Marxism has long been subject to criticism from the theorists of Political Ecology, and in recent years, as the concerns of Green thinkers have become harder to ignore, Marxists have begun to respond to this challenge, defending and sometimes amending Marxist theory in response to Green criticisms. This paper addresses one issue within this debate: the controversy over Marx’s commitment to the growth, or development, of the productive forces. My aim is to dispute the contention of Marx’s Green critics, that (...) his concept of the development of the productive forces leads inevitably to the exacerbation of ecological problems, and, more speculatively, to suggest some advantages of using this concept to investigate ecological problems. (shrink)

This paper sets out to defend human genetic engineering with a new bioethical approach, post-humanism, combined with a radical democratic political framework. Arguments for the restriction of human genetic engineering, and specifically germ-line enhancement, are reviewed. Arguments are divided into those which are fundamental matters of faith, or "bio-Luddite" arguments, and those which can be addressed through public policy, or "gene-angst" arguments.The four bio-Luddite concerns addressed are: Medicine Makes People Sick; There are Sacred Limits of the Natural Order; Technologies Always (...) Serve Ruling Interests; The Genome is Too Complicated to Engineer. I argue that these are matters of faith that one either accepts or rejects, and that I reject.The non-fundamentalist or pragmatic concerns I discuss are: Fascist Applications; The Value of Genetic Diversity; The Geneticization of Life; Genetic Discrimination and Confidentiality; Systematically Bad Decisions by Parents; Discrimination Against the Disabled; Unequal Access; The Decline of Social Solidarity. I conclude that all these concerns can be adequately addressed through a proactive regulative framework administered by a liberal democratic state. Therefore, even germ-line genetic enhancement should eventually made available since the potential benefits greatly outweigh the potential risks. (shrink)

This paper addresses five questions: First, what is trajectory of Western liberal ethics and politics in defining life, rights and citizenship? Second, how will neuro-remediation and other technologies change the definition of death for the brain injured and the cryonically suspended? Third, will people always have to be dead to be cryonically suspended? Fourth, how will changing technologies and definitions of identity affect the status of people revived from brain injury and cryonic suspension? I propose that Western liberal thought is (...) working towards a natural end, a “telos.” In response to a variety of biotechnologies, law and public opinion in liberal democracies will be forced to make explicit that the rights of a living thing are determined by its level of consciousness. I discuss the way that technology will force three clarifications about the value of consciousness, at the beginning, the end and boundaries of human life. Sentience and personhood will become the basis of moral concern, regardless of its media. Just as human rights have become independent of race, gender and property, rights will become independent of being a breathing human being. But even as we make this transition, the cryonically preserved are still likely to be considered dead for pragmatic reasons, albeit with gradually increasing rights as technology makes their reanimation increasingly probable. I suggest that it could be acceptable to cryonicists that the frozen continue to be defined as dead if assisted suicide can be legalized. Under a liberal assisted suicide policy cryonicists might be allowed to carry out suspension before a declaration of death, preserving the maximum amount of neural information. The gradual redefinition of life and personal identity in terms of psychological continuity will also have consequences for the legal status of the reanimated. If, due to information loss, the reanimated do not meet a threshold of psychological continuity, they may be considered new persons. Cryonicists may therefore wish to specify ahead of time whether they are still interested in being reanimated if pre-animation assessment suggests that the result will not meet the necessary threshold of continuity. Finally, I touch on the way that neural technology will fundamentally problematize the separate, autonomous self on which liberal democratic values are based, leading to a legal and political Singularity. It is this looming neural Singularity that makes the proposed liberal democratic telos a final stage in humanistic thought, before it is superceded by something radically different. (shrink)

