Moses Maimonides, known by the acronym "Rambam," was unquestionably the foremost intellectual figure of medieval Judaism. Born in Cordova, Spain, forced at an early age to conceal his faith, he emigrated to Morocco and then Palestine before settling in Egypt, where financial necessity compelled him to study medicine and where he eventually became personal physician to Saladin. Although his medical skills were renowned and his writings in this field were widely studied throughout the Western world in the following centuries, (...) Maimonides' primary interest was theology. He devoted ten years to preparing Mishnah Torah and fifteen years to The Guide to the Perplexed - the first written in Hebrew, the second in Arabic. These studies of Jewish law were first considered radical in their efforts to reconcile religious and scientific thought, but later became pillars of traditional Jewish faith. Dr. Lenn Goodman has prepared new translations from these works, arranging the extensive excerpts by topic to focus on Maimonides' principal contributions to philosophy. These are accompanied by commentary and analysis, clarifying the complexities of his thought and providing the historical and religious background required by the modern lay reader. The introduction details Rambam's life and evaluates his role in history and theology. The study of Maimonides is essential to the understanding of Judaism and Western culture. Rambam makes his writings accessible to those who cannot work from the original texts, and meaningful to those who have not had extensive previous exposure to medieval theology. — Publisher description. (shrink)

This chapter contains sections titled: The Status of Humans in Maimonides' Ontology Matter, Privation, and Evil Accounting for Multiplicity of Persons The Constitution of Soul and Body Immortality of the Soul: Personal or General? Conclusion further reading.

Beginning with a definition of 'ethos' as one's dwelling place and 'ethics' as the practice of that which constitutes one's 'ethos', this thesis explores the relation between the production of meaning, embodiment and difference in the philosophies of Hegel, Nietzsche and Heidegger. The aim is to explore the possibility of an ethics of sexual difference evoked by Foucault's and Derrida's re-reading of this philosophical tradition. ;The frame for my analysis is established by outlining Foucault's approach to ethics, showing how he (...) cannot account for sexual difference within his proposed aesthetics of self. The economy of difference which Derrida finds in operation under the motif of differance promises an ethics of difference which would include women. But, as he doesn't account explicitly for embodiment, Derrida has attracted the criticism that either differance is a co-option of the 'feminine' or has nothing to do with 'real-life women'. Drawing on my reading of Derrida's approach to difference, but highlighting the problem of embodiment, I return to the tradition with which Derrida and Foucault are engaged in order to locate the body of woman. ;My reading of Hegel's philosophy establishes that, for him, ethical action is based on the social constitution of the body as a sign of the self. This is drawn from his theory of the sign and his discussion of the mechanism of habit formation. I bring this reading to bear upon his discussion of 'ethical life' and sexual difference in the the Phenomenology of Spirit. ;The chapter on Nietzsche's philosophy begins with a reading of the relation between language, moral evaluation and the social constitution of the bodily self. I argue that Nietzsche's aesthetics of self is an ethics of difference pitted against a morality which assumes sameness and equality of outcome. Focusing on his notion of the 'pathos of distance' necessary for 'self-overcoming', I then locate the role of 'woman' within this ethics. ;My reading of Heidegger's early work finds that his analysis of Dasein's temporality allows for the conditions for the possibility of an ethics of difference against the normalising discourses of the 'they'. However, the distinctions he uses in this analysis are problematic as is his neglect of the question of embodiment. I bring my critique of these distinctions to Heidegger's claim that Dasein is sexually neutral and that sexual difference is an ontical 'dispersal into bodiliness and sexuality'. ;I conclude that, through their critiques of the social model of exchange between self-present individuals, all these theorists have something to offer an ethics of sexual difference. But only insofar as they do not forget the body of woman. (shrink)

Late in life, Foucault identified with “the critical tradition of Kant,” encouraging us to read both thinkers in new ways. Kant’s “Copernican” strategy of grounding knowledge in the limits of human reason proved to stabilize political, social-scientific, and medical expertise as well as philosophical discourse. These inevitable limits were made concrete in historical structures such as the asylum, the prison, and the sexual or racial human body. Such institutions built upon and shaped the aesthetic judgment of those considered (...) “normal.” Following Kant through all of Foucault’s major works, this book shows how bodies functioned as “problematic objects” in which the limits of post-Enlightenment European power and discourse were imaginatively figured and unified. It suggests ways that readers in a neoliberal political order can detach from the imaginative schemes vested in their bodies and experiment normatively with their own security needs. (shrink)

Late in life, Foucault identified with “the critical tradition of Kant,” encouraging us to read both thinkers in new ways. Kant’s “Copernican” strategy of grounding knowledge in the limits of human reason proved to stabilize political, social-scientific, and medical expertise as well as philosophical discourse. These inevitable limits were made concrete in historical structures such as the asylum, the prison, and the sexual or racial human body. Such institutions built upon and shaped the aesthetic judgment of those considered (...) “normal.” Following Kant through all of Foucault’s major works, this book shows how bodies functioned as “problematic objects” in which the limits of post-Enlightenment European power and discourse were imaginatively figured and unified. It suggests ways that readers in a neoliberal political order can detach from the imaginative schemes vested in their bodies and experiment normatively with their own security needs. (shrink)

ABSTRACT This article seeks to draw parallels between today’s transmodern reality and the events recounted in Margaret Atwood’s The Testaments and in The Handmaid’s Tale Hulu TV series, particularly Seasons 2 and 3. Addressing issues such as controlled reproduction, violence, corporeal subjection of women, and environmental injustice, I focus on the body as a site of social construction, vulnerability and control. Drawing on the work of various scholars, I argue that the body is simultaneously a site of vulnerability and (...) of resistance that exceeds totalitarian categories, thus allowing for empowering “modes of heterogeneity,” fluidity, diversity, environmental as well as transcorporeal. In Gilead, the totalitarian state where Atwood’s two novels are set, it is the body that is acted upon, with massive repression and violence, and it is the body that resists by forming alternative relations and practices, which eventually facilitate the fall of Gilead from within. Throughout my analysis, I draw on the transmodern concept, while widening it toward the corporeal enmeshment with others in order to demonstrate that it is the interdependence of vulnerability and empowerment that reveals transmodernity’s “new visions of justice.”. (shrink)

Paper-based stool records are used in public and private residential homes throughout Denmark. Although they represent a simple technology, they are an important tool in ensuring proper personal hygiene for residents. This article shows how the use of stool records involves both scientific and everyday forms of knowledge. While the activity of keeping stool records derives its legitimation from the scientific study of feces, those who work with the stool records on a daily basis have found some very different applications (...) for the technology. These applications foster a variety of understandings of stool records in residential homes. Is it their aim to help satisfy biological needs? Is it to ensure control? Is it to ensure individual freedom? Is it to ensure efficiency? Is it to display professionalism? Is it to maintain order in the everyday operation of the residential home? To explore the answers to these questions, the article introduces insight from the work of the German sociologist Niklas Luhmann that bear upon how a mundane technology like stool records can function as a mediator between theory and practice, the body and the social, and between different care tasks in residential homes. (shrink)

