Volume 30, Issue 1, March 2024, Page 83-88.

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like (...) the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

Although much has been written on the dead-donor rule in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of (...) the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward. (shrink)

The biophilosophic justification for the idea that “brain death” is death needs to support two claims: that what dies in human death is a human organism, not merely a psychological entity distinct from it; that total brain failure signifies the end of the human organism as a whole. Defenders of brain death typically assume without argument that the first claim is true and argue for the second by defending the “integrative unity” rationale. Yet the integrative unity rationale has fallen on (...) hard times. In this article, I give reasons for why we should think of ourselves as organisms, and why the “fundamental work” rationale put forward by the 2008 President’s Council is better than the integrative unity rationale, despite persistent objections to it. (shrink)

Arian Lewis provides a comprehensive overview of how the United Kingdom’s medicolegal context manages challenges to determining death by neurologic criteria (DNC) and suggests that a well-crafted s...

Shavelson et al., argues that California’s End of Life Option Act (ELOA) violates the Americans with Disabilities Act (ADA), because the ELOA requires the patient to “self-administer” their prescri...

Nielsen Bush and Mjaaland (“the authors” hereafter) argue that controlled donation after circulatory death (cDCD) protocols that target abdominal organs are consistent with the dead donor rule (DDR...

There are increasing calls for rejecting the ‘dead donor’ rule and permitting ‘organ donation euthanasia’ in organ transplantation. I argue that the fundamental problem with this proposal is that it would bestow more worth on the organs than the donor who has them. What is at stake is the basis of human equality, which, I argue, should be based on an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be (...) to make our worth contingent upon variable quality of life of judgments that can only be based on properties that come in degrees. Thus, rejecting the ‘dead donor’ rule comes at the expense of our egalitarian principles with respect to the value each individual human life has in relation to the protections against killing. (shrink)

The dead donor rule (DDR) prohibits retrieval protocols that would be lethal to the donor. Some argue that compliance with it can be maintained by satisfying the requirements of double‐effect reasoning (DER). If successful, one could support organ donation without reference to the definition of death while being faithful to an ethic that prohibits intentionally killing innocent human life. On the contrary, I argue that DER cannot make lethal organ donation compatible with the DDR, because there are plausible ways it (...) fails DER's requirements. A key takeaway is that the theories of intention and proportionality assumed in DER matter for its plausibility as a constraint on practical reasoning. (shrink)

The articles by Bernat, Busch, Dudzinski et al., and Derse illustrate the difficulties with reconciling normothermic regional perfusion (NRP) with the dead donor rule (DDR) (Bernat forthcoming; Busch forthcoming; Dudzinski et al. forthcoming; Derse forthcoming). I appreciate their arguments because they help illuminate the issues that generate a dilemma: either reject NRP or the DDR. I am convinced that the dilemma is unavoidable because the procurement team is involved with determining and securing the death of the donor when circulation restarts. (...) Evidence for this is found in the reasons and recommendations given for blocking blood flow to the brain, both of which betray a lack of certainty over the donor’s vital status. The surgical activity in NRP therefore conflicts with the values the DDR protects: respect for the donor’s life and avoidance of conflict of interest. (shrink)

Walter Sinnott-Armstrong and Franklin G Miller recently argued that the wrongness of killing is best explained by the harm that comes to the victim, and that ‘total disability’ best explains the nature of this harm. Hence, killing patients who are already totally disabled is not wrong. I maintain that their notion of total disability is ambiguous and that they beg the question with respect to whether there are abilities left over that remain relevant for the goods of personhood and human (...) worth. If these goods remain, then something more is lost in death than in ‘total disability,’ and their explanation of what makes killing wrong comes up short. But if total disability is equivalent with death, then their argument is an interesting one. (shrink)

In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...) and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP. (shrink)

The themes of this issue—which include the meaning of our health and disease concepts, the so-called “medical gaze” and its embedded power relations, and the epistemic value of mixing therapy with research—are introduced by reflecting on a case about an infant girl whose head is observed to be somewhat flat.