In a recent article in this journal, Savulescu and Schuklenk defend and extend their earlier arguments against a right to medical conscientious objection in response to criticisms raised by Cowley. I argue that while it would be preferable to be less accommodating of medical conscientious than many countries currently are, Savulescu and Schuklenk's argument that conscientious objection is ‘simply unprofessional’ is mistaken. The professional duties of doctors should be defined in relation to the interests of patients and society, and for (...) reasons set out in this article, these may support limited accommodation of conscientious objection on condition that it does not impede access to services. Moreover, the fact that conscientious objection appears to involve unjustifiable compromise from the objector's point of view is not a reason for society not to offer that compromise. Arguing for robust enforcement of the no-impediment condition, rather than opposing conscientious objection in principle, may be a more effective way of addressing the harms resulting from an over-permissive conscientious objection policy. (shrink)

Transhumanism, the belief that technology can transcend the limitations of the human body and brain, is part of the family of Enlightenment philosophies. As such, transhumanism has also inherited the internal tensions and contradictions of the broad Enlightenment tradition. First, the project of Reason is self-erosive and requires irrational validation. Second, although most transhumanists are atheist, their belief in the transcendent power of intelligence generates new theologies. Third, although most transhumanists are liberal democrats, their belief in human perfectibility and governance (...) by reason can validate technocratic authoritarianism. Fourth, transhumanists are divided on the balance between democracy and the market. Fifth, teleological expectations of unstoppable progress are in tension with awareness of the indeterminacy of the future. Sixth, transhumanists are divided between advocates of ethical universalism and ethical relativism. Seventh, the rational materialist denial of discrete persistent selves calls into question the transhumanist project of individual longevity and enhancement. (shrink)

A principal challenge facing the progressive bioethics project is the crafting of a consistent message on biopolitical issues that divide progressives. -/- The regulation of enhancement technologies is one of the issues central to this emerging biopolitics, pitting progressive defenders of enhancement, “technoprogressives,” against progressive critics. This essay [PDF] will argue that technoprogressive biopolitics express the consistent application of the core progressive values of the Enlightenment: the right of individuals to control their own bodies, brains and reproduction according to their (...) own conscience, under democratic states that work for the public good. -/- Insofar as left bioconservatives want to ensure the safety of therapies and their equitable distribution, these concerns can be addressed by thorough and independent regulation and a universal health care system, and a progressive bioethics of enhancement can unite both enthusiasts and skeptics. Insofar as bioconservative concerns are motivated by deeper hostility to the Enlightenment project however, by assertion of pre-modern reverence for human uniqueness for instance, then a common program is unlikely. -/- imageAfter briefly reviewing the political history and contemporary landscape of biopolitical debates about enhancement, the essay outlines three meta-policy contexts that will impact future biopolicy: the pressure to establish a universal, cost-effective health insurance system, the aging of industrial societies, and globalization. Technoprogressive appeals are outlined that can appeal to key constituencies, and build a majority coalition in support of progressive change. Finally, some guiding principles for a technoprogressive approach to biopolicy are offered. (shrink)

Advances in forensic techniques have expanded the temporal horizon of criminal investigations, facilitating investigation of historic crimes that would previously have been considered unsolvable. Public enthusiasm for pursuing historic crimes is exemplified by recent high-profile trials of celebrities accused of historic sexual offences. These circumstances give new urgency to the question of how we should decide which historic offences to investigate. A satisfactory answer must take into account the ways in which the passage of time can erode the benefits of (...) criminal investigation, the costs associated with investigating old crimes, and the need to prioritize investigations in the face of limited police resources. This article emphasizes the first of these factors. It begins by considering the moral goals of a criminal justice system and the contribution of criminal investigations to the achievement of these goals, distinguishing between contributions that depend on further steps in the criminal justice process, such as prosecution and punishment, and contributions that can have value independently of these further steps. Using this important distinction, the article then examines a range of factors that relate the passage of time to criminal justice goals, including the seriousness of the crime; deterioration of evidence; death of the offender, victim and others affected by the crime; and diminished psychological connectedness between those affected by the crime and their current selves. While the range and non-uniformity of relevant factors preclude a simple answer to the question of when historic crimes should be investigated and call instead for case-by-case assessment, we find that the analysis does support some general conclusions that can guide such an assessment. (shrink)

