When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

This book treats practical and political reasoning as an active engagement with the world and other people; it cannot be understood as exclusively cognitive and this is seen as a virtue rather than a deficiency. Informal, emotional, characterological, aesthetic and interactional aspects of thought can be constituents of reasonable arguing. The work examines key capacities connected with argumentation, in a variety of fields from professional and medical ethics to work organization and the practice of art.

This paper examines the doctrine of double effect as it is typically applied. The difficulty of distinguishing between what we intend and what we foresee is highlighted. In particular, Warren Quinn's articulation of that distinction is examined and criticised. It is then proposed that the only credible way that we can be said to foresee that a harm will result and mean something other than that we intend it to result, is if we are not certain that that harm will (...) result. The ramifications of this are explored. The paper concludes with a moral evaluation of a variety of cases that have harmful outcomes. It is recommended both that we abandon the doctrine of double effect and that we cease to describe cases with harmful outcomes in a dishonest way. (shrink)

The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impugnity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and a right (...) of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it. CiteULike Connotea Del.icio.us What's this? (shrink)

A quasi-experimental design was used to determine whether there are differences in sociomoral reasoning, as indicated by the Sociomoral Reflection Objective Measure-Short Form (SROM-SF), between a group of students who completed a research ethics course and a comparable control group. The SROM-SF was administered as a pre-test and post-test to both groups of students, those enrolled in the class (n=20) as well as the control group (n=18). Analysis of Covariance (ANCOVA) on the post-test results of the SROM-SF with the pre-test (...) scores as a covariate indicated significant difference between the groups at the .05 alpha level (p < .031). The results of this study concur with other research suggesting that ethics training that includes an interactive component (e.g., discussion g roups that accompany lecture presentations) affects sociomoral reasoning, primarily by preventing the regression in SROM-SF scores evidenced by students in the control group. (shrink)

I bring you greetings from the United States, where its citizens have been closely following the events of the past three weeks. There has been a great change in the feelings of common American people towards the Russian people. Many have expressed their sense of identity and solidarity with the people of Moscow and St. Petersburg as they witnessed the resistance for the attempted coup. Americans have enormous respect for constitutional government as well as for democracy, and they saw the (...) coup as unconstitutional from the start. A major factor was the television news service. The major American broadcast networks  NBCD, CBS, ABC  and the cable networks, especially CNN  provided often live coverage throughout the days and nights of events in the streets and squares of Moscow, and later in the halls of the Soviet and Russian Parliaments. We witnessed press conferences, from one with the committee of 8 to one 3 nights ago in which Boris Yeltsin and Mikhail Gorbachev spoke with the American people. We made our individual judgments about events, often listening to debates between experts and scholars on Soviet affairs  some Russian, some Ukrainian, some from the Baltic states  and we spoke frequently and freely with one another  even some of discussions with our friends were televised. We experienced fear and dread as it seemed great military forces were being brought to bear on your White House. We wept with grief and rage as the deaths of Russians confronting tanks were reported. We cheered to see Russian women scolding soldiers in the streets. In the aftermath, there has been much discussion of Russia’s needs and how Americans might help. In that curious mixture of avarice and beneficence that is the way of American business, discussions were held on starting a restaurant, and import service, on how to use rubles to pay for local expenses and hard currency for profit-taking. (shrink)

Three ethical principles currently determine both law and practice with respect to starting and stopping dialysis in end stage renal disease cases: Medical Futility, Respect for Life, and Patient Sel-determination. Even where dialysis is not medically futile, patients possessing capacity, and patients lacking capacity but with valid, functioning proxy decision-makers, self-determination is the dominant principle, in that efforts to prolong and preserve life may be set aside or not initiated at the request of the adequately informed patient or the patient’s (...) proxy, both presumed conclusively to be acting in the patient’s own “best interests.” Where the patient lacks capacity and there is no proxy, Respect for Life dominates, and we are required to initiate and continue dialysis that is not medically futile, except where there is available clear and compelling evidence that the patient would not want life prolonged with dialysis, as in an advance directed or documented conversation. This category of patients — those lacking capacity who have given neither advance directives nor designated proxies — constitutes a continuum of cases. “At one extreme is the patient who will actually be harmed by dialysis — that is, the effects of dialysis will cause damage to other functions, or will cause significant increase in pain and suffering that would not occur absent the dialysis. In such situations, it can be said that [initiation of] continuation of dialysis is not medically reasonable,”i or is medically futile. The middle portion is the range of “difficult cases . . . where the therapeutic value of dialysis is.. (shrink)

