Abstract:Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the (...) profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection. (shrink)

For decades, physicians, philosophers, theologians, lawyers, and the public considered brain death a settled issue. However, a series of recent cases in which individuals were declared brain dead yet physiologically maintained for prolonged periods of time has challenged the status quo. This signals a need for deeper reflection and reexamination of the underlying philosophical, scientific, and clinical issues at stake in defining death. In this paper, I consider four levels of philosophical inquiry regarding death: the ontological basis, actual states of (...) affairs, epistemological standards, and clinical criteria for brain death. I outline several candidates for the states of affairs that may constitute death, arguing that we should strive for a single, unified ontological definition of death as a loss of integrated functioning as a unified organism, while acknowledging that two states of affairs may satisfy this concept. I argue that the clinical criteria for determining whole-brain death should be bolstered to meet the epistemic demand of sufficient certainty in defining death by adding indicators of cerebro-somatic dis-integration to the traditional triad of loss of consciousness, loss of brainstem function, and absence of confounding explanations. (shrink)

Increasingly, physicians are being asked to provide technical services that many believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, (...) I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices. (shrink)

The word ‘dignity’ is used in a variety of ways in bioethics, and this ambiguity has led some to argue that the term must be expunged from the bioethical lexicon. Such a judgment is far too hasty, however. In this article, the various uses of the word are classified into three serviceable categories: intrinsic, attributed, and inflorescent dignity. It is then demonstrated that, logically and linguistically, the attributed and inflorescent meanings of the word presuppose the intrinsic meaning. Thus, one cannot (...) conclude that these meanings are arbitrary and unrelated. This categorization and logical and linguistic analysis helps to unravel what seem to be contradictions in discourse about dignity and bioethics, and provides a hierarchy of meaning that has potential normative implications. (shrink)

Why do humans act in opposition to what they take to be the best course of action? Thero (cognitive science, Rensselaer Polytechnic Institute and Adirondack Community College) considers this akrasia within the philosophic tradition, recognizing both weak (satisfying a less strict set of criteria) and strict types. He works through thought from Socr.

Towards the end of the last century, bioethics underwent an “empirical turn,” characterized by an increasing number of empirical studies about issues of bioethical concern. Taking a cue from the evidence-based medicine movement, some heralded this as a turn toward evidence-based ethics. However, it has never been clear what this means, and the strategies and goals of evidence-based ethics remain ambiguous. In this article, the author explores what the potential aims of this movement might be, ultimately arguing that, while the (...) development of good empirical research can and should aid in ethical deliberation, one ought to avoid assuming or suggesting that empirical studies themselves determine normative prescriptions and proscriptions. The limits of the use of empirical studies in bioethics are explored in detail, and 10 potential ways that such studies can soundly contribute to bioethics are described. Good ethics depends upon sound facts, but ethics cannot be based on evidence alone. (shrink)

While there has been much discussion about the role of oaths in medical ethics, this discussion has previously centered on the content of various oaths. Little conceptual work has been done to clarify what an oath is, or to show how an oath differs from a promise or a code of ethics, or to explore what general role oath-taking by physicians might play in medical ethics. Oaths, like promises, are performative utterances. But oaths are generally characterized by their greater moral (...) weight compared with promises, their public character, their validation by transcendent appeal, the involvement of the personhood of the swearer, the prescription of consequences for failure to uphold their contents, the generality of the scope of their contents, the prolonged time frame of the commitment, the fact that their moral force remains binding in spite of failures on the part of those to whom the swearer makes the commitment, and the fact that interpersonal fidelity is the moral hallmark of the commitment of the swearer. Oaths are also distinct from codes. Codes are collections of specific moral rules. Codes are not performative utterances. They do not commit future intentions and do not involve the personhood of the one enjoined by the code. Recent attacks on oath-taking by physicians are discussed. Two arguments in favor of oath-taking are presented: one on the basis of the nature of medicine as a profession and the other on the basis of rule-utilitarian considerations. No attempt is made to define which oath a physician should swear. (shrink)

This chapter examines the concepts of respect, self‐respect, and mastery and servitude to show that Wong does nothing wrong, and in fact something exceedingly noble, in dedicating his life to the service of Doctor Stephen Strange. Manservants and butlers are a notable element of comic book stories. Batman has Alfred, Iron Man and the Avengers have Jarvis, and of course, Doctor Strange has Wong. Wong's servitude leads to a more robust self‐consciousness and awareness of the world, and self‐consciousness is an (...) important foundation for self‐respect, which defeats any accusation of servility. Through his work for Doctor Strange, Wong better understands himself and the role he plays in protecting the world, which in turn makes him more aware of why he is worthy of respect and why the world is worth saving. (shrink)