Transhumanism is a modern expression of ancient and transcultural aspirations to radically transform human existence, socially and bodily. Before the Enlightenment these aspirations were only expressed in religious millennialism, magical medicine, and spiritual practices. The Enlightenment channeled these desires into projects to use science and technology to improve health, longevity, and human abilities, and to use reason to revolutionize society. Since the Enlightenment, techno‐utopian movements have dynamically interacted with supernaturalist millennialism, sometimes syncretically, and often in violent opposition. Today the transhumanist (...) movement, a modern form of Enlightenment techno‐utopianism, has evolved a number of subsects, from the libertarian utopians funded by billionaire Peter Thiel, to religious syncretists like the Mormon Transhumanist Association, to the left‐wing technoprogressives and their bioliberal intellectual allies. In reaction to accelerating technological innovation and transhumanist ideas, apocalyptic Christians, and even secular catastrophists, have begun to incorporate human enhancement into their End Times scenarios. With all sides believing that the fate of humanity hangs in the balance, there is a growing likelihood of violent confrontation. (shrink)

Ethical dilemmas involving tax issues were identified by members of the American Institute of Certified Public Accountants as posing the most difficult ethical problem for them (Finn et al., Journal of Business Ethics 7(8), pp. 607–609, 1988). The KPMG tax shelter fraud case proves that the tax profession has not gone untainted in the age of numerous accounting and corporate scandals, such as the Enron débâcle (Sikka and Hampton, Accounting Forum 29(3), 325–343, 2005). High-profile scandals serve to highlight the problems (...) caused by differences in ethical judgement among accountants and tax practitioners and the issue of ethics has been brought publicly to the forefront of the profession. Nevertheless, the nature and dimension of ethical issues in tax practice have been largely unexplored (Erard, Journal of Public Economics 52(2), 163–197, 1993; Marshall et al., Journal of Business Ethics 17(12), 1265–1279, 1998; Frecknall Hughes, Unpublished PhD Thesis, The University of Leeds, 2002). This research aims to contribute to the debate on ethics in tax practice by reporting interview data on tax practitioners’ perceptions of ethics in the jurisdictions of Ireland and the United Kingdom and exploring the link or equation of ethics with risk management. (shrink)

Purpose: To determine the relative value that patients place on consent for procedures in the emergency department (ED) and to define a set of procedures that fall in the realm of implied consent. Methods: A questionnaire was administered to a convenience sample 134 of 174 patients who were seen in the ED of a Midwestern teaching hospital. The questionnaire asked how much time they believed was necessary to give consent for various procedures. Procedures ranged from simple (venipuncture) to complex (procedural (...) sedation). Results: Participants valued a simple blood draw at a low mean of 1.02 minutes of extra time and a lumbar puncture at a high mean of 7.78 minutes. Of all participants 52% and 48% noted a time-value of ?0? time on blood draw and intravenous line starts, respectively, indicating that they desire no additional consent for these procedures. Conclusion: Defining a set of ED procedures covered under implied consent will be difficult because many patients value formal consent for even the simplest procedure. (shrink)

BackgroundConcerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.AimTo analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.DesignThe data presented in this paper were collected as part of a wider research study of end-of-life care in an acute (...) hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.ResultsDiscussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.ConclusionsThis paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed. (shrink)

Because much of the recent philosophical interest in functions has been motivated by their application in biology and other sciences, most of the ensuing discussions have focused on functional explanations to the neglect of the practical role of functional knowledge. This practical role is essential for understanding how users form plans involving artifacts. We introduce the concept of instrumental function which is intended to capture the features of functional claims that are relevant to practical—in particular, instrumental—reasoning. We discuss the four (...) primary features of an instrumental function ascription, the teleological component of such ascriptions and give a clear definition of malfunction in terms of incapability to perform as well as “normal” tokens of the same type. (shrink)

Dementia affects millions of people throughout the world. Thinking through Dementia offers a critique of the main models used to understand dementia-the biomedical, neuropsychological, and social constructionist. It discusses clinical issues and cases, together with philosophical work that might help us to better understand and treat this illness.

