Today's medicine is spiritually deflated and morally adrift; this book explains why and offers an ethical framework to renew and guide practitioners in fulfilling their profession to heal. What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics (...) meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of "health care services" for the sake of the patient's subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange. Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient's health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics. (shrink)

It is common wisdom that today’s medicine focuses too much on treating those who are sick and too little on preventing the sickness in the first place. This essay proposes that Jesus’ teaching in the Sermon on the Mount challenges that assumption and the preventive medicine to which it has given rise. In light of Jesus’ teaching, the essay identifies four apparent problems with much of preventive medicine. It then offers four heuristics that might form a basic Christian logic for (...) medicalizing risk—for discerning when and why it would be fitting, wise, and faithful for Christians to make use of medicine to avoid future illness and death. (shrink)

It is often said that the world is explained by laws of nature together with initial conditions. But does that mean initial conditions don’t require further explanation? And does the explanatory role played by initial conditions entail or require that time has a preferred direction? This chapter looks at the use of the ‘initialness defence’ in physics, the idea that initial conditions are intrinsically special in that they don’t require further explanation, unlike the state of the world at other times. (...) Such defences commonly assume a primitive directionality of time to distinguish between initial and final conditions. Using the case study of the time-asymmetry of thermodynamics and the so-called ‘past hypothesis’ — the hypothesis that the early universe was in a state of very low entropy —, I outline and support a deflationary account of the initialness defence that does not pre- suppose a basic directionality of time, and argue that there is a relevant explanatory asymmetry between initial conditions and the state of systems at other times only if certain causal conditions are satisfied. Hence, the initialness defence is available to those who reject a fundamental direction of time. (shrink)

Uncivil behavior by leaders may be viewed as an effective way to motivate employees. However, supervisor incivility, as a form of unethical supervision, may be undercutting employees’ ability to do their jobs. We investigate linkages between workplace incivility and perceived work ability, a variable that captures employees’ appraisals of their ability to continue working in their jobs. We draw upon the appraisal theory of stress and social identity theory to examine incivility from supervisors as an antecedent to PWA, and to (...) investigate job involvement and grit as joint moderators of this association. Results from data collected in two samples of working adults provided evidence for three-way interactions in relation to PWA. Among employees with high levels of grit, there was no significant relation between supervisor incivility and PWA, regardless of employee job involvement. However, we found some evidence that for those low in grit, having high job involvement was associated with a stronger relationship between supervisor incivility and PWA. Findings attest to the importance of unethical supervisor behavior, showing the potential for supervisor incivility to erode PWA, as well as the importance of grit as a potential buffer. (shrink)

Abordaré la crítica de Axel Honneth a la primera Escuela de Frankfurt y su aparente omisión de Herbert Marcuse. Defenderé a Marcuse contra algunas de las críticas hechas por Honneth a la teoría crítica temprana de la Escuela de Frankfurt. Luego argumentaré que Marcuse siempre estuvo en busca de una subjetividad radical, incluso cuando advirtió contra los mecanismos unidimensionales en curso de producción de sujetos. Finalmente, mostraré que Honneth también construye su proyecto en torno a la búsqueda de una subjetividad (...) radical, pero aborda el problema a través de una teoría de la intersubjetividad que complementa el proyecto de Marcuse. (shrink)

The medical profession’s increasing acceptance of “physician aid-in-dying” indicates the ascendancy of what we call the provider-of-services model for medicine, in which medical “providers” offer services to help patients maximize their “well-being” according to the wishes of the patient. This model contrasts with and contradicts what we call the Way of Medicine, in which medicine is a moral practice oriented to the patient’s health. A steadfast refusal intentionally to harm or kill is a touchstone of the Way of Medicine, one (...) unambiguously affirmed by Christians through the centuries. Moreover, physician aid-in-dying contradicts one of the distinctive contributions that the Christian era brought to medicine, namely, a taken-for-granted solidarity between medical practitioners and those suffering illness and disability. Insofar as medical practitioners cooperate in aid-in-dying, they contradict this solidarity and undermine the trust that patients need to allow themselves to be cared for by physicians when they are sick and debilitated. (shrink)

