The high technology and the costs involved in critical care disclose the implausibility of applying the American standard version of bioethics in the developing world. The American standard version of bioethics was framed during the rapid secularization of the American culture, the emergence of a new image for the medical profession, the development of high technology medicine, an ever greater demand in resources, and a shift of focus from families and communities to individuals. This all brought with it a particular (...) ideology of health care which promised Americans (1) the best of care, (2) equal care, and (3) physician/patient choice, without (4) runaway costs. This essay argues that this moral project is impossible in practice. This impossibility is especially salient in developing countries. In addition to the fact that it is financially impossible to provide all in the developing world with the standard of care accepted by law, policy, and convention in developed countries, different moral perspectives with different orderings of values will seem more or less plausible in different cultures. Indeed, such an approach would be harmful. A concrete bioethics applicable across the world does not appear possible. (shrink)

Engelhardt invites readers to understand what it means to live in a world after God, where questions of sin and virtue have been replaced with life-and-death-style choices. After God provides a dark prophetic vision. But there is still hope. As Engelhardt argues, In this culture, children now grow up apart from and defended against a recognition of the God Who lives. They are nurtured in a social fabric that is structured so as to avoid a recognition of, much (...) less an encounter with, God. Nevertheless... a traditional Christianity has endured, even though its morality and bioethics have become ever more strongly counter-cultural. The source of this traditional Christian otherness over against the surrounding post-theistic culture lies in the origins of Christianity itself, in the Christianity of the Apostles and the Fathers, namely, in Orthodox Christianity. Against the tenor of the times, disregarding the animus to set traditional Christianity aside, and despite heretics prominent within its fold, Orthodox Christianity remains a light in a world after God. --! From back cover. (shrink)

The book challenges the values of much of contemporary bioethics and health care policy by confronting their failure to secure the moral norms they seek to apply.

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

This collection of essays examines the ways in which disputes and controversies about the application of scientific knowledge are resolved. Four concrete examples of public controversy are considered in detail: the efficacy of Laetrile, the classification of homosexuality as a disease, the setting of safety standards in the workplace, and the utility of nuclear energy as a source of power. The essays in this volume show that debates about these cases are not confined to matters of empirical fact. Rather, as (...) is seen with most scientific and technical controversies, they focus on and are structured by complex ethical, economic, and political interests. Drs. Engelhardt and Caplan have brought together a distinguished group of scholars from the sciences and humanities, who sketch a theory of scientific controversy and attempt to provide recommendations about the ways in which both scientists and the public ought to seek more informed resolutions of highly contentious issues in science and technology. Scientific Controversies is offered as a contribution to the better understanding of the roles of both science and nonscientific interests in disputes and controversies pertaining to science and technology. (shrink)

The philosophy of medicine cum bioethics has become the socially recognized source for moral and epistemic direction in health-care decision-making. Over the last three decades, this field has been accepted politically as an authorized source of guidance for policy and law. The field's political actors have included the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the Department of Health, Education, and Welfare, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research, the National Bioethics Advisory Commission, and the new Council on Bioethics; these groups and agencies have set forth rules on issues ranging from the role of humans in biomedical research to the production of human embryos for research, the definition of death, and the permissibility of human cloning. The members of the field are not just scholars and teachers in an academic realm directed to both theoretical and applied issues. They are, in addition, practitioners of a conceptual and moral trade that possesses a legal and political standing. This essay critically addresses the sudden emergence of bioethics as a societally recognized source of moral guidance, a source replete with authorized moral experts. Attention is directed to moral and conceptual assumptions that have led the philosophy of medicine, and especially bioethics, to acquire a quasi-juridical/political role in guiding clinical choices, framing health-care policy, and directing court holdings. (shrink)

The epistemological and sociological consequences of post-modernity include the inability to show moral strangers, in terms they can see as binding, the moral wrongness of activities such as abortion. Such activities can be perceived as morally disordered within a content-full moral narrative, but not outside of the context it brings. Though one can salvage something of the Enlightenment project of justifying a morality that can bind moral strangers, one is left with moral and metaphysical views that can be recognized as (...) impoverished and incomplete by those who live their lives within the embrace of a content-full moral narrative. The cardinal dualism of post-modemity is not that which separates mind from body, but the gulf between the morality binding moral strangers and that binding moral friends. Keywords: dualism, human embryo, personhood, post-modernity CiteULike Connotea Del.icio.us What's this? (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been (...) dedicated to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

Proceedings of the first trans-disciplinary symposium on philosophy and medicin held at Galveston, Texas, May 9-11,1974.