In a recent article Steven Cowan defended the claim that female subordination and male authority are merely functional differences. Drawing insights from Natural Law, I argue that complementarianism typically speaks of these as proper functions of male and female designs, thus making men and women metaphysically unequal in being. Furthermore, I maintain that the function "serving as a means to an end" is less valuable than the function "having the authority to direct the end." Hence, Cowan fails to defeat the (...) objection that the claim that women are equal to men in being, but subordinate in role is incoherent. (shrink)

In this paper, I introduce the ideas to be discussed in the articles of this journal with reference to an imaginary case involving a pregnant woman declared dead on the basis of neurological criteria. I highlight the fact that although these ideas have proved useful for advancing certain claims in bioethical debates, their implications are not always well understood and may complicate our arguments. The ideas to be discussed are an ethic internal to the profession of medicine; the difference between (...) killing and letting die; the organism as a whole; and the “lives” and interests of the dead. (shrink)

Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the (...) institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process. (shrink)

Smith argues that death caused by transplant surgery will not harm permanently unconscious patients, because they will not suffer a setback to their interests in the context of donation. Therefore, so the argument goes, the dead donor rule can be abandoned, because requiring a death declaration before procurement does not protect any relevant interest from being thwarted. Smith contends that a virtue of his argument is that it avoids the controversies over defining and determining death. I argue that it does (...) not and explain why no change in policy is justified. (shrink)

Giubilini and Minerva argue that the permissibility of abortion entails the permissibility of infanticide. Proponents of what we refer to as the Birth Strategy claim that there is a morally significant difference brought about at birth that accounts for our strong intuition that killing newborns is morally impermissible. We argue that strategy does not account for the moral intuition that late-term, non-therapeutic abortions are morally impermissible. Advocates of the Birth Strategy must either judge non-therapeutic abortions as impermissible in the later (...) stages of pregnancy or conclude that they are permissible on the basis of premises that are far less intuitively plausible than the opposite conclusion and its supporting premises. (shrink)

In ‘Dilemma for Appeals to the Moral Significance of Birth’, we argued that a dilemma is faced by those who believe that birth is the event at which infanticide is ruled out. Those who reject the moral permissibility of infanticide by appeal to the moral significance of birth must either accept the moral permissibility of a late-term abortion for a non-therapeutic reason or not. If they accept it, they need to account for the strong intuition that her decision is wrong (...) as well as deny the underlying normative principle that killing a viable fetus requires good reason, and not wanting to care for the child when the child could be easily placed for adoption is not a good enough reason to abort. If they reject the moral permissibility of the late-term abortion, they need to explain why her decision is wrong. Doing so, however, will undermine their own project of denying infanticide by appeal to birth. Walter Veit argues that the dilemma relies too much on intuition and does not live up to biological continuity. We explain why his criticisms are unconvincing. (shrink)

Benjamin Gregg’s Creating Human Nature: The Political Challenges of Genetic Engineering is a wide-ranging and controversial approach to the politics of genetic engineering. The book consists of thr...

Joshua Mezrich is a practicing transplant surgeon who draws on his experiences, and those of his patients, to provide a "here's where we're at" moment in the story of transplant medicine. In so doing, he explains what it is like to practice while telling the stories of his patients, donors, and the pioneering surgeons who persisted in the face of failure to make what Mezrich does a work of healing. Written for a popular audience, When Death Becomes Life is perhaps (...) the most accessible work yet on the modern history of organ transplantation and what the current "standard of care" actually looks like. Indeed, it rounds out a "trinity" of quality books about the transplant experience, this one from the surgeon's... (shrink)

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of (...) the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk. (shrink)

