Pediatricians provided expert testimony that, in the case of Baby K, provision of ventilator support goes beyond accepted standards of care for anencephalic infants and so is medically futile. This argument, however reasonable, does not persuade those who believe in the absolute value of even a fraction of human life. In Baby K, court records indicate that Ms. H, Baby K's mother, persistently adheres to the sanctity-of-life principle on religious grounds.While I think that quality-of-life considerations have a (...) role in medical decision making, those who reject such considerations must be respected. This article makes the following claims, on behalf of religious dissenters: the Baby K case should be interpreted in light of the freedom of religion guaranteed in the First Amendment ; religious beliefs should not be trivialized in clinical ethics, even if reason, not belief, is the language of the public forum; the time-honored free exercise clause is essential to the American experiment in liberty and should not be overridden in the name of a concept as vague as futility; and free exercise of religion deserves serious discussion in the futility debate, and significant religious accommodation must be included in any hospital or societal futility policies. In the concluding section, issues are raised regarding the balance between religious consideration and resource allocation. (shrink)

An anencephalic infant, who came to be known as Baby K, was born at Fairfax Hospial in Falls Church, Virginia, on October 13, 1992. From, the moment of birth and repeatedly thereafter, the baby's mother insisted that aggressive measures be pursued, including cardiopulmonary resuscitation and ventilator support, to keep the baby alive as long as possible. The physicians complied. However, following the baby's second admission for respiratory failure, the hospital sought declaratory relief from the court permitting (...) it to forgo emergency life support on the grounds that “a requirement to provide respiratory assistance would exceed the prevailing standard of medical care,” and that “because any treatment of their condition is futile, the prevailing standard of medical care for infants with anencephaly is to provide warmth, nutrition, and hydration.” The United States Court of Appeals for the Fourth Circuit ruled in favor of the baby's mother, citing the federal Emergency Medical Treatment and Active Labor Act , which contained no “standard of care” exception to the requirement to provide “treatment necessary to prevent the material deterioration of the individual's condition.” An appeal to the United States Supreme Court was rejected. The baby died some two and one-half years later of cardiac arrest during her sixth visit to the emergency department of Fairfax Hospital for respiratory failure. (shrink)

In its decision in ex parte Blood the Court of Appeal relied on European Community (EC) law to hold that the Human Fertilization and Embryology Authority had acted unlawfully in taking its decision to prevent Mrs Blood from exporting sperm taken from her dying husband without his written consent. The Blood case raises the issue of the extent to which EC law may affect the regulation of human reproduction in the Member States. Responding to fears that such national regulation might (...) be ‘swept away’ by the commodifying nature of EC law, this article considers the scope of the potential application of EC law to regulation of human reproduction. The cautious conclusion is that, while there may be some increase in deregulatory pressures, the ‘vertical relationship’ of supreme EC law to national law may turn out to be less significant than ‘horizontal relationships’ between policy makers within and between the EU and its Member States. (shrink)

The ethical tensions inherent in all Baby Doe treatment decisions are compounded by medical uncertainty. Physicians both here and abroad have adopted various strategies. Swedish doctors tend to withhold treatment from the beginning from infants for whom statistical data suggest a grim prognosis. The British are more likely to initiate treatment but withdraw it if the infant appears likely to die or suffer severe brain damage. The trend in the U.S. is to start treating any baby who is (...) potentially viable and continue until it is virtually certain that the infant will die. The “least worst” strategy is an individualized one: starting treatment gathering data, and then reassessing the decision. (shrink)

The use of racial categories in biomedicine has had a long history in the United States. However, social hierarchy and discrimination, justified by purported scientific differences, has also plagued the history of racial categories. Because “race” has some correlation with biological and genetic characteristics, there has been a call not to “throw the baby out with the bathwater” by eliminating race as a research or clinical category. I argue that race is too undefined and fluid to be useful as (...) a proxy for biology or genetics. (shrink)

What was really going on in the Baby K case? Many people have posed that or similar questions to me when I have been introduced as the attorney for Baby K's mother. In a nutshell, the courts in Baby K ruled that a hospital is required to provide emergency medical care to an anencephalic baby at the mother's request. In this paper, I provide some insights into the factors that underlie the litigation and the legal issues (...) decided by the courts. In my view, this case involved a myriad of legal questions, religious principles, power struggles, and health care resources arguments that could arise in other contexts. (shrink)

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

It is argued by Anderson and also in the BrazierReport that Commercial Surrogate Motherhood (C.S.M.)contracts and agencies should be illegal on thegrounds that C.S.M. involves the commodification ofboth mothers and babies. This paper takes issue withthis view and argues that C.S.M. is not inconsistentwith the proper respect for, and treatment of,children and women. A case for the legalisation ofC.S.M. is made.

