The concept of altruism, or disinterested concern for another's welfare, has been discussed by everyone from theologians to psychologists to biologists. In this book, evolutionary, neurological, developmental, psychological, social, cultural, and religious aspects of altruistic behavior are examined. It is a collaborative examination of one of humanity's essential and defining characteristics by renowned researchers from various disciplines. Their integrative dialogue illustrates that altruistic behavior is a significant mode of expression that can be studied by various scholarly methods and understood from (...) a variety of perspectives in both the humanities and the sciences. Altruism and Altruistic Love establishes a framework for scholarship on altruism by presenting definitions, a historical overview, a review of contemporary research, and debates in various disciplines, as well as a discussion of directions for future work. (shrink)

Over the past two years, debate about the use of data taken from Nazi concentration camp experiments has intensified. Many survivors of the Holocaust have been particularly offended at the publication of hypothermia or other data. This article argues against the use of unethically obtained data, and considers the debate from the perspective of the rights of Holocaust victims.

Tube feeding is often presented as a nearly risk free and beneficial treatment for patients with dementia. But evidence shows that its benefits are illusory, while its risks are greater than many realize. Assisted oral feeding and good hospice care are better options.

The authority of the intact self over the future severely demented self is based on notions of integrity and precedent autonomy. Despite criticism of this authority, the principle of precedent autonomy in the care of people with Alzheimer disease or other progressive and irreversible dementias retains its moral significance.

The increased recognition and reported prevalence of autism spectrum disorders combined with the associated societal and clinical impact call for a broad grassroots community-based dialogue on treatment related ethical and social issues. In these Stony Brook Guidelines, which were developed during a full year of community dialogue with affected individuals, families, and professionals in the field, we identify and discuss topics of paramount concern to the ASD constituency: treatment goals and happiness, distributive justice, managing the desperate hopes for a cure, (...) sibling responsibilities, intimacy and sex, diagnostic ethics, and research ethics. The members of the dialogue core committee included doctors, ethicists, administrators, social workers, ministers, disability experts, and many family members of individuals with autism who were especially engaged in community activities on behalf of their constituency, including siblings, parents, and grandparents. Our guidelines are not based on “top-down” imposition of professional expertise, but rather on a “bottom-up” grass roots attention to the voices of affected individuals and families speaking from experience. These guidelines can inform clinical practice, but they also are meaningful for the wider social conversation emerging over the treatment of individuals with ASD. (shrink)

This article examines the role of two distinct forms of analogy in moral discourse. The use of analogy in moral discourse. The use of analogy in abortion debates in used as an example of the dominance of analogy in applied ethics.

This article presents a set of moral arguments regarding the selective abortion of fetuses on the basis of prenatal screening for late onset genetic diseases only, and for Huntington's Disease* in particular. After discussion of human suffering, human perfection and the distinctive features of the lives of people confronting late onset genetic disease, the author concludes that selective abortion is difficult to justify ethically, although it must remain a matter of personal choice.

The interface between religion, psychiatry, and ethics is often a locus for considerable controversy. This article focuses on the response of American psychiatry to religious nonconformism, and to religious conversion generally. At issue is the societal pressure against unpopular religious movements. The author argues for an ethic that conserves the freedom of religious conscience, and that guards against inquisitions in the guise of medical expertise and nosology.

The Greater Cleveland community Dialogue on values and Health Care most recently took up the questions of health care rationing and of access to long-term care. The Dialogue, funded by the Cleveland Foundation, involves a Core Group of thirty community leaders representing major interest groups, joined together in an attempt to build consensus or acceptable compromise. The purpose of the dialogue is to identify moral values that can provide signposts for public policy regarding health care distribution.

Pediatricians provided expert testimony that, in the case of Baby K, provision of ventilator support goes beyond accepted standards of care for anencephalic infants and so is medically futile. This argument, however reasonable, does not persuade those who believe in the absolute value of even a fraction of human life. In Baby K, court records indicate that Ms. H, Baby K's mother, persistently adheres to the sanctity-of-life principle on religious grounds.While I think that quality-of-life considerations have a role in medical (...) decision making, those who reject such considerations must be respected. This article makes the following claims, on behalf of religious dissenters: the Baby K case should be interpreted in light of the freedom of religion guaranteed in the First Amendment ; religious beliefs should not be trivialized in clinical ethics, even if reason, not belief, is the language of the public forum; the time-honored free exercise clause is essential to the American experiment in liberty and should not be overridden in the name of a concept as vague as futility; and free exercise of religion deserves serious discussion in the futility debate, and significant religious accommodation must be included in any hospital or societal futility policies. In the concluding section, issues are raised regarding the balance between religious consideration and resource allocation. (shrink)