On October 26, 1984, Dr. Leonard Bailey and the transplant team of Loma Linda University Medical Center in California operated on a five-pound baby girl born a few weeks earlier with hypoplastic left heart syndrome. In babies born with this defect the left side of the heart is much smaller than the right and is unable to pump sufficient blood to sustain life for more than a few weeks. This rare defect occurs about once in every 12,000 live births; it (...) accounts for about a quarter of all cardiac deaths of newborns. In an operation known as a xenograft, involving cross-species transplantation of an organ, Dr. Bailey removed the defective heart from the baby and replaced it with the heart of a baboon. (shrink)

My assigned task in today’s colloquium is to review philosophers’ perspectives on the broad question of whether health care rationing ought to target the elderly. This is a revolutionary question, particularly in a society that is so sensitive to apparent discrimination, and the question must be approached carefully if it is to be successfully dealt with. Three subordinate questions attend this one and must be addressed in the course of answering it. The first such question has to do with the (...) issue of justice: how is it fair to target the elderly in achieving reductions in health care costs? Isn’t the proposal, or for that matter, isn’t targeting any age group, morally objectionable as a species of ageism, just as targeting members of a particular race or sex would be racist or sexist? The second subordinate question has to do with the issue of fittingness. Given that we can show in some way that targeting the elderly is not inherently unjust, why would limiting health care to them be a fitting thing for medicine to do? How would it fit, for example, with the traditional commitments of medicine, to sustain life, to relieve suffering, to heal and cure and restore function? And in particular, if medicine has the ability to save and relieve and restore the elderly, why should it replace that set of commitments with a different set for this particular population? The third subordinate question seems political, an arena reserved for one of my speaker colleagues today. There are, I believe, some underlying philosophical dimensions to its answer, and so I will say something about it. The philosophical/political questions is, Given that rationing health care to the elderly is not patently unjust, and given that a case can be made out that the ends of medicine are not violated by such limitation, shy should the elderly, as a group, assent to such a limitation? I want to address these subordinate questions, for I believe them to be the chief stumbling blocks for the possibility of an affirmative answer to our... (shrink)

Robert Almeder has argued1 that three “fourth conditions” for nondefectiveness of knowledge justification claims, proposed in the recent literature,2 are essentially similar, require modification in order to eliminate the possibility of an unknowable defeater, and, so modified, render attainment of non-basic factual knowledge impossible. Although I believe there are objections to be raised against his exposition and reduction of the three proposed fourth conditions, I wish only to raise some doubts about the supposed necessity of the modifications and then to (...) argue against his claim that, so modified, the result is too stringent. (shrink)

There are two fundamental types of ethical theory: those based on the notion of choosing one’s actions so as to maximize the value or values to be expected as consequences of those actions (called consequentialist or teleological theories [from the Greek telos, meaning aim or purpose]; and those based on the notion of choosing one’s actions according to standards of duty or obligation that refer not to consequences but to the nature oaf actions and the motives that are held by (...) those performing them (called deontological theories [from the Greek deon, meaning that which is necessary or binding]). We will consider each type more fully and give specific instances of each type as illustrations. (shrink)

