The March 2002 symposium Human Dignity and Reproductive Technology brought together philosophers, theologians, scientists, lawyers, and scholars from across the United States. The essays of this book are the contributions of the symposium's participants.

The authors respond to a letter by Mitchell Berger in the March‐April 2024 issue of the Hastings Center Report concerning their essay “Securing the Trustworthiness of the FDA to Build Public Trust in Vaccines.”.

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

The development of culture-independent strategies to study microbial diversity and function has led to a revolution in microbial ecology, enabling us to address fundamental questions about the distribution of microbes and their influence on Earth’s biogeochemical cycles. This article discusses some of the progress that scientists have made with the use of so-called “omic” techniques (metagenomics, metatranscriptomics, and metaproteomics) and the limitations and major challenges these approaches are currently facing. These ‘omic methods have been used to describe the taxonomic structure (...) of microbial communities in different environments and to discover new genes and enzymes of industrial and medical interest. However, microbial community structure varies in different spatial and temporal scales and none of the ‘omic techniques are individually able to elucidate the complex aspects of microbial communities and ecosystems. In this article we highlight the importance of a spatiotemporal sampling design, together with a multilevel ‘omic approach and a community analysis strategy (association networks and modeling) to examine and predict interacting microbial communities and their impact on the environment. (shrink)

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Thus, one cannot (...) conclude that these meanings are arbitrary and unrelated. This categorization and logical and linguistic analysis helps to unravel what seem to be contradictions in discourse about dignity and bioethics, and provides a hierarchy of meaning that has potential normative implications. (shrink)

Abstract:Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the (...) profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection. (shrink)

Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

Accounting ethics failures have seized headlines and cost investors billions of dollars. Improvement of the ethical reasoning and behavior of accountants has become a key concern for the accounting profession and for higher education in accounting. Researchers have asked a number of questions, including what type of accounting ethics education intervention would be most effective for accounting students. Some researchers have proposed virtue ethics as an appropriate moral framework for accounting. This research tested whether Smithian virtue ethics training, based on (...) Adam Smith’s “The Theory of Moral Sentiments”, is effective in improving accounting student’s cognitive moral development. This research used a pre-test, treatment, post-test, quasi-experimental design utilizing the Defining Issues Test 2 instrument to measure students’ CMD. Analysis of DIT-2 gain scores did show a significant improvement in subjects’ personal interest scores and a significant improvement in an overall measure of CMD, the DIT N2 index, whereas their DIT-2 post-conventional scores did not improve significantly. This research supports the proposition that the concepts contained in Smithian virtue ethics can contribute to an effective accounting ethics education intervention. However, further research is required to determine what concepts should be included to improve accounting students’ post-conventional moral reasoning. (shrink)

The surviving sources on the Stoic theory of division reveal that the Stoics, particularly Chrysippus, believed that bodies, places and times were such that all of their parts themselves had proper parts. That is, bodies, places and times were composed of gunk. This realisation helps solve some long-standing puzzles about the Stoic theory of mixture and the Stoic attitude to the present.

Psychiatric and neurological disorders have historically provided key insights into the structure-function rela- tionships that subserve human social cognition and behavior, informing the concept of the ‘social brain’. In this review, we take stock of the current status of this concept, retaining a focus on disorders that impact social behavior. We discuss how the social brain, social cognition, and social behavior are interdependent, and emphasize the important role of development and com- pensation. We suggest that the social brain, and its (...) dysfunction and recovery, must be understood not in terms of specific structures, but rather in terms of their interaction in large-scale networks. (shrink)

One of the most important questions in the debate over the morality of euthanasia and assisted suicide is whether an important distinction between killing patients and allowing them to die exists. The U.S. Supreme Court, in rejecting challenges to the constitutionality of laws prohibiting physician-assisted suicide, explicitly invoked this distinction, but did not explicate or defend it. The Second Circuit of the U.S. Court of Appeals had previously asserted, also without argument, that no meaningful distinction exists between killing and allowing (...) to die. That court had reasoned that if this were so, it would be discriminatory to allow persons on life support to end their lives by removing such treatment, while those who are not connected to life support would be denied similar access to death. (shrink)

