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)

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.

v. 1. A-C -- v. 2. D-J -- v. 3. K-Q -- v. 4. R-Z.

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)

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!?".

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)

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.

The aim of this article is to describe the phenomenon of male rape from the victims’ perspectives. The methodology employed relied on transcendental phenomenology in order to create the rich descriptions of the lived experiences of three male survivors of rape. From the descriptions elicited from the formulation of an open-ended question, it was discovered that the phenomenon of male rape has a dominant structure that is related to the destruction and reconstruction of the masculine self. The research also revealed (...) several textural themes that include the characteristics of the assault, treatment and support that victims receive, the effects of the assault on the self, disclosure, the learning and life changes brought about by the assault, the victims’ feelings towards their assailants and the effect of the assault on the victims’ relationships. This study hopes to facilitate further descriptive research on the phenomenon of male rape in order that greater knowledge be gleaned and applied regarding its prevention and healing processes. (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.

AUTOBIOGRAPHICAL SKETCH In the late I wrote some articles defending a kind of Westermarckian view of the sources of moral judgments, and became interested ...

This volume contains all of the presidential addresses given before the American Society for Value Inquiry since its first meeting in 1970. Contributions are by Richard Brandt*, Virgil Aldrich*, John W. Davis*, the late Robert S. Hartman*, James B. Wilbur*, the late William H. Werkmeister, Robert E. Carter, the late William T. Blackstone, Gene James, Eva Hauel Cadwallader, Richard T. Hull, Norman Bowie*, Stephen White*, Burton Leiser+, Abraham Edel, Sidney Axinn, Robert Ginsberg, Patricia Werhane, Lisa M. Newton, Thomas Magnell, Sander (...) Lee, John M. Abbarno, Ruth Miller Lucier, and Tom Regan*. Autobiographical sketches* by all of the living contributors and one recently deceased, biographical statements of the remainder, together with photographic portraits of all the contributors*, make this volume a unique record of value inquiry during the past quarter century. __. (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)

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)

Deprivation and Freedom investigates the key issue of social deprivation. It looks at how serious that issue is, what we should do about it and how we might motivate people to respond to it. It covers core areas in moral and political philosophy in new and interesting ways, presents the topical example of disability as a form of social deprivation, shows that we are not doing nearly enough for certain sections of our communities and encourages that we think differently about (...) how we should best organise our societies in the future. The book develops a comprehensive yet refreshingly simple account of human freedom, which shows how the ability to realise our freedom is partly definitive of freedom itself. That account conclusively illustrates how many deprivations represent remediable inequalities of important and very basic human freedoms, posing the question as to why societies continue to do so little about them. In answering that question, Hull shows how the idea of social exclusion is misleading and, instead, tackles the far more pertinent and challenging issue of societies' failure to include. The moral seriousness of non-inclusion, the failure to provide for freedom, is evaluated via critical discussion of a variety of central themes and distinctions in ethical and political theory. The author shows how such themes and distinctions comprise a framework for evaluating a raft of social issues, in turn providing a unique resource for students of moral, political and applied philosophy. The book concludes with an innovative, challenging and effective combination of analytic and continental styles, so to address the critical question of how we might actually motivate constructive social change. In doing so, it shows how a variety of approaches can work successfully together to provide an emphatic case for greater social inclusion. Deprivation and Freedom shows how even fairly modest claims about social provision illustrate that we should be doing a lot more about social deprivation than we are now. It should be of interest to anyone who is concerned with questions about the type of society in which they live, what it says about us to continue as we are - and how we might motivate realistically achievable social change. (shrink)

_Deprivation and Freedom _investigates the key issue of social deprivation. It looks at how serious that issue is, what we should do about it and how we might motivate people to respond to it. It covers core areas in moral and political philosophy in new and interesting ways, presents the topical example of disability as a form of social deprivation, shows that we are not doing nearly enough for certain sections of our communities and encourages that we think differently about (...) how we should best organize our societies in the future. The book develops a comprehensive yet accessible account of human freedom, which shows how the ability to realise our freedom is partly definitive of freedom itself. That account conclusively illustrates how many deprivations represent remediable inequalities of important and very basic human freedoms, posing the question as to why societies continue to do so little about them. In answering that question, Richard J. Hull shows how the idea of social exclusion is misleading and, instead, tackles the far more pertinent and challenging issue of societies' failure to include. The moral seriousness of non-inclusion, the failure to provide for freedom, is evaluated via critical discussion of a variety of central themes and distinctions in ethical and political theory. The author shows how such themes and distinctions comprise a framework for evaluating a raft of social issues, in turn providing a unique resource for students of moral, political and applied philosophy. The book concludes with an innovative, challenging and effective combination of analytic and continental styles, so to address the critical question of how we might actually motivate constructive social change. In doing so, it shows how a variety of approaches can work successfully together to provide an emphatic case for greater social inclusion. _Deprivation and Freedom _shows how even fairly modest claims about social provision illustrate that we should be doing a lot more about social deprivation than we are now. It should be of interest to anyone who is concerned with questions about the type of society in which they live, what it says about us to continue as we are – and how we might motivate realistically achievable social change. (shrink)

_Deprivation and Freedom_ investigates the key issue of social deprivation. It looks at how serious that issue is, what we should do about it and how we might motivate people to respond to it. It covers core areas in moral and political philosophy in new and interesting ways, presents the topical example of disability as a form of social deprivation, shows that we are not doing nearly enough for certain sections of our communities and encourages that we think differently about (...) how we should best organise our societies in the future. The book develops a comprehensive yet refreshingly simple account of human freedom, which shows how the ability to realise our freedom is partly definitive of freedom itself. That account conclusively illustrates how many deprivations represent remediable inequalities of important and very basic human freedoms, posing the question as to why societies continue to do so little about them. In answering that question, Hull shows how the idea of social exclusion is misleading and, instead, tackles the far more pertinent and challenging issue of societies' failure to include. The moral seriousness of non-inclusion, the failure to provide for freedom, is evaluated via critical discussion of a variety of central themes and distinctions in ethical and political theory. The author shows how such themes and distinctions comprise a framework for evaluating a raft of social issues, in turn providing a unique resource for students of moral, political and applied philosophy. The book concludes with an innovative, challenging and effective combination of analytic and continental styles, so to address the critical question of how we might actually motivate constructive social change. In doing so, it shows how a variety of approaches can work successfully together to provide an emphatic case for greater social inclusion. _Deprivation and Freedom_ shows how even fairly modest claims about social provision illustrate that we should be doing a lot more about social deprivation than we are now. It should be of interest to anyone who is concerned with questions about the type of society in which they live, what it says about us to continue as we are - and how we might motivate realistically achievable social change. (shrink)

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)

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)

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)

This work is a publication of a manuscript left unfinished at his death by the author. From the time of their conversations in 1936, William Henry Werkmeister has studied the phenomenon of Martin Heidegger's thought and the critical literature commenting on it. During a period spanning 36 years, Werkmeister wrote some nine articles and reviews about his findings. He turned to other interests, but the Heidegger phenomenon continued to reside at the back of his mind. At age ninety, Werkmeister set (...) out once again to write a work that would unify Heidegger's thought, clarify a number of its essential features, place Heidegger's chief works in an order that corresponds to the time line of his thought, critically appraise the development of his thought against the work of other German philosophers, and assess the question of Heidegger's alleged Nazi sympathies. (shrink)