End-of-life care became an important issue in the late 1960s and early 1970s. It was in great part driven by complaints about the care of the dying: lack of patient autonomy, indifferent or insensitive physicians, and inadequate pain control. The main task of those who worked to improve the situation centered on changing each of those variables, assuming that would do the job. But it has worked to a moderate extent only and the problem is not fully solved. The main (...) omission has been a failure to confront the medical enterprise itself, which believes in endless progress and conducts a war against death. Only a change in those underlying values can bring about further significant change. (shrink)
Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)
There are two puzzles about health care for children that need explanation. Why is it the sentimentality Americans express about children has not been backed by solid health care programs? If children are to have good health care, how can a case for their high priority be made, particularly in light of the fact that their health is the best of all age groups in the country? The first question is explored, but the second question is the focus of this (...) paper. A priority system for health care is proposed, and at the same time an argument is presented for why children should have a high priority despite their generally good health. (shrink)
One of the most important developments in international medicine over the past two decades has been a turn to the market as a way of coping with rising costs and responding to calls for more freedom from government control. A full moral evaluation of the relationship of medicine and the market requires asking a wide range of questions bearing on the meaning and impact of market strategies on the economics of health care and on the clinical and public health outcomes (...) of those strategies. A number of the leading questions are presented and some provisional answers offered. (shrink)
Managers of organizations should be aware of the attitudes of employees concerning whistleblowing. Employee views should affect how employers choose to respond to whistleblowers through the evolving law of wrongful discharge.This article reports on a survey of employee attitudes toward the legal protection of whistleblowers and presents an analysis of the results of that survey.
The JSTOR Archive is a trusted digital repository providing for long-term preservation and access to leading academic journals and scholarly literature from around the world. The Archive is supported by libraries, scholarly societies, publishers, and foundations. It is an initiative of JSTOR, a not-for-profit organization with a mission to help the scholarly community take advantage of advances in technology. For more information regarding JSTOR, please contact support@jstor.org.
Recent events demonstrated to the world a growing sense of interconnection and interdependence that will call for universal values and ethical behaviors on the part of journalists. In this article I look at journalism, likening this profession of inquiry to that of scientists, and I look at journalism ethics as a body of knowledge before identifying universal characteristics and suggesting that because of the many universal values that bond humans at whatever location, journalists should be able to agree on common (...) ethical principles. (shrink)
A confession is in order. As did almost everyone else of a certain persuasion, I recoiled when Sarah Palin invoked the notion of a "death panel" to characterize reform efforts to improve end-of-life counseling. That was wrong and unfair. But I was left uneasy by her phrase. Had I not been one of a handful of bioethicists over the years who had pushed to bring the need for rationing of health care to public attention and proposed ways to carry it (...) out? And was not a common thread running through the latter efforts the likely necessity of some kind of committee or other public mechanism to make the hard decisions? Were we not in other words talking about a "death panel," even if none of us has been so imprudent to .. (shrink)
This paper looks at the future from the perspective of the way in which present thinking can influence what the future might be. It assumes that history shapes the future and that the present generation is in a position to shape it. It looks at the future of medicine as a science and a professional discipline, of health care as policy and politics, of culture and ideology as forces shaping medicine and health care, and of biomedical ethics as an influential (...) source of wisdom and perspective. The paper argues that a strong future for bioethics requires a broad rather than a reductionistic vision of its proper work. (shrink)