Mitochondrial replacement therapy (MRT) utilises nuclear transfer technology to replace defective mitochondria with healthy ones and thereby minimise the risk of a mitochondrial disease passing from a mother to her child. It promises much but comes with ethical controversy, significant risk of harm and many unknowns. Forming a position on MRT requires accurate information about the current state of knowledge, and an appreciation of the ethical issues at stake. Ethical deliberations will vary depending on the framework used. There are in (...) principle objections to MRT on the grounds of direct harm to human embryos and germline genetic modification. But even without these objections MRT can be weighed in terms of the balance between risks and benefits, alternatives and uncertainties. This paper explores the evidence and lays out the relevant issues to assist such a deliberation. (shrink)

Next SectionSome argue that genetic enhancements and environmental enhancements are not importantly different: environmental enhancements such as private schools and chess lessons are simply the old-school way to have a designer baby. I argue that there is an important distinction between the two practices—a distinction that makes state restrictions on genetic enhancements more justifiable than state restrictions on environmental enhancements. The difference is that parents have no settled expectations about genetic enhancements.

The twentieth-century German philosopher Martin Heidegger distinguished “meditative” and “calculative” modes of thinking as a way of highlighting the problematique of modern technology and the limits of modern science. In doing so he also was prescient to recognize, in 1955, that the most significant danger to the future of humanity are developments in molecular biology and biotechnology, in contrast to the post-World War global threat of thermonuclear weapons. These insights are engaged here in view of recent discussion of the need (...) for international regulation of heritable human genome editing and the announcement in 2018 of the birth of the world’s first gene-edited babies in China. Heidegger’s call for meditative thinking requires modern medicine and the life sciences to appropriate the phenomenological conception of the human “way to be” such that it is not restricted to the “present-at-hand” physiology and pathology of the human body. (shrink)

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be (...) covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. (shrink)

In November 2018, Dr. He Jiankui announced the birth of two baby girls born through the use of in vitro fertilization technology and the use of the gene-editing tool CRISPR-Cas9. There has been nigh uniform international condemnation of the clinical trial for violating international norms governing genomic research, especially research in human embryos that has implications for the germline. At issue also is the question whether the parents and the clinical research team harmed, and therefore wronged, the two girls. (...) Here this question is engaged through application of the reasoning Derek Parfit has provided on the non-identity problem. One concludes that on this reasoning the parents are not morally culpable on that argument, although there is other reasoning that is to be considered to resist the Parfitian conclusion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Individual in Relation to the Sangha in American Buddhism:An Examination of "Privatized Religion"Kenneth K. TanakaIn his celebrated book Bowling Alone (2000), Robert Putnam noted the increased level in the phenomenon of "privatized religion" within the previous thirty-five years. Many of the Baby Boomer generation left churches in the late 1960s and the 1970s. Some sought out new religious movements and religious therapies, but most simply "dropped out" (...) of organized religion altogether. He cites Wade Clark Roof and William McKinney, specialists in American religion, who describe the outcome of this trend in American religious behavior: "[The consequence was a] tendency toward highly individualized religious psychology without the benefits of strong supportive attachments to believing communities. A major impetus in this direction in the post-1960s was the thrust toward greater personal fulfillment and quest for the ideal self.... In this climate of expressive individualism, religion tends to become "privatized," or anchored in the personal realms."1 Putnam observes that although privatized religion may be "morally compelling and psychologically fulfilling," it involves less social capital than environments in which individuals are connected to other individuals in shared faith commitment.Interestingly, American Buddhism may be one of the beneficiaries of this trend, for the recent growth of Buddhism in the United States is partly attributable to the climate of "privatized" religion. Nowhere is this symbolized more than by the so-called Nightstand Buddhists.2The Nightstand Buddhists derive their name from their practice of placing a Buddhist meditation book on the nightstand after reading it before they go to sleep. They get up the next morning and practice to the best of their ability the meditation they had read about the night before. Further, they may frequently attend lectures at the local university and visit a Buddhist center's web-page or participate in an online Buddhist discussion group. And if we were to visit them, we might find their homes decorated with Buddhist artifacts.But these Nightstand Buddhists do not show up in any statistics on the [End Page 115] American Buddhist population because they would not identify themselves as Buddhists. According to Thomas Tweed, who coined the term Nightstand Buddhists, "Sympathizers (= Nightstand Buddhists) are those who have some sympathy for Buddhism but do not embrace it exclusively or fully. When asked, they would not identify themselves as Buddhists. They would say they are Methodists, or Jewish, or unaffiliated."3 However, they have been an important part of the story of Buddhism in America from its beginning and continue to be so today.Among the three million Buddhists currently estimated to be in the United States, I believe there are Buddhists who exhibit many of the same characteristics as the Nightstand Buddhists. And this number is significant, particularly among those converts to Buddhism whose main practice is meditation. This group of convert Buddhists is one segment of the larger Buddhist community in the United States, which I have categorized into four groups.41. New Asian American Buddhists (those who have mostly arrived in the United States since the 1960s: Vietnamese, Thai, Korean, Cambodian, Myanmar, Laotian, and Sri Lankan).2. Old-line Asian American Buddhists (those who were established before World War II: Chinese and Japanese).3. Convert Buddhists whose main practice is meditation (predominately Euro-Americans practicing in the Zen, Vipassanā, and Tibetan traditions).4. Convert Buddhists whose main practice is chanting (Sōkagakkai International–USA, a sizable percentage of whom are African and Hispanic Americans).In this paper, I wish to focus on a Jōdo Shinshū temple from the second group (old-line Asian American Buddhists) and on several centers collectively that belong to the Zen, Vipassanā, and Tibetan traditions from the third group (convert Buddhists whose main practice is meditation), looking at the manner in which individuals relate to their respective institutions and traditions, with special attention given to the phenomenon of "privatized religion."For purposes of this paper, my definition of "privatized religion" is based on the observation of Roof and McKinney, cited above, as "a tendency for individuals (1) to emphasize practicing at home over religious centers, and (2) to value the subjective and the inward." The homebound orientation is connected... (shrink)