This essay is meant as a form of philosophical exorcism. The goal is to dispel the view that there are general secular grounds for holding human germline genetic engineering to be intrinsically wrong, a malum in se, or a morally culpable violation of human nature. The essay endorses the view that major obligations of prudence and care attend the development of this technology. However, these justifiable moral concerns can be seen more clearly when one has dispelled what must, from a (...) secular perspective, be regarded as pseudo-issues. (shrink)

This chapter explores the view that religious claims have no legitimate place in the public forum. This exploration involves a critical re-examination of the public versus private distinction that would place religious commitments and grounds for action in a sphere isolated from that of public discourse and public choice. In the process, this chapter brings into question John Rawls's defense of a public discourse that seeks to marginalize religious commitments.

Bioethics is not merely a theoretical discipline but a practice as well. Indeed, bioethics is a sort of moral trade. Bioethicists serve on ethics committees, give expert testimony to courts, provide guidance for healthcare policy, and receive payment for these services. The difficulty is that their role as experts able to guide clinical choice and public policy formation is brought into question by the diversity of moral understandings regarding central moral issues at the heart of the culture wars in healthcare. (...) The disconfirmation of the expert role of bioethicists by their apparent actual role as partisans of particular moral schools and perspectives could be set aside, were there an avenue to moral consensus, a door to a common moral vision to guide this new profession of moral experts. This brief article addresses the hunger for consensus in bioethics, its impossibility with respect to the controversial issues that mark the field, and the inclination nevertheless to deny this manifest diversity by appeals to a consensus that could allow bioethicists to function as ethics experts able substantively to guide clinical choices and public policy. (shrink)

Contemporary Christians are separated by foundationally disparate understandings of Christianity itself. Christians do not share one theology, much less a common understanding of the significance of sin, suffering, disease, and death. These foundational disagreements not only stand as impediments to an intellectually defensible ecumenism, but they also form the underpinnings of major disputes in the culture wars, particularly as these are expressed in healthcare. There is not one Christian bioethics of sin, suffering, sickness, and death. In this article, the character (...) of the moral-theological visions separating the various Christianities and thus their bioethics is examined. Particular emphasis is placed on the differences that set contemporary Western theology at odds with the theology of the Christianity of the first millennium. As is shown, the ground for this gulf lies in the divide between traditional and post-traditional views of the appropriate role of philosophy in theology, a difference rooted in disparate understandings of the meaning of church and of the meaning of the logos, the Son of God. (shrink)

The cardinal question in Christian moral theory and bioethics is whether the knowledge that Christians have (1) by grace and (2) by revelation (e.g., regarding the character of human and cosmic history as reaching from creation through the Incarnation and the Redemption to the Second Coming and the restoration of all things) makes a crucial contribution to understanding morality, as for example issues such as the good death and the morality of physician-assisted suicide and euthanasia. This article argues that such (...) a contribution is made by grace and revelation. The reduction of Roman Catholic moral theology and bioethics to secular bioethics is explored, as well as the necessity of the unique knowledge possessed by Christians for adequate end-of-life decision-making. (shrink)

H. Tristram Engelhardt, Jr.; Medicine, Philosophy, and Theology: Christian Bioethics Reconsidered, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

The prospect of germ-line genetic engineering, the ability to engineer genetic changes that can be passed on to subsequent generations, raises a wide range of moral and public policy questions. One of the most provocative questions is, simply put: Are there moral reasons that can be articulated in general secular terms for accepting human nature as we find it? Or, at least in terms of general secular moral restraints, may we reshape human nature better to meet our own interests, as (...) we define them? This question in turn raises the further question of whether human nature as it now exists has a moral standing akin to sacredness that can be understood in nonreligious terms. This essay will take as a given that it is not possible to show in general secular moral terms that human nature has a sanctity or special moral standing that should guide secular health-care policy. In addition, as this essay shows, it is not possible through appeals to considerations of authorizing consent or beneficence toward others to remedy this failure to establish a sanctity or special moral standing for human nature. Absent a religious or culturally normative understanding of human nature and given the availability of germline genetic engineering, there is a plurality of possibilities for refashioning our nature. The unavailability of substantive secular moral constraints on germ-line genetic engineering discloses a secularly licit plurality of possibilities for human nature. The likelihood that we will be able to refashion our human nature reveals how few general secular moral constraints there are to guide us. Paradoxically, the more we are able to reengineer our human nature, the less guidance is available. The plurality of possible conceptions of human well-being that can be pursued through germ-line genetic engineering challenges our self-understanding as humans. Given human freedom, and in the absence of taken-for-granted religious or cultural moral constraints, the likelihood of germ-line genetic engineering opens the possibility of human nature in the plural. (shrink)

