamp and JamesChildress provide an expanded discussion of the ethical theory underlying their treatment of issues in medical ethics. Balancing judgements remain central to their method, as does the contention that such judgements are more than intuitive. This theory is developed precisely in response to the common skepticism directed at "principlism" in medical ethics. Such skepticism includes the claim that moral reasoning comes to a dead halt (...) when confronted by competing conflicts between moral norms in a given pluralistic situation. In this paper, I use examples from the text to show that despite the authors’s arguments to the contrary, balancing judgements are the product of unreasoned intuitions. Given the necessity of some such judgements in any principle based system, my argument highlights the degree to which principled ethical reasoning rests upon an arational core. (shrink)
In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. Ethics of (...) service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)
In the United States alone, industrial and agricultural toxins account for about 60,000 avoidable cancer deaths annually. Pollution-related health costs to Americans are similarly staggering: $13 billion a year from asthma, $351 billion from cardiovascular disease, and $240 billion from occupational disease and injury. Most troubling, children, the poor, and minorities bear the brunt of these health tragedies. Why, asks Kristin Shrader-Frechette, has the government failed to protect us, and what can we do about it? In this book, at once (...) brilliant and accessible, Shrader-Frechette reveals how politicians, campaign contributors, and lobbyists--and their power over media, advertising, and public relations--have conspired to cover up environmental disease and death. She also shows how science and regulators themselves are frequently "captured" by well-funded polluters and special interests. But most important, the author puts both the blame--and the solution--on the shoulders of ordinary citizens. She argues that everyone, especially in a democracy, has a duty to help prevent avoidable environmental deaths, to remain informed about, and involved in, public-health and environmental decision-making. Toward this end, she outlines specific, concrete ways in which people can contribute to life-saving reforms, many of them building on recommendations of the American Public Health Association. As disturbing as it is, Shrader-Frechette's message is ultimately hopeful. Calling for a new "democratic revolution," she reminds us that while only a fraction of the early colonists supported the American Revolution, that tiny group managed to change the world. Her book embodies the conviction that we can do the same for environmental health, particularly if citizens become the change they seek. -/- "Influential and impressive. " - Nicholas A. Ashford, Massachusetts Institute of Technology "Important and compelling, clearly written, accessible. I enthusiastically recommend this book." - James F. Childress, University of Virginia "This book shakes the reader." - Avner de-Shalit, Hebrew University of Jerusalem "Powerful, perspicuous, convincing. Essential reading for today." - Inmaculada de Melo-Martin "A must-read - a book you won't want to put down." - Kevin Elliott, University of South Carolina "An eloquent and persuasive plea to scientists and citizens." - George W. Fisher, Johns Hopkins University "Engaging, compelling - deserves to be read by nearly everyone." - William R. Freudenberg, University of California, Santa Barbara "By one of America's foremost philosophers and public intellectuals; immensely readable, courageous, often startling, insightful." - Richard Hiskes, University of Connecticut "Timely, accessible, and written with enviable clarity and passion. A distinguished philosopher sounds an ethical call to arms to prevent illness and death from pollution." - Sheila Jasanoff, Harvard University "A blistering account of how advocacy must be brought to bear on issues of justice and public health." - Jeffrey Kahn, University of Minnesota "Breaks new ground in linking environmental protection with social justice. A brilliant inquiry." - Sheldon Krimsky, Tufts University "Powerful, lucid, disturbing, poignantly hopeful, lively; deserves to be widely read." - Hugh Lacey, Swarthmore College "A powerful call to action that needs to be heard by consumers and policymakers alike." - Anna C. Mastroianni, University of Washington "No other author can so forcefully bring together ethical analysis, government policy, and environmental science. Outstanding." - Colleen Moore, University of Wisconsin "Accessible, thoughtful, exceptional. It made me want to go out and slay a few dragons of my own!" - Felicity Sackville Northcott, Johns Hopkins University "Convincing, with an impressive command of scientific knowledge. No book more clearly demonstrates the need for citizen action." - Mark Sagoff, University of Maryland "Like Rachel Carson's Silent Spring - brilliant, brave." - Sylvia Hood Washington, University of Illinois, Chicago "This book is inspirational as much as it is scientific....Highly recommended." -- CHOICE. (shrink)
The paper addresses the issue of how indemocratic societies a procedure might be formulatedto facilitate ethical judgements on modernbiotechnologies used in food production. A frameworkfor rational ethical analysis, the Ethical Matrix, isproposed. The Matrix adapts the principles describedby Beauchamp and Childress for application to medicalissues, to interest groups (e.g., producers,consumers, and the biotic environment) affected bythese technologies. The use of the Matrix isillustrated by applying it to an example of a ``novelfood,'' viz., a form of genetically modified maize.
Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and JamesChildress, holds that this fundamental value is found in the life that can choose and determine itself. First, I (...) articulate Lee and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous self-determination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion. (shrink)
In this paper it will be argued that Beauchamp and Childress' principle-based approach to bioethics has strongly pragmatic features. Drawing on the writings of William James, I first develop an understanding of methodological pragmatism as a method of justification. On the basis of Beauchamp's and Childress' most recent proposals concerning moral justification in the fifth edition of their Principles of Biomedical Ethics (2001), I then discuss different aspects that the principle-based approach and methodological pragmatism have in common.
Tom Beauchamp and JamesChildress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a 'common morality', or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the absence of (...) a full-blooded analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empirical method of determining the common morality's norms is suggested. In this paper, I outline this method, before arguing that it is difficult to see how it might be thought to achieve its purpose. (shrink)
Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and JamesChildress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the (...) state of play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)
In an article titled, "Who Shall Live When Not All Can?", JamesChildress proposes a system for allocating scarce lifesaving medical resources based on random selection procedures. Childress writes of random selection procedures, [They] "cannot be dismissed as a ‘non-rational’ and ‘non-human’ ... without an inquiry into the reasons, including human values which might justify it." My thesis is that once we concentrate on determining the rationality of random selection procedures, we will see that Childress's claim (...) that we cannot dismiss such procedures as ‘non-rational’ is open to question. My claim will be that while both random selection and social worth procedures are rationally defensible systems, random selection procedures easily lead to specific choices that are objectively irrational, apart from the limited perspective of the random selection process itself. Keywords: allocation, random selection, rationality, rational decision-making, scarce resources, social worth CiteULike Connotea Del.icio.us What's this? (shrink)
In this essay I first provide a brief explanation of the principle of double effect (PDE) and the propositions that it entails regarding the distinction betweenintention and foresight (I/F distinction) and the distinction’s relevance to ethical evaluation. Then I address several recent critiques of PDE and the I/F distinctionby influential ethicists including Judith Jarvis Thomson, Tom Beauchamp and JamesChildress, and Jonathan Bennett. I argue that none of these critiques issuccessful. In the process of refuting the critiques, I (...) also give prima facie reason to believe that the I/F distinction is relevant to evaluation of agents and their actions and that PDE is a defensible ethical principle. (shrink)
Henri J. Renard, S. J.: a sketch, by J. P. Jelinek.--The good as undefinable, by M. Childress.--Gottlieb Söhngen's sacramental doctrine on the mass, by J. F. Clarkson.--Christ's eucharistic action and history, by B. J. Cooke.--Objective reality of human ideas: Descartes and Suarez, by T. J. Cronin.--A medieval commentator on some Aristotelian educational themes, by J. W. Donohue.--God as sole cause of existence, by M. Holloway.--Knowledge, commitment, and the real, by R. O. Johann.--John Locke and sense realism, by H. R. (...) Klocker.--The being of nonbeing in Plato's Sophist, by Q. Lauer.--Ethics and verification, by R. McInerny.--Analogy and the fourth way, by J. J. O'Brien.--Love and being, by W. L. Rossner.--Complexity in human knowledge: its basis in form/matter composition, by E. L. Rousseau.--Toward a more dynamic understanding of substance and relation, by J. M. Somerville.--The origin of participant and of participated perfections in Proclus' Elements of theology, by L. Sweeney. (shrink)
In this paper three models of teaching and learning medical ethics are discussed critically, the traditional and revised vocational models, and the patient-centred model. The autonomy-oriented patient-centred ethics of Beauchamp and Childress is rejected in favour of a hermeneutic practical ethics. A performative conception of ethics teaching is recommended as the most appropriate model for use in the theory and practice of ethics pedagogy.