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 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)

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 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)

An Emergency Department (ED) nurse caring for seventeen-year-old Bethany requests ethics consultation in a situation, ED boarding of a minor patient, that has become more and more common in recent...

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...

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)

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)

This is a paperback edition of a major contribution to the field, first published in hard covers in 1977. The book outlines a general theory of rational behaviour consisting of individual decision theory, ethics, and game theory as its main branches. Decision theory deals with a rational pursuit of individual utility; ethics with a rational pursuit of the common interests of society; and game theory with an interaction of two or more rational individuals, each pursuing his own interests in a (...) rational manner. (shrink)

The Nature of Classification discusses an old and generally ignored issue in the philosophy of science: natural classification. It argues for classification to be a sometimes theory-free activity in science, and discusses the existence of scientific domains, theory-dependence of observation, the inferential relations of classification and theory, and the nature of the classificatory activity in general. It focuses on biological classification, but extends the discussion to physics, psychiatry, meteorology and other special sciences.

Preface.--Science, ideology, and world view.--Objectives and methods in intellectual history.--The Kuhnian paradigm and the Darwinian revolution in natural history.--Biology and social theory in the nineteenth century.--Darwin as a social evolutionist.--Darwinism as a world view.--From Huxley to Huxley.--Postscript.

One of the paradoxes of the physical sciences is that as our knowledge has progressed, more and more diverse physical phenomena can be explained in terms of fewer underlying laws, or principles. In Hidden Unity, eminent physicist John Taylor puts many of these findings into historical perspective and documents how progress is made when unexpected, hidden unities are uncovered between apparently unrelated physical phenomena. Taylor cites examples from the ancient Greeks to the present day, such as the unity of (...) celestial and terrestrial dynamics (17th century), the unity of heat within the rest of dynamics (18th century), the unity of electricity, magnetism, and light (19th century), the unity of space and time and the unification of nuclear forces with electromagnetism (20th century). Without relying on mathematical detail, Taylor's emphasis is on fundamental physics, like particle physics and cosmology. Balancing what is understood with the unestablished theories and still unanswered questions, Taylor takes readers on a fascinating ongoing journey. John C. Taylor is Professor Emeritus of Mathematical Physics at the University of Cambridge. A student of Nobel laureate Abdus Salam, Taylor's research career has spanned the era of developments in elementary particle physics since the 1950s. He taught theoretical physics at Imperial College, London, and at the Universities of Oxford and Cambridge, and he has lectured worldwide. He is a Fellow of the Royal Society and a Fellow of the Institute of Physics. (shrink)