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period (...) of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Moses Maimonides: The Man and His WorksAlfred L. IvryHerbert A. Davidson. Moses Maimonides: The Man and His Works. New York: Oxford University Press, 2005. Pp. x + 567. Cloth, $45.00Herbert Davidson is a scholar of exceptional brilliance whose previous studies of medieval Jewish and Islamic philosophy have been widely acclaimed. In the present work, he ventures beyond philosophical argument to encompass an analysis of every aspect of (...) the life and work of one of the most celebrated—and controversial—figures in Jewish history, Moses Maimonides (1138–1204). In so doing, Davidson discloses a formidable knowledge of Talmud and rabbinic literature, as well as of the history, science, astronomy, medicine and philosophy of Maimonides' day. Davidson offers elegant descriptions and often challenging evaluations of Maimonides' life, education, and work: the rabbinic oeuvre, philosophical and medical treatises, and miscellaneous epistles.Maimonides' accomplishments do not include a number of works commonly but mistakenly attributed to him, in Davidson's opinion. He offers persuasive reasons (though admittedly not always conclusive proof) for rejecting Maimonidean authorship of a "Treatise on Logic," and the Epistles "In Opposition to Astrology" and "On Religious Persecution." Davidson's rejection of the last named epistle abets his interpretation of the early period of Maimonides' life, according to which he was not compelled to convert or to dissimulate a faith in Islam, as many think. [End Page 484]It is a cardinal principle for Davidson, though he does not identify the term as such, that Maimonides never practiced dissimulation in any significant way, or as Davidson sees it, that he did not lie. Davidson's Maimonides, for all the personal failings he notes, is a figure of immense rectitude and religious sincerity, to be taken at his word.Davidson comes, then, to defend Maimonides against his past and present critics who see esoteric and heretical teachings lurking behind Maimonides' protestations of orthodox belief. Davidson is no simple apologist for Maimonides, however, and does not hesitate to identify places in Maimonides' writings where the Master nodded. Such places abound for Davidson in Maimonides' philosophical masterpiece (as it is commonly thought), the Guide for the Perplexed, raising the strong suspicion that Davidson hardly regards it as such (creation arguments apart). He is much more taken with Maimonides' rabbinic acumen and achievements than with his philosophical work, arguing that Maimonides did not, when writing the Guide, have the time and concentration he possessed when composing the Commentary on the Mishnah and the Mishneh Torah.Davidson is assured by the strong and traditional affirmations of faith expressed in Maimonides' rabbinic writings that he maintained the same beliefs in his philosophy. The reconciliation of faith and reason is a theme that runs through all of Maimonides' writings. For Davidson this issues in a religious philosophy both radical and conservative: radical in that the Jewish God assumes an Aristotelian mien; conservative in that a "measure of personality" (365) is expressed through the act of creation and the performance of other miracles, notably the revelation at Sinai, prophecy, and resurrection. Problematic as he acknowledges the latter notion is for Maimonides, Davidson yet believes he held it.This is typical of Davidson's iconoclastic posture towards much of contemporary Maimonidean scholarship. Davidson does not believe Maimonides knew all that much philosophy and was not as careful with his writing as he claimed; that he did not have a first-hand knowledge of Aristotle, using Avicenna mostly instead; that his vaunted secret "Accounts of Creation and of the Chariot" were thinly disguised common notions of medieval physics and metaphysics; and that his entire claim to secret or esoteric teachings has none of the significance scholars in the past or present have given it.Here Davidson's bête noir is Leo Strauss, whom he regards as projecting his own dissimulating tactics upon Maimonides, turning him into an atheist (400). Davidson sees Shlomo Pines, adopting Strauss' methodology, as foisting an agnostic posture upon Maimonides. Davidson does not consider a Deistic alternative, probably assuming it incompatible with a creator God. Yet Maimonides' God functions dispassionately in His governance of the world, not knowing individuals directly, and offering them only a collective immaterial immortality.Maimonides exempts Moses and... (shrink)

Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due (...) to epistemic injustices and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles. (shrink)

This paper examines the relationship between medical technology and liminal states of “undeath” as presented in “The Facts in the Case of M. Valdemar” and the real-life case of Jahi McMath, who was maintained on life support for over four years following a diagnosis of brain death. Through this juxtaposition, “Valdemar” comes to function as a modern fable, an uneasy herald of medical technology’s potential to create liminal states between life and death. The ability to transgress these boundaries (...) bears a cost, however: both Valdemar and Jahi McMath lose the autonomy to direct their respective narratives. Yet, their utterances “from beyond the grave” highlight the precarious nature of their position and the ethical concerns therein. Poe’s literary performance of “undeath” therefore serves to caution real-life cases in which life support is used to sustain an individual reported to be brain-dead. Such application of life-sustaining technology complicates the fundamental binary of life/death, allowing its subjects to resist textual closure. Even as Poe’s work represents an imaginative interrogation of the scientific enterprise, this nineteenth-century story holds a mirror to contemporary medical practice, inviting a reconsideration of the ethics, language, and power relations surrounding the fraught relationship between death and medical technology. (shrink)

Within the fields of social medicine and the medical humanities, chronic illness is acknowledged not just as an individually but as a socially transformative experience. The proliferation of published ‘illness narratives’ in recent years attests to the socially compelling nature of this particular story of transformation. Indeed, illness narratives have, in the past decade or so, become a rich source of interest in sociological and medical anthropological work for their capacity to map the material transformation of person to (...) patient, of an assumed to a newly fluid model of subjectivity. Their significance is particularly visible in the cultural context of the west, where more people live both to be diagnosed with chronic illnesses (such as cancer) and to survive them. With a focus on two recently published Australian works, Eating the Underworld: A Memoir in Three Voices (2001), by the psychologist Doris Brett, and Tiger’s Eye: A Memoir (2001), by the historian Inga Clendinnen, this paper will consider how the illness experience marks a transformation of embodied subjectivity that, in turn, triggers transformations of other kinds. These works have quite different intents, but they provide models for exploring how physical and individual transformation through illness becomes the occasion for reconsidering the body of history, and of the resonances of history in social memory. (shrink)

