How should we respond to individuals with disabilities? What does it mean to be disabled? Over fifty million Americans, from neonates to the fragile elderly, are disabled. Some people say they have the right to full social participation, while others repudiate such claims as delusive or dangerous. In this compelling book, three experts in ethics, medicine, and the law address pressing disability questions in bioethics and public policy. Anita Silvers, David Wasserman, and Mary B. Mahowald test important theories (...) of justice by bringing them to bear on subjects of concern in a wide variety of disciplines dealing with disability. They do so in the light of recent advances in feminist, minority, and cultural studies, and of the groundbreaking Americans with Disabilities Act. (shrink)

Fetal tissue transplants have now been successful in primates, raising the possibility of treatment for Parkinson's disease and other chronic illnesses. Whether or not abortion is morally justified, use of human fetal tissue for research or therapy is justified in certain circumstances. The rationale, both for permitting transplantation of fetal tissue and for limitations in exercising the technology, is based on the same set of ethical principles that supported restrictive legislation in the past: respect for autonomy and a balancing of (...) harms and benefits that gives priority to those most affected. (shrink)

Book reviewed in this article: Women & Children in Health Care: An Unequal Majority. By Mary Briody Mahowald.

All persons, while different from one another, have the same value: this is the author's relatively uncontroversial starting point. Her end point is not uncontroversial: an ideal of justice as human flourishing, based on each person's unique set of capabilities. Because the book's focus is women's health care, gender justice, a necessary component of justice, is central to examination of the issues. Classical pragmatists and feminist standpoint theorists are enlisted in support of a strategy by which gender justice is promoted. (...) Two features of the book are unique: (1) the topics presented cover the entire life span of women, not just those related to reproduction; (2) a range views about moral status are applied not only to fetuses but also to individuals already born. Attention to these features is intended to facilitate ethical consistency or moral integrity and respect for those who hold different moral views. While delineating and defending the book's perspective, the first section provides an overview of bioethics, critiques prevalent approaches to bioethics and models of the physician-patient relationship, and sketches distinguishing aspects of women's health care that are prevalently neglected. Positions about moral status are also presented. The second section identifies topics that are indirectly as well as directly related to women's health, such as domestic violence and caregiving. Brief cases illustrate variables relevant to each topic. Empirical and theoretical considerations follow each set of cases; these are intended to precipitate more expansive and critical examination of the issues raised. The last section is devoted to an egalitarian ideal that may be pursued through an ethic of virtue or supererogation rather than obligation. By embracing this ideal, according to the author, moral agents support a more demanding level of morality than guidelines or laws require. (shrink)

Adoption, from the Latin opiate, “to choose,” means “to take into a relationship, especially another's child as one's own”. The word implies a permanent taking of responsibility. While the assumption that biological parents should rear their children is vital to society, adoption provides an alternative that is sometimes necessary.

When I first became acquainted with the thought of the American philoso pher Josiah Royce, two factors particularly intrigued me. The first was Royce's claim that the notion of community was his main metaphysical tenet; the second was his close association with the two American pragmatists, Charles Sanders Peirce and William James. Regarding the first factor, I was struck by the fact that a philosopher who died in 1916 should emphasize a topic of such contemporary significance not only in philosophy (...) but in so many other vital fields as well (sociology, psychology, politics, theology - to name only a few). Regarding the second, I was curious as to whether the pragmatism of Peirce and James might have influenced Royce during the course of their professional and personal contacts. Similarly, I wondered whether the idealism of Royce might have affected the thought of Peirce and James. To have appeased my curiosity in regard to all three thinkers, however, would have required (at least) three books. As a start I have now appeased it in regard to one. In researching the writings of Royce I found my way to the Houghton Library and to the Archives of Harvard University at Cambridge, Massa chusetts, where the unpublished manuscripts of Royce are preserved. (No editing job has yet been done on this bulk of material, though such would certainly be a welcome contribution to American philosophy. (shrink)