Market metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues’ analysis of modernization in their book The Homeless Mind and place that analysis in conversation with Max Weber’s 1917 lecture “Science as a Vocation” to argue that the rise of market metaphors betokens the carry-over to medical practice of various features from the institutions of technological production and bureaucratic administration. We refer to this carry-over as the product presumption. The product presumption (...) foregrounds accidental features of medicine while hiding its essential features. It thereby confounds the public understanding of medicine and impedes the professional achievement of the excellences most central to medical practice. In demonstrating this pattern, we focus on a recent article, “Physicians, Not Conscripts—Conscientious Objection in Health Care,” in which Ronit Stahl and Ezekiel Emanuel decry conscientious refusals by medical practitioners. We demonstrate that Stahl and Emanuel’s argument depends on the product presumption, ignoring and undermining central features of good medicine. We conclude by encouraging conscientious resistance to the product presumption and the language it engenders. (shrink)

Cognitive science has recently made some startling discoveries about temporal experience, and these discoveries have been drafted into philosophical service. We survey recent appeals to cognitive science in the philosophical debate over whether time objectively passes. Since this research is currently in its infancy, we identify some directions for future research.

For most of the past generation, clinicians have been taught to treat patients' pain until the patient says it is relieved. The opioid crisis has forced both clinicians and patients to reconsider that approach. This essay considers how Christians in particular might assume and seek to overcome their experiences of persistent pain. Wise and faithful responses to pain, especially chronic pain, can take their bearings from how early Christians made sense of the place of both medicine and suffering in a (...) faithful life. This results in not asking medicine to resolve persistent pain, especially not through the use of opioids. Resisting the impulse to medicalize chronic pain will require patience on the part of those who suffer, and both patience and fortitude on the part of the clinicians to whom they present. (shrink)

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human experience, (...) to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

I will address Axel Honneth’s critique of the early Frankfurt School and his apparent omission of Marcuse. I will defend Marcuse against some of the criticisms of early Frankfurt School critical theory made by Honneth. I will then argue that Marcuse was always in search of radical subjectivity, even as he warned against the ongoing one-dimensional mechanisms of subject production. Finally, I will show that Honneth also builds his project around the search for radical subjectivity but approaches the problem through (...) a theory of intersubjectivity which complements Marcuse’s project. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life care, bioethics, and (...) health policy discuss if age should guide rationing decisions. (shrink)

Doctors often refuse patients' REQUESTS, even when patients request interventions that are legal and permitted by the medical profession. This is a fact about the practice of medicine so familiar that it is easy to overlook.Doctors' refusals are neither new nor infrequent, and only a small minority occasion any controversy. Surgeons refuse to operate when they believe a surgery is unlikely to succeed. Physicians refuse medications when they believe the medications are unlikely to be helpful. Clinicians refuse requested interventions because (...) of concerns about safety or efficacy, and they refuse because of less tangible concerns that are no less real. Some pediatricians refuse to supplement the growth hormone of boys... (shrink)

Some interesting exceptions notwithstanding, the traditional logic of economic efficiency has long favored hierarchical forms of organization and disfavored democracy in business. What does the balance of arguments look like, however, when values besides efficient revenue production are brought into the picture? The question is not hypothetical: In recent years, an ever increasing number of corporations have developed and adopted socially responsible behaviors, thereby hybridizing aspects of corporate businesses and social organizations. We argue that the joint pursuit of financial and (...) social objectives warrants significant rethinking of organizational democracy’s merits compared both to hierarchy and to non-democratic alternatives to hierarchy. In making this argument, we draw on an extensive literature review to document the relative lack of substantive discussion of organizational democracy since 1960. And we draw lessons from political theory, suggesting that the success of political democracy in integrating diverse values offers some grounds for asserting parallel virtues in the business case. (shrink)

While the COVID-19 pandemic riveted public attention on questions regarding how to respond reasonably to risk of illness, everyday medical care involves more mundane forms of pharmaceutical risk management for conditions like high blood pressure, prediabetes, or high cholesterol. This essay, and the collection it introduces, explore medicalization of risk as a theological problem, drawing on resources such as the Sermon on the Mount that caution us about the potential dangers of risk management to Christian discipleship. Medicalization of risk threatens (...) to become an idol that promises immanent security at the cost of one’s relationship with God and others. It misleads contemporary society as to the true human end and medicine’s own capabilities to provide temporal salvation. The essays in this special issue illustrate these problems with respect to pharmaceutical risk management. (shrink)

This article discusses what is involved in having full moral status, as opposed to a lesser degree of moral status and surveys different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

Habermas's paradigm of communicative action is usually taken to be pretty much dominated by consensus, "Yes-saying." What if this were a radically one-sided perception? We take up this unorthodox position by arguing that "no-saying" in this paradigm is typically overlooked and underemphasized. To demonstrate this, we consider how negativity is figured at the most basic onto-ethical level in communicative action, as well as expressed in civil disobedience, a phenomenon to which Habermas assigns the remarkable role of "touchstone" (Prufstein) of constitutional (...) democracy. Once the importance of no-saying is drawn out, the paradigm looks distinctly less hostile to dissensus and agonism in democratic life. (shrink)

In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession.1.