While there has been much discussion about the role of oaths in medical ethics, this discussion has previously centered on the content of various oaths. Little conceptual work has been done to clarify what an oath is, or to show how an oath differs from a promise or a code of ethics, or to explore what general role oath-taking by physicians might play in medical ethics. Oaths, like promises, are performative utterances. But oaths are generally characterized by their greater moral (...) weight compared with promises, their public character, their validation by transcendent appeal, the involvement of the personhood of the swearer, the prescription of consequences for failure to uphold their contents, the generality of the scope of their contents, the prolonged time frame of the commitment, the fact that their moral force remains binding in spite of failures on the part of those to whom the swearer makes the commitment, and the fact that interpersonal fidelity is the moral hallmark of the commitment of the swearer. Oaths are also distinct from codes. Codes are collections of specific moral rules. Codes are not performative utterances. They do not commit future intentions and do not involve the personhood of the one enjoined by the code. Recent attacks on oath-taking by physicians are discussed. Two arguments in favor of oath-taking are presented: one on the basis of the nature of medicine as a profession and the other on the basis of rule-utilitarian considerations. No attempt is made to define which oath a physician should swear. (shrink)

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

The Rule of Double Effect has played an important role in bioethics, especially during the last fifty years. Its major application in bioethics has been in providing physicians who are opposed to euthanasia with a moral justification for using opioid analgesics in treating the pain of patients whose death might thereby be hastened. It has also prominently been applied to certain obstetric cases. The scope of application of double effect is actually much broader than medical ethics, extending to cover such (...) topics as strategic bombing in warfare. This article, while general in theory, concentrates on its applications in medical ethics. (shrink)

We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

The notion of the value of life is often invoked in discussions regarding medical care for the sick and the dying. This theme has figured in arguments about medical ethics for decades, but many of the phrases associated with this concept have received little serious scrutiny. It is true that some philosophers have declared a few commonly used phrases such as “the sanctity of life,” “the infinite value of life,” and “the value of life itself” to be unclear at best (...) or misguided at worst. Their hasty dismissal of these phrases, however, is not the end of the story. I generally agree with this philosophical judgment but for reasons very different from those typically given by others. Moreover, the reasons I wish to .. (shrink)

Pellegrino was there at the beginning of the field. In the 1950s and 60s, before there was a Kennedy Institute of Ethics or a Hastings Center; before the word ‘bioethics’ itself was coined, Pellegrino was writing articles such as "Ethical Considerations in the Practice of Medicine and Nursing," published in 1964. He was among those who started the Society for Health and Human Values—a precursor organization to the American Society for Bioethics and Humanities. He was the founding editor of the (...) Journal of Medicine and Philosophy at a time when the notion that there was a relationship between philosophy and medicine was foreign to both physicians and philosophers. The authors of the articles published in the very .. (shrink)

Many states in the U.S. have adopted policies regarding human embryonic stem cell (hESC) research in the last few years. Some have arrived at these policies through legislative debate, some by referendum, and some by executive order. New York has chosen a unique structure for addressing policy decisions regarding this morally controversial issue by creating the Empire State Stem Cell Board with two Committees—an Ethics Committee and a Funding Committee. This essay explores the pros and cons of various policy arrangements (...) for making public policy decisions about morally controversial issues in bioethics (as well as other issues) through the lens of Deliberative Democracy, focusing on the principles of reciprocity, publicity, and accountability. Although New York's unique mechanism potentially offers an opportunity to make policy decisions regarding a morally controversial subject like hESC research in accord with the principles of Deliberative Democracy, this essay demonstrates its failure to do so in actual fact. A few relatively simple changes could make New York's program a real model for putting Deliberative Democracy into practice in making policy decisions regarding controversial bioethical issues. (shrink)

