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...

For many years, the downtown in Clarksdale, with a municipal population of 17,960 and located in the northern part of the Mississippi Delta, had lost its role as the centre providing a wide range of jobs and services to those living in the surrounding region. For many cities and towns in America, downtown decline has been associated with the flight to the suburbs and the growth in shopping malls serving flourishing gated communities. In Clarksdale’s case, downtown decline has been due (...) largely to the advent of big box retailing and the location of new retail and commercial developments along the state highway on the edge of town, combined with the loss of jobs and population associated with agricultural restructuring. Today, however, Clarksdale has taken up the challenge to ‘revitalize’ the downtown in the face of economic adversity. Recovery is under way, and much of this is associated with blues music and Delta culture: Clarksdale is situated at the fabled ‘crossroads’ of Highways 49 and 61 and is also the home to national icons in literature, art and other cultural pursuits. These are key elements around which the downtown revitalization effort is focused. This paper charts the process by which the Clarksdale community has embarked on the road to downtown recovery, and highlights the town’s indelible links with the blues, borne out of years of toil, hardship and social deprivation. The paper emphasizes the importance of ‘champions’ and ‘creative people’, drawing on community support, in achieving downtown revitalization. Positive results are becoming evident with new businesses and jobs, improved levels of service, refurbishment of derelict buildings, a renewed sense of place, and an uplift in community confidence. The significance of cultural tourism to downtown revitalization is highlighted, with particular emphasis on the global appeal of blues, but with its roots firmly established in Clarksdale and the Delta. (shrink)

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)

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)

A DISQUISITION ON GOVERNMENT. In order to have a clear and just conception of the nature and object of government, it is indispensable to understand ...

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)

This bibliography is a comprehensive listing of published works by John Locke, including all known editions and translations of his works, abridgments and selections in anthologies and several works which he edited or translated, from the first editions to the present. It covers not only the works published during Locke's lifetime, but also those printed from the voluminous manuscripts he left behind at his death in 1704. In addition, Locke's works are set in their original controversial context: entries are (...) provided for the works Locke wrote about and for the attacks and defenses his writings provoked during and immediately following his lifetime. An appendix contains a list of works incorrectly attributed to Locke. Three indexes complete the bibliography: an index to the names of the editors, the translators, and authors of works cited in the annotations; an index to the titles of anonymous works; and a language index that lists all the works that have been translated into each language. (shrink)

This paper concerns the semantics of belief-sentences. I pass over ontologically lavish theories which appeal to impossible worlds, or other points of reference which contain more than possible worlds. I then refute ontologically stingy, quotational theories. My own theory employs the techniques of possible worlds semantics to elaborate a Fregean analysis of belief-sentences. In a belief-sentence, the embedded clause does not have its usual reference, but refers rather to its own semantic structure. I show how this theory can accommodate quantification (...) into belief-contexts. I close with skirmishes against the threat posed by the Liar Paradox. (shrink)

E. P. Wigner 's argument that the probability of the existence of self-reproducing units, e.g., organisms, is zero according to standard quantum theory is stated and analyzed. Theorems are presented which indicate that Wigner 's mathematical result in fact should not be interpreted as asserting the improbability of self-reproducing units.