Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

Physicians may justifiably limit patients' refusals of medical interventions when the refusal is based on a negative right to noninterference coupled with a request for an unreasonable alternative.

Appearing in English for the first time, Schelling’s 1842 lectures develop the idea that many philosophical concepts are born of religious-mythological notions.

The American Journal of Bioethics, Volume 12, Issue 7, Page 1-2, July 2012.

The ethics of managing obstetric patients in medical disasters poses ethical challenges that are unique in comparison to other disaster patients, because the medical needs of two patients—the pregnant patient and the fetal patient—must be considered. We provide an ethical framework for doing so. We base the framework on the justice-based prevention of exploitation of populations of patients, both obstetric and non-obstetric, in medical disasters. We use the concept of exploitation to identify a spectrum from ethically acceptable, to ethically challenging, (...) to ethically unacceptable, management of obstetric patients in medical disasters. We also address the ethics of the care of obstetric and neonatal patients when the resources of a hospital are completely overwhelmed in a large-scale medical disaster. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 59-61, December 2011.

This paper starts with one of Chalmers’ basic points: first-hand experience is an irreducible field of phenomena. I claim there is no ‘theoretical fix’ or ‘extra ingredient’ in nature that can possibly bridge this gap. Instead, the field of conscious phenomena requires a rigorous method and an explicit pragmatics for its exploration and analysis. My proposed approach, inspired by the style of inquiry of phenomenology, I have called neurophenomenology. It seeks articulations by mutual constraints between phenomena present in experience and (...) the correlative field of phenomena established by the cognitive sciences. It needs to expand into a widening research community in which the method is cultivated further. (shrink)

Heuser, Eller and Byrne provide important descriptive ethics data about how physicians counsel women on the clinical management of pregnancies complicated by severe fetal anomalies. The authors present an account of what such counselling ought to be based on, the ethical concept of the fetus as a patient and the professional responsibility model of obstetric ethics. When there is certainty about the diagnosis and either a very high probability of either death as the outcome of the anomaly or survival with (...) severe and irreversible deficit of cognitive developmental capacity as a result of the anomaly diagnosed, the pregnant woman should be offered the alternatives of aggressive and non-aggressive obstetric management and induced abortion before viability. It is also ethically permissible to offer feticide followed by termination of pregnancy after viability in such cases. This ethically justified approach will reduce the variation in the actual practices of specialists in maternal–fetal medicine described by Heuser, Eller and Byrne. (shrink)

With precision and profundity born of 30 years of devoted study, John Boyle offers an essential introduction to St. Thomas Aquinas on Scripture, shedding helpful light on the goals, methods, and commitments that animate the Angelic Doctor's engagement with the sacred page. Because the genius of St. Thomas's approach to the Bible lies not so much in its novelty but rather in the fidelity and clarity with which he recapitulates the riches of the preceding interpretive Tradition, this initiation into St. (...) Thomas's vision of Scripture is itself an orientation to the Church's vision of Scripture, from the Fathers through and beyond the Middle Ages. St. Thomas's embeddedness within the Church's Tradition and his own historical context is integral to his approach to Scripture, yet it sets him at some distance from modern readers, for whom his interpretive vision may seem perplexing or even impenetrable. In this Primer, Boyle first provides an acclimation to this medieval context through a survey and explanation of pertinent technical terminology used by St. Thomas and characteristic of the scholastic theology of the time. With an eye to the medieval practice of considering Scripture according to the fourfold division of causes, Boyle builds on this initial foundation by exploring in turn St. Thomas's accounts of the end or use of Scripture (final cause), its divine and human authorship (efficient cause), its order and division (material cause), and its literary styles or genres (formal cause). Drawing on writings from across St. Thomas's corpus, but especially his work On the Commendation and Division of Sacred Scripture and the prologues to his biblical commentaries, Boyle masterfully elucidates both the hermeneutical principles and deep wisdom of the Angelic Doctor's approach to Scripture, imparting invaluable guidance not only for reading and understanding St. Thomas and other great masters of the Tradition, but also-and ultimately-for understanding Scripture in light of this Tradition and reading it with greater benefit and joy. (shrink)

With fascinating historical anecdotes and incisive scientific analysis, this important work combines ancient thought with modern theory to reveal a new way of viewing our universe that can expand our awareness, our lives, and may well point the way to a new science for the twenty-first century.

