Moral conflicts over medical treatment that are the result of differences in fundamental moral commitments of the stakeholders, including religiously grounded commitments, can present difficult challenges for clinical ethics consultants. This article begins with a case example that poses such a conflict, then examines how consultants might use different approaches to clinical ethics consultation in an effort to facilitate the resolution of conflicts of this kind. Among the approaches considered are the authoritarian approach, the pure consensus approach, and the ethics (...) facilitation approach described in the Core Competencies for Healthcare Ethics Consultation report of the American Society for Bioethics and Humanities, as well as a patient advocate approach, a clinician advocate approach, and an institutional advocate approach. The article identifies clear limitations to each of these approaches. An analysis of the introductory case illustrates those limitations, and the article concludes that deep-seated conflicts of this kind may reveal inescapable limits of current approaches to clinical ethics consultation. (shrink)

This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care. Green's proposal, however, requires considerable relaxation of the constraints Rawls places on the original position and thus jeopardizes Rawls' arguments for the two (...) principles of justice. Norman Daniels claims that health care is best understood as a means for helping to achieve Rawls' goal of equality of fair opportunity. Daniels acknowledges, however, that his interpretation cannot justify a basic right to health care; rather, it would at best require that certain kinds of care be made available to certain kinds of individuals. Finally, in place of the notion of health care is a human right, it is suggested that the provision of health care is a social ideal which may inspire the creation of specific legal rights. On this view, social provision of health care may properly vary significantly from culture to culture. Despite this variability, social systems may still be criticized on moral grounds. Keywords: justice, right to health care, equality, fair opportunity. (shrink)

Current federal policy, as reflected in the final Baby Doe rule, will have a chilling effect on the ability of doctors to care appropriately for severely disabled infants. The policy threatens to prolong life unjustifiably for such infants. It will force physicians to violate a duty to do no harm without compensating benefit. And it raises serious problems for the just distribution of health care.

This commentary, while sympathetic to Thomasma and Pellegrino [15], raises three sets of questions concerning the adequacy of their view of medicine as a foundation for medical ethical decision-making. The first set of questions concerns the account of the nature of medicine presented by Thomasma and Pellegrino. It is argued that the account is not clearly univocal and that even the most important description offered requires further clarification. Questioned, secondly, is the reasoning used by Thomasma and Pellegrino to propel their (...) movement from establishing an evaluative component in medicine to asserting an ethical dimension to medical judgment. It is argued that the authors equivocate in their presentation between the medical and moral uses of value terms. Finally, the role of the living body as a foundation for medical ethics is questioned, both in terms of the normative force such a ground can generate, and in terms of the range of duties to which this foundation must commit the profession. (shrink)

Who should have access to assisted reproductive technologies? Which one of many seriously ill patients should be offered the next available transplant organ? When may a surrogate decision maker decide to withdraw life-prolonging measures from an unconscious patient? Questions like these feature prominently in the field of health care ethics and in the education of health care professionals. This book provides a concise introduction to the major concepts, principles and issues in health care ethics, using case studies throughout to illustrate (...) and analyse challenging ethical issues in contemporary health care. Topics range widely, from confidentiality and truthfulness to end-of-life care and research on human subjects. Ethics and Health Care will be a vital resource for students of applied ethics, bioethics, professional ethics, health law and medical sociology, as well as students of medicine, nursing and other health care professions. (shrink)

In his book Engineered Death: Abortion, Suicide, Euthanasia and Senecide, John Woods uses an argument from analogy to establish the following conclusion: even if one grants that foetuses are not persons but only potential persons, killing foetuses is murder. Murder, according to Woods, is the defeasibly wrongful violation of the right to life ascribed to persons. If this argument is successful, it would of course have profound consequences for the ongoing philosophical debate over the morality of abortion. Whether or (...) not they hold that foetuses are persons, philosophers would be forced to adopt the same moral attitude toward foeticide as they would adopt toward the killing of persons. That is, the killing of foetuses and the killing of persons would be defeasibly wrong in the same way; their wrongfulness could be defeated only in special and limited circumstances, perhaps like those suggested by Judith Thomson in her “Defense of Abortion”. (shrink)

This article examines two currently disputed issues regarding public policy for mentally retarded people. First, questions are raised about the legal tradition of viewing mental competence as an all-or-nothing attribute. It is argued that recently developed limited competence and limited guardianship laws can provide greater freedom for retarded people without sacrificing needed protection. Second, the question of who should act paternalistically for retarded people incapable of acting for themselves is examined. Rothman's claim that special formal advocates are the best representatives (...) for retarded people is discussed and criticized. It is argued that parents, professionals and legal advocates should share decision-making authority on behalf of those who are incompetent. (shrink)

Although voluntarily stopping eating and drinking as a way to hasten one’s death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics literature in recent years. After a brief review of the broader context of human death and dying, this article poses and examines 11 conceptual, personal, and public policy questions about VSED. The article identifies essential features of VSED and discusses whether VSED is a type of suicide. (...) It identifies reasons why people may or may not choose VSED, and it considers responses by family members and professional caregivers to people who have chosen VSED. It also considers how public policies may permit and regulate or restrict the practice of VSED. Examination of these questions is designed to increase understanding of VSED and to inform moral evaluation of this practice. (shrink)

Decision-making capacity (DMC) is, in many ways, a central organizing concept of modern health care ethics. Patients with DMC have the moral—if not always the legal—authority to make all manner of...

Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct and disciplinary procedures. The article (...) concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach. (shrink)

Book reviewed in this article: Ethics and Critical Care Medicine. John C. Moskop and Loretta Kopelman, eds. Dordrecht: D. Reidel “Ethical Moments in Critical Care Medicine,” symposium issue of Critical Care Clinics. James P. Orlowski and George A. Kanoti, eds.

How should the hospital’s ethics consultation service respond to this request from the Emergency Department for advice about “how to proceed” in caring for ED patient Benjamin? In order to off...

Alterity, the difference that being-other makes, is not an overt theme in the writing of Ueda Shizuteru, and yet by bringing alterity to the fore we are able to connect and examine several themes that Ueda does engage explicitly. It will turn out that several models of alterity are discernable in Ueda’s philosophy, and their common ground opens a mode of being-other that offers an alternative to dominant models of irreducible difference. Ueda’s philosophy of language suggests four alternative configurations that (...) increasingly allow for the dual emergence of authentic otherness and selfhood. Those configurations are intimated in his interpretations of Nishida’s pure experience, of the interplay of language and silence, of a dialogue envisioned in a Zen oxherding picture, and of the poetic form known as linked verse, which best models how discrete beings help create a world in common. (shrink)

We outline some ways in which motor neglect (the underutilization of a limb despite adequate strength) and hysterical paralysis (failure to move a limb despite no relevant structural damage or disease) may throw light on the pathophysiology of catatonia. We also comment on the manifold inadequacies of distinguishing too firmly between symptoms of “neurologic origin” and of “psychiatric origin.”.

The eight essays and three responses collected in Rethinking Borders were commissioned from an exciting range of leading younger writers, artists and intellectuals whose work has raised significant questions about the border cultures in ...

Each chapter heading bears a phrase from a contemporary author, held to incorporate the character of that section of the study under consideration. Chapter 1 carries the title given to early English translations of the Lettres provinciales; chapter 2 recalls the description of Pascall by Boyle and other English scientists; and chapter 3 draws from Kennett's preface to his version of the Pensees. The heading of chapter 4 is from Pope's Essay on Man. The exclamation which introduces chapter 5 concludes (...) an essay in the Gentleman's Magazine for 1789, probably by Boswell; the words for chapter 6 come from a pastoral letter of John Wesley; and chapter 7 represents the verdict of Coleridge. The title of the book itself is derived from the heading to the twenty-first chapter of Kennett's Pensees, which seems to have forecast the essence of the eighteenth-century's perplexity upon the issues raised by Pascal: 'The strange Contrarieties discoverable in Human Nature, with regard to Truth, and Happiness, and many other things.'. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

When von Neumann's and Morgenstern's Theory of Games and Economic Behavior appeared in 1944, one thought that a complete theory of strategic social behavior had appeared out of nowhere. However, game theory has, to this very day, remained a fast-growing assemblage of models which have gradually been united in a new social theory - a theory that is far from being completed even after recent advances in game theory, as evidenced by the work of the three Nobel Prize winners, (...) class='Hi'>John F. Nash, John C. Harsanyi, and Reinhard Selten. Two of them, Harsanyi and Selten, have contributed important articles to the present volume. This book leaves no doubt that the game-theoretical models are on the right track to becoming a respectable new theory, just like the great theories of the twentieth century originated from formerly separate models which merged in the course of decades. For social scientists, the age of great discover ies is not over. The recent advances of today's game theory surpass by far the results of traditional game theory. For example, modem game theory has a new empirical and social foundation, namely, societal experiences; this has changed its methods, its "rationality. " Morgenstern (I worked together with him for four years) dreamed of an encompassing theory of social behavior. With the inclusion of the concept of evolution in mathematical form, this dream will become true. Perhaps the new foundation will even lead to a new name, "conflict theory" instead of "game theory. (shrink)

For Swedish visionary Emanuel Swedenborg, God's love and wisdom is the basis for everything that happens in the world, from creation itself to the details of our everyday existence. In this volume, he describes the nature of God and heaven and how they relate to our human existence. This edition is a reprint of an 1885 translation by John C. Ager.

This book presents the first detailed history of the modern passport and why it became so important for controlling movement in the modern world. It explores the history of passport laws, the parliamentary debates about those laws, and the social responses to their implementation. The author argues that modern nation-states and the international state system have 'monopolized the 'legitimate means of movement',' rendering persons dependent on states' authority to move about - especially, though not exclusively, across international boundaries. This new (...) edition reviews other scholarship, much of which was stimulated by the first edition, addressing the place of identification documents in contemporary life. It also updates the story of passport regulations from the publication of the first edition, which appeared just before the terrorist attacks of 9/11, to the present day. (shrink)