I come before you today at the invitation of your Colloquium Chair, Professor Claes Lundgren. It was his thought that a colloquium session devoted to some of the foundational questions, or presuppositions, of animal might prove interesting. Such an examination may have several aims. 1) It provides an opportunity to reflect on and review together a common activity that, in the perceptions of some concerned fellow citizens and in the history of the discipline of physiology, has had some highly questionable (...) periods and prima facie objectionable practices. 2) It allows us to become more articulate about what we do, that we may speak effectively on its behalf to our critics. 3) Similarly, it enables us to speak to the concerns of our students, both of medicine and of physiology, whom we may initiate into the uses of animals without clarifying to them our perceptions of those uses and their rationale and justification. 4) Finally, such a stock-taking may occasion our own self-evaluation of our practices, with a possible result being the improvement of those practices from a moral point of view. And I suppose that Professor Lundgren asked me to speak with some of those aims in mind. (shrink)

In the May, 1960, issue of the American Bar Association Journal (vol. 499), Morton Birnbaum, a lawyer and physician, argued for a legal right to psychiatric treatment of the involuntarily committed mentally ill person. In the 18 years since his article appeared,, there have been several key court cases in which this concept of a right to psychiatric treatment has figured prominently and decisively. It is important to note that the language of the decisions have had at least an indirect (...) effect in the recently enacted mental Hygiene Law of the State of New York. While I shall not seek to establish the historical thesis that Birnbaum’s article has been efficacious in bringing about both these court decisions and changes in statutory laws, I do want to examine Birnbaum’s article and some of the opinions for three cases: Wyatt v. Stickney (1972), Wyatt v. Aderholt (1974), and O’Connor v. Donaldson (422 US 563, 1975), in an effort to understand both the significance of these changes in our laws and the underlying philosophical and ethical notions of which they are an expression. Birnbaum observed that the notable feature of the legal situation at the time was that there had not been recognized a constitutional requirement that one who had been institutionalized for mental illness according to due process must receive treatment. Birnbaum argued that the effects of an omission of such a requirement to treat were that mental institutions typically offered only custodial care, that patients who were held only under custodial care typically did not improve, and that the result was that involuntary incarceration in a mental institution was, at least from the point of view of the patient, functionally no different than would be imprisonment for an unspecified period of time. Birnbaum argued for a recognition and enforcement in the courts of the right to treatment “...as a necessary and overdue development of our present concept of due process of law,” i.e., as required by the 14th Amendment to the U.S.. (shrink)

Second, let me offer an apology for not having a handout for this talk. I do have a website that contains most of my talks and published papers, as well as various other ravings collected over thirty-plus years of ruminating, and you are each welcome to visit it and acquire for your own reading pleasure or other legitimate purposes (such as composing refutations of my foolish views) such copies as you may require. Just don’t steal my ideas and misrepresent them (...) as your own! The address is http://www.richard-t-hull.com. This paper should be posted there within the month. (shrink)

on the part of physicians are most welcome and not to be disputed. If widely implemented, they should substantially improve the atmosphere of relations between patients and physicians. So, what, if anything, is to be said about his diagnoses and prescriptions, other than "Right on!?".

Good Morning! When I was asked to talk on the subject of Dying in America at a breakfast meeting, It occurred to me that I might get to make some wisecracks about how we eat, at a breakfast where we would be served croissants, butter, sausage and eggs, and berries served with Devonshire cream: certainly the most tasteful form of dying in America! Nor have we been disappointed: quiche and ham should do quite nicely. Then, after last Tuesday’s election, someone (...) approached me and asked if my talk was gong to be on Democratic Party politics. I suppose the title “Dying in America: might fit that subject very nicely! Another wag asked whether I was going to discuss the Buffalo Bills’ current football season . . . . All of these possible applications of the phrase “Dying in America” point to the enormous importance we attach to the idea of dying, and the ways we use that idea in our very metaphorical language. That kind of richness of language is a sure sign, as Joseph Campbell would remind us, that culturally pervasive myths are constructed around the idea of dying. Now, I don’t intend to talk about Campbell’s views at all today, and I will avoid a short course on myths. But I will make just one or two observations about myths so that you are not uncomfortable with my later use of the term. For one of our myths about myths is that, in this educated and scientifically literate society, we don’t have any myths; myths are supposed to be the glue of fictional beliefs that holds primitive societies together, and we certainly are not primitive. Well, let me explain how I intend to use the idea of myth to illuminate some of our values and practices associated with the idea of dying in America. First, by a myth I mean a culturally pervasive set of beliefs and values that tends to center on a single, simple archetypal image or scenario. And second, by calling something mythic I mean to invoke perhaps a number of myths operating as a cluster of culturally important determinants of attitudes and behaviors.. (shrink)