This article develops a phenomenology of suffering with an emphasis on matters relevant to medical practice and bioethics. An attempt is made to explain how suffering can involve many different things—bodily pains, inability to carry out everyday actions, and failure to realize core life values—and yet be a distinct phenomenon. Proceeding from and expanding upon analyses found in the works of Eric Cassell and Elaine Scarry, suffering is found to be a potentially alienating mood overcoming the (...) person and engaging her in a struggle to remain at home in the face of loss of meaning and purpose in life. Suffering involves painful experiences at different levels that are connected through the suffering-mood but are nevertheless distinguishable by being primarily about my embodiment, my engagements in the world together with others, and my core life values. Suffering is in essence a feeling , but as such, it has implications for and involves the person’s entire life: how she acts in the world, communicates with others, and understands and looks upon her priorities and goals in life. Suffering-moods are typically intense and painful in nature, but they may also display a rather subconscious quality in presenting things in the world and my life as a whole in an alienating way. In such situations, we are not focused directly upon the suffering-mood—as in the cases of pain and other bodily ailments—but rather, upon the things that the mood presents to us: not only our bodies, but also other things in the world that prevent us from having a good life and being the persons we want to be. Such suffering may in many cases be transformed or at least mitigated by a person’s identifying and changing her core life values and in such a manner reinterpreting her life story to become an easier and more rewarding one to live under the present circumstances. (shrink)

BackgroundIt has been argued that ethics review committees—e.g., Research Ethics Committees, Institutional Review Boards, etc.— have weaknesses in reviewing big data and artificial intelligence research. For instance, they may, due to the novelty of the area, lack the relevant expertise for judging collective risks and benefits of such research, or they may exempt it from review in instances involving de-identified data.Main bodyFocusing on the example of medical research databases we highlight here ethical issues around de-identified data sharing which (...) motivate the need for review where oversight by ethics committees is weak. Though some argue for ethics committee reform to overcome these weaknesses, it is unclear whether or when that will happen. Hence, we argue that ethical review can be done by data access committees, since they have de facto purview of big data and artificial intelligence projects, relevant technical expertise and governance knowledge, and already take on some functions of ethical review. That said, like ethics committees, they may have functional weaknesses in their review capabilities. To strengthen that function, data access committees must think clearly about the kinds of ethical expertise, both professional and lay, that they draw upon to support their work.ConclusionData access committees can undertake ethical review of medical research databases provided they enhance that review function through professional and lay ethical expertise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Plato's Utopia Recast: His Later Ethics and PoliticsGeorge HarveyChristopher Bobonich. Plato's Utopia Recast: His Later Ethics and Politics. Oxford: Clarendon Press of Oxford University Press, 2002. Pp. xi + 643. Cloth, $49.95.In tracing developments in Plato's views between his middle- and late-period dialogues, Plato's Utopia Recast focuses on the differences between philosophers and non-philosophers with respect to their capacities to become genuinely virtuous. The central thesis of this (...) extensive work is that the Laws reveals a degree of optimism about the prospects for non-philosophers in attaining virtue and happiness not found in dialogues of the middle period. Specifically, Bobonich describes this development in terms of four claims that he thinks Plato denies in the Phaedo and Republic but later affirms in the Laws: first, that at least some non-philosophers are capable of being virtuous; second, that they can value virtue for its own sake; third, that they can value the virtue and happiness in others for its own sake; and fourth, that these non-philosophers are capable of living happy lives.Bobonich devotes most of the first chapter to describing Plato's pessimism about non-philosophers in the middle period. The cause for this pessimism is both epistemic and psychological. In the Phaedo, non-philosophers are incapable of knowing what is genuinely valuable. Failure to grasp non-sensible value properties means that in non-philosophers, reason simply takes over the ends defined by bodily impulses. The Republic is less pessimistic, but even here, Plato's tripartitioning of the soul makes clear that the rational part of the soul in non-philosophers fails to fulfill its proper ruling function. Bobonich's claim is that the more optimistic view presented in the Laws is indicative of developments not only in Plato's political theory, but also in the areas of psychology and epistemology.The central feature of the political theory advanced in the Laws is that the proper goal of legislation is not victory in war, but the cultivation of virtue in all citizens. More importantly for Bobonich, it suggests that all citizens, both philosophers and non-philosophers, are capable of attaining some degree of genuine virtue. For evidence of this, he points to the preludes that accompany each piece of legislation designed to provide a rational justification for what the laws command. In identifying virtue as the aim of legislation, Bobonich observes that the Laws endorses a dependency thesis about goods, making the value of a dependent good such as wealth, honor or military victory dependent upon its possessor being virtuous. His position is that Plato's endorsement of this dependency thesis in the Laws implies that ordinary citizens are capable of at least a partial grasp of what is genuinely valuable, making some degree of virtue and happiness attainable.Bobonich's view that this optimism about non-philosophers has implications for Plato's later epistemology and psychology is developed in the third and fourth chapters. He argues that the Republic's partitioning of the soul into three distinct, agent-like parts is abandoned in the later dialogues in favor of a more unified conception. This approach in the [End Page 334] middle period served to account for akratic action and the formation of non-rational desires, but Bobonich believes that Plato came to see this doctrine as ultimately flawed. By contrast, the Laws offers an account of akratic action and non-rational desire that maintains a unified subject and avoids the problems found in partitioning. In chapter four, Bobonich considers how the Laws' unified conception of the subject, supported by the Phaedrus, Philebus and Timaeus, reveals how all human aims and desires, both rational and non-rational, are structured and conceptualized through the soul's rational faculty. In this unified conception of the subject, Bobonich sees important implications for the role of non-rational elements in the ethical education of even ordinary human beings.In the fifth and final chapter, Bobonich returns to politics, and considers how Plato's conception of citizenship in the Laws reflects the more optimistic view of human nature. He examines how citizens in the Laws develop non-instrumental concerns for the happiness... (shrink)

Artificial intelligence is changing healthcare and the practice of medicine as data-driven science and machine-learning technologies, in particular, are contributing to a variety of medical and clinical tasks. Such advancements have also raised many questions, especially about public trust. As a response to these concerns there has been a concentrated effort from public bodies, policy-makers and technology companies leading the way in AI to address what is identified as a "public trust deficit". This paper argues that a (...) class='Hi'>focus on trust as the basis upon which a relationship between this new technology and the public is built is, at best, ineffective, at worst, inappropriate or even dangerous, as it diverts attention from what is actually needed to actively warrant trust. Instead of agonising about how to facilitate trust, a type of relationship which can leave those trusting vulnerable and exposed, we argue that efforts should be focused on the difficult and dynamic process of ensuring reliance underwritten by strong legal and regulatory frameworks. From there, trust could emerge but not merely as a means to an end. Instead, as something to work in practice towards; that is, the deserved result of an ongoing ethical relationship where there is the appropriate, enforceable and reliable regulatory infrastructure in place for problems, challenges and power asymmetries to be continuously accounted for and appropriately redressed. Data sharing not applicable as no datasets generated and/or analysed for this study. (shrink)