My purpose in this paper is to show that current legal criteria for paternalistic involuntary psychiatric confinement of the mentally ill are both too narrow and too broad. I do this by first developing a principle of justified paternalistic interference with adults, which I take to be acceptably protective of individual liberty, but which does not require unnecessary sacrifices of individual welfare. After offering an analysis of current legal criteria for involuntary confinement, 1 argue that an acceptable theory of paternalistic (...) interference reveals that those criteria (1) exclude some cases where confinement would be morally permissible, and (2) allow paternalistic confinement of many whose detention is not morally justifiable. Keywords: paternalism, incompetence, involuntary civil confinement, liberty, beneficence, harm CiteULike Connotea Del.icio.us What's this? (shrink)
Despite the international interest in priority setting as an important tool for health policy, there has been comparatively little interest in the setting of research priorities. One of the few places where there has been such an interest is at the National Institutes of Health (NIH) in the United States. Under pressure from Congress to explain its priority setting process, the NIH has tried to explain the criteria and process it uses. The NIH procedure is described, and the problems created (...) by the criteria it uses are analyzed. Although it uses the language of priority setting, it is uncertain whether it does have a real method of setting priorities. Nonetheless, despite the lack of a method, the results of its work are lauded. In the long run, however, NIH will need a more rigorous method of setting priorities. (shrink)
Costs, blogs, and rationing. In 1985 I was invited to take part in an Office of Technology Assessment project on the impact new technologies would have on the future of Medicare. The study concluded that those technologies would cause great problems, inexorably driving up costs. Some limits would, sooner or later, have to be set on Medicare spending. I was immediately hooked by that problem, wrote a book about it, and have followed it ever since. Yet even though the problem (...) of rising Medicare costs was identified nearly twenty-five years ago, not much was done about it, and it became politically hazardous even to talk about it. Now it has become an immediate issue, but the rhetoric of urgency and the cost .. (shrink)
The Silent Scream, a videotape which includes footage of a real time sonogram of an abortion in progress, has been receiving considerable attention in America as the anti-abortion movement’s latest argument. The tape has been enthusiastically endorsed by President Reagan and has been distributed to every member of Congress and to each of the Supreme Court justices. It is produced and narrated by Bernard N. Nathanson, a practicing obstetrician and gynecologist, and it includes a number of implicit and explicit claims (...) which are highly controversial. Chief among these are: (1) the claim that since we can draw no morally significant line during the stages of fetal development, the fetusmust be recognized as a person from conception onward, (2) the claim that the film is a high tech, state of the art proof that abortion is the brutal murder of an innocent human being, (3) the claim that in abortion the fetus experiences terror and pain, and (4) the claim that as long as abortion is legal, showing this film (or one relevantly similar) must be made part of the informed consent procedure for abortion. My purpose in this paper is to examine these claims to see if The Silent Scream adds anything to the moral case for making abortion illegal. I give particular attention to two claims which are seldom addressed in the abortion debate, viz., that the fetus experiences terror and pain during an abortion, and that women have not had the information they need (but which this film provides) to give an adequately informed consent to abortion. Since there is so much confusion in the abortion debate, and since this film trades on that confusion, my broader purpose is to add some clarificationto the public discussion of this issue, which is daily becoming a more divisive issue of public policy. (shrink)
When (if ever) may a professional deceive a client for the client's own good? Under what conditions (if any) is whistle-blowing morally required? These are just some of the questions that scholars as diverse as Michael D. Bayles, Thomas Nagel, Sissela Bok, Jessica Mitford, and Peter A. French confront in this stimulating anthology. Organized around philosophical issues such as the moral foundations of professional ethics, models of the professional-client relationship, deception, informed consent, privacy and confidentiality, professional dissent, and professional virtue, (...) the volume illuminates the complex ethical issues that arise in journalism, law, health care, counselling, education, engineering, business, politics, and social science research. A variety of pedagogical aids--including clear introductions to and study questions for each set of readings, concrete cases designed to focus discussion, and an appendix on preparing cases and position papers--makes the text invaluable for both students and teachers of professional ethics. (shrink)