In this dissertation I consider the merits of certain nominalist accounts of phenomena related to the character of ordinary objects. What these accounts have in common is the fact that none of them is an error theory about standard cases of predication and none of them deploys God or uniquely theistic resources in its explanatory framework. -/- The aim of the dissertation is to answer the following questions: -/- • What is the best nominalist account on offer? • How might (...) it be improved? • Does it ultimately succeed? -/- I will argue that while so-called trope theory is the best account on offer, it can be significantly improved—or replaced—by a novel version of nominalism that is modeled after trope theory. Ultimately, however, I will argue that even the novel version fails. -/- The dissertation unfolds as follows. In Chapter 1, I introduce Austere Nominalism (AN), which is perhaps the most extreme version of nominalism that falls within the scope of the dissertation. AN is often described as the view that there exist only concrete particulars. According to AN, it is unnecessary to posit any entities other than ordinary objects—turkeys, tables, and the like—in order to account for explananda related to the character of those objects. (Such explananda include the phenomenon of attribute agreement, of attribute possession, of true subject-predicate sentences, etc.) In this chapter I argue that AN fails to provide an adequate account of these explananda. In addition, introducing and criticizing AN serves an important heuristic role for the rest of the dissertation. To understand this role, we must distinguish between the basic explanatory strategy deployed by the austere nominalist and the type of explananda for which she deploys that strategy. The austere nominalist deploys the strategy to account for the character of ordinary objects. As I argue in Chapter 1, this deployment is a failure. As I go on to show in Chapter 2, the widespread rejection AN has led to a variety of rival accounts of the character of ordinary objects. In rejecting AN, however, these accounts also tacitly reject its basic explanatory strategy. Thus goes the baby with the bathwater, since, arguably, there are some attractive features of AN’s basic explanatory strategy. Indeed, those who defend the most prominent version of nominalism—trope theory—seem to overlook the advantages of AN’s basic strategy, and by so doing, make an unnecessary concession to the realist. Or so I argue in Chapter 3. And, as I will argue in Chapter 4, the strongest version of nominalism is a novel account, modeled after trope theory, that deploys AN’s basic strategy at a more fundamental level than that of ordinary objects. This novel account—troper theory—is closer in spirit to AN than is traditional trope theory. (Thus, AN serves as a foil for the discussion of other nominalist views.) Finally, in the Afterword I indicate how troper theory is equally vulnerable to some of the traditional objections that plague trope theory. Thus, if you are not convinced that traditional objections to trope theory are conclusive and you want to be a nominalist, then you should abandon trope theory and adopt troper theory. If you take traditional objections against trope theory to have significant force, then you should reject both theories. (shrink)