Pediatricians provided expert testimony that, in the case of Baby K, provision of ventilator support goes beyond accepted standards of care for anencephalic infants and so is medically futile. This argument, however reasonable, does not persuade those who believe in the absolute value of even a fraction of human life. In Baby K, court records indicate that Ms. H, Baby K's mother, persistently adheres to the sanctity-of-life principle on religious grounds.While I think that quality-of-life considerations have a role in medical (...) decision making, those who reject such considerations must be respected. This article makes the following claims, on behalf of religious dissenters: the Baby K case should be interpreted in light of the freedom of religion guaranteed in the First Amendment ; religious beliefs should not be trivialized in clinical ethics, even if reason, not belief, is the language of the public forum; the time-honored free exercise clause is essential to the American experiment in liberty and should not be overridden in the name of a concept as vague as futility; and free exercise of religion deserves serious discussion in the futility debate, and significant religious accommodation must be included in any hospital or societal futility policies. In the concluding section, issues are raised regarding the balance between religious consideration and resource allocation. (shrink)

Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the “good” provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies (...) and institutional goal setting, and of educational programs. We offer several practical suggestions for PPCC implementation, including structuring healthcare systems so as to nurture professional meaning, integrity, and inter-personal reflective emotional processing as a buffer against burnout and as a key to better patient care. It should not bring into question the primacy of practitioner commitment to the good of patients, nor should it be taken to suggest in any way a shift in focus away from patients’ values and respect for patient autonomy. PPCC asserts that the respect for patient’s values and autonomous choices properly remains the ethical benchmark of modern healthcare systems, along with altruistic professional commitment to the optimal care of patients. However, it enunciates an explicit commitment to structuring systems that allow for and actively encourage the professional well-being and wellness upon which good patient care depends. (shrink)

Ethicists who advocate the permissibility of infanticide often have misrepresented history in their arguments. The Western tradition supports the prohibition of active killing of congenitally impaired or premature newborns whose futures are uncertain.

The human life span has been extended considerably, and among the very old, women outnumber men by a large margin. Thus, the aging society cannot be adequately addressed without taking into account the experience of women in specific. This article focuses on women as caregivers for aging parents. It critically assesses what some women philosophers are saying about the basis and limits of these caregiving duties.

This article focuses on the elderly patient with a progressive and irreversible dementia, most often of the Alzheimer type. However dementia, the decline in mental function from a previous state, can occur in all ages. For example, if Alzheimer's disease is the dementia of the elderly, increasingly AIDS is the dementia of many who are relatively young. I will not present the major ethical issues relating to dementia care following the progression of disease from the mild to the severe stages, (...) for I have done this elsewhere. Among the issues included are: presymptomatic testing, both psychological and genetic; responsible diag- nostic disclosure and use of support groups; restrictions on driving and other activities; preemptive assisted suicide; advance directives for research and treatment; quality of life in relation to the use of life-extending technologies; and euthanasia. (shrink)

Adoption, from the Latin opiate, “to choose,” means “to take into a relationship, especially another's child as one's own”. The word implies a permanent taking of responsibility. While the assumption that biological parents should rear their children is vital to society, adoption provides an alternative that is sometimes necessary.

Health care decision making has changed profoundly during the past several decades. Advances in scientific knowledge, technology, and professional skill enable medical providers to extend and enhance life by increasing the ability to cure disease, manage disability, and palliate suffering. Ironically, the same interventions can prolong painful existence and protract the dying process. Recognizing that medical interventions, especially lifesustaining measures, are not always medically appropriate or even desired by a patient or family, health care professionals endeavor to determine who should (...) make health care decisions and according to what standards. The importance that Western culture places on individual rights and self-determination is reflected in the growing advocacy for patient autonomy and the discrediting of physician paternalism. However, the question of autonomy becomes more complex when patients lack the capacity to decide for themselves.Advance directives represent one response to the dilemma of decision making for incapacitated patients. The original advance directive, the living will, is a written list of instructions reflecting the individual's wishes about care, usually at the end of life. (shrink)