In this paper I consider, in connection with dementia, two views of the person. One view of the person is derived from Locke and Parfit. This tends to regard the person solely in terms of psychological states and his/her connections. The second view of the person is derived from a variety of thinkers. I have called it the situated-embodied-agent view of the person. This view, I suggest, more readily squares with the reality of clinical experience. It regards the person as (...) embedded in a history and culture. The human person is also an embodied agent. I contend that this view encourages a more appropriate approach towards the ethical issues that arise in dementia and towards people with dementia. (shrink)

The precautionary principle has its origins in debates about environmental policy, but is increasingly invoked in bioethical contexts. John Harris and Søren Holm argue that the principle should be rejected as incoherent, irrational, and representing a fundamental threat to scientific advance and technological progress. This article argues that while there are problems with standard formulations of the principle, Harris and Holm's rejection of all its forms is mistaken. In particular, they focus on strong versions of the principle and fail to (...) recognize that weaker forms, which may escape their criticisms, are both possible and advocated in the literature. (shrink)

. The ability to enforce the provisions of a code of conduct influences whether the code is effective in shaping behavior. Enforcement relies in part on the willingness of organization members to report violations of the code, but research from the business and educational environment suggests that fewer than half of those who observe code violations follow their organizations procedures for reporting them. Based on a review of the literature in the business and educational environments, and a survey of 3605 (...) students at a mid-sized comprehensive university, this paper attempts to make conceptual sense of the non-reporting phenomenon. We present a conceptual framework based on four distinct factors which we have labeled: (1) factual non-responsibility; (2) moral non-responsibility; (3) consequential exoneration; and, (4) functional exoneration. Each of these factors suggest a different remedial strategy as well as provide a theoretical foundation for future research. Testable propositions for future research are developed, and some implications for organization leaders are discussed. (shrink)

There has been considerable work on practical reasoning in artificial intelligence and also in philosophy. Typically, such reasoning includes premises regarding means–end relations. A clear semantics for such relations is needed in order to evaluate proposed syllogisms. In this paper, we provide a formal semantics for means–end relations, in particular for necessary and sufficient means–end relations. Our semantics includes a non-monotonic conditional operator, so that related practical reasoning is naturally defeasible. This work is primarily an exercise in conceptual analysis, aimed (...) at clarifying and eventually evaluating existing theories of practical reasoning (pending a similar analysis regarding desires, intentions and other relevant concepts). (shrink)

Learning to see the continuity between our everyday decision-making and our decision-making around new biotechnologies is key to acclimatizing to our enhanced future. By excavating this decision-making, Singh helps us see that Ritalin isn’t really that big a deal and helps dispel what Malcolm Gladwell (1999) noted as the “strange inversion of moral responsibility” encouraged by books like ‘Ritalin Nation’ and ‘Running on Ritalin,’ whose authors “seek to make those parents and physicians trying to help children with A.D.H.D. feel guilty (...) for doing so.”. (shrink)

Robotics and artificial intelligence are beginning to fundamentally change the relative profitability and productivity of investments in capital versus human labor; creating technological unemployment at all levels of the workforce; from the North to the developing world. As robotics and expert systems become cheaper and more capable the percentage of the population that can find employment will also fall; stressing economies already trying to curtail "entitlements" and adopt austerity. Two additional technology-driven trends will exacerbate the structural unemployment crisis in the (...) coming decades; desktop manufacturing and anti-aging medicine. Desktop manufacturing threatens to disintermediate the half of all workers involved in translating ideas into products in the hands of consumers; while anti-aging therapies will increase the old age dependency ratio of retirees to tax-paying workers. Policies that are being proposed to protect or create employment will have only a temporary moderating effect on job loss. Over time these policies; which will impose raise costs; lower the quality of goods and services; and lower competitiveness; will become fiscally impossible and lose political support. In order to enjoy the benefits of technological innovation and longer; healthier lives we will need to combine policies that control the pace of replacing paid human labor with a universal basic income guarantee provided through taxation and the public ownership of wealth. The intensifying debate over the reform of "entitlements" will be the strategic opening for a campaign for BIG to replace disability and unemployment insurance; Social Security; and other elements of the welfare state. (shrink)