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of (...) xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research. (shrink)

n recent years, there has been a resurgence of academic interest in Adam Smith. As a consequence, a large number of PhD dissertations on Smith have been written by international scholars - in different languages, and in many diverse disciplines, including economics, women’s studies, philosophy, science studies, political theory and english literature: diversity which has enriched the area of study. In response to this activity, and in order to making these contributions more easily accessible to other Smith scholars, Leonidas (...) Montes and Eric Schliesser have edited this important new book. Of interest to Smith scholars and those interested in the history of economic thought in general, the contributions to this book are self-consciously interdisciplinary and skilfully employ many different methodologies. (shrink)

Adam Omelianchuk argues that my defense of the distinction between woman’s equality in being and subordinate role fails. I respond that his case misses the point of certain aspects of my argument, that it begs the main question, and that it depends upon an unclear notion of metaphysical equality/inferiority.

Two complete eBooks for one low price! Created and compiled by the publisher, this Philosophy & Ethics bundle brings together two important titles in one, e-only bundle. With this special bundle, you’ll get the complete text of the following two titles: _Philosophy For Dummies_ _Philosophy For Dummies_ is for anyone who has ever entertained a question about life and this world. In a conversational tone, the book's author – a modern-day scholar and lecturer – brings the greatest wisdom of the (...) past into the challenges that we face now. This refreshingly different guide explains philosophical fundamentals and explores some of the strangest and deepest questions ever posed to human beings, such as: How do we know anything? What does the word _good_ mean? Are we ever really free? Do human beings have souls? Is there life after death? Is there a God? Is happiness really possible in our world? _Ethics For Dummies_ An easy-to-grasp guide to addressing the principles of ethics and applying them to daily life How do you define "good" versus "evil?" Do you know the difference between moral "truth" and moral relativity? Whether or not you know Aristotle from Hume, _Ethics For Dummies_ will get you comfortable with the centuries-old study of ethical philosophy quickly and effectively! _Ethics For Dummies_ is a practical, friendly guide that takes the headache out of the often-confusing subject of ethics. In plain English, it examines the controversial facets of ethical thought, explores the problem of evil, demystifies the writings and theories of such great thinkers through the ages as Aristotle, Confucius, Descartes, Kant, Nietzsche, and so much more. You’ll learn how to apply the concepts and theories of ethical philosophy to your everyday life. Whether you're currently enrolled in an ethics course or are interested in living a good life but are vexed with ethical complexities_, Ethics For Dummies_ has you covered! About the Author of _Philosophy For Dummies_ Tom Morris, Ph.D., author of True Success and other books, taught philosophy at Notre Dame University for 15 years and currently heads the Morris Institute for Human Values. About the Authors of _Ethics For Dummies_ Christopher Panza, PhD, is an associate professor of philosophy at Drury University and coauthor of Existentialism For Dummies. Adam Potthast, PhD, is an assistant professor of philosophy at Missouri University of Science and Technology. (shrink)

Perception is one of the most pervasive and puzzling problems in philosophy, generating a great deal of attention and controversy in philosophy of mind, psychology and metaphysics. If perceptual illusion and hallucination are possible, how can perception be what it intuitively seems to be, a direct and immediate access to reality? How can perception be both internally dependent and externally directed? Perception is an outstanding introduction to this fundamental topic, covering both the perennial and recent work on the problem. (...) class='Hi'>Adam Pautz examines four of the most important theories of perception: the sense datum view; the internal physical state view; the representational view; and naïve realism, assessing each in turn. He also discusses the relationship between perception and the physical world and the issue of whether reality is as it appears. Useful examples are included throughout the book to illustrate the puzzles of perception, including hallucinations, illusions, the laws of appearance, blindsight, and neuroscientific explanations of our experience of pain, smell and color. The book covers both traditional philosophical arguments and more recent empirical arguments deriving from research in psychophysics and neuroscience. The addition of chapter summaries, suggestions for further reading and a glossary of terms make Perception essential reading for anyone studying the topic in detail, as well as for students of philosophy of mind, philosophy of psychology and metaphysics. (shrink)

An argument for the inclusion of the human perspective within science and how it makes science possible.

