American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

McCullough et al. recognize that revenge and forgiveness jointly constitute a functional strategic complex. However, they model the halves of the complex as outputs of modules selected for regulating dyadic relationships. This is backwards. Forgiveness is a culturally evolved institution that can be exapted for use in dyadic contexts; it would be cheap talk among dyads were it not for the shadow of society.

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions - not all - are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and (...) knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time. (shrink)

Simon Blackburn posed a dilemma for any realist attempt to identify the source of necessity. Either the facts appealed to to ground modal truth are themselves necessary, or they are contingent. If necessary, we begin the process towards regress; but if contingent, we undermine the necessity whose source we wanted to explain. Bob Hale attempts to blunt both horns of this dilemma. In this paper I examine their respective positions and attempt to clear up some confusions on either side. I (...) come to defend Hale’s conclusion that both horns of the dilemma can be resisted. I end by defending my own account of the source of necessity, and showing why it does not fall victim to Blackburn’s problem. (shrink)

Health research is increasingly being conducted on a global scale, particularly in the developing world to address leading causes of morbidity and mortality. While research interest has increased, building scientific capacity in the developing world has not kept pace. This often leads to the export of human tissue (defined broadly) from the developing to the developed world for analysis. These practices raise a number of important ethical issues that require attention.

The term “exceptionalism” was introduced into health care in 1991 when Bayer described “HIV exceptionalism” as the policy of treating the human immunodeficiency virus different from other infectious diseases, particularly other sexually transmitted diseases. It was reflected in the following practices: pre- and post-HIV test counseling, the development of specific separate consent forms for HIV testing, and stringent requirements for confidentiality of HIV test results. The justification for these practices was the belief that testing was essential for prevention and that (...) patients might not seek HIV testing if confidentiality were not guaranteed. Confidentiality was believed to be particularly important given the degree of discrimination and stigmatization associated with the illness. Anonymous testing was a further step in ensuring strict confidentiality, even though such a practice prevented public officials from contacting partners and others who were at risk. (shrink)

Renunciation as a creative force is the animating idea behind Ross Posnock s new book. Taking up acts of abandonment, rejection, and refusal that have long baffled critics, he shows how renunciation has reframed the relationship of writers, philosophers, and artists to society in productive and unpredictable ways.".

This paper presents a dialogue between a psychotherapist whom we will call Lilly, and Ross Channing Reed, Ph.D., a philosopher and philosophical counselor. Lilly begins by asking Ross a series of questions regarding philosophical counseling and his approach to working with her. Ross discusses his philosophy and approach to philosophical counseling, what it is like to provide counseling for a therapist, and the educational nature of philosophical counseling. Topics addressed include the nature of unarticulated trauma, the repetition (...) compulsion, moral evil, the narrative construction of a human life, the potentially debilitating effects of moralizing about feelings, the importance of humor, spirituality and philosophy, embodiment, the arts, and Alice Miller’s concept of the “Enlightened Witness.” Next, Ross asks Lilly a series of questions relating to her personal and professional journey prior to and during philosophical counseling. Lilly reveals that she spent significant time in therapy with a psychologist prior to philosophical counseling. She discusses why she sought counseling from a philosopher, how philosophical counseling has been beneficial in her personal and professional lives, and how philosophical counseling has been different from other forms of counseling. (shrink)

The first principle of the Nuremberg Code requires the informed consent of the subject. Proxy consent was not addressed until the Declaration of Helsinki. U.S. policies regarding consent for the participation of children in research would not be finalized for almost two more decades in subpart D of the federal regulations that govern the participation of subjects in research. In October 2000, the Children's Health Act was passed. Title X required the Secretary of the Department of Health and Human Services (...) to conduct a review of the regulations under subpart D and “to consider any modifications necessary to ensure the adequate and appropriate protection of children participating in research, and report the findings of the Secretary to Congress.” In this article, I provide a brief overview of the current informed consent requirements in pediatric research, which include requirements for parental permission and the child's assent. I then examine the moral bases for these requirements; whether the current policies are consistent with these moral foundations; and if not, how the policies ought to be modified. a. (shrink)