This article focuses on how the human body and body parts such as the legs, abdomen, and torso are conceptualized in Spanish director Pedro Almodóvar's films. The comparative analysis follows a qualitative methodology in which instances of the use of body parts are analyzed within their multimodal, sociocultural, and cinematic contexts. Through camera work and mise-en-scène, the actors' bodies and bodily functions are mapped onto complex cultural, social, and filmic targets within the narrative structure. Ultimately, the author (...) shows how artistic creativity is an activity whose purpose is a reembodiment of the emotion by visual and physical alteration. The new body is an environment onto which traditional views of the body based on folk theories are mapped, and body parts and functions are metonymically highlighted. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religion and the Body in Medical ResearchCourtney S. Campbell (bio)AbstractReligious discussion of human organs and tissues has concentrated largely on donation for therapeutic purposes. The retrieval and use of human tissue samples in diagnostic, research, and education contexts have, by contrast, received very little direct theological attention. Initially undertaken at the behest of the National Bioethics Advisory Commission, this essay seeks to explore the theological and religious questions (...) embedded in nontherapeutic use of human tissue. It finds that the “donation paradigm” typically invoked in religious discourse to justify uses of the body for therapeutic reasons is inadequate in the context of nontherapeutic research, while the “resource paradigm” implicit in scientific discourse presumes a reductionist account of the body that runs contrary to important religious values about embodiment. The essay proposes a “contribution paradigm” that provides a religious perspective within which research on human tissue can be both justified and limited.The retrieval and use of human tissue samples for diagnostic, therapeutic, research, and educational purposes represent further developments in scientific study of the human body as a source of medical information. Following the completion of its examination of the ethical and policy issues pertaining to human cloning in the spring of 1997, the National Bioethics Advisory Commission (NBAC) returned to the set of questions for which it had been originally constituted, including ethical issues that arise in human subjects research. One issue that proved controversial for the human genetics subcommittee of NBAC was the scientific, philosophical, and legal status of tissue and other body parts (usually surgical specimens) that had been retrieved from patients (not research subjects) who had given general consent to the use of their body materials for research and educational purposes. The subcommittee addressed questions about the adequacy of general versus specific [End Page 275] consent, the scientific merits of identifiable versus anonymous samples and claims about patient confidentiality, and the justification for patient refusals and requests that the materials be returned to the patient or discarded rather than made available for scientific research. In an effort to better understand the ramifications of research on human tissue, the subcommittee commissioned several background papers that examined these questions from ethical, legal, research, and religious perspectives. What follows is a modified version of the report on religious considerations originally presented to the genetics subcommittee of NBAC.The central question examined in this article is whether tissue banking for purposes of research presents distinctive theological issues or prompts objections from religious communities or scholars. Religious discussion of human organs and tissues has focused largely on donation for therapeutic purposes (what I describe as the “donation paradigm”); hence, there is very little direct consideration of nontherapeutic uses of such tissue. It is possible, however, to describe implications and suggest inferences by considering (1) religious attitudes to the human body and to organs, tissues, and cells removed from the body, and (2) religious discussions of modes of transfer of body parts, such as donations, offerings, sales, and abandonment. By and large, this discussion will reflect themes that emerge from the central Western religious traditions, with some attention given to Eastern and Native perspectives.The Body: Religious Holism, Scientific Reductionism, Private PropertyThe human body as an organic totality has long been the subject of theological reflection and a symbol for religious communities. However, much less attention has been devoted to the religious status of organs, tissues, cells, and DNA. The reflection of religious scholars and communities on the status of body parts has been prompted by the necessity to confront practical questions in personal and public health and in communal life, such as justifications for surgery, autopsies, organ donation, or burial. Scientific and research interest in parts of the body can sometimes conflict with religious values about bodily integrity. Indeed, E. Richard Gold cites the “disparate claims of scientific investigation and religious belief on the body” as the exemplary case of incommensurate values regarding the body. According to Gold (1996, p. 149), “The body, from a scientific viewpoint, is a source of knowledge of physical development, aging, and disease. From a religious perspective, the body is understood [End Page 276] as a sacred object, being created in the image... (shrink)

Knowledge management hinges upon the presumption that workers within an organization possess knowledge that can be converted into concrete business improvements if the information is harvested and disseminated to others to whom it could be of use. True knowledge management must involve capturing the internal knowledge generated by a firm—its best thinking on products, customers, competitors and processes—and sharing it. Insofar as organizations are concerned, postmodernists argue that one view that has been in appropriately privileged is that of the (...) organization rather than the process of organizing. They draw our attention to the link between individual and collective identity. If there is a link between individual identity and how that individual behaves, there may also a link between collective identity and organizational action, for which a study on discourse ethics is essential. After considering the implications of knowledge management and the actual situation and work culture where the knowledge workers are in action, this paper raises and explores the questions wherein lies our individual identity and what its functional relation ship with the collective identity is. It has been envisaged in this article that through principles-driven cross-functional teams and innovative organizational mechanisms, sharing and conviction building need to be facilitated in modern organizations phasing out bureaucratic approaches and hierarchical power domination. Flexibility with a focused attitude is a must for organizations to adapt in a changing environment. (shrink)

Knowledge management hinges upon the presumption that workers within an organization possess knowledge that can be converted into concrete business improvements if the information is harvested and disseminated to others to whom it could be of use. True knowledge management must involve capturing the internal knowledge generated by a firm—its best thinking on products, customers, competitors and processes—and sharing it. Insofar as organizations are concerned, postmodernists argue that one view that has been in appropriately privileged is that of the (...) organization rather than the process of organizing. They draw our attention to the link between individual and collective identity. If there is a link between individual identity and how that individual behaves, there may also a link between collective identity and organizational action, for which a study on discourse ethics is essential. After considering the implications of knowledge management and the actual situation and work culture where the knowledge workers are in action, this paper raises and explores the questions wherein lies our individual identity and what its functional relation ship with the collective identity is. It has been envisaged in this article that through principles-driven cross-functional teams and innovative organizational mechanisms, sharing and conviction building need to be facilitated in modern organizations phasing out bureaucratic approaches and hierarchical power domination. Flexibility with a focused attitude is a must for organizations to adapt in a changing environment. (shrink)

Described as one of the two fathers of medical law, Professor Peter Skegg has been a leading figure in the study of law and medicine. Over a 46 year academic career at the University of Auckland, University of Oxford, and the University of Otago, Professor Skegg has helped develop the field of medical law into a burgeoning academic discipline and has provided intellectual guardianship for the practice of law and medicine. This collection brings together contemporaries, colleagues, and former (...) students of Professor Skegg to celebrate his enduring contribution to the study of medical law. This edited collection contains twelve essays written by a range of internationally recognised medical lawyers. The topics cover the regulation of medical practitioners, consent, rights in bodily material, euthanasia, compensation and ethical approval for medical research, treatment orders for mental health conditions, and surrogacy laws. Whilst some of the essays return to territory that has been initially surveyed by Peter s research and analysis, others touch upon some wider medical law topics, illustrating Peter s lasting contribution to medical law as well as mapping out some of the new frontiers for the discipline of medical law. Academics, students and practitioners, from a range of jurisdictions, who are interested in how the law governs the provision of healthcare will benefit reading the various essays contained here. In addition, anyone who has had the good fortune of working with, or learning from, Professor Skegg will also enjoy the opportunity to return to the field of study that he founded. (shrink)