People often have a strong intuitive sense that we ought to rescue those in serious need, even in cases where we could produce better outcomes by acting in other ways. It has become common in such cases to refer to this as the Rule of Rescue. Within the medical field this rule has predominantly been discussed in relation to decisions about whether to fund particular treatments. Whilst in this setting the arguments in favour of the Rule of Rescue have generally (...) been found to be unconvincing, there are some reasons for thinking that it may have more of a role to play at the clinical level. In this article we examine three lines that such reasoning might take. In each case we argue that the reasons given do not support the adoption of a Rule of Rescue in clinical practice. (shrink)

Background For a variety of sociological reasons, different types of centredness have become important in health and social care. In trying to characterize one type of centredness, we were led to consider, at a conceptual level, the importance of the notion of centredness in general and the reasons for there being different types of centeredness. Method We searched the literature for papers on client-, family-, patient-, person- and relationship- centred care. We identified reviews or papers that defined or discussed the (...) notions at a conceptual level. The reviews and papers were analyzed as text transcripts. Results We identified 10 themes that were common to all the types of centredness. At a conceptual level we could not identify thematic differences between the types of centredness. These findings were subjected to a philosophical critique using ideas derived from Wittgenstein. Conclusion Different types of centredness are required in different contexts. The differences are justified by their practical utility. The unifying themes of centredness, however, reflect a movement in favour of increasing the social, psychological, cultural and ethical sensitivity of our human encounters. (shrink)

Dementia is an illness that raises important questions about our own attitudes to illness and aging. It also raises very important issues beyond the bounds of dementia to do with how we think of ourselves as people--fundamental questions about personal identity. Is the person with dementia the same person he or she was before? Is the individual with dementia a person at all? In a striking way, dementia seems to threaten the very existence of the self.LThis book brings together philosophers (...) and practitioners to explore the conceptual issues that arise in connection with this increasingly common illness. Drawing on a variety of philosophers such as Descartes, Lock, Hume, Wittgenstein, the authors explore the nature of personal identity in dementia. They also show how the lives and selfhood of people with dementia can be enhanced by attention to their psychological and spiritual environment. Throughout, the book conveys a strong ethical message, arguing in favor of treating people with dementia with all the dignity they deserve as human beings. The book covers a range of topics, stretching from talk of basic biology to talk of a spiritual understanding of people with dementia. Accessibly written by leading figures in psychiatry and philosophy, the book presents a unique and long overdue examination of an illness that features in so many of our lives. (shrink)

This thesis is intended t0 help develop the theory 0f coalgebras by, Hrst, taking classic theorems in the theory 0f universal algebras amd dualizing them and, second, developing an interna] 10gic for categories 0f coalgebras. We begin with an introduction t0 the categorical approach t0 algebras and the dual 110tion 0f coalgebras. Following this, we discuss (c0)a,lg€bra.s for 2. (c0)monad and develop 2. theory 0f regular subcoalgebras which will be used in the interna] logic. We also prove that categories 0f (...) coalgebras are completc, under reasonably weak conditions, and simultaneously prove the wellknown dual result for categories 0f algebras. We dose the second chapter with 2. discussion 0f bisimulations in which we introduce a weaker 110tion 0f bisimulaticn than is current in the literature, but which is w€H—b€ha.v€d and reduces t0 the standard defmition under the assumption 0f choice. (shrink)