In this paper I argue that both defence and criticism of the claim that humans act ‘under the guise of the good’ neglects the metaphysical roots of the theory. I begin with an overview of the theory and its modern commentators, with critics noting the apparent possibility of acting against the good, and supporters claiming that such actions are instances of error. These debates reduce the ‘guise of the good’ to a claim about intention and moral action, and in so (...) doing have become divorced from the theory's roots in classical and medieval philosophy. Aristotle and Aquinas’ ‘guise of the good’ is primarily a metaphysical claim resting on the equivalence between actuality and goodness, from which conclusions about moral action are derived. I show the reasoning behind their theory and how it forms the basis for the claims about intention and action at the centre of the modern debate. Finally, I argue that the absence of its original foundation is apparent in recent attacks on the ‘guise of the good’. It is unsurprising that modern action theory and ethics have not always been able to comfortably accommodate the ‘guise of the good’; they are only telling half of the story. (shrink)

Coercion is morally objectionable: it’s bad to be coerced and it’s wrong to coerce people. But why is coercion objectionable? In this paper, I advance an egalitarian account of what’s objectionable about coercion. The account is rooted in the idea that certain relationships, like those of master to slave and lord to peasant, are relationships of subordination or domination. These relationships are morally objectionable. Moreover, such relationships are in part constituted by asymmetries of power. A master subordinates a slave because (...) the master has more power over the slave than vice versa. The account says that coercion is objectionable because it creates such asymmetries of power, and so creates relationships of subordination. I show how this account can address its most serious problems, and how it can illuminate what’s wrong with blackmail, exploitation, withholding aid, and compulsion. (shrink)

Philosophers have begun exploring justifications, such as liability and lesser-evil justifications, for consumer boycotting that are rooted in just war theory. The libertarian challenge holds that even morally objectionable consumer boycotts are nonetheless morally permissible in the sense that doing their constituent acts violates no rights or duties: consumer choice, information sharing, and advocacy are already permissible actions; boycotters do not acquire any special permissions that they did not already possess. I argue that even if consumers’ activities are generally permissible, (...) they can become impermissible when done with certain intentions. Liability-based accounts of permissible boycotting should accept the view that intention is relevant to permissibility. Accepting this view marks a discontinuity between mere consumer choice and boycotting, and a discontinuity between permissible and impermissible boycotting, strengthening the argument that liability-based and lesser evil principles may sometimes be necessary for the permissibility of some consumer boycotts. (shrink)

The Implementation Problem for conceptual engineering is, roughly, the problem conceptual engineers face when attempting to bring about the conceptual change they support. An important aspect of this problem concerns the extent to which attempting to implement concepts can lead to unintended negative consequences. Not only can conceptual engineers fail to implement their proposals, but their interventions can produce outcomes directly counter to their goals. It is therefore important to think carefully about the prospect of attempted implementation leading to unintended (...) negative consequences: what sort of negative consequences can conceptual engineers expect? Are some forms of conceptual engineering more likely than others to lead to such consequences? And is conceptual engineering still viable even given the risk of such consequences? This paper addresses such questions. I begin by outlining different forms of conceptual engineering (Section 1), before examining how they can produce unintended negative consequences (Section 2). I then discuss some implications of the fact that attempted implementation can produce unintended negative consequences, suggesting that, among other things, some forms of conceptual engineering are less viable than others (Section 3). I conclude, though, by considering some of the ways in which conceptual engineering is nonetheless a worthwhile pursuit (Section 4). (shrink)

A preview of my book *Perception*. Discusses the relationship between perception and the physical world and the issue of whether reality is as it appears. Useful examples are included throughout the book to illustrate the puzzles of perception, including hallucinations, illusions, the laws of appearance, blindsight, and neuroscientific explanations of our experience of pain, smell and color. The book covers both traditional philosophical arguments and more recent empirical arguments deriving from research in psychophysics and neuroscience. The addition of chapter summaries, (...) suggestions for further reading and a glossary of terms make Perception essential reading for anyone studying the topic in detail, as well as for students of philosophy of mind, philosophy of psychology and metaphysics. (shrink)