This article is a critical examination of the approach to truth in Foucault’s late writing on the topic of ‘parrhesia’. I argue that his 1983 Berkeley seminar on ‘Discourse and Truth’ approaches the topic of truth as a positive value and that this approach presents, at least prima facie, a problem of continuity with his earlier critique of the presumption of an exclusionary relation between truth and power in works such as Discipline and Punish and The History of Sexuality: An (...) Introduction. Does the ethical notion of ‘parrhesia’ imply a different relation between truth and power than the one developed in the earlier works? And if so, what are we to make of the difference? In particular, 1) what does it mean to say that speaking the truth is dangerous? And 2) Are the two positions on truth compatible? What does it take to reconcile the two perspectives? (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was discussed in committee meetings. (...) In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

In August 2000, Arthur Matas and his colleagues de scribed a protocol in which their institution began to accept as potential donors, individuals who came to the University of Minnesota hospital offering to donate a kidney to any patient on the waiting list. Matas and his colleagues refer to these donors as nondirected donors by which is meant that the donors are altruistic and that they give their organs to an unspecified pool of recipients with whom they have no emotional (...) relationship. This paper represents an ethical and policy critique of the nondirected donation protocol that was implemented at the University of Minnesota in August 1999. Specifically, I address the ethical questions: Whether altruistic living solid organ donations by strangers should be permitted? And if so, What are appropriate ethical guidelines for such donations? (shrink)

The aim of this paper is to identify and partially defend a form of practical reason involved in a number of central cases of human action. Against the claims of rational choice theory that reasoning about action is primarily instrumental, it argues for a form of practical reason which allows for the indeterminate, open?ended and creative nature of the most important examples of human action. Rational choice theory not only gives a distorted account of the reasoning involved in these cases; (...) it also ? and more fundamentally ? misconceives the nature of human agency. What moves us to act are characteristically not our ?preferences?, but our ?desires?, and the logic of desire is not that of means to end, but of narrative coherence. The paper also argues that rational choice theory fails to recognize the essentially social nature of rationality, and in its ambition to construct social theory on the basis of rational choice it fails to recognize the fundamental role of trust in social relationships. (shrink)

vol. I. Logic: Categoriae. De interpretatione. Analytica priora. Analytica posteriora.--vol. II. Natural philosophy: Physica. De caelo. De generatione et corruptione.--vol. III. Psychology: De anima. Parva Naturalia.--vol. IV. Metaphysics: Metaphysica.--vol. V. Ethics: Ethica Nicomachea.--vol. VI. Politics and poetics: Politica. De poetica.

More than 24,000 patients await organ transplants and the number is increasing yearly. Living donors are an important source of transplant organs. In this paper, I argue that we can morally justify allowing children to serve as donors. Yet, I also argue that their participation must be restricted in order to prevent their exploitation.The paper is divided into six sections. In the first section, I show why the traditional principles of personal autonomy and beneficence are not adequate morally to justify (...) the participation of children in the nontherapeutic role of organ donor. Next, I argue that the moral justification of the child’s participation must be based on the intimate family relationship which permits activities that would be unacceptable in the public domain. In the third section, I argue that family autonomy ought to be limited by the principle of respect for persons. In the fourth section, I propose five principles to guide the participation of children as organ donors. In section five, I discuss the role of the child in the decision-making process. In section six, I critically examine the criteria for equity in donor selection. (shrink)

Abstract In this paper, I argue that the traditional philosophical approach of taking cognitively and emotionally competent adult people to be the prototypical instances of agency should be revised in light of current work in the behavioral sciences. Logical consistency in application is better served by taking simple goal-directed and feedback-governed systems such as insects as the prototypes of the concept of agency, with people being agents ?by extension? in the same sense as countries or corporations.

In this book, Yagisawa defends a type of realism about merely possible worlds and individuals.1 The view defended is much closer to David Lewis’s genuine modal realism than it is to any kind of actualist or ersatzist modal realism, and I think the best way of understanding Yagisawa’s view will be to see where it differs from Lewis’s. To that end, let’s briefly remind ourselves of Lewis’s theory.