A classic avenue that victims can take to hold a corporation to account and obtain redress for the harms they have suffered is civil litigation. In the past decades, such attempts have been pursued against corporations in the tobacco industry, the pharmaceutical industry, the asbestos industry or industries working with asbestos and, more recently, the extractive industries. However, it is notoriously difficult for victims whose rights have been violated by corporations to obtain effective redress in civil procedures. A rich body (...) of burgeoning scholarly literature and policy documents has addressed the extent to which systematic and institutional factors are obstacles to victims seeking justice for corporate misconduct. In this article, we will not focus on these systemic and institutional factors but on the role of corporate defence lawyers as their functioning also impacts the capacity of victims of corporate wrongdoing to effectuate their rights. We will address the question of what can be expected from a legal-ethical point of view from corporate defence lawyers advising and representing their corporate clients in large-scale civil liability cases. As a partial answer, we will develop a critique of amoral lawyering as a working philosophy in this context. In addition, we will touch upon the feasibility of a possible alternative. (shrink)

Background The concept of “health security” is often used to motivate public health responses, yet the ethical values that underpin this concept remain largely unexamined. The recent Australian responses to COVID-19 serve as an important case study by which we can analyse the pre-existing literature to see what ethical values shaped, and continue to shape, Australia’s response. Methods We conducted a critical interpretive literature review of academic and grey literatures within key databases, resulting in 2,220 sources. After screening (...) for duplicates and relevance, we analysed ninety-six sources. Results First, risk and uncertainty are a leading focus, with a heavy concentration on risks to life and health. Second, free movement, safety, and security were recurringly emphasized, albeit narrowly focused upon the safety of the population. Third, legitimacy was a recurring theme, and it is here that discussions of “health security” figured highly. Conclusion Discussions of harm from government and associated official bodies fail to adequately distinguish between various senses of harm. Moreover, while the literature often discusses the balancing of rights, the steps involved in the weighing of these rights is rarely adequately explained and defended. We suggest that decision-makers should endeavour to clearly identify and defend the values undergirding their decisions in the public sphere. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

This book is a discussion of the most timely and contentious issues in the two branches of neuroethics: the neuroscience of ethics; and the ethics of neuroscience. Drawing upon recent work in psychiatry, neurology, and neurosurgery, it develops a phenomenologically inspired theory of neuroscience to explain the brain-mind relation. The idea that the mind is shaped not just by the brain but also by the body and how the human subject interacts with the environment has significant implications for free (...) will, moral responsibility, and moral justification of actions. It also provides a better understanding of how different interventions in the brain can benefit or harm us. In addition, the book discusses brain imaging techniques to diagnose altered states of consciousness, deep-brain stimulation to treat neuropsychiatric disorders, and restorative neurosurgery for neurodegenerative diseases. It examines the medical and ethical trade-offs of these interventions in the brain when they produce both positive and negative physical and psychological effects, and how these trade-offs shape decisions by physicians and patients about whether to provide and undergo them. (shrink)

Knowledge management hinges upon the presumption that workers within an organization possess knowledge that can be converted into concrete business improvements if the information is harvested and disseminated to others to whom it could be of use. True knowledge management must involve capturing the internal knowledge generated by a firm—its best thinking on products, customers, competitors and processes—and sharing it. Insofar as organizations are concerned, postmodernists argue that one view that has been in appropriately privileged is that of the (...) organization rather than the process of organizing. They draw our attention to the link between individual and collective identity. If there is a link between individual identity and how that individual behaves, there may also a link between collective identity and organizational action, for which a study on discourse ethics is essential. After considering the implications of knowledge management and the actual situation and work culture where the knowledge workers are in action, this paper raises and explores the questions wherein lies our individual identity and what its functional relation ship with the collective identity is. It has been envisaged in this article that through principles-driven cross-functional teams and innovative organizational mechanisms, sharing and conviction building need to be facilitated in modern organizations phasing out bureaucratic approaches and hierarchical power domination. Flexibility with a focused attitude is a must for organizations to adapt in a changing environment. (shrink)

In this book, Douglas Walton examines the philosophical nature of two issues currently associated with medical ethics. In order to work towards an analysis of the concept of death that could function as a target towards which the medical criteria of death could be directed, he proposes the foundations for a theory free of logical contradictions, paradoxes, and other perplexities. This is the "superlimiting theory" which introduces the notion of a "possible person." The connection of these philosophical ideas (...) with medico-legal concerns like brain death and the Harvard criteria is discussed. Professor Walton then goes on to examine the difference between killing and letting die. Through a close study of the logic of action sentences, he develops a model that is discussed in the light of the ethical and jurisprudential realities of medical ethics to see if the distinction between bringing something about and letting something happen is one that makes a moral difference in the evaluation of actions. Numerous problematic conceptual snags are dealt with, and the author consistently supports the conceptual clarity and respectability of the distinction. Other relevant discriminations of an action-theoretic sort, such as that between "direct" and "indirect" euthanasia, are studied, and the concluding chapter applies the conceptual analysis to a philosophical discussion of attitudes towards death, asking, "Is it rational to fear death?". (shrink)

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness (...) requires a process of re-identification. Medical interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has. (shrink)

It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how (...) the adult's right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views. (shrink)

Modern medicine has produced many wonderful technological breakthroughs that have extended the limits of the frail human body. However, much of the focus of this medical research has been on the physical, often reducing the human being to a biological machine to be examined, understood, and controlled. This book begins by asking whether the modern medical milieu has overly objectified the body, unwittingly or not, and whether current studies in bioethics are up to the task of restoring (...) a fuller understanding of the human person. In response, various authors here suggest that a more theological/religious approach would be helpful, or perhaps even necessary. Presenting specific perspectives from Judaism, Christianity and Islam, the book is divided into three parts: "Understanding the Body," "Respecting the Body," and "The Body at the End of Life." A panel of expert contributors—including philosophers, physicians, and theologians and scholars of religion— answer key questions such as: What is the relationship between body and soul? What are our obligations toward human bodies? How should medicine respond to suffering and death? The resulting text is an interdisciplinary treatise on how medicine can best function in our societies. Offering a new way to approach the medical humanities, this book will be of keen interest to any scholars with an interest in contemporary religious perspectives on medicine and the body. (shrink)