Technological advances force redefinition of action-mandating concepts and language through complex social, political and economic tendencies that collectively determine what has been dubbed “the technological imperative.” The reverse is also true: redefinition of concepts shapes and guides the direction of technological development through shaping public beliefs and expectations. A powerful and far-reaching example of such occurred with the redefinition of “death” and the concept’s transformed relationship to transplantation technology.

At a meeting of the American Society for Value Inquiry in Chicago last spring, and again at a conference on biomedical ethics last fall in London, Ontario, David J. Roy, Head of the Institute for Medical Humanities, University of Montreal, described a developing situation in the biomedical technologies about which he and many of his colleagues in the profession share an enormous apprehension. The biomedical sciences have in their possession, in development, and on the drawing boards a technology that has (...) the potential of enabling us to alter much of what has to date been seen as fundamental givens and fixed points of the human situation, from the forms of human reproduction, through the frequency of distribution of various human characteristics, to those very characteristics themselves. His question , in the form of a plea, was this: it is becoming desperately urgent that scientists and technologists in these fields be given guidance about what they are doing; the sense is that what can be done ranges far beyond what should be done, and that the technological imperative (do what technology makes possible) and the epistemological imperative (find a use for what we know) are so strong that, in the absence of a normative consensus of what it is to be human, these sciences and technologies may well have a transforming impact upon a society that is not prepared to control them. When it becomes possible to eliminate the traditional and biological form of human reproduction, with the development of in vitro fertilization and the artificial placenta, shall we? When it becomes possible to eliminate deleterious genes from the human gene pool (or to limit their occurrence to the level of chance mutation), shall we? When it becomes possible to enable parents to select in advance characteristics of their offspring, from sex to hair and eye color, and perhaps even to influence the polygenic determinate and determinable characteristics of race, stature, aggressiveness, intelligence and talent, to the point that we can influence the distribution of propensities and abilities in the population to fit more closely the manpower needs of our society, shall we? Shall we breed astronauts, musicians.. (shrink)

In this age of interdisciplinary interaction, we probably owe one another disclosures of our qualifications for commenting on each other’s profession. And you might well wonder why a philosopher would be asked to address this distinguished society of professiona l geologists. So, let me give what information I can about my qualifications to talk this evening about, of all things, the ethics of water geology.

The theme advanced and developed by Boris Albini and Gary Ketcham in two issues of the Reporter (May 7, 1987, and February 25, 1988) involve several key concepts: sentience and suffering, life and death, compassion, contradictory rights and conflicting values. I propose to recapitulate those developed themes in order to assess what has been clarified, what still remains obscure, and what has gone unaddressed. For me the issues of which they write are live ones, and my own mind is unsettled (...) on many points. This recapitulation is thus a personal statement to them both. (shrink)

This presentation is designed to stimulate philosophers' interest in the Allied Health Professions, as areas of inquiry appropriate to philosophical reflection and particularly rewarding to those with a major focus on value and its experience. With their careful attention to the ways in which value is present in human experience, their second-order principles for designating priority relations among conflicting values, their ability to transfer the results of sustained inquiry into issues of responsibility and decision making from one context to another, (...) philosophers should find the study of the Allied Health Professions rewarding and fulfilling. But with the longstanding commitment to education and the new commitment to applied ethics and values represented by the emergence of institutes and centers devoted to value inquiry in the many professions, philosophers will find these fields increasingly receptive to measured overtures to integrate the humanistic concerns of philosophy into the Allied Health Science curriculum. Attention to the nature and theory of the activities of the Allied Health Professions may also serve to limit the hegemony of medicine in bioethics courses and texts, and thus better enable teachers of bioethics to assist pre-professional students in understanding their chosen professions as embodying the values about which axiology and ethics theorize. (shrink)