Apology is arguably the central act of the reparative work required after wrongdoing. The analysis by Claudia Card of complicity in collectively perpetrated evils moves one to ask whether apology ought to be requested of persons culpably complicit in institutional evils. To better appreciate the benefits of and barriers to apologies offered by culpably complicit wrongdoers, this article examines doctors’ complicity in a practice that meets Card's definition of an evil, namely, the non-medically necessary, nonconsensual “normalizing” interventions performed on babies (...) born with intersex anatomies. It argues that in this instance the complicity of doctors is culpable on Card's terms, and that their culpable complicity grounds rightful demands for them to apologize. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are (...) extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity. (shrink)

Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United (...) States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (shrink)

This paper reports the results of a survey study examining the knowledge, motivations and concerns of egg-share donors and recipients, and assesses the clinical and policy implications of these findings. The survey, combining quantitative and qualitative items, was completed by 48 donors and 38 recipients who took part in an egg-sharing scheme at the London Women's Clinic between 2007 and 2009. Although the most important motivation for all egg-sharers was to have a baby, both donors and recipients displayed multiple (...) motivations, including elements of self-interest and altruism. Many viewed egg-sharing as a reciprocal process in which two women with different needs help one another. The results are reassuring from an ethical and policy perspective: they suggest that if information about egg-sharing was more widely available (especially through general practitioners), more women may consider becoming egg-share donors, gaining swift access to their own treatment and reducing the UK's egg donor shortage. (shrink)

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice during (...) their stay in the NICU. The recordings took place from 27 weeks postmenstrual age until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies. (shrink)

A leading cognitive scientist argues that a deep sense of good and evil is bred in the bone. From John Locke to Sigmund Freud, philosophers and psychologists have long believed that we begin life as blank moral slates. Many of us take for granted that babies are born selfish and that it is the role of society—and especially parents—to transform them from little sociopaths into civilized beings. In Just Babies, Paul Bloom argues that humans are in fact hardwired with a (...) sense of morality. Drawing on groundbreaking research at Yale, Bloom demonstrates that, even before they can speak or walk, babies judge the goodness and badness of others’ actions; feel empathy and compassion; act to soothe those in distress; and have a rudimentary sense of justice. -/- Still, this innate morality is limited, sometimes tragically. We are naturally hostile to strangers, prone to parochialism and bigotry. Bringing together insights from psychology, behavioral economics, evolutionary biology, and philosophy, Bloom explores how we have come to surpass these limitations. Along the way, he examines the morality of chimpanzees, violent psychopaths, religious extremists, and Ivy League professors, and explores our often puzzling moral feelings about sex, politics, religion, and race. In his analysis of the morality of children and adults, Bloom rejects the fashionable view that our moral decisions are driven mainly by gut feelings and unconscious biases. Just as reason has driven our great scientific discoveries, he argues, it is reason and deliberation that makes possible our moral discoveries, such as the wrongness of slavery. Ultimately, it is through our imagination, our compassion, and our uniquely human capacity for rational thought that we can transcend the primitive sense of morality we were born with, becoming more than just babies. -/- Paul Bloom has a gift for bringing abstract ideas to life, moving seamlessly from Darwin, Herodotus, and Adam Smith to The Princess Bride, Hannibal Lecter, and Louis C.K. Vivid, witty, and intellectually probing, Just Babies offers a radical new perspective on our moral lives. (shrink)

This letter responds to the essay “If Not Now, Then When? Taking Disability Seriously in Bioethics,” by Debjani Mukherjee, Preya S. Tarsney, and Kristi L. Kirschner, in the May‐June 2022 issue of the Hastings Center Report.