We present a case study of how mathematicians write for mathematicians. We have conducted interviews with two research mathematicians, the talented PhD student Adam and his experienced supervisor Thomas, about a research paper they wrote together. Over the course of 2 years, Adam and Thomas revised Adam’s very detailed first draft. At the beginning of this collaboration, Adam was very knowledgeable about the subject of the paper and had good presentational skills but, as a new PhD (...) student, did not yet have experience writing research papers for mathematicians. Thus, one main purpose of revising the paper was to make it take into account the intended audience. For this reason, the changes made to the initial draft and the authors’ purpose in making them provide a window for viewing how mathematicians write for mathematicians. We examined how their paper attracts the interest of the reader and prepares their proofs for validation by the reader. Among other findings, we found that their paper prepares the proofs for two types of validation that the reader can easily switch between. (shrink)

This lively and accessible textbook provides a comprehensive and unified introduction to classical and modal logics, treating them with the same level of rigour and detail and showing how they fit together. A fully self-contained learning resource, it will be ideal for upper-level university courses.

The epistemic relevance of forgiveness has been neglected by both the discussion of forgiveness in moral psychology and by social epistemology generally. Moral psychology fails to account for the forgiveness of epistemic wrongs and for the way that wrongs in general have epistemic implications. Social epistemology, for its part, neglects the way that epistemic trust is not only conferred but repaired. In this essay, I show that the repair of epistemic trust through forgiveness is necessary to the economy of knowledge (...) for fallible persons like us. Despite the fact that forgiveness is never included on lists of important intellectual virtues or epistemic activities, it is vital to our lives as social knowers. Likewise, an account of forgiveness that neglects its epistemic dimension is importantly incomplete. (shrink)

The quest for freedom from hunger and repression has triggered in recent years a dramatic, worldwide reform of political and economic systems. Never have so many people enjoyed, or at least experimented with democratic institutions. However, many strategies for economic development in Eastern Europe and Latin America have failed with the result that entire economic systems on both continents are being transformed. This major book analyzes recent transitions to democracy and market-oriented economic reforms in Eastern Europe and Latin America. Drawing (...) in a quite distinctive way on models derived from political philosophy, economics, and game theory, Professor Przeworski also considers specific data on individual countries. Among the questions raised by the book are: What should we expect from these experiments in democracy and market economy? What new economic systems will emerge? Will these transitions result in new democracies or old dictatorships? (shrink)

ABSTRACT This paper identifies a number of questions that any plausible theory of epistemic blame ought to answer. What is epistemic blame? When is someone an appropriate target of epistemic blame? And what justifies engaging in epistemic blame? I argue that a number of problems arise when we try to answer these questions by using existing conceptions of moral blame. I then consider and reject Brown’s [2020] belief-desire model of epistemic blame. Finally, I argue that an agency-cultivation model of moral (...) responsibility is not only able to help us to develop a plausible theory of epistemic blame; it is particularly well-placed to do so. (shrink)

Alex Worsnip argues in favor of what he describes as a particularly robust version of fallibilism: subjects can sometimes know things that are, for them, possibly false (in the epistemic sense of 'possible'). My aim in this paper is to show that Worsnip’s argument is inconclusive for a surprising reason: the existence of possibly false knowledge turns on how we ought to model entailment or consequence relations among sentences in natural language. Since it is an open question how we ought (...) to think about consequence in natural language, it is an open question whether there is possibly false knowledge. I close with some reflections on the relation between possibly false knowledge and fallibilism. I argue that there is no straightforward way to use linguistic data about natural language epistemic modals to either verify or refute the fallibilist thesis. (shrink)