Media coverage and statements by various Catholic spokespersons regarding the case of Terri Schiavo has generated enormous and deeply unfortunate confusion regarding Church teaching about the use of life-sustaining treatments. Two weeks ago, for example, I received a letter from the superior of a community of Missionary Sisters of Charity, who operate a hospice here in the United States The Missionary Sisters of Charity are the community founded by Mother Theresa, the 20th Century saint whose primary ministry was to rescue (...) dying Untouch-ables from the streets of Calcutta and bring them into her convent where they were washed, sheltered, fed if they were able to eat, prayed for, and cherished. In other words, the sisters gave these poor souls the gift of a death with dignity. The order Mother Theresa founded has continued this ministry, running hospices in the United States and elsewhere for the homeless, the destitute, those dying of AIDS and poverty and drug addiction, and all those dying alone and otherwise unwanted. (shrink)

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. Disease (...) can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated. The article (...) concludes by discussing the relevance of this concept of dignity to the spiritual and ethical care of the dying. (shrink)

Metaphysics has no place in the science-religion discourses if understood as an a priori universal content of the nature and causes of all things. From an overview of the positive and negative dimensions and challenges of the contemporary science-religion discourses within each conversation partner itself and between the two, it is argued that metaphysical reflection represents a contextual-linguistic event that ‘takes place’ only after the contextual giveness is taken up within a very concrete historical-linguistic frame of reference for sense making. (...) In a metaphoric sense, it is conclusively compared with the movements of atoms of which we can only state afterwards where the atoms have been. In this sense, McGrath’s remark that ‘etaphysics is not the precondition of any engagement with the world, but its inferred consequence’ is supported. The ‘was’ of metaphysical thinking represents the emergent product of the concrete and specific lifeworlds in which they have ‘taken place’, that is, ‘eventuated’. The ‘was’ of metaphysical reflection is the most powerful event of credofication for human beings in living, making sense of and participating empathically in the question ‘why there is something rather than nothing?’. (shrink)

Horan offers a substantial challenge to the narrative of radical orthodoxy's idiosyncratic take on Scotus and his role in ushering in the philosophical age of the modern. This volume not only corrects the received account of Scotus but opens a constructive way forward toward a positive assessment and appropriation of Scotus's work for contemporary theology. --Book cover.

Wrestling and arguing with God: between insider and outsider African perspectives -- Introduction to Richard Kearney's intellectual autobiography: where do you come from, Richard Kearney? -- Where I speak from: a short intellectual autobiography -- Phenomenology in South Africa: an indirect encounter with Richard Kearney -- Transcendence and anatheism -- Response to Richard Kearney's Anatheism: Anatheism and holy folly -- Kearney between poles: is too much lost in the middle? -- Strangers, Gods and Africa: in dialogue with Richard Kearney on (...) Otherness -- Approaching the threshold: hospitality as a pedagogical wager in the work of Richard Kearney -- God-talk, the biblical prophets and Richard Kearney -- 'Strange' theology: engaging with Richard Kearney -- Trinitarian theology and Richard Kearney's anatheism: an engagement -- After God but behind the Cross: the procession as a way to re-encounter God in a culture beyond classical liturgy -- Touch gives rise to thought: Paul Ricoeur and Pumla Gobodo-Madikizela on mutual recognition and carnal hermeneutics -- Towards hospitality between enemies -- Across oceans: a conversation on otherness, hospitality and welcoming a strange God. (shrink)

The new hominin fossil called Homo naledi that was discovered 2 years ago in the Dinaledi Chamber was welcomed into the species of human relatives on 10 September 2015. Welcomed? Representing at least 15 individuals with most skeletal elements repeated multiple times, this is the largest assemblage of a single species of hominins yet discovered in Africa. Do, however, these bones represent a new Homo species? It is this question that I have tried to capture in my playful grammatically incorrect (...) title ‘Welcmo Naledi’! However, it is not this question that I will endeavour to answer, but a very different theological implication. My aim in this article is definitely not to argue an opinion on the diverse question regarding the discovery of the fossil skeletons from the Dinaledi Chamber. My aim is related but different, much more modest, restricted and focused. It is to ask ‘on the other historic side’ of Naledi about human distinctiveness and symbolic behaviour, specifically on soteriology. Within the broader contemporary philosophical-theological discourses on anthropology and specifically the fundamental question, ‘Are we special?’, I would like ultimately to take on the intriguing theological implications for soteriology from the Naledi findings. (shrink)