Howard Brody expresses concern that citing the “two cases that put futility on the map,” namely Helga Wanglie and Baby K, may be providing ammunition to the opponents of the concept of medical futility. He in fact joins well-known opponents of the concept of medical futility in arguing that it is one thing for the physician to say whether a particular intervention will promote an identified goal, quite another to say whether a goal is worth pursuing. In the latter (...) instance, physicians are laying themselves open “to the criticism of taking on basic value judgments that are more appropriately left to patients and their surrogates.” Brody states that in both the Wanglie and Baby K cases, the “basic value judgments” had to do with the worthiness of maintaining unconscious life via medical technology. He classifies this as “a question of professional integrity—but not a question of futility,” adding that “more than semantics hinges on this distinction.” The “more than semantics” factor is a pragmatic, even political one. Failure to make this distinction renders physicians “that much more suspect and less trustworthy in the public debate.”. (shrink)

This article reflects on the author's modest experience as an expert witness in two trials: Osheroff vs. Greenspan (1983), and In the Matter of Baby K (1994). Bioethicists' expertise as scholar-teachers and consultants on particular issues merits qualification by judges as expert witnesses. The article argues that a different kind of expertise – strong moral advocacy – is required to be an effective expert witness. The major lessons of expert witnessing for the author concern the demands and strains on (...) the bioethicist's role as scholar, teacher, and consultant. The Baby K case is analyzed in some detail, due to its importance for bioethics, ethics consultation, and the testimony of bioethicists on either side of the case. Rules of thumb are offered to guide decisions as to choices regarding expert witnessing, as well as a discussion of the interaction of law and bioethics. (shrink)

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that (...) all life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)

The debate about medical futility is no longer in its infancy. Scholarly literature on this seemingly intractable problem is voluminous. The list of widely publicized cases in which physicians have wanted to discontinue life-sustaining medical treatment that families demand has grown to include not just Helga Wanglie, but also Baby Rena, Baby L, Jane Doe, Joseph Finelli, Baby K, and Teresa Hamilton. A futility case has now been decided at the appellate court level.Commentators have generated three kinds (...) of proposals for resolving these conflicts. One group contends that the problem can be solved within the physician-patient-family relationship. While some in this group view professional authority broadly enough to warrant unilateral judgments by physicians that interventions desired by the patient or family should not be provided, others contend that physician authority does not extend that far, and that any resolution must be constrained by informed consent requirements. (shrink)

US court decisions guaranteeing life-sustaining care to anencephalic infants have been viewed with disfavor, and sometimes disbelief, by some ethicists who do not believe in the necessity of life-sustaining support for those without cognitive abilities or an independently sustainable future. The distance between these two views – one legal and inclusive, the other medical and specific – seems unbridgeable. This paper reports on a program using multicriterion decision making to define and describe persons in a way which both acknowledges the (...) differences perceived by many as well as those commonalities insisted on in U.S. court decisions. It does this through application of the Analytic Hierarchy Process to a hierarchy of humanness criteria, and secondarily through reference to that concept''s subset, personhood. (shrink)

Trait emotional intelligence (“trait EI”) concerns our perceptions of our emotional abilities, that is, how good we believe we are in terms of understanding, regulating, and expressing emotions in order to adapt to our environment and maintain well-being. In this article, we present succinct summaries of selected findings from research on (a) the location of trait EI in personality factor space, (b) the biological underpinnings of the construct, (c) indicative applications in the areas of clinical, health, social, educational, organizational, and (...) developmental psychology, and (d) trait EI training. Findings to date suggest that individual differences in trait EI are a consistent predictor of human behavior across the life span. (shrink)