This is an English translation of Schelling's Ideas for a Philosophy of Nature (first published in 1797 and revised in 1803), one of the most significant works in the German tradition of philosophy of nature and early nineteenth-century philosophy of science. It stands in opposition to the Newtonian picture of matter as constituted by inert, impenetrable particles, and argues instead for matter as an equilibrium of active forces that engage in dynamic polar opposition to one another. In the revisions of (...) 1803 Schelling incorporated this dialectical view into a neo-Platonic conception of an original unity divided upon itself. The text is of more than simply historical interest: its daring and original vision of nature, philosophy, and empirical science will prove absorbing reading for all philosophers concerned with post-Kantian German idealism, for scholars of German Romanticism, and for historians of science. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

I begin by criticizing an elaboration of an argument in this journal due to Hawley , who argued that, where Leibniz’s Principle of the Identity of Indiscernibles faces counterexamples, invoking relations to save PII fails. I argue that insufficient attention has been paid to a particular distinction. I proceed by demonstrating that in most putative counterexamples to PII , the so-called Discerning Defence trumps the Summing Defence of PII. The general kind of objects that do the discerning in all cases (...) form a category that has received little if any attention in metaphysics. This category of objects lies between indiscernibles and individuals and is called relationals: objects that can be discerned by means of relations only and not by properties. Remarkably, relationals turn out to populate the universe. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of 'unborn patient' has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of 'unborn child.' There is a long history of the descriptive use of 'unborn child.' Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of 'unborn child' should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

"Not only one of the best but also the most comprehensive treatment of Stoicism written in this century." --Times Literary Supplement.

"The chief business of twentieth-century philosophy” is “to reckon with twentieth-century history," claimed R. G. Collingwood. In this remarkable collection of essays, Frank Ankersmit demonstrates the prescience of that remark and goes a long way toward meeting its challenge. Responding to the work of Hayden White, Arthur Danto, and Hans-Georg Gadamer, he examines such issues as the difference between historical representation and artistic expression, the status of metaphor in historical description, and the relation of postmodernism to historicism. Ankersmit's fluent grasp (...) of European thought and his ability to incorporate concepts from literary theory, art history, the philosophy of science, and political thought into his analyses assure that this collection will interest readers throughout the humanities. (shrink)

This landmark work provides a systematic introduction to systems of modal logic and stands as the first presentation of what have become central ideas in philosophy of language and metaphysics, from the "new theory of reference" and non-linguistic necessity and essentialism to "Kripke semantics.".

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of (...) the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. (shrink)

Ethics for Enemies comprises three original philosophical essays on torture, terrorism, and war. F. M. Kamm deploys ethical theory in her challenging new treatments of these most controversial practical issues. First she considers the nature of torture and the various occasions on which it could occur, in order to determine why it might be wrong to torture a wrongdoer held captive, even if this were necessary to save his victims. In the second essay she considers what makes terrorism wrong--whether it (...) is the intention to harm civilians, rather than harm to them being 'collateral damage,' or something else--and whether terrorism is always wrong. The third essay discusses whether having a right reason, in the sense of a right intention, is necessary in order for a war to be just. Kamm then examines ways in which the harms of war can be proportional to the achievement of the just cause and other goods that war can bring about, so as to make the declaration of war permissible. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Disjunctivism about perceptual appearances, as I conceive of it, is a theory which seeks to preserve a naïve realist conception of veridical perception in the light of the challenge from the argument from hallucination. The naïve realist claims that some sensory experiences are relations to mind-independent objects. That is to say, taking experiences to be episodes or events, the naïve realist supposes that some such episodes have as constituents mind-independent objects. In turn, the disjunctivist claims that in a case of (...) veridical perception like this very kind of experience that you now have, the experiential episode you enjoy is of a kind which could not be occurring were you having an hallucination. The common strategy of arguments from hallucination set out to show that certain things are true of hallucinations, and hence must be true of perceptions. For example, it is argued that hallucinations must have non-physical objects of awareness, or that such states are not relations to anything at all, but are at best seeming relations to objects. In insisting that veridical perceptual experience is of a distinct kind from hallucination, the disjunctivist denies that any of these conceptions of hallucination challenges our conception of veridical perceptions as relations to mind-independent objects. More specifically, I assume that the disjunctivist advocates naïve realism because they think that this position best articulates how sensory experience seems to us to be just through reflection. If the disjunctivist is correct in this contention, then anyone who accepts the conclusion of the argument from hallucination must also accept that the nature of sensory experience is other than it seems to us to be. In turn, one may complain that any such error theory is liable to lead to sceptical consequences. A Humean scepticism about the senses launches a challenge about our knowledge of the world through questioning the conception we have of what sense experience is, and how it can provide knowledge of the world. (shrink)

Book reviewed in this article: Ethics in Obstetrics and Gynecology. By Laurence B. McCullough and Frank A. Chervenak.

Recent advances in physics render a reconsideration of the Place of Mathematics in the Interpretation of the Universe particularly timely. On the one hand, we have the introduction of non-euclidian geometry, which has given rise to much controversy informed or otherwise; on the other hand, we find mysterious forms of mathematics, invented to cope with the quantum difficulties, which so far have escaped metaphysical investigation or criticism. It would seem most desirable that these modes of interpreting reality should be examined (...) from the broader philosophical point of view. (shrink)