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Over the past decade, scores of articles have been published debating whether and when it is ethical for physicians to refuse requests from patients for legal, professionally permitted interventions. Numerous voices have condemned "conscientious refusals" for obstructing patients' access to needed and "standard" health-care services, for imposing physicians' personal ideologies on patients, and for contradicting physicians' professional ethical obligations. Conversely, other voices argue that conscientious refusals are essential for maintaining the integrity of clinicians as moral agents, for assuring the renown (...) of the broader medical profession, and for preventing the imposition of moral viewpoints onto minorities... (shrink)

The stories in this collection can be described as stories of transgression. The writers have learned that public expressions of religious faith or reasoning are to be kept separate from the practices of caring for patients. Mixing the two is dangerous. Yet, as the stories indicate, many health practitioners cannot help themselves: their religion comes through, shaping their encounters with patients in all manner of ways. Religion comes through not as a distraction from medicine but as integral to their efforts (...) to care well for their patients. (shrink)

It is an unresolved question in quantum mechanics whether quantum states apply to individual quantum systems, or to ensembles of quantum systems. We show by way of a thought experiment that quantum states apply only to ensembles of quantum systems. A further unresolved question is whether quantum systems possess ontic states. If a quantum state is the state of an ensemble, as we claim, the answer to this question is that quantum states are not ontic. However, a notable recent result (...) in quantum foundations shows that if there are any ontic states at all, then the quantum state must be ontic. Collectively, these two results imply that there are no ontic states. We examine the assumptions required for these results, and suggest that the retrospective effect on state preparations by entangling measurements provides good reason for relaxing the assumption of preparation independence at the ontic level. (shrink)

In the United States and Europe, an increasing emphasis on equality has pitted rights claims against each other, raising profound philosophical, moral, legal, and political questions about the meaning and reach of religious liberty. Nowhere has this conflict been more salient than in the debate between claims of religious freedom, on one hand, and equal rights claims made on the behalf of members of the lesbian, gay, bisexual, and transgender community, on the other. As new rights for LGBT individuals have (...) expanded in liberal democracies across the West, longstanding rights of religious freedom -- such as the rights of religious communities to adhere to their fundamental teachings, including protecting the rights of conscience; the rights of parents to impart their religious beliefs to their children; and the liberty to advance religiously-based moral arguments as a rationale for laws -- have suffered a corresponding decline. Timothy Samuel Shah, Thomas F. Farr, and Jack Friedman's volume, Religious Freedom and Gay Rights brings together some of the world's leading thinkers on religion, morality, politics, and law to analyze the emerging tensions between religious freedom and gay rights in three key geographic regions: the United States, the United Kingdom, and continental Europe. What implications will expanding regimes of equality rights for LGBT individuals have on religious freedom in these regions? What are the legal and moral frameworks that govern tensions between gay rights and religious freedom? How are these tensions illustrated in particular legal, political, and policy controversies? And what is the proper way to balance new claims of equality against existing claims for freedom of religious groups and individuals? Religious Freedom and Gay Rights offers several explorations of these questions. (shrink)

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

This anthology of classic and cutting-edge statements in literary theory has now been updated to include recent influential texts in the areas of Ethnic Studies, Postcolonialism and International Studies. A definitive collection of classic statements in criticism and new theoretical work from the past few decades. All the major schools and methods that make up the dynamic field of literary theory are represented, from Formalism to Postcolonialism. Enables students to familiarise themselves with the most recent developments in literary theory and (...) with the traditions from which these new theories derive. (shrink)

From the Supreme Court to the bedroom, privacy is an intensely contested interest in our everyday lives and privacy law. Some people appeal to privacy to protect such critical areas as abortion, sexuality, and personal information. Yet, privacy skeptics argue that there is no such thing as a right to privacy. I argue that we cannot abandon the concept of privacy. If we wish to avoid extending this elusive concept to cover too much of our lives or shrinking it to (...) cover too little, we must come to understand it. After exploring the privacy arguments of philosophers and constitutional and tort privacy law, I argue for a new definition of privacy and an explanation of its value that clarifies and resolves many of our conflicts. Privacy is critical because it allows us to protect a realm in which we can have intimate relations with others. (shrink)

These twelve original essays are 'after' Marx in several senses. The first and most obvious is the purely chronological sense: They are written one hundred years after Marx's death.