The issues of human cloning and stem cell retrieval are inseparable in circumstances in which the rationale of self-preservation may be invoked as a negative right. I apply this rationale to a hypothetical case in which cloning is necessary to preserve the bodily integrity or life of an individual. Self-preservation as moral integrity is examined in a narrower context, i.e., as applicable to those for whom deliberate termination of embryonic life is morally-problematic. This issue is addressed through comparison with two (...) paradigms commonly used in support of clinical practice: the distinction between letting die and killing, and the permissibility of vital organ retrieval after death. Although these paradigms are questionable in their own right, they offer a rationale by which scientists and clinicians may respect the negative right to moral integrity of those with whom they disagree. (shrink)

I argue for compatibility between feminism and medicine by developing a model of the physician-other relationship which is essentially egalitarian. This entails rejection of (a) a paternalistic model which reinforces sex-role stereotypes, (b) a maternalistic model which exclusively emphasizes patient autonomy, and (c) a model which focuses on the physician's conscience. The model I propose (parentalism) captures the complexity and dynamism of the physician-other relationship, by stressing mutuality in respect for autonomy and regard for each other's interests.

Neural fetal tissue transplantation offers promise as a treatment for devasting neurologic conditions such as Parkinson's disease. Two types of issues arise from this procedure: those associated with the use of fetuses, and those associated with the use of neural tissue. The former issues have been examined in many forums; the latter have not. This paper reviews issues and arguments raised by the use of fetal tissue in general, but focuses on the implications of the use of neural tissue for (...) basic concepts of personnood and personal identity. (shrink)

**** Revision of the second edition of 1983 (cited in BCL3). Now arranged in chronological order, with a new introduction and headnotes. Annotation copyright by Book News, Inc., Portland, OR.

Here is the doubt that triggers my inquiry: I have two beliefs that are apparently at odds. The first is that we should never kill; the second, that we should always attempt to alleviate pain. The apparent conflict between these beliefs arises from the fact that death may constitute the ultimate pain relief.

When surgery is performed on pregnant women forthe sake of the fetus (MFS or maternal fetalsurgery), it is often discussed in terms of thefetus alone. This usage exemplifies whatphilosophers call the fallacy of abstraction: considering a concept as if it were separablefrom another concept whose meaning isessentially related to it. In light of theirpotential separability, research on pregnantwomen raises the possibility of conflictsbetween the interests of the woman and those ofthe fetus. Such research should meet therequirement of equipoise, i.e., a (...) state ofgenuine uncertainty about the risks andbenefits of alternative interventions ornoninterventions. While illustrating thefallacy of abstraction in discussions of MFS,we review the rationale for explicitacknowledgment of the essential tie betweenfetus and pregnant woman. Next we examinewhether it is possible to meet the requirementof equipoise in research on MFS, focusing on afetal condition called myelomeningocele. Weshow how issues related to equipoise innonpregnant populations appear also in debatesregarding MFS. We also examine evidence insupport of claims that the requirement ofequipoise has been satisfied with respect to``the fetal patient'' while considering risks andbenefits to gestating women only marginally ornot at all. After delineating challenges andpossibilities for equipoise in MFS research, weconclude with a suggestion for avoiding thefallacy of abstraction and achieving equipoiseso that research on MFS may be ethicallyconducted. (shrink)

Paternalism is generally construed to entail two claims about persons toward whom it is directed: that their liberty is impeded, and that their good or interests are promoted or intended. Two recent arguments on the subject are based on the writings of John Stuart Mill: one* by Gerald Dworkin, maintains that paternalism is sometimes justified; the other, by Tom Beauchamp, claims that paternalism is never justified. My critique of both positions is based on a concept of human life as developmental. (...) In that context I argue that Mill's views themselves entail paternalism, Dworkin's position collapses into Beauchamp's, and Beauchamp neglects the crucial role of liberty in his critique of Mill. My conclusion suggests that a parental model be substituted for that of the pater, so that the individual's capacity for freedom be fully respected. (shrink)