Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.
: New genetic technologies continue to emerge that allow us to control the genetic endowment of future children. Increasingly the claim is made that it is morally "irresponsible" for parents to fail to use such technologies when they know their possible children are at risk for a serious genetic disorder. We believe such charges are often unwarranted. Our goal in this article is to offer a careful conceptual analysis of the language of irresponsibility in an effort to encourage more care (...) in its use. Two of our more important sub-claims are: (1) A fair judgment of genetic irresponsibility necessarily requires a thick background description of the specific reproductive choice; and (2) there is no necessary connection between an act's being morally wrong and its being irresponsible. These are distinct judgments requiring distinct justifications. (shrink)
The modern debate on whether—and why—physicians and hospitals can refuse patient or family demands for treatment on grounds of “futility” will be reaching its 20th anniversary this year (Blackhall, 1987). The early debate focused on the use of CPR, for good historical and clinical reasons, and CPR probably remains the primary target of hospital policy. But the reach of the arguments over futility extends well beyond this context, most vividly illustrated by the case of Helga Wanglie and the many commentaries (...) it spawned (Brody, 1998; Schneiderman, 1998; Trotter, 1999). There seems no obvious reason in principle that questions about futility cannot be raised about virtually any form of treatment that patients or families might demand, including such things as chemotherapy for cancer (Tomlinson, 2001). Still, we might fairly ask what new dimensions and complexities the futility question acquires when it moves onto decisions about treatments other than CPR. This is what I would like to do in this essay. I will use dialysis as the case in point, although I hope to extract lessons from the dialysis example that will be pertinent to other forms of life-sustaining treatment, like ventilators. (shrink)
In the latest edition of Principles of Biomedical Ethics , Tom Beauchamp and James Childress 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)
The whole brain-death criterion of death now enjoys a wide acceptance both within the medical profession and among the general public. That acceptance is in large part the product of the contention that brain death is the proper criterion for even a conservative definition of death – the irreversible loss of the integrated functioning of the organism as a whole. This claim – most recently made in the report of the Presidential Commission and in a comprehensive article by James Bernat (...) and others – is based upon a series of fallacious arguments. Chief among these is the argument that whole brain-death is the proper criterion for the conservative definition because the brain is the organ that integrates the rest of the organism. A central part of the paper shows that this argument rests upon a confusion between a function and the mechanism that performs it, and replies to the defenses that the Presidential Commission makes on this point. The concluding portion of the paper argues that this issue is not merely of academic interest, but has the potential for undermining the present consensus that supports the use of whole brain-death criteria. * Keywords: brain-death, definition of death, determination of death * I would like to thank Howard Brody and Bruce Miller for helpful suggestions and criticisms. CiteULike Connotea Del.icio.us What's this? (shrink)
What mechanisms underlie children’s language production? Structural priming—the repetition of sentence structure across utterances—is an important measure of the developing production system. We propose its mechanism in children is the same as may underlie analogical reasoning: structure-mapping. Under this view, structural priming is the result of making an analogy between utterances, such that children map semantic and syntactic structure from previous to future utterances. Because the ability to map relationally complex structures develops with age, younger children are less successful than (...) older children at mapping both semantic and syntactic relations. Consistent with this account, 4-year-old children showed priming only of semantic relations when surface similarity across utterances was limited, whereas 5-year-olds showed priming of both semantic and syntactic structure regardless of shared surface similarity. The priming of semantic structure without syntactic structure is uniquely predicted by the structure-mapping account because others have interpreted structural priming as a reflection of developing syntactic knowledge. (shrink)
By strict definition, television journalism, like every form of journalism, has always been ?unreal?; some form of constructed mediated reality.1 But now, television journalism is coming to a crossroads?one where ethics and technology will meet squarely at right angles if not head?on. And it is reality, even the constructed mediated kind, that will be at risk. In a few years, television journalism at the network and local levels will have the capability, through television's emerging conversion from analog to digital technology, (...) to easily manipulate video and audio in utterly fundamental ways. It will be simple to completely re?shape, even to create, reality. The question won't be: ?Is it live or is it Memorex?"2 rather, it will be something like: ?Is it real or is it digitex?"3This article explores this new technology and the concomitant merger of form and substance in television journalism; it presents several hypothetical examples of this kind of unethical behavior and the motivations behind them; and, finally, it wonders what impact unethical digitexing might have on the First Amendment. (shrink)
This article is an attempt to clarify a confusion in the brain death literature between logical sufficiency/necessity and natural sufficiency/necessity. We focus on arguments that draw conclusions regarding empirical matters of fact from conceptual or ontological definitions. Specifically, we critically analyze arguments by Tom Tomlinson and Michael B. Green and Daniel Wikler. which, respectively, confuse logical and natural sufficiency and logical and natural necessity. Our own conclusion is that it is especially important in discussing the brain death issue to (...) observe the distinction between logical and natural sufficiency/necessity in a strict fashion. Keywords: brain death, definition, criteria, natural vs logical necessity, logical vs natural sufficiency CiteULike Connotea Del.icio.us What's this? (shrink)
Baylis, Tomlinson, and Hoffmaster each raise a number of critiques in response to Bliton's manuscript. In response, we focus on three themes we believe run through each of their critiques. The first is the ambiguity between the role of ethics consultation within an institution and the role of the actual ethics consultant in a particular situation, as well as the resulting confusion when these roles are conflated. We explore this theme by revisiting the question of What's going on? in (...) clinical ethics consultations. Moving from those issues associated with the role of the ethics consultant to those associated with the role of inquiry within the practice of ethics consultation, we then take up the serious challenge that Bliton seems shackled by the assumptions and institutional dispositions embedded in the medical culture in which he is working. This reveals the second theme, namely that there is a risk of co-optation when acting in a role that derives its legitimacy from institutional sources. Finally, we focus on an even more problematic implication stemming from the first two, namely that the focus on institutional power as the crucial factor for determining ethical significance has the effect of distorting, and perhaps obscuring, other forms of relational, interpersonal, and moral meaning. (shrink)