Surgeries inevitably raise questions of bodily integrity: how the post-surgical body reframes (or does not reframe) its experiences of functionality to incorporate new features. Nevertheless, when we try to define or delimit the concept of bodily integrity, it becomes increasingly important to think about how the physical and social unease caused by some forms of surgeries sits alongside the more transformative potential of surgical bodily modification. This article focuses on aesthetic genital surgeries on infants with disorders of (...) sex development (DSD, previously termed ‘intersex’ conditions). Using the work of Pierre Bourdieu and Elizabeth Freeman on time, bodies and ‘chrononormativity’, this article excavates not only the temporalities that produce what I would term ‘chrono-abnormalities’ of sex development, but also the temporalized medical responses, including surgeries, which retrieve ‘abnormal’ bodies into more normative time-lines. My conclusion is that when DSD-affected individuals experience aesthetic genital surgeries as painful and full of social unease this is not necessarily because the pre-surgical body was the ‘natural’, ‘whole’ or ‘intact’ body prior to surgery. Instead, it is because these surgeries interrupt what Bourdieu would term a sense of corporeal ‘immersion into the forthcoming’; an immersion which, in his theory of time as social action, is intimately linked with social power and possibilities. (shrink)

The historical context of body and tissue donation is deeply problematic, with patriarchal and colonial narratives. The contemporary context of molecular and genetic biology further complicates issues of bodily donation through narratives of abstraction and extraction. As practitioners working outside the conventional boundaries of scientific study learn the tools and techniques to extract and use bodily materials, they are also learning and challenging the procedures and processes. This article approaches questions of bodily donation through the edited transcript (...) of a conversation between artists who regularly use body fluids and cellular bodily materials in their practice, moderated by Louise Mackenzie and Ilke Turkmendag as part of the Taboo–Transgression–Transcendence in Art & Science Conference held online with the support of the University of Applied Arts, Vienna, 2020. The panel challenged the ethical and conceptual assumptions made in biotechnological research and reconsidered where the boundaries of the body lie, what ‘authority’ research carries and what choices researchers make when using the bodies of others. The transcribed conversation addresses taboos of the female body, specifically menstruation, the commodification of tissue from female human bodies, human milk politics and questions biopolitical treatment of the female body. The full, unedited panel conversation, including questions from the audience, and an accompanying video of edited interviews with panellists, is available online at https://www.loumackenzie.com/offering-the-body. (shrink)

These essays examine the ways in which the consideration of ethical questions is shaped by the structures of knowledge and communication at work in clinical ...

Empirical studies on people's moral attitudes regarding ethically challenging topics contribute greatly to research in medical ethics. However, it is not always clear in which ways this research adds to medical ethics as a normative discipline. In this article, we aim to provide a systematic account of the different ways in which attitudinal research can be used for normative reflection. In the first part, we discuss whether ethical judgements can be based on empirical work alone and we (...) develop a sceptical position regarding this point, taking into account theoretical, methodological and pragmatic considerations. As empirical data should not be taken as a direct source for normative justification, we then delineate different ways in which attitudes research can be combined with theoretical accounts of normative justification in the second part of the article. Firstly, the combination of attitudes research with normative-ethical theories is analysed with respect to three different aspects: The extent of empirical data which is needed, the question of which kind of data is required and the ways in which the empirical data are processed within the framework of an ethical theory. Secondly, two further functions of attitudes research are displayed which lie outside the traditional focus of ethical theories: the exploratory function of detecting and characterising new ethical problems, and the field of ‘moral pragmatics’. The article concludes with a methodological outlook and suggestions for the concrete practice of attitudinal research in medical ethics. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the (...) Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the (...) Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the (...) Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

Studies have shown that students may feel emotional discomfort when they are asked to identify ethical problems which they have encountered during their training. Teachers in medical ethics, however, more often focus on the cognitive and rational ethical aspects and not much on students’ emotions. The purpose of this qualitative study was to explore students’ feelings and emotions when dealing with ethical problems during their clinical training and explore differences between two countries: Indonesia and the (...) Netherlands. We observed a total of eighteen ethics group discussions and interviewed fifteen medical students at two medical schools. Data were interpreted and analyzed using content analysis. We categorized students’ negative emotions based on their objects of reflection and came up with three categories: emotions concerning their own performance, emotions when witnessing unethical behaviors, and emotions related to barriers and limitations of their working environment. Our study suggests that addressing emotional responses in a culturally sensitive way is important to develop students’ self-awareness. Teachers should be able to guide students to reflect on and be critical of their own thoughts and emotions, to understand their own moral values, especially when confronted with other individuals. (shrink)

This paper explores how managers and professionals from two functional areas, finance and accountancy and human resource management, perceive, think about and act upon ethical conundrums at work. The study is based on 43 interviews in which respondents were asked to report on ethical issues and incidents they had experienced at work. A conceptual framework is presented which is used to analyse the critical incidents.

In this book Raymond L. Weiss examines how a seminal Jewish thinker negotiates the philosophical conflict between Athens and Jerusalem in the crucial area of ethics. Maimonides, a master of both the classical and the biblical-rabbinic traditions, reconciled their differing views of morality primarily in the context of Jewish jurisprudence. Taking into consideration the entire corpus of Maimonides' writings, Weiss focuses on the ethical sections of the Commentary on the Mishnah and the Mishneh Torah , but also discusses the (...) Guide of the Perplexed , the letters of Maimonides, and his medical works. The gulf between classical philosophy and the Torah made the task of Maimonides extraordinarily difficult. Weiss shows that Maimonides subtly preserves the tension between those traditions while producing a practical accommodation between them. To explain how Maimonides was able to accomplish this twofold goal, Weiss takes seriously the multilevel character of Maimonides' works. Weiss interrupts Maimonides as a heterodox thinker who, with utter integrity, faces the Law's encounter with philosophy and gives both the Torah and philosophy their due. (shrink)

BackgroundOne of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it.MethodsWe conducted 20 in-depth interviews and 3 virtual focus groups among four types of key (...) stakeholders in the United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable.ResultsAll four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL.ConclusionBecause of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings. (shrink)