Physician-assisted suicide offers a moral and theological Rorschach test. Foundational commitments regarding morality and theology are disclosed by how the issue is perceived and by what moral problems it is seen to present. One of the cardinal differences disclosed is that between Western and Orthodox Christian approaches to theology in general, and the theology of dying and suicide in particular. Confrontation with the issue of suicide is likely to bring further doctrinal development in many of the Western Christian religions, so (...) as to be able to accept physician-assisted suicide and euthanasia. (shrink)

H. Tristram Engelhardt, Jr.; Generic Chaplaincy: Providing Spiritual Care in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

H. Tristram Engelhardt, Jr.; The DeChristianization of Christian Health Care Institutions, or, How the Pursuit of Social Justice and Excellence can Obscure the.

Instead of benefitting from open meetings and public discussions, the Clintons drafted their health care plan in private and asked that it be accepted in haste. They advance an ideology that claims we can receive the best care for all without any increase in cost or rationing, and then they use "ethicists" to justify this ideology through a supposedly common morality. However, there is no such common morality. In the context of American pluralism, one must look to the actual consent (...) of the governed and recognize the limits on state authority. The result will be a two tiered system of health care, with a basic tier focusing on cost-effective care for the poor that eliminates suffering rather than equalizing inputs, and a space for collateral private insurance. Keywords: Clinton health plan, egalitarianism of envy, egalitarianism of altrusim, limited democracy, moral pluralism CiteULike Connotea Del.icio.us What's this? (shrink)

H. Tristram Engelhardt, Jr.; Medicine and the Biomedical Sciences After God: Do Right-Worshipping Christians Know More Than Others About the Content of Morality.

Much of contemporary philosophy, political theory, and social thought has been shaped directly or indirectly by Georg Wilhelm Friedrich Hegel, though there is considerable disagreement about how his work should be understood. He has been described both as a metaphysician and characterized as an ironic narrator who anticipated the character of philosophy after metaphysics. His position is equally ambiguous with regard to his political thought. He has been construed both as an enemy of the liberal state and as a friend (...) of freedom. This volume's revisionist reassessment, building on the scholarship of Klaus Hartmann, explores these ambiguities in favor of a non-metaphysical reading of Hegel's arguments. It also shows how the foundations of his political thought support a liberal democratic state. This reappraisal of Hegel's arguments resituates him as a philosopher who anticipates the difficulties of post-modernity and offers a basis for reassessing ontology, aesthetics, and revolution. Philosophers and those doing work in political theory will find this volume of great interest. (shrink)

Book reviewed in this article: Bioethics and Secular Humanism: The Search for a Common Morality. By H. Tristram Engelhardt, Jr.

H. Tristram Engelhardt, Jr.; Bioethics after the Enlightenment, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 3, 1 January 20.

Of all the moral concerns regarding privacy in its various meanings, this essay selects only one: the right to be left alone by others, in particular, by government. Because moral controversies in pluralist societies tend to be interminable, and surely controversies regarding privacy are no exception, I approach the right to privacy in terms of the centrality of persons. When there are foundational disputes about which content-full moral view should govern, it is not possible to resolve such controversies without begging (...) the question or conceding at the outset crucial moral premises. This observation is not to affirm a moral skepticism or relativism. At worst, it involves an epistemic skepticism, a skepticism about the possibility of resolving controversies by sound rational argument without begging the question or engaging in an infinite regress. (shrink)

H. Tristram Engelhardt, Jr.; Roman Catholic Social Teaching and Religious Hospital Identity in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies.