Although consumers are increasingly engaged with ethical factors when forming opinions about products and making purchase decisions, recent studies have highlighted significant differences between consumers' intentions to consume ethically, and their actual purchase behaviour. This article contributes to an understanding of this 'Ethical Purchasing Gap' through a review of existing literature, and the inductive analysis of focus group discussions. A model is suggested which includes exogenous variables such as moral maturity and age which have been well covered in the literature, (...) together with further impeding factors identified from the focus group discussions. For some consumers, inertia in purchasing behaviour was such that the decision-making process was devoid of ethical considerations. Several consumers manifested their ethical views through post-purchase dissonance and retrospective feelings of guilt. Others displayed a reluctance to consume ethically due to personal constraints, a perceived negative impact on image or quality, or an outright negation of responsibility. Those who expressed a desire to consume ethically often seemed deterred by cynicism, which caused them to question the impact they, as an individual, could achieve. These findings enhance the understanding of ethical consumption decisions and provide a platform for future research in this area. (shrink)

One of the unique insights provided by the growing number of fully sequenced genomes is the pervasiveness of gene duplication and gene loss. Indeed, several metrics now suggest that rates of gene birth and death per gene are only 10–40% lower than nucleotide substitutions per site, and that per nucleotide, the consequent lineage‐specific expansion and contraction of gene families may play at least as large a role in adaptation as changes in orthologous sequences. While gene family evolution is pervasive, it (...) may be especially important in our own evolution since it appears that the “revolving door” of gene duplication and loss has undergone multiple accelerations in the lineage leading to humans. In this paper, we review current understanding of gene family evolution including: methods for inferring copy number change, evidence for adaptive expansion and adaptive contraction of gene families, the origins of new families and deaths of previously established ones, and finally we conclude with a perspective on challenges and promising directions for future research. (shrink)

Loss of the Y‐chromosome is a common feature of species with chromosomal sex determination. However, our understanding of why some lineages frequently lose Y‐chromosomes while others do not is limited. The fragile Y hypothesis proposes that in species with chiasmatic meiosis the rate of Y‐chromosome aneuploidy and the size of the recombining region have a negative correlation. The fragile Y hypothesis provides a number of novel insights not possible under traditional models. Specifically, increased rates of Y aneuploidy may impose positive (...) selection for (i) gene movement off the Y; (ii) translocations and fusions which expand the recombining region; and (iii) alternative meiotic segregation mechanisms (achiasmatic or asynaptic). These insights as well as existing evidence for the frequency of Y‐chromosome aneuploidy raise doubt about the prospects for long‐term retention of the human Y‐chromosome despite recent evidence for stable gene content in older non‐recombining regions. (shrink)

This chapter explores the relations of different kinds of power, philosophically understood – sovereign power, disciplinary power, and biopower – and argues that the politics of the Star Wars galaxy is animated by an ontology, or metaphysical picture, centered on power. It further argues that The Mandalorian criticizes this power ontology with the introduction of the Child, Grogu, who generates a different kind of Force: a relational ontology of love. Grogu and the love he generates point to a different way (...) of being in the world than power. Ultimately, The Mandalorian offers a different ontology of power – an ontology of love – as a radical alternative to the bindings of political power. Palpatine is correct that power dynamics shape the confrontational relationship between the Jedi and Sith, which is fed by the Jedi's disavowal of strong attachments. (shrink)

Of Goals and Goods and Floundering About: A Dissensus Report on Clinical Ethics Consultation Content Type Journal Article Pages 275-291 DOI 10.1007/s10730-009-9101-1 Authors Jeffrey P. Bishop, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, Suite 400 Nashville Tennessee 37203 USA Mark J. Bliton, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Avenue, (...) Suite 400 Nashville Tennessee 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 3. (shrink)

Erratum to: Echo Calling Narcissus: What Exceeds the Gaze of Clinical Ethics Consultation? Content Type Journal Article Pages 171-171 DOI 10.1007/s10730-010-9132-7 Authors Jeffrey P. Bishop, Saint Louis University Tenet Chair of Health Care Ethics, Albert Gnaegi Center for Health Care Ethics Salus Center, Room 527, 3545 Lafayette Ave St. Louis MO 63104-1314 USA Joseph B. Fanning, Vanderbilt University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Mark J. Bliton, Vanderbilt (...) University Center for Biomedical Ethics and Society 2525 West End Ave., 4th Floor, Suite 400 Nashville TN 37203 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 22 Journal Issue Volume 22, Number 2. (shrink)

What is it like to live with the label “Disability?” NIB editorial staff and narrative symposium editors, Jeffery Bishop and Naomi Sunderland developed a call for stories, which was sent to several list serves, shared with the 1000 Voices Project community and posted on Narrative Inquiry in Bioethics ’ website. The request for personal stories from people who identify with the label “disabled” asked them to: consider how the label “disability” interacts with other aspects of their life in (...) health care settings; does the term “disability” reflect their actual embodied experiences of impairment or does it fail to do justice to their particular experience of impairment; describe the kind of experiences that are possible because of the impairment(s); discuss how the label has affected their “authentic voice”; and many other concepts about what effects the label has on their lives. These authors share deeply personal experiences that will help readers understand their world, challenges, and joys. Thirteen stories are found in the print version of the journal and an additional five supplemental stories are published online only through Project MUSE. The stories are complemented by four commentary articles by Elizabeth R. Schiltz; Lorna Hallahan; Nicole Matthews, Kathleen Ellem, and Lesley Chenoweth; and Jeffery Bishop, Rachelle Barina, and Devan Stahl. These scholars come from the disciplines of law, social work, media studies, medicine, and bioethics from Australia and the United States. Together, the symposium’s storytellers and commentators offer striking and informative insights into the everydayness of living with disabilities. (shrink)

The stories in this issue of Narrative Inquiry in Bioethics demonstrate two important things. First these stories explore the space between bodily impairment and the social structures that both enable and constrain the flourishing of those who are differently embodied. The authors of these narratives resist the dominant biomedical interpretation of their impairments, but also demonstrate their dependency upon others—social, medical, or familial others. Second, in writing these narratives, the authors are also engaged in an act of identity formation, which (...) sometimes challenge and sometimes embrace the label of disability. By telling their stories in the middle of the action of their lives— in media res, taking up or resisting the label of disability—they also demonstrate the way in which lives can be lived open to new possibilities and interpretations. (shrink)

Voluntary active euthanasia and physician assisted suicide should not be legalised because too much that is important about living and dying will be lostIn the first of this two part series, I unpack the historical philosophical distinction between killing and allowing a patient to die in order to clear up the confusion that exists. Historically speaking the two kinds of actions are morally distinct because of older notions of causality and human agency. We no longer understand that distinction primarily because (...) we have shifted our notions of causality from a traditional formulation to a modern formulation of causality and thus of moral assessment that focuses on the effects of an action. In this essay, I prepare the ground for a companion essay by showing that the traditional formulation allows us to maintain notions of meaning and purpose to human living and dying that are precluded in the efficiency paradigm of modernity. Taken together with the companion essay, I am claiming that voluntary active euthanasia and physician assisted suicide should not be legalised because too much that is important about dying and living will be lost.TWO LIESIt would be naïve to think that euthanasia, in either the VAE sense, or in the more passive sense of PAS, does not happen. It would even be naïve to think that it does not occur in a non-voluntary form. It would be equally naïve, however, to think it could be controlled through governmental regulation. The real question with regard to PAS/VAE, put so eloquently by Martha Minow, is which lie do you countenance: the lie that euthanasia does not already happen, or the lie that it can be controlled without having repercussions well beyond the limits of procedural mastery?1 With this two part paper series, I will argue that the …. (shrink)

Despite the belief that metaphors are thought to be powerful persuasive devices, little empirical evidence exists to support this claim. A first step in examining the persuasive impact of metaphors is to measure recall and production variables concerning the persuasive message. This study examined recollections regarding the Iran-Contra hearings among honors introductory psychology students. Recall of the hearings appeared heavily influenced by externally imposed (i.e., media, politicians) metaphors. Moreover, metaphors used typically expressed an attitude about the Iran-Contra affair, particularly about (...) Lieutenant Colonel Oliver North's involvement. (shrink)

Death cannot be mastered through a metaphysics of efficiency that interprets all actions in terms only of cause and effect, but it can be transcended if we leave the frame open to death’s ambiguityIn the second of this two part series, I describe how in shifting our frames from one of human purpose and meaning to one of efficiency, we shift the possible answers we get to our questions about voluntary active euthanasia and physician assisted suicide . Thus, by placing (...) VAE/PAS within the frame of efficiency, we narrow our focus to the final effect in the world of cause and effect—namely death. Thus, in ensconcing euthanasia within a legal framework meant to instrumentally and efficiently control euthanasia, we are in fact narrowing our focus on death. Thus, in legalising VAE/PAS we are not just adding one choice to a panoply of other choices, we are in fact changing the nature of all choices, for each choice conditions all others. We should therefore live with the lie that VAE/PAS do not happen as opposed to living with the lie that through efficient legal control we protect patients from medical dominance.AN ANECDOTESeveral years ago an acquaintance told me about a terrible situation in which he found himself during the Vietnam war. He was Green Beret—one of the elite special forces corps of the US army. He was in an area that was officially off limits to the US. His unit came under heavy fire and a buddy was shot in several places but was still alive. His comrade was in serious pain, but what scared him the most was that he might die in the jungle, be eaten by a wild animal, or be captured by the enemy. There was no way to get him out. The wounded soldier …. (shrink)

Two problems have long been confused with each other: the gravitational redshift as discussed by the equivalence principle; and the Doppler shift observed by a detector which moves with constant proper acceleration away from a stationary source. We here distinguish these two problems and give for the first time a solution of the former which is ‘exact’ within the context of the equivalence principle in a sense discussed in the paper. The equivalence principle leads to transformations between flat spacetimes. These (...) are analyzed, and a generalized Lorentz transformation is proposed which covers transformations from inertial to uniformly accelerated frames of reference. (shrink)

The Heythrop Journal, Volume 63, Issue 3, Page 333-348, May 2022.

The flight to reference is a widely-used strategy for resolving philosophical issues. The three steps in a flight to reference argument are: (1) offer a substantive account of the reference relation, (2) argue that a particular expression refers (or does not refer), and (3) draw a philosophical conclusion about something other than reference, like truth or ontology. It is our contention that whenever the flight to reference strategy is invoked, there is a crucial step that is left undefended, and that (...) without a defense of this step, the flight to reference is a fatally flawed strategy; it cannot succeed in resolving philosophical issues. In this paper we begin by setting out the flight to reference strategy and explaining what is wrong with arguments that invoke the strategy. We then illustrate the problem by considering arguments for and against eliminative materialism. In the final section we argue that much the same problem undermines Philip Kitcher's attempt to defend scientific realism. (shrink)

After describing Heidegger's critique of metaphysics as ontotheology, I unpack the metaphysical assumptions of several transhumanist philosophers. I claim that they deploy an ontology of power and that they also deploy a kind of theology, as Heidegger meant it. I also describe the way in which this metaphysics begets its own politics and ethics. In order to transcend the human condition, they must transgress the human.

The call for a narrative medicine has been touted as the cure-all for an increasingly mechanical medicine. It has been claimed that the humanities might create more empathic, reflective, professional and trustworthy doctors. In other words, we can once again humanise medicine through the addition of humanities. In this essay, I explore how the humanities, particularly narrative medicine, appeals to the metaphysical commitments of the medical institution in order to find its justification, and in so doing, perpetuates a dualism of (...) humanity that would have humanism as the counterpoint to the biopsychosociologisms of our day. (shrink)

This essay places Foucault's work into a philosophical context, recognizing that Foucault is difficult to place and demonstrates that Foucault remains in the Kantian tradition of philosophy, even if he sits at the margins of that tradition. For Kant, the forms of intuition—space and time—are the a priori conditions of the possibility of human experience and knowledge. For Foucault, the a priori conditions are political space and historical time. Foucault sees political space as central to understanding both the subject and (...) objects of medicine, psychiatry, and the social sciences. Through this analysis one can see that medicine's metaphysics is a metaphysics of efficient causation, where medicine's objects are subjected to mechanisms of efficient control. (shrink)

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

Technology tends toward perpetual innovation. Technology, enabled by both political and economic structures, propels society forward in a kind of technological evolution. The moment a novel piece of technology is in place, immediately innovations are attempted in a process of unending betterment. Bernard Stiegler suggests that, contra Heidegger, it is not being-toward-death that shapes human perception of time, life, death, and meaning. Rather, it is technological innovation that shapes human perception of time, life, death, and meaning. In fact, for Stiegler, (...) human evolution has always been part of technological evolution. While one can quibble with the notion of human-technology co-evolution, there is something to be said for the way in which human perception of time, of ageing, and of death seems to be judged against the horizon of perpetual evolution of technological innovation. In this technological imaginary, of which modern medicine is constituent, ageing and death seemingly may be infinitely deferred, and it is this innovating deferral that shapes the contemporary social imaginary around ageing and death in modern medicine. Yet, the reality of living and dying always manifests itself differently than the scripts given to us by the technological imaginary with its myth of endless innovation. In fact, I shall argue that, where the Church created an ars moriendi, the technological imaginary gives us an ars ad mortem when it becomes clear that ageing and death cannot be infinitely deferred. And further, I shall argue that the Church must revivify its ars vivendi—that is to say, its liturgies, its arts, its technics—as a counter narrative to the myth of perpetual innovation that shapes the technological imaginary. (shrink)

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. RCOPE is an instrument designed to categorize (...) religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control. (shrink)

Humanity does not gradually progress from combat to combat until it arrives at universal reciprocity, where the rule of law finally replaces warfare; humanity installs each of its violences in a system of rules and thus proceeds from domination to domination. (Foucault, 1984, 85)In this essay, I take a note from Michel Foucault regarding the notion of biopolitics. For Foucault, biopolitics has both repressive and constitutive properties. Foucault's claim is that with the rise of modern government, the state became exceedingly (...) concerned about the body politic, the bodies that make up the polis, including the health of those bodies. However, Giorgio Agamben claims that Foucault and all western political philosophy misses the relationship between power and Sovereignty, with disastrous results and totalizing tendencies. I explore the case of Terri Schiavo claiming that the social conservatives have attempted to politicize bare life in its legal maneuverings, but I also show how the social liberals open an uncontrollable space between life and death. Both the left and the right miss the aporia at the heart of western political philosophy, and bioethics is complicit in the totalizing effects of contemporary medicine. (shrink)

“The Zadeh Scenario,” when taken together with the subsequent layers of peer review and commentary on that peer review, highlights two crucial insights regarding peer review for clinical ethics. The first is one that most of Finder’s peer reviewers miss: peer-reviewers who would give attestation to quality need to be critically attentive to, and reflective about, the evidence supplied to them by candidates. The second is a more significant point: the kind of doing that is clinical ethics consultation is a (...) local form of moral enquiry, seeking not just to achieve medical – or clinical ethical – goals, but to enact human goods. Good peer review thus turns on being clear regarding the goods of ethics consultation. Buried inside “The Zadeh Scenario” one can find several goods of clinical ethics. These goods are subjective, idiosyncratically named and defined by patients, and embedded in an institution of healthcare that purports to be of service to the goods of health. The clinical ethics consultant, at her best, acts as a careful mid-wife, attempting to bring forth the goods desired, the goods possible, and perhaps even the goods that, while desired, are not possible. After all, some goods pursued by patients are not possible due to the limits of medicine. On the other hand, some goods pursued by medicine are not desired by patients. And equally, some goods pursued by clinical ethicists might be limited, provisional, and local. “The Zadeh Scenario” thus acts to problematize the goals of clinical ethics consultation, asking it to focus on the goods that the practice might bring forth. (shrink)

