To be old is to face the end of life. This is not to say that young people never die. Nor that the old have nothing else to do, no valuable contribution still to make. But after old age comes death. That=s simply a biological fact. It will remain a fact regardless of the medical technologies..
Advocates of communal living often urge that life in a commune provides the framework for a deeper knowledge of other people. I believe this is clearly true and because it is true, communal living is also instrumental in promoting self knowledge. The dialogue that is part of the life of a commune enables one to incorporate the insights of the other members into his understanding of himself and his world.
Most professions rest on the expertise of their members. Professionals are professionals primarily because they know more than most of us about something of importance to our society or to many members of it. Professionals are given power, respect, prestige, and above average incomes. If professionals are worthy of this status, it is largely because of their special knowledge and the way they use it. And if professionals have special rights and responsibilities, it is also primarily because of the social (...) positions they occupy due to their presumed expertise. (shrink)
A 78 year old married woman with progressive Alzheimer's disease was admitted to a local hospital with pneumonia and other medical problems. She recognized no one and had been incontinent for about a year. Despite aggressive treatment, the pneumonia failed to resolve and it seemed increasingly likely that this admission was to be for terminal care. The patient's husband (who had been taking care of her in their home) began requesting that the doctors be less aggressive in her treatment and, (...) as the days wore on, he became more and more insistent that they scale back their aggressive care. The physicians were reluctant to do so, due to the small but real chance that the patient could survive to discharge. But her husband was her only remaining family, so he was the logical proxy decisionmaker. Multiple conferences ensued, and finally a conference with a social worker revealed that the husband had recently proposed marriage to the couple's housekeeper and she had accepted. (shrink)
We are beginning to recognize that the prevalent ethic of patient autonomy simply will not do. Since demands for health care are virtually unlimited, giving autonomous patients the health care they want will bankrupt our health care system. We can no longer simply buy our way out of difficult questions of justice by expanding the health care pie until there is enough to satisfy the wants and needs of everyone. The requirements of justice and the needs of other patients must (...) temper the claims of autonomous patients. (shrink)
Business ethics – both stockholder and stakeholder theories – makes the same mistake as the one made by the traditional ethics of medicine. The traditional ethics of medicine was a teleological ethics predicated on the assumption that the goal of medicine was to prolong life and promote better health. But, as bioethicists have made plain, these are not the only or even the overriding goals of most patients. Most of us have goals and values that limit our desire for medical (...) treatments. Similarly, the view of the stockholder in business ethics is that the stockholder has only one interest – profit. If stockholders have no other values or interests that would limit their desire for additional profit, their sole interest is in profit maximization. But investors are real people with interests and values that balance and limit their desire for profit. It would be an extremely odd individual who cared for nothing except more profit. And institutional investors are supposed to serve the interests of individual investors. Stockholders hold many stakes in the firms in which they invest. The conclusion that most stockholders have interests that would limit the pursuit of maximum profit has significant implications both for business ethics and for the management of for-profit corporations. Something like “informed consent for investors” is needed. Corporate managers, to the extent that they are to be agents of their stockholders, must not simply pursue profit maximization. They must ascertain the interests and values of their investors that limit the single-minded pursuit of profit. (shrink)
For Socrates, philosophy is self-examination. If the Euthyphro is still to be philosophy in this sense, it must challenge people living now. This paper offers a reading that does this. First, a better case is made for something like the kind of expertise Euthyphro claims and for his position about piety. Second, Socrates and Euthyphro embody different views about the kind of expertise that would be relevant to discovering and engendering piety. Finally, Socrates’ unorthodox conception of piety is made explicit. (...) With these features highlighted, the Euthyphro still possesses the power to provoke and challenge. (shrink)
