In lieu of an abstract, here is a brief excerpt of the content:The “Wider View”: André Hellegers’s Passionate, Integrating Intellect and the Creation of BioethicsWarren Thomas Reich* (bio)AbstractThis article provides an account of how André Hellegers, founder and first Director of the Kennedy Institute of Ethics at Georgetown University, laid medicine open to bioethics. Hellegers’s approach to bioethics, as to morality generally and also to medicine and biomedical science, involved taking the “wider view”—a value-filled vision that integrated and gave meaning (...) to what otherwise was disparate, precarious, and conflicting. This article shows how Hellegers’s wider view of bioethics was shaped by events in his own life, his resultant sense of the precariousness of life and health, his commitment to religious inclusiveness, his research in fetal medicine, his clinical experience in obstetrics, his role in the struggle to change the teaching of the Roman Catholic Church on fertility control, and his developing concepts of health and disease. Hellegers was committed to and worked toward bioethics as a self-consciously interdisciplinary field in which the contributing disciplines adapt to each other—rather than sustain themselves as autonomous disciplines—to create a dynamic and complex intellectual, clinical, and social activity.André Hellegers’s personality and life were like that of a meteor: brief appearance on the scene; high-speed, flaming trajectory; quick burn-out; its smallest residue worth examining for ages to come. You had to watch carefully, for otherwise you might miss what he was about—what he was really about. He had an unusually probing and unflagging mind, coupled with the ability to make people think; and in a very real sense, that is what he was always about. André was an extremely effective communicator. He was like Fred Astaire: he had flair and charm, and no matter how crowded the room, you instantly knew when he entered it. Like Astaire, he had a deep intensity and striving for perfection while making his art always look like great fun. He was an engaging [End Page 25] story-teller who also knew how to stun intelligent people with his insightful, often ironic and humorous thinking that got to the bottom of things very quickly, leaving his interlocutors with a huge agenda for further reflection. Yet in spite of all this alluring talent, André never attracted attention to himself in a vain way. Even as raconteur, he was always working, getting people to think and talk.There were three great passions in Hellegers’s life that enabled him to inspire and shape bioethics as he did. He had a passionate intellect that was constantly probing for new clarity at new levels of understanding and values, and he had the ability to infect other people with his intellectual passion. André Hellegers was deeply rooted in a Catholicism scarcely imaginable in the United States—an open, historically-conscious, northern European faith that kept him free of ideology while providing him a foundation on which he built a rich ecumenicity of theological and philosophical bioethics. Finally, and perhaps most decisively for his founding work in bioethics, Hellegers pushed and probed to get a world that was almost totally unaccustomed to communicating over disciplinary lines (incredibly, virtually no interdisciplinary conferences had taken place before his day) to dialogue and collaborate across the barriers of medicine, politics, and religion.IntroductionThe customary way of writing a history of someone’s involvement in the origins of something—say, the origins of a nation or, I suppose, the origins of bioethics—certainly would not customarily start with the foregoing type of vignette. It would have as its purpose to discuss such things as issues, events that raised issues, methods pursued and applied, and outcomes achieved. However, in this modest account of some of the major contributions of the late André E. Hellegers, M.D., to the development of the field of bioethics, I intend to focus on a different level of historical inquiry, one that portrays and explains the person, his world-view, and his motivation, as well as the cultural forces and events that conspired to make Hellegers and the people with whom he came into contact vibrant with a sense of innovative and creative—not to mention urgent—inquiry. I believe that... (shrink)

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as (...) well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics. (shrink)

The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the (...) collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language. (shrink)

It is commonly assumed that grounding relations are asymmetric. Here I develop and argue for a theory of metaphysical structure that takes grounding to be nonsymmetric rather than asymmetric. Even without infinite descending chains of dependence, it might be that every entity is grounded in some other entity. Having first addressed an immediate objection to the position under discussion, I introduce two examples of symmetric grounding. I give three arguments for the view that grounding is nonsymmetric (I call this view (...) ‘metaphysical interdependence’). These arguments are: (i) that metaphysical interdependence is the only theory able to reconcile competing intuitions about grounding; (ii) that it is the only theory consistent with both ‘gunk’ and ‘junk’; and (iii) that offers a satisfactory solution to the problem concerning whether or not grounding is itself grounded. (shrink)