This article presents arguments and evidence that run counter to the widespread assumption among scholars that humans are intuitive Cartesian substance dualists. With regard to afterlife beliefs, the hypothesis of Cartesian substance dualism as the intuitive folk position fails to have the explanatory power with which its proponents endow it. It is argued that the embedded corollary assumptions of the intuitive Cartesian substance dualist position (that the mind and body are diff erent substances, that the mind and soul are intensionally (...) identical, and that the mind is the sole source of identity) are not compatible with cultural representations such as mythologies, funerary rites, iconography and doctrine as well as empirical evidence concerning intuitive folk reasoning about the mind and body concerning the afterlife. Finally, the article suggests an alternative and more parsimonious explanation for understanding intuitive folk representations of the afterlife. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.2 (2003) 341-362 [Access article in PDF] Virgin Father and Prodigal Son Stephen Brockmann I IN BOTH THE UNITED STATES and Germany—as well as in much of the rest of the Western world—the baby-boom generation now holds a controlling position in politics, economics, and culture. The election of Bill Clinton (born in 1946) to the Presidency signaled the generational shift in the United States as (...) early as 1992, and that shift was confirmed by the election campaign of 2000, in which both candidates, Al Gore (born in 1948) and George W. Bush (born in 1946), in spite of their differences, represented the same generation. In Germany the political shift in generations did not occur until 1998, when Gerhard Schröder (born slightly before the beginning of the German baby boom, in 1944) defeated Helmut Kohl (born in 1930).Significantly, Kohl is a member of the generation of Germans born during the 1930s and reared during the years of the Third Reich but too young to have played any significant role, either negative or positive, during the Nazi era. No member of this generation born in the 1930s ever became President in the United States, where the generation of World War Two veterans dominated national politics from Eisenhower to George Herbert Walker Bush. However what in America is a "silent generation" has been, in Germany, the generation most closely identified with the success of the Federal Republic of Germany: these were the so-called Flakhelfer (antiaircraft helpers) who had been children during the war. Kohl therefore famously referred to them as having the "grace of late birth," meaning that they, unlike the war veterans, were presumably untouched by any form of collective guilt for Nazi crimes against humanity. Whereas in the United States the Presidency was transferred directly from the World War Two veterans to [End Page 341] baby boomers—and in the case of the two Bush presidencies, literally, albeit indirectly, from father to son—in Germany the transition from the World War Two veterans (particularly former Chancellor Helmut Schmidt) to the baby boomers was interrupted by a long period of domination by the in-between generation of Flakhelfer.In both countries the baby-boom generation represents a significant shift in sensibilities and encompasses the generation involved in student protest and oppositional social movements in the 1960s and 1970s. In the United States these included the anti-Vietnam War movement, the feminist and gay-rights movements, the sexual revolution, the civil-rights movement, and the ecological movement, as well as, on the extreme fringes, terrorist groupings such as the Weather Underground and a great many religious sects and cults. In Germany the baby boomers formed many parallel groups and movements, including antiwar, feminist, ecological, and gay segments, as well as a proliferation of sectarian Marxist political groupings (so-called K-Gruppen, with the "K" meaning "Kommunist"). In the United States, Bill Clinton was an antiwar protester in the 1960s and 1970s, while both Gerhard Schröder and his Green Foreign Minister Joschka Fischer (born in 1948) had participated in left-wing political movements during the same period.In both West Germany and the United States the heyday of protest movements in the 1960s and 1970s signaled a generational split, with younger people—the very generation that is now in power in the two countries—accusing their elders of Machiavellian cynicism, imperialism, patriarchy, and worse. Such accusations can be recalled by the formerly popular slogans "Hey, hey, LBJ, how many kids did you kill today?" in the United States and "Unter den Talaren der Muff von tausend Jahren" ("under the academic regalia the stench of a thousand years") in Germany. The latter slogan was a reference not just to a generalized stodginess on the part of elderly German academics but to Hitler's invocation of a "Thousand-Year Reich;" German students were none-too-subtly suggesting that many of their professors had once been Nazis.The difference in these two slogans—one referring to past and the other to present sins—corresponds to a major distinction between the two baby... (shrink)

Practical deliberation often involves conditional judgements about what will (likely) happen if certain alternatives are pursued. It is widely assumed that the conditionals useful in deliberation are counterfactual or subjunctive conditionals. Against this, I argue that the conditionals of deliberation are indicatives. Key to the argument is an account of the relation between 'straightforward' future-directed conditionals like ' If the house is not painted, it will soon look quite shabby' and * "w e r e ' ' e d F (...) D C s like ' If the house were not to be painted, it would soon look quite shabby': an account on which both of these types of FDCs are grouped with the indicatives for semantic treatment and on which, while conditionals of both types are properly used in means/ends deliberations, those of the ' were'ed-up variety are especially well suited for that purpose. (shrink)

What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of (...) responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered—namely, clinicians’ willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians’ need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. (shrink)

This was one of SCSS President Stephen M. Krason’s “Neither Left nor Right, but Catholic” columns that appear monthly in Crisis and The Wanderer. It discusses the tragic case of Charlie Gard, the baby who a U.K. hospital would not discharge so his parents could take him to the U.S. for experimental treatment for a rare, normally terminal DNA disorder that might have saved his life. Krason says that the case illustrated a number of dangerous current trends in Western (...) political societies: the advancement of the euthanasia/“quality of life” mindset, the suppression of parental rights by both child protective-type agencies and courts that are overly-deferential to them, runaway judicial power generally, the increasing authoritarianism of functional experts, and the unwillingness of elected political officials and leaders to come to the aid of the citizenry by standing up to them and the unelected bureaucrats and judges who protect them and more generally to uphold the traditional legal norms and principles that they are violating. (shrink)