Amid the controversies surrounding physician-assisted suicides, euthanasia, and long-term care for the elderly, a major component in the ethics of medicine is notably absent: the rights and welfare of the survivor's family, for whom serious illness and death can be emotionally and financially devastating. In this collection of eight provocative and timely essays, John Hardwig sets forth his views on the need to replace patient-centered bioethics with family-centered bioethics. Starting with a critique of the awkward language with which philosphers argue (...) the ethics of personal relationships, Hardwig goes on to present a general statement on the necessity of family-centered bioethics. He reflects on proxy decisions, the effects of elder care on the family, the financial and lifestyle consequences of long-term care, and physician-assisted suicide from the perspective of the family. His penultimate essay, "Is There a Duty to Die?" carries the idea of family-centered ethics to its logical, controversial, conclusion; comments upon this essay from Daniel Callahan, Larry Churchill, Joanne Lynn, and journalist Nat Hentoff offer differing views on this highly charged subject. As advances in medicine prolong patient's lives, the welfare of those ultimately responsible for medical care-the family-must be addressed. Hardwig's courageous and illuminating essays set forth a new direction in bioethics: one that considers the welfare of everyone concerned. (shrink)
When <span class='Hi'>Richard</span> Lamm made the statement that old people have a duty to die, it was generally shouted down or ridiculed. The whole idea is just too preposterous to entertain. Or too threatening. In fact, a fairly common argument against legalizing physician-assisted suicide is that if it were legal, some people might somehow get the idea that they have a duty to die. These people could only be the victims of twisted moral reasoning or vicious social pressure. It goes (...) without saying that there is no duty to die. (shrink)
There are good reasons — both medical and moral — for wanting to redistribute health care resources, and American hospitals and physicians are already involved in the practice of redistribution. However, such redistribution compromises both patient autonomy and the fiduciary relationship essential to medicine. These important values would be most completely preserved by a system in which patients themselves would be the agents of redistribution, by sharing their medical resources. Consequently, we should see whether patients would be willing to share (...) before we resort to surreptitiously redistributing their resources or denying medical care to some who want and need it. We should change our health care payments systems to allow patients to donate their medical benefits to those in need. (shrink)
find myself believing all sorts 0f things for which I d0 not possess evidence: that smoking cigarettes causes lung cancer, that my car keeps stalling because the carburetor needs LO be rebuilt, that mass media threaten democracy, that slums cause emotional disorders, that my irregular heart beat is premature ventricular contraction, that students} grades are not correlated with success in the ncmacadcmic world, that nuclear power plants are not safe (enough) . . . The list 0f things I believe, though (...) I have no evidence for the truth of them, is, if not infinite, virtually endless. And.. (shrink)
W0mcn’s liberation, it is oftcn said, strikes closer t0 home than othcr forms of human liberation. Although basic shifts in attitudes arc required for thc liberation 0f, for example, workers 0r blacks and othcr ethnic minorities, thcsc types of liberation could bc accomplished without fundamental changes in what we call 0ur “privatc" lives or 0ur personal relationships. The liberation 0f blacks 0r workers is largely an affair 0f public roles and institutions, 21 matter 0f socialjusticc, and it is thus carried (...) 0ut relatively impcrsonally and anonymously in the marketplace and workplace, thc university and governmental institutions. Granted, if thc liberation 0f blacks and workers is t0 bc complete, I might have t0 bc willing t0 have some in my club and my suburb. Somc 0f my bcst friends might then bc blacks 0r workers, and I might even have t0 bc willing t0 have my daughter marry 0nc. Nonetheless, it might well be truc that my club and neighborhood, my friendships, and my relationship t0 my daughter could go 0n pretty much as bcforc, 0ncc "thcy” had been admitted. (shrink)
In thc Foundations, Kant draws a distinction bctwccn action which is in accord with duty and action which is done from the motive of duty. This is 21 famous distinction, of course, and thcrc arc many interesting issues concerning it and its implications for ethical thcory. In this paper, I wish t0 focus on just 0nc noteworthy feature of K2mt’s usc of this distinction. Likc any distinction bctwccn logical compatiblcs, this 0nc yields four logically possible classes of action: (1) actions (...) which are both in accord with duty and from duty; (2) actions which arc neither from duty nor in accord with duty; (3) actions which are in accord with duty but not from duty; and (4) actions which are from duty but not in accord with duty. What intcrcsts mc about these four possibilities is that, to thc best of my knowledge, Kant never considers or even mentions the last 0f these possibilities: action from duty but not in accord with duty. This is perhaps surprising in a philosopher with Kant’s intcrcst in logic and passion for thoroughness. Onc would have thought that hc would mention this logical possibility, cvcn if only in order to discount it as not really possible. Beginning with the idea that there arc cases of action from duty but not in accord with duty, I argue in this paper that Kant could not have admitted that thcrc can be actions of this kind, for their cxistcncc un-. (shrink)