Christians are not immune to psychological and psychiatric illness. Yet, Christians should also be careful not to permit popular cultural trends to shape the way that they think about the use of psychiatric treatment with medication. In this essay, I suggest that the tendencies for default usage of psychiatric medication can be problematic for Christians in contemporary culture where a technological imaginary exists. Modern scientific studies of psychiatric medication are partly constructive of how we imagine ourselves. The typical justification for (...) the usage of technology in contemporary culture is the theme of cocreation with God, where Christians see any usage of technology as equivalent to our participating in God’s ongoing creative activity. I challenge these ideas in the foregoing paper, noting that the modern technological imaginary that animates modern psychiatry is as constricting as it is enabling. I conclude with a different take on what it might mean for Christians to be cocreators with God. (shrink)

A growing number of scholars have suggested that there is a unique I-You relation that obtains between persons in face-to-face encounters, but while the increased attention paid to the second-person has led to many important insights regarding the nature of this relation, there is still much work to be done to clarify what makes the second-person relation distinct. In this paper we wish to develop recent scholarship on the second-person by means of a phenomenological analysis of a doctor-patient interaction. In (...) such an interaction the doctor and patient continuously shift between the observational I-It and the interactive I-You, and recognizing the difference between observation and interaction not only helps to defend the claim that this relation is sui generis, but also uncovers the co-constitution of experience from within this relation. As we argue, engaging another second-personally involves a shared experience that is a result of incorporating the other’s mental states into one’s own while standing in the second-person relation. (shrink)

A growing number of scholars have suggested that there is a unique I-You relation that obtains between persons in face-to-face encounters, but while the increased attention paid to the second-person has led to many important insights regarding the nature of this relation, there is still much work to be done to clarify what makes the second-person relation distinct. In this paper we wish to develop recent scholarship on the second-person by means of a phenomenological analysis of a doctor-patient interaction. In (...) such an interaction the doctor and patient continuously shift between the observational I-It and the interactive I-You, and recognizing the difference between observation and interaction not only helps to defend the claim that this relation is sui generis, but also uncovers the co-constitution of experience from within this relation. As we argue, engaging another second-personally involves a shared experience that is a result of incorporating the other’s mental states into one’s own while standing in the second-person relation. (shrink)

Technology is evolving at a rate faster than human evolution, especially human moral evolution. There are those who claim that we must morally bioenhance the human due to existential threats (such as climate change and the looming possibility of cognitive enhancement) and due to the fact that the human animal has a weak moral will. To address these existential threats, we must design human morality into human beings technologically. By moral bioenhancement, these authors mean that we must intervene technologically in (...) the biology of the human animal in order to get it to behave morally to address these existential threats. I will bring the idea of moral bioenhancement into conversation with two philosophers of technology. Bernard Stiegler has argued that technology and culture, and thus technology and human beings, have always evolved hand in hand. Peter-Paul Verbeek notes that we have always designed morality into technology, and thus he sees technology as mediating human morality. When we offload human intentionality onto technology, Verbeek argues, technological objects and systems participate in shaping the moral subjectivity of the human actor. I will show that modern technological bioenhancement obliterates human being. Whereas in the past, human culture was handed from generation to generation through the mediation of technology, in the modern era, the human becomes the raw material upon which a technological will (imperative) rides. (shrink)

The essays in this issue of JMP are devoted to critical engagement of my book, The Anticipatory Corpse. The essays, for the most part, accept the main thrust of my critique of medicine. The main thrust of the criticism is whether the scope of the critique is too totalizing, and whether the proposed remedy is sufficient. I greatly appreciate these interventions because they allow me this occasion to respond and clarify, and to even further extend the argument of my book. (...) In this response essay, I maintain that the regnant social imaginary of medicine is the regnant social imaginary of our time. It is grounded in a specific ontotheology: where ontology is a power ontology; where material is malleable to the open-ended organization of power and dependent only on working out the efficient mechanisms of its enactment; where ethically it is oriented only to the immanent telos of utility maximization in the short run, and ultimately to some posthuman future in the long run. This ontotheology originates in the anticipatory corpse and is ordered toward some god-like posthuman being. The entire ontotheology finds enactment through the political economy of neoliberalism. This social imaginary constantly works to insulate itself from other social imaginaries through the use of its institutional power, through marginalization, circumscription, or absorption. The modern social imaginary of neoliberal societies marginalizes and politically isolates other social imaginaries, or transforms them into something acceptable to the neoliberal imaginary. Yet, these other social imaginaries could influence the larger social imaginary in novel ways, sometimes through withdrawal and sometimes through challenges. These other practices—again, usually practices ordered according to different ontological and teleological purposes—might serve as a source of renewal and transformation, but only if the practitioners of these other social imaginaries understand the ontotheological powers that they are up against. (shrink)