The LinGO Redwoods initiative is a seed activity in the design and development of a new type of treebank. A treebank is a (typically hand-built) collection of natural language utterances and associated linguistic analyses; typical treebanks—as for example the widely recognized Penn Treebank (Marcus, Santorini, & Marcinkiewicz, 1993), the Prague Dependency Treebank (Hajic, 1998), or the German TiGer Corpus (Skut, Krenn, Brants, & Uszkoreit, 1997)—assign syntactic phrase structure or tectogrammatical dependency trees over sentences taken from a naturally-occuring source, often newspaper (...) text. Applications of existing treebanks fall into two broad categories: (i) use of an annotated corpus in empirical linguistics as a source of structured language data and distributional patterns and (ii) use of the treebank for the acquisition (e.g. using stochastic or machine learning approaches) and evaluation of parsing systems. While several medium- to large-scale treebanks exist for English (and some for other major languages), all pre-existing publicly available resources exhibit the following limitations: (i) the depth of linguistic information recorded in these treebanks is comparatively shallow, (ii) the design and format of linguistic representation in the treebank hard-wires a small, predefined range of ways in which information.. (shrink)
In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest (...) demand on health care resources. If age were to become a limiting factor, as Dr. Callahan suggests it should, the limits that will be set are limits that will affect women more drastically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)
My assigned task in today’s colloquium is to review philosophers’ perspectives on the broad question of whether health care rationing ought to target the elderly. This is a revolutionary question, particularly in a society that is so sensitive to apparent discrimination, and the question must be approached carefully if it is to be successfully dealt with. Three subordinate questions attend this one and must be addressed in the course of answering it. The first such question has to do with (...) the issue of justice: how is it fair to target the elderly in achieving reductions in health care costs? Isn’t the proposal, or for that matter, isn’t targeting any age group, morally objectionable as a species of ageism, just as targeting members of a particular race or sex would be racist or sexist? The second subordinate question has to do with the issue of fittingness. Given that we can show in some way that targeting the elderly is not inherently unjust, why would limiting health care to them be a fitting thing for medicine to do? How would it fit, for example, with the traditional commitments of medicine, to sustain life, to relieve suffering, to heal and cure and restore function? And in particular, if medicine has the ability to save and relieve and restore the elderly, why should it replace that set of commitments with a different set for this particular population? The third subordinate question seems political, an arena reserved for one of my speaker colleagues today. There are, I believe, some underlying philosophical dimensions to its answer, and so I will say something about it. The philosophical/political questions is, Given that rationing health care to the elderly is not patently unjust, and given that a case can be made out that the ends of medicine are not violated by such limitation, shy should the elderly, as a group, assent to such a limitation? I want to address these subordinate questions, for I believe them to be the chief stumbling blocks for the possibility of an affirmative answer to our.... (shrink)
To be human is to humanize; a radically empirical aesthetic, by J. J. McDermott.--Dream and nightmare; the future as revolution, by R. C. Pollock.--William James and metaphysical risk, by P. M. Van Buren.--Knowing as a passionate and personal quest; C. S. Peirce, by D. B. Burrell.--The fox alone is death; Whitehead and speculative philosophy, by A. J. Reck.--A man and a city; George Herbert Mead in Chicago, by R. M. Barry.--Royce; analyst of religion as community, by J. Collins.--Human experience (...) and God; Brightman's personalistic theism, by D. Callahan.--William James and the phenomenology of religious experience, by J. M. Edie.--Pragmatism, religion, and experienceable difference, by R. W. Sleeper.--How is religious talk justifiable, by J. W. McClendon, Jr. (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)
Norman Daniels' and Daniel Callahan's recent work attempts to develop and deepen theories of justice in order to accommodate intergenerational moral issues. Elsewhere, I have argued that Callahan's arguments furnish inadequate support for the age rationing policy he accepts. This essay therefore examines Daniel's account of age rationing, together with the complex theory of age-group justice that buttresses it. Sections one and two trace the main features of Daniels' prudential lifespan approach. Section three calls into question the theory's (...) conformity to liberal tenets. The next section attempts to show that the outcome of the prudential approach fails to match our considered judgments. The brief final section offers a broader perspective on the task of articulating a liberal theory of age-group justice. Keywords: elderly, age-group justice, biomedical model of disease, rationing, liberalism, distributive justice CiteULike Connotea Del.icio.us What's this? (shrink)