Medical therapy, research and technology enable us to make our bodies, or parts of them, available to others in an increasing number of ways. This is the case in organ, tissue, egg and sperm donation as well as in surrogate motherhood and clinical research. Bringing together leading scholars working on the ethical, social and cultural aspects of such bodily exchanges, this cutting-edge book develops new ways of understanding them. Bodily Exchanges, Bioethics and Border Crossing both (...) probes the established giving and selling frameworks for conceptualising bodily exchanges in medicine, and seeks to develop and examine another, less familiar framework: that of sharing. A framework of sharing can capture practices that involve giving up and giving away part of one's body, such as organ and tissue donation, and practices that do not, such as surrogacy and research participation. Sharing also recognizes the multiple relationalities that these exchanges can involve and invites inquiry into the context in which they occur. In addition, the book explores the multiple forms of border crossing that bodily exchanges in medicine involve, from the physical boundaries of the body to relational borders - as can happen in surrogacy - to national borders and the range of ethical issues that these various border-crossings can give rise to. Engaging with anthropology, sociology, philosophy, and feminist and postcolonical perspectives, this is an original and timely contribution to contemporary bioethics in a time of increasing globalization. It will be of use to students and researchers from a range of humanities and social science backgrounds as well as medical and other healthcare professionals with an interest in bioethics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Changing Functions, Moral Responsibility, and Mental IllnessCraig Edwards (bio)Keywordsmental illness, responsibility, character, dysfunction, personhoodI thank both Wakefield and Tomasini for their illuminating comments. Both commentaries are thought provoking and warrant a full response. However, as always, space is limited and I must make the all-too-predictable apology for not addressing both commentaries in full. Wakefield's contribution more directly engages with, and challenges, my claims, and so I focus (...) on addressing his concerns.ClarificationsWakefield correctly notes that I am interested in how mental illness (and illness generally) operates to remove moral responsibility for one's actions. Despite this, it seems at several points that he and I are talking about two different, albeit related, concepts of mental illness. 'Mental illness' is used to both explain and excuse certain behaviors, but these two functions, explanatory and exculpable, do not always operate simultaneously. As we discover biological explanations for apparently immoral behaviors, the question arises as to whether the explanation should remove the immorality and liability for punishment. The 'sick role' can be divided into two aspects. One is the role of deserving and warranting medical treatment. The other is the negation of moral responsibility. Wakefield's own example, pedophilia, involves the first sense of the sick role but not the second. Wakefield's use of this example is unusual, because it deftly highlights the limitation of his HD account. Pedophilia is a mental disorder in the sense of warranting treatment, and is a mental illness under Wakefield's model, but it is not something that negates moral responsibility. There is a sense of the term 'mental illness'—an important and, as I argue, an objective sense—that is relevant to establishing one's moral responsibility for such behaviors.In addressing my account of mental illness as though it contained two distinct answers, 'mental illness as dysfunction of rational agency, or 'mental illness as moral judgment,' it is unclear whether Wakefield takes them to be conjunctive or alternative. Hence it is worth reiterating in point form the structure of my account:1. Illness involves dysfunction;2. The 'proper function' of a bodily or psychological mechanism is determined by the purpose that we impose upon that mechanism (within the constraints of our biological needs);3. Dysfunction of rational agency is necessary, but not sufficient, for 'mental illness' in the normative sense relevant to negating moral responsibility; and [End Page 105]4. The distinction between 'mental illness' (in the above sense) and the many dysfunctions of rational agency for which we are morally responsible, turns upon (objective) normative facts rather than features internal to the dysfunctions themselves.Functions and ValueWakefield misses the point when he criticizes my comment that, although bodily mechanisms are fairly uniformly valued, there is substantial historical and cross-cultural variation in the way people value personhood. He notes—accurately, but irrelevantly—that people almost always place great value on their capacity for rational agency, probably more so than many aspects of their physical health. My comment, taken in context, has nothing to do with how much people value personhood, but has everything to do with what kinds of purposes people want their mental and physical processes to achieve. A heart has the same function for a Londoner today as it did for a Japanese peasant a thousand years ago, and although it is possible for us to want it to achieve other purposes, any culture that seriously imputes a different set of vital functions on the heart is likely to be rather disappointed. By contrast, our species has experienced vast changes in the demands we make of our rational and intellectual capacities—dysfunctions like dyslexia and alcoholism were irrelevant before the availability of written communication and alcohol.Wakefield's HD account is unable to deal with the relevance of such change. The link between evolutionary function and illness is tenuous in any event. Evolutionary explanations of specific mechanisms are often untestable, simply positing some evolutionary purpose that happens to fit our understanding of what the mechanism does. If we were to discover that alcoholism evolved as a means of increasing birthrates, or (perhaps more plausibly) that anxiety disorders occur among those for whom... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture provided an (...) interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

The field of Neuro-Engineering seems to be on the fast track towards accomplishing its ultimate goal of potentially replacing the nervous system in the face of disease. Meanwhile, the patients and professionals involved are continuously dealing with human bodily experience and especially how neuro-engineering devices could become part of a user’s body schema: the domain of ‘embodied phenomenology’. This focus on embodiment, however, is not sufficiently reflected in the current literature on ethical and philosophical issues in neuro-engineering. (...) In this article we will focus on this lacuna by explaining existing data on neuro-engineering user’s experiences by using phenomenological concepts such as transparency and the concepts that may facilitate this: functionality, sensorimotor feedback and affective tolerance. By introducing and applying these concepts to four real life case examples, we will discuss practical implications and guidelines which can contribute to the actual success of incorporation of the device by the patient. First, we will discuss the importance of a ‘Patient Preference Diagnosis’, which can serve as a way to prepare the patient for the existential reorientation involved in the process. In addition, a Patient Transparency Diagnosis during and after such a process is also relevant when wanting to provide the medical field in general with feedback, and the patient in particular with possibilities to fine-tune the device. From these practical guidelines we will conclude that the phenomenological approach can be very valuable when applied to the field of neuro-engineering. (shrink)