Health care decision making has changed profoundly during the past several decades. Advances in scientific knowledge, technology, and professional skill enable medical providers to extend and enhance life by increasing the ability to cure disease, manage disability, and palliate suffering. Ironically, the same interventions can prolong painful existence and protract the dying process. Recognizing that medical interventions, especially lifesustaining measures, are not always medically appropriate or even desired by a patient or family, health care professionals endeavor to determine who should (...) make health care decisions and according to what standards. The importance that Western culture places on individual rights and self-determination is reflected in the growing advocacy for patient autonomy and the discrediting of physician paternalism. However, the question of autonomy becomes more complex when patients lack the capacity to decide for themselves.Advance directives represent one response to the dilemma of decision making for incapacitated patients. The original advance directive, the living will, is a written list of instructions reflecting the individual's wishes about care, usually at the end of life. (shrink)

Intraspecific niche variation can differentially impact community processes and can represent the initial stages of adaptive radiation. Here we test for intraspecific differences in niche use in a keystone species, the alewife (Alosa pseudoharengus). To test whether feedbacks between predator foraging traits and prey communities have led to differences in niche use, we compare the diet composition and trophic position of anadromous and landlocked alewife populations. These populations differ in phenotypic traits related to foraging (gill raker spacing, gape width, and (...) prey selectivity). Trait differences appear to have resulted from eco-evolutionary feedbacks between alewives and their zooplankton prey, and suggest that these two life history forms are exploiting different niches. Direct diets show that anadromous alewives consume a greater biomass of predatory copepods than do landlocked alewives. Anadromous alewives also consume more ostracods—a littoral prey item—as the growing season progresses. These diet differences do not translate into a significant difference in trophic position, as estimated from stable isotopes. However, stable-isotope estimates of diet source show that during early fall, anadromous alewives obtain significantly more of their dietary carbon from the littoral food web. This increased reliance on littoral prey is likely a result of a diet switch that occurs in response to the alewife-driven exhaustion of large-bodied prey items available in the pelagic zone, i.e., alewife niche construction. These findings show the existence of important intraspecific niche differences in the alewife and support the role of eco-evolutionary feedbacks in shaping these niche differences. The initiation of alewife divergence is the result of dam building by humans. Therefore, alewife niche differentiation can be considered to be an eco-evolutionary byproduct of human cultural niche construction. (shrink)

Recent work on the ethics of love may be divided into norm-centered and affective-centered approaches. Norm-centered approaches, exemplified by Hallett and Outka, argue for either moral parity between self and other or for self-subordination; they regard self-love as legitimate within strict boundaries; and they sharply distinguish agape from other forms of love. Affective-centered approaches, exemplified by Vacek and Post, con- centrate on love for God as the central context for neighbor-love; they ac- cord a high status to friendship, marriage, (...) and other primary relationships; and they regard all forms of love as Christian in that they are transformed by grace and constitute cooperation with God. The re- maining agenda for both approaches is primarily theological, including especially the need to develop an extended application of the doctrines of creation and grace for the status of "special relations" in the ethics of love. (shrink)

Volume 39 of the Tanner Lectures on Human Values includes lectures initially scheduled during the academic year 2019-2020. Owing to the global coronavirus pandemic, some were delivered at a later date. The Tanner Lectures are published in an annual volume. In addition to permanent lectures at nine universities, the Tanner Lectures on Human Values funds special one-time lectures at selected higher educational institutions in the United States and around the world.

The Clinton administration's revised rules regulating but not prohibiting the common practice in managed care of linking physician compensation with cost cutting and control of services demonstrates the complexity of ethical issues in managed care. As originally proposed, the federal guidelines on payment for Medicare and Medicaid services would have precluded any interrelationship between payment to physicians and delivery of services. Such a restriction would have gutted the primary mechanism in managed care plans to curb the unacceptably high cost of (...) healthcare delivery: making physicians directly responsible for cost control by placing them at direct financial risk. At first blush such a linkage seems to involve an obvious and irreconcilable conflict of interest. How can a physician be responsible for the well-being of a patient while at the same time aware that a proportion of his or her income is linked to the provision of cost-conscious care? (shrink)

Slowing the aging process would be one of the most dramatic and momentous ways of enhancing human beings. It is also one that mainstream science is on the brink of pursuing. The state of the science, together with its possible impact, make it an important example for how to think about research into all enhancement technologies.

Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.