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine’s distinction between (...) martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent’s actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. (shrink)

This chapter presents a historical analysis of pseudoscience, tracking down the coinage and currency of the term and explaining its shifting meaning in tandem with the emerging historical identity of science. The discussions cover the invention of pseudoscience; science and pseudoscience in the late nineteenth century; pseudoscience in the new century; and pseudoscience and its critics in the late twentieth century.

This book considers the common human predicament that we often choose an action other than the one we perceive to be best. Philosophers know this problem as _akrasia_. The author develops a nuanced understanding of the nature and causes of _akrasia_ by integrating the best insights of Socrates, Aristotle, Augustine, and Aquinas, and several contemporary philosophers.

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

Male-male competition is involved in inter- and intrasexual selection, with both endocrine and psychological factors presumably contributing to reproductive success in human males. We examined relationships among men’s naturally occurring testosterone, their self-perceived mate value, self-esteem, sociosexuality, and expected likelihood of approaching attractive women versus situations leading to child involvement. We then monitored changes in these measures in male rowers from Cambridge, UK, following a manipulated “win” or “loss” as a result of an indoor rowing contest. Baseline results revealed that (...) men with heightened testosterone and SPMV values typically had greater inclinations toward engaging in casual sexual relationships and a higher likelihood of approaching attractive women in a hypothetical social situation. As anticipated, both testosterone and SPMV increased following a manipulated “victory” and were associated with heightened sociosexuality, and increased expectations toward approaching attractive women versus individuals who would involve them in interacting with children after the race. SPMV and self-esteem appeared to mediate some of the effects of testosterone on post-race values. These findings are considered in the broader context of individual trade-offs between mating and parental effort and a model of the concurrent and dynamic androgenic and psychological influences contributing to male reproductive effort and success. (shrink)

The word ‘dignity’ arises continuously in the debate over euthanasia and assisted suicide, both in Europe and in North America. Unlike the phrases ‘autonomy’ and ‘slippery slope’, ‘dignity’ is used by those on both sides of the question. For example, the organizations most prominently associated with the campaign that culminated in the recent legalization of euthanasia in Belgium are the Association pour la Droit de Mourir dans la Dignité and Recht op Waardig Sterven. Yet when Belgium passed its euthanasia law, (...) that nation’s Catholic bishops declared, “All this is opposed to the fundamental respect for human life that lies at the heart of a society based on human dignity”. Or, consider the fact that the legislation that legalized assisted suicide in the state of Oregon, U.S.A., was called the “Death with Dignity Act.” Yet opponents of assisted suicide in the United States, such as the Family Research Council, have declared that, “The idea of assisted suicide is a poison pill that kills the dignity of a precious human life”.Over and above differences in translation, the word ‘dignity’ cannot mean the same thing in all four of the preceding sentences. It cannot be the univocal basis of moral arguments both for and against euthanasia and assisted suicide. A better understanding of this word would therefore help to bring clarity and insight to the arguments about euthanasia and assisted suicide in Europe, North America, and throughout the world. (shrink)

Dear Norm,Thank you for sharing such a personal and heartfelt essay. I have been asked by the editors to comment. Reading it inspires me to do so in a similarly heartfelt way. Although I don't know you well, I thought I'd write to you as if you were my patient.I share your sense that Alzheimer disease is a terrible scourge. I've seen much of this disease over a lifetime of practice, and I deeply understand its ravages and the debility and (...) suffering it causes. But what you propose is not a good solution for the problems that Alzheimer disease poses for patients, families, and society. It will ultimately do far more harm than good. Please let me try to explain. (shrink)