The field of Neuro-Engineering seems to be on the fast track towards accomplishing its ultimate goal of potentially replacing the nervous system in the face of disease. Meanwhile, the patients and professionals involved are continuously dealing with human bodily experience and especially how neuro-engineering devices could become part of a user’s body schema: the domain of ‘embodied phenomenology’. This focus on embodiment, however, is not sufficiently reflected in the current literature on ethical and philosophical issues in neuro-engineering. (...) In this article we will focus on this lacuna by explaining existing data on neuro-engineering user’s experiences by using phenomenological concepts such as transparency and the concepts that may facilitate this: functionality, sensorimotor feedback and affective tolerance. By introducing and applying these concepts to four real life case examples, we will discuss practical implications and guidelines which can contribute to the actual success of incorporation of the device by the patient. First, we will discuss the importance of a ‘Patient Preference Diagnosis’, which can serve as a way to prepare the patient for the existential reorientation involved in the process. In addition, a Patient Transparency Diagnosis during and after such a process is also relevant when wanting to provide the medical field in general with feedback, and the patient in particular with possibilities to fine-tune the device. From these practical guidelines we will conclude that the phenomenological approach can be very valuable when applied to the field of neuro-engineering. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Good of Recognition: Phenomenology, Ethics, and Religion in the Thought of Lévinas and Ricœur by Michael SohnLevi CheckettsThe Good of Recognition: Phenomenology, Ethics, and Religion in the Thought of Lévinas and Ricœur Michael Sohn WACO, TX: BAYLOR UNIVERSITY PRESS, 2014. 172 PP. $69.95Michael Sohn's book The Good of Recognition: Phenomenology, Ethics, and Religion in the Thought of Lévinas and Ricœur explores the philosophical and religious writings of (...) two of twentieth-century France's most significant thinkers, Paul Ricœur and Emmanuel Lévinas, "to gain, by thinking with and through them, an insight into the phenomenon of recognition" (128). Recognition, to these authors, is not merely an act of re-cognition (identifying something one already knows), nor is it simple cognition (consciousness of something). For Lévinas, to whom Ricœur is indebted for his own work, recognition precedes ontological identification and is a "sensation of the infinite" in the Other (29). Recognition entails "a primordial ethical claim by the other" (57), up to and including self-sacrifice. For Ricœur, on the other hand, recognition of the other is situated in the "loving struggle for existence" between people seeking mutual recognition (72) and presents itself as "one among many sources of value and motivation" [End Page 207] for moral decision (81). In other words, while recognition of the other is a central concept in both authors' ethical writings, Sohn notes that "Lévinas' phenomenological description of recognition emerges out of a fundamental project to uncover the principle of all principles," while "Ricœur's attention to the locus of will integrates passivity and activity as it is taken up within the dialectic of the voluntary and the involuntary," making recognition one value among others (127).In highlighting the different positions of each of these authors, Sohn structures his writing in a highly systematized and clear way. He first divides the book broadly by author, then for each author devotes a chapter each to philosophical and religious approaches to recognition. Within each chapter, he outlines the intellectual influences for the given author, then articulates in turn the phenomenon, the ethics, and the politics of recognition. This tactic serves as a helpful reference for readers interested in Sohn's comparative project, though it sometimes leads to repetition insofar as there are overlaps in how different thinkers, philosophical schools, or principles function for each area. The overall project is framed by an introductory chapter that briefly outlines the main points of discussion throughout the book and a conclusion that summarizes, compares, and contextualizes the significance of the project. Sohn offers this text as a clarifying study of the phenomenon of recognition, a term the application of which "touches upon a broad spectrum of issues ranging from battles over multiculturalism to questions of national sovereignty and from matters of international human rights to social movements within feminism and human rights" (135). With such a broad range of applications, this relatively short examination of two pivotal thinkers' works on recognition is highly valuable.This work will be of interest to ethicists hoping to use the works of Ricœur or Lévinas, or to philosophers and historians interested in the development of recognitionbased ethics. Sohn provides thorough citations from the broad corpuses of both authors, giving students of either philosopher a helpful resource both for summarizing ideas and for carrying out research. Sohn also provides deep intellectual genealogies for each author, noting how thinkers such as Edmund Husserl, Karl Jaspers, Karl Barth, G.W.F. Hegel, Immanuel Kant, and their interpreters influenced Lévinas and Ricœur; he downplays the influence of thinkers like Martin Heidegger, Martin Buber, and Gabriel Marcel. This book does offer useful and clear summaries of the main ideas discussed, but it may be difficult for newer students unfamiliar with French language or philosophical concepts. Overall, this book is a valuable reference tool for Lévinas and Ricœur studies, especially those that focus on the phenomenology, religious thought, ethics, or politics of these two men. [End Page 208]Levi CheckettsGraduate Theological UnionCopyright © 2017 Society of Christian Ethics... (shrink)

How do Goya's representations of the body disrupt the Enlightenment's configurations of the corporeal? If for eighteenth-century aesthetics the body is both the site of ideal beauty and the limit of what can and may be represented, then Goya's panoply of monsters provides a way of understanding other modes of reason(ing), other ways of representing the body and its functions within culture. In his work there is a recuperation of those elements that seem to lie outside the ken of (...) the Enlightenment project: physicality, animality, hybridity, the grotesque, the popular; a recognition of the animal nature of the body and the products of bodily impulses and forces. A rethinking of the body would incorporate an understanding of its role as a physical and social phenomenon in the constitution of the subject. Following on from Paul Ilie's concept of counter-rational Reason, which he defines as the opposite of a uniform centre of rationality in representative thought, the first half of my paper will consider Goya's problematization of representation. My analysis of a selection of drawings from the collection Los Caprichos (1799) will focus not just on the representation of bodies in the painter's work but on his exploration of bodies in their material variety—configurations of modes of constructing the body. This examination of Goya's prolific pictorial negotiations and adaptations of flesh and world will draw upon contemporary approaches to theorizing the body, namely the theories of Julia Kristeva and Elizabeth Grosz. (shrink)

How do Goya's representations of the body disrupt the Enlightenment's configurations of the corporeal? If for eighteenth-century aesthetics the body is both the site of ideal beauty and the limit of what can and may be represented, then Goya's panoply of monsters provides a way of understanding other modes of reason, other ways of representing the body and its functions within culture. In his work there is a recuperation of those elements that seem to lie outside the ken of (...) the Enlightenment project: physicality, animality, hybridity, the grotesque, the popular; a recognition of the animal nature of the body and the products of bodily impulses and forces. A rethinking of the body would incorporate an understanding of its role as a physical and social phenomenon in the constitution of the subject. Following on from Paul Ilie's concept of counter-rational Reason, which he defines as the opposite of a uniform centre of rationality in representative thought, the first half of my paper will consider Goya's problematization of representation. My analysis of a selection of drawings from the collection Los Caprichos will focus not just on the representation of bodies in the painter's work but on his exploration of bodies in their material variety—configurations of modes of constructing the body. This examination of Goya's prolific pictorial negotiations and adaptations of flesh and world will draw upon contemporary approaches to theorizing the body, namely the theories of Julia Kristeva and Elizabeth Grosz. (shrink)

In this book, Douglas Walton examines the philosophical nature of two issues currently associated with medical ethics. In order to work towards an analysis of the concept of death that could function as a target towards which the medical criteria of death could be directed, he proposes the foundations for a theory free of logical contradictions, paradoxes, and other perplexities. This is the "superlimiting theory" which introduces the notion of a "possible person." The connection of these philosophical ideas (...) with medico-legal concerns like brain death and the Harvard criteria is discussed. Professor Walton then goes on to examine the difference between killing and letting die. Through a close study of the logic of action sentences, he develops a model that is discussed in the light of the ethical and jurisprudential realities of medical ethics to see if the distinction between bringing something about and letting something happen is one that makes a moral difference in the evaluation of actions. Numerous problematic conceptual snags are dealt with, and the author consistently supports the conceptual clarity and respectability of the distinction. Other relevant discriminations of an action-theoretic sort, such as that between "direct" and "indirect" euthanasia, are studied, and the concluding chapter applies the conceptual analysis to a philosophical discussion of attitudes towards death, asking, "Is it rational to fear death?". (shrink)