Sandia National Laboratories, located in Albuquerque, New Mexico, was originally a part of Los Alamos Laboratory. In 1949, AT&T agreed to manage Sandia, which they did for the next 44 years. During those Cold War years, Sandia was the prime weapons engineering laboratory for Los Alamos and Lawrence Livermore. As such, it bore prime responsibility for designing and adapting nuclear weapons for the military services' delivery systems, and ensuring the safety and reliability of the stockpile. The Labs' history has been (...) unevenly documented, hindered by the secret nature of its work and the desire of management to maintain a low public profile. There have been three history programs at Sandia: a restricted history published internally in 1963; another history program in the early 1980s that resulted in a history of the Labs' first decade; and the current history program dating from the mid-1990s, which has published a general history and several monographs. This article discusses the challenges and problems inherent in documenting the history of a national weapons laboratory during the last 50 years. (shrink)

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place (...) of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests. (shrink)

As the expansion of the Internet and the digital formatting of all kinds of creative works move us further into the information age, intellectual property issues have become paramount. Computer programs costing thousands of research dollars are now copied in an instant. People who would recoil at the thought of stealing cars, computers, or VCRs regularly steal software or copy their favorite music from a friend's CD. Since the Web has no national boundaries, these issues are international concerns. The contributors-philosophers, (...) legal theorists, and business scholars, among others-address questions such as: Can abstract ideas be owned? How does the violation of intellectual property rights compare to the violation of physical property rights? Can computer software and other digital information be protected? And how should legal systems accommodate the ownership of intellectual property in an information age? Intellectual Property is a lively examination of these and other issues, and an invaluable resource for librarians, lawyers, businesspeople, and scholars. (shrink)

Moral bioenhancement is a topic that will only increase in controversy as neuroscience advances.

Over the last decade and a half there has emerged growing interest in the concept of “emotional intelligence” (henceforth EI), particularly within literature relating to occupational psychology, leadership, human resource management, and training. This paper considers the rise of EI as a managerial discourse and seeks to make sense of it, first in relation to existing accounts of emotion at work, and subsequently through utilising the analytical possibilities presented by the work of Norbert Elias and Michel Foucault. The case of (...) EI is employed here as a concrete empirical site within which to explore potential complementarities between the analyses of Elias and Foucault, in particular around Elias’s arguments concerning the changing character of the social constraint towards self restraint , and Foucault’s discussion of power/knowledge and governmentality. EI is found to enshrine a more general move towards greater emotional possibility and discretion both within the workplace and beyond — an ostensible emancipation of emotions from corporate attempts to script the management and display of employee feelings. However, it is argued that rather than offering a simple liberation of our emotional selves, EI presents demands for a heightened emotional reflexivity concerning what is emotionally appropriate at work and beyond. As such, EI involves both greater emotional “freedom” plus a proliferation of new modalities of emotional control, albeit based now on the expression of feelings as much as their repression. Ultimately, these seemingly paradoxical aspects of EI serve to highlight an important point of inter-section in the work of Elias and Foucault around their conceptualisations of power, selfhood, and the shifting character of social control. (shrink)

This essay is concerned with an enigmatic passage at the heart of Gilles Deleuze's Difference and Repetition which locates the origin of ideas in an “aleatory point”. Deleuze develops this claim th...

Herodotus’ account of the Athenian spear carrier Epizelus’ psychogenic mutism following the Marathon Wars is usually cited as the first documented account of post-traumatic stress disorders in historical literature. This paper describes much earlier accounts of post combat disorders that were recorded as occurring in Mesopotamia during the Assyrian dynasty. The descriptions in this paper include many symptoms of what we would now identify in current diagnostic classification systems as post-traumatic stress disorders, including flashbacks, sleep disturbance and low mood. The (...) Mesopotamians explain the disorder in terms of spirit affliction; the spirit of those enemies whom the patient had killed during battle causing the symptoms. (shrink)

Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows (...) generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics. (shrink)