It is commonly held that Christian ethics generally and Christian bioethics particularly is the application of Christian moral systems to novel problems engaged by contemporary culture and created by contemporary technology. On this view, Christianity adds its moral vision to a technology, baptizing it for use. In this essay, I show that modern technology is a metaphysical moral worldview that enacts its own moral vision, shaping a moral imaginary, shaping our moral perception, creating moral subjects, and shaping what we imagine (...) as moral intentions. In fact, modern technics has its own liturgics, which is foreign to Christian Divine Liturgy. Divine Liturgy is world forming, showing us a different world than the one that comes into relief in the ersatz liturgy of modern medical technics. (shrink)

Full-Blooded religion is not acceptable in mainstream bioethics. This article excavates the cultural history that led to the suppression of religion in bioethics. Bioethicists typically fall into one of the following camps. 1) The irreligious, who advocate for suppressing religion, as do Timothy F. Murphy, Sam Harris, and Richard Dawkins. This irreligious camp assumes American Fundamentalist Protestantism is the real substance of all religions. 2) Religious bioethicists, who defend religion by emphasizing its functions and diminishing its metaphysical commitments. Religious defenders (...) empty religion of its theology to present its feel-good functions in a way that is acceptable to the irreligious. However, religion reduced to its functions dissolves into a counter-culture that may counteract materialism but lacks the power to motivate much more. This article criticizes both camps, as both presume Enlightenment myths and consequently neuter religion. Both irreligious and religious bioethicists commonly presume Enlightenment myths about secularity and religion. Secularity is presumed neutral and rational. Religion is presumed divisive and irrational. This myth provides built-in value-judgements; we have already judged secularity as good and religion as bad. Much of the debate over religion in bioethics is arguing over false stereotypes of religion. Consequently, mainstream bioethics neuters religion, while the irreligious are gifted political power to define the field. (shrink)

I, along with others, have been critical of the social construction of brain death and the various social factors that led to redefining death from cardiopulmonary failure to irreversible loss of brain functioning, or brain death. Yet this does not mean that brain death is not the best threshold to permit organ harvesting—or, as people today prefer to call it, organ procurement. Here I defend whole-brain death as a morally legitimate line that, once crossed, is grounds for families to give (...) permission for organ donation. I do so in five moves. First, I make the case that whole-brain death is a social construction that transformed one thing, coma dépassé, into another thing, brain death, as a result of social pressures. Second, I explore the way that the 1981 President’s Commission tried to establish the epistemological certainty of brain death, hoping to avoid making arcane metaphysical claims and yet still utilizing metaphysical claims about human beings. Third, I explore the moral meaning of the social construction of a definition that cannot offer metaphysical certainty about the point at which somebody becomes just some body. Fourth, I describe how two moral communities—Jewish and Catholic—actually ground their metaphysical positions with regard to brain death in the normativity of prior social relations. Finally, I conclude with a reflection on the aesthetic-moral enterprise of the metaphysical-epistemological apparatus of brain death, concluding that only such an aesthetic-moral approach is sufficiently strong to stave off the utility-maximizing tendencies of late-modern Western cultures. (shrink)

This article, which introduces the special section on The Urban Problematic, takes as its starting point the ways in which categories associated with the ‘urban’ have broken down, such that the once singular and coherent concept ‘city’ has disintegrated in certain ways: the notion has been demythologized, so that representations of the city must now be regarded as partial and invested; and cities themselves have become opaque and unpredictable both to urban scholars and to governments, planners and various kinds of (...) welfare organizations. The indications of crisis, captured for instance by concerns about the slums, favelas and shanty towns of the world’s megacities, also indicate that much of what counts in modern urban life is in some way connected with the marginal, the unofficial, and the supplemental. The article takes a supplemental view of the current state of urban dwelling. This involves at the same time a longer, more patient, historical view in its attempt to understand the current state of the city as part of a shift in the play of heterogeneous forces. With reference to the articles contained in The Urban Problematic, this introductory article finally draws attention to some of the urgent and critical issues of contemporary urbanism. (shrink)

The doctrine of the mature minor began as an emergency exception to the rule of parental consent. Over time, the doctrine crept into cases that were non-emergent. In this essay, we show how the doctrine also developed in the context of the latter part of the 20th century, at the same time that the sexual revolution, the pill, and sexual liberation came to be seen as important symbols of female liberation—liberation that required that female minors be granted the status of (...) a mature minor. To do so moves sexual morality out of the domain of the family, where it had always been situated, and into the domain of the state. We also show how a phenomenological account of the care of the body in the family conforms to the latest in neuroscientific understandings of adolescent brain development. The family attenuates the dependency of adolescents and provides an important social contextualization for the care of the body, including the inculcation of sexual mores in adolescence. We conclude that the drive to push sexual decision making as a matter of state concern further undermines the foundations of the moral meanings of sex and sexuality. (shrink)

Compelled by recent public and politicized cases in which withdrawal of nutrition and hydration were at issue, this essay examines recent Church statements and argues that the distinction between private and public forms of human life is being lost. Effacing the distinction between the sphere of the home (oikos), where the maintenance of life (zoē) occurs, and the city (polis), where political and public life (bios) occurs, may have unforeseen and unwanted consequences. Through their well-intentioned efforts to preserve the sanctity (...) of life, certain bishops and the Congregation for the Doctrine of the Faith have unfortunately brought political considerations into the home, taking decision-making authority away from those most intimately related to the patient. Thus, the question of removing nutrition and hydration in the case of patients such as Schiavo and Englaro becomes politicized and abstract, in contrast with the Church's previous positions on the importance of proportionate means in the maintenance of life, local decision making, and its recognition of life as a penultimate end. (shrink)

E. Haavi Morreim's book, Holding Health Care Accountable , insightfully describes several features of the current crisis in malpractice in relation to the health care marketplace. In this essay, I delineate the key and eminently practical guide for reform that she lays out. I argue that her insights bring us to more fundamental aspects than immanent medical economy and accountability - aspects that are ignored at present. I describe the features of immanent economy and how they tend to cover over (...) epistemological and existential finitude in medicine, show how economy can in fact create new medical knowledge, and show that necessary error is a real feature of day-to-day medical practice. The current system, even with Morreim's reforms, remains at the level of immanent economy, but with modifications may point to the features of medicine that transcend medical knowledge and economy. The gifts of medicine cannot be reduced to the immanent medical economy, and any attempt to do so results in crisis. A health care that points to finitude and fallibility is one that points to the mystery of human existence and mortality. Any health care financing system that helps to delineate finitude - both epistemological and existential - is one that will give patients a new lease on living and dying. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

Tolerance is at the heart of Western liberalism, permitting mutually exclusive ideas and practices to coexist peacefully with one another, without the proponents of the differing ideas and practices killing one another. Yet, nothing challenges tolerance like the practice of sunna, female circumcision, clitorectomy, or genital mutilation. In this essay, I critique the Western critics of the practices, not in order to defend these practices, but rather to show that Western liberalism itself does not offer transcultural and transtemporal principles, for (...) these principles only cohere within the tradition of liberalism. The Western critique of sunna often maps onto the bodies of African women Western symbolic notions of sexual and political freedom, as symbolized in the clitoris. The practices of sunna cohere within the web of beliefs, the tradition, of those who practice them and, thus, are rationally justified within those traditions. I offer Alasdair MacIntyre's notion of moral inquiry as a guide through the complex world of cultural and moral dialogue between differing traditions. (shrink)