The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a (...) critical survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)
Daniel Callahan has not simply proposed alterations of important features of the health economy. He has constructed a blue print for society drawing on concepts of what is natural and appropriate to human beings. He is, in effect, establishing a new social order. Like any social order, Callahan's system has its justificatory schemes or founding myths. This paper offers a feminist examination of the functions that these four myths – the concept of a whole of life; the stages (...) of life; a tolerable death; and a reconstruction of the meaning of the aged in terms of sacrifice – fulfill in Callahan's new social order. Callahan's concept of a whole of life reflects the power he assigns to nature, and the futility and harm he associates with attempts to repudiate biological imperatives. It introduces the stages of human life, tolerable death, and aging. The paper critically examines these concepts. Keywords: feminist medical ethics, aging, allocation of medical resources CiteULike Connotea Del.icio.us What's this? (shrink)
In this paper I try to defend the notion that the dead can be harmed, in opposition to Callahan and in accord with some ideas of Feinberg. In agreement with Parlit, I argue that the existence of a person has degrees. I suggest that properlies of a subject, such as “reputations” and claims, can persist after death, aIthough the subject as such does not and that these can be harmed. A promise, e.g., can be frustrated merely by being ignored; (...) in that sense a dead person can be wronged, and if wronged, s/he can be harmed. (shrink)
Daniel Callahan's concept of a sustainable medicine is examined by looking at experiences Old Order Amish communities have had with organ and bone marrow transplantation. The Amish possess many characteristics that might make them embrace limits on the use of expensive, life-prolonging medical treatments: they believe that the good of the individual should be subordinated to the good of the community, they are suspicious of progress as a goal, and they are more comfortable with dying than many other modern (...) Americans. However, the Amish actively pursue these treatments without the benefit of private or government insurance. Although the Amish affective response to sick individuals is worthy of emulating, their commitment to help individuals obtain and pay for transplants has had negative financial and cultural effects on some Amish communities. The Amish experience can thus teach us lessons about how to care for one another when we are sick and dying, but it can also teach us how difficult but important it is to limit some forms of expensive care for the good of our communities. (shrink)
The worst possible way to resolve this issue is to leave it up to individual choice. There is no known social good coming from the conquest of death (Bailey, 1999). - Daniel Callahan Dramatically extending the human lifespan seems increasingly possible. Many bioethicists object that life-extension will have Malthusian consequences as new Methuselahs accumulate, generation by generation. I argue for a Life-Years Response to the Malthusian Objection. If even a minority of each generation chooses life-extension, denying it to them (...) deprives them of many years of extra life, and their total extra life-years are likely to exceed the total life-years of a majority who do not want life-extension. This is a greater harm to those who want extended life than the Malthusian harms to those who refuse extended life, both because losing an extra year of life is worse than enduring a year of Malthusian conditions, and because the would-be Methuselahs have more life-years at stake. Therefore, even if life-extension seems likely to cause severe overcrowding and resource shortages, that threat is not sufficient to justify society in restricting the development or availability of life-extension. (shrink)
In this article, we analyzed the effect of various factors on moral judgment and ethical attitudes of working persons. It was found that the effect of various socio-demographic factors on ethical attitudes varied between the two different categories of ethical issues under study, issues which involve explicit violation of laws vis-à-vis issues which involved social concerns. Our results did not support the implication of Callahan’s hypothesis that males are more sensitive to rule-based ethical issues while women are to issues (...) involving social concerns; it was found that females have a lower acceptability of unethical behaviors related to both categories of issues in Hong Kong, whereas gender effect was not statistically significant in Mainland China. University education also had no significant effect on ethical attitudes. Religion played an important role in affecting ethical attitudes, however, its effect varied with different types of religions; Christianity was found to be most favorable to higher ethical standards, but people of traditional Chinese religion had a higher acceptability of unethical behaviors involving social concerns compared to people with no religion. Our finding also indicated that employees in state-owned enterprises, private employees, employees in foreign-investment firms, and employers in Mainland China all had a higher acceptability of unethical law-breaking behaviors compared to workers in collectives, throwing doubt on the validity of convergence theory in Mainland China. (shrink)
Queen Christina of Sweden was unconventional in her time, leading to hypotheses on her gender and possible hermaphroditic nature. If genetic analysis can substantiate the latter claim, could this bring the queen into disrepute 300 years after her death? Joan C. Callahan has argued that if a reputation changes, this constitutes a change only in the group of people changing their views and not in the person whose reputation it is. Is this so? This paper analyses what constitutes change (...) and draws out the implications to the reputation of the dead. It is argued that a reputation is a relational property which can go through changes. The change is “real” for the group changing their views on Queen Christina and of a Cambridge kind for the long dead queen herself. Cambridge changes result in new properties being acquired, some of which can be of significance. (shrink)
Throughout his career as an academic theologian, Karl Rahner never explicitly set himself the task of working out a theory of language. Nonetheless, the seminal insights for such a theory were formulated in his extensive corpus as functions of other, more properly theological concerns. These consist chiefly of the development of religious doctrine and the cult of the Sacred Heart (See DD, BH, ST, TM, ULM). Other important insights appear in his treatment of the hermeneutics of eschatological statements and the (...) relation between Christianity and poetry (See HES, PC, PP). All these theological concerns have received scholarly attention (See Barnes 1994, Bonsor 1987, Callahan 1985, Corduan 1978, Doud 1983, Hines 1989, Phan 1988, Thompson 1992, Walsh 1977). As for Rahner’s theory of language, scholarship has shown how a coherent system can be constructed from the disparate sources that contain it (See Masson 1979, 224–33; and 1980, 266–72). In developing this previous work, the present article will ex plain how Rahner’s theory is derived from his distinctive meta physics of the symbol. Scholarship is only beginning this discussion, although the centrality of symbolism in Rahner’s thought has been well treated. [See Callahan 1982, Fields 2000 (esp. 6–16, 92–97), Motzko 1976, H. Rahner 1964, Wong 1984.] In addition, this paper will also suggest that an origin of Rahner’s symbolic view of language lies in Heidegger’s aesthetics. Bringing this origin to the fore will lead to a concluding discussion about the debt that Rahner owes his mentor at Freiburg University. (shrink)
Oh, the places I’ve been: A valediction. In August 2009, when I joined The Hastings Center as a research assistant, I was an ambitious recent graduate of Davidson College with a thirst to learn more about bioethics and its role in the policy-making process. Nearly two years later, as I approach my last day at The Hastings Center, I am reminded of my first day, one that alone might make aspiring bioethicists envious. At the conclusion of lunch, Dan Callahan, (...) the Center’s cofounder, invited me to his office to discuss my academic and professional interests. Although I understand why I may have been so nervous walking into his office that day, I quickly learned that he was as genuinely interested to hear what I, a .. (shrink)
: This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory (...) bioethics." It involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences. (shrink)
George, B. J. Jr. The evolving law of abortion.--Guttmacher, A. F. The genesis of liberalized abortion in New York: a personal insight.--Callahan, D. Abortion: some ethical issues.--Jakobovits, I. Jewish views on abortion.--Drinan, R. F. The inviolability of the right to be born.--Schwartz, R. A. Abortion on request: the psychiatric implications.--Fleck, S. A psychiatrist's views on abortion.--Niswander, K. R. Abortion practices in the United States: a medical viewpoint.--Macintyre, M. N. Genetic risk, prenatal diagnosis, and selective abortion.--Messerman, G. A. Abortion counselling: (...) shall women be permitted to know?--Pilpel, H. F. and Zuckerman, R. J. Abortion and the rights of minors. (shrink)