Many states in the U.S. have adopted policies regarding human embryonic stem cell (hESC) research in the last few years. Some have arrived at these policies through legislative debate, some by referendum, and some by executive order. New York has chosen a unique structure for addressing policy decisions regarding this morally controversial issue by creating the Empire State Stem Cell Board with two Committees—an Ethics Committee and a Funding Committee. This essay explores the pros and cons of various policy arrangements (...) for making public policy decisions about morally controversial issues in bioethics (as well as other issues) through the lens of Deliberative Democracy, focusing on the principles of reciprocity, publicity, and accountability. Although New York's unique mechanism potentially offers an opportunity to make policy decisions regarding a morally controversial subject like hESC research in accord with the principles of Deliberative Democracy, this essay demonstrates its failure to do so in actual fact. A few relatively simple changes could make New York's program a real model for putting Deliberative Democracy into practice in making policy decisions regarding controversial bioethical issues. (shrink)

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory (...) of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the circumspect view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine -- an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice. (shrink)

Media coverage and statements by various Catholic spokespersons regarding the case of Terri Schiavo has generated enormous and deeply unfortunate confusion regarding Church teaching about the use of life-sustaining treatments. Two weeks ago, for example, I received a letter from the superior of a community of Missionary Sisters of Charity, who operate a hospice here in the United States The Missionary Sisters of Charity are the community founded by Mother Theresa, the 20th Century saint whose primary ministry was to rescue (...) dying Untouch-ables from the streets of Calcutta and bring them into her convent where they were washed, sheltered, fed if they were able to eat, prayed for, and cherished. In other words, the sisters gave these poor souls the gift of a death with dignity. The order Mother Theresa founded has continued this ministry, running hospices in the United States and elsewhere for the homeless, the destitute, those dying of AIDS and poverty and drug addiction, and all those dying alone and otherwise unwanted. (shrink)

Metaphysics has no place in the science-religion discourses if understood as an a priori universal content of the nature and causes of all things. From an overview of the positive and negative dimensions and challenges of the contemporary science-religion discourses within each conversation partner itself and between the two, it is argued that metaphysical reflection represents a contextual-linguistic event that ‘takes place’ only after the contextual giveness is taken up within a very concrete historical-linguistic frame of reference for sense making. (...) In a metaphoric sense, it is conclusively compared with the movements of atoms of which we can only state afterwards where the atoms have been. In this sense, McGrath’s remark that ‘etaphysics is not the precondition of any engagement with the world, but its inferred consequence’ is supported. The ‘was’ of metaphysical thinking represents the emergent product of the concrete and specific lifeworlds in which they have ‘taken place’, that is, ‘eventuated’. The ‘was’ of metaphysical reflection is the most powerful event of credofication for human beings in living, making sense of and participating empathically in the question ‘why there is something rather than nothing?’. (shrink)

While 3/11 has altered energy policies around the world, insufficient attention has focused on reactions from local nuclear power plant host communities and their neighbors throughout Japan. Using site visits to such towns, interviews with relevant actors, and secondary and tertiary literature, this article investigates the community crisis management strategies of two types of cities, towns, and villages: those which have nuclear plants directly in their backyards and neighboring cities further away (within a 30 mile radius). Responses to the disaster (...) have varied with distance to nuclear facilities but in a way contrary to the standard theories based on the concept of the . Officials in communities directly proximal to nuclear power plants by and large remain supportive of Japan's nuclear power program, while those in cities and towns at a distance (along with much of the general public) have displayed strong opposition to the pre 3/11 status quo. Using qualitative data, this article underscores how national energy and crisis response policies rest strongly on the political economy, experiences of, and decisions made at the subnational level. (shrink)

The new hominin fossil called Homo naledi that was discovered 2 years ago in the Dinaledi Chamber was welcomed into the species of human relatives on 10 September 2015. Welcomed? Representing at least 15 individuals with most skeletal elements repeated multiple times, this is the largest assemblage of a single species of hominins yet discovered in Africa. Do, however, these bones represent a new Homo species? It is this question that I have tried to capture in my playful grammatically incorrect (...) title ‘Welcmo Naledi’! However, it is not this question that I will endeavour to answer, but a very different theological implication. My aim in this article is definitely not to argue an opinion on the diverse question regarding the discovery of the fossil skeletons from the Dinaledi Chamber. My aim is related but different, much more modest, restricted and focused. It is to ask ‘on the other historic side’ of Naledi about human distinctiveness and symbolic behaviour, specifically on soteriology. Within the broader contemporary philosophical-theological discourses on anthropology and specifically the fundamental question, ‘Are we special?’, I would like ultimately to take on the intriguing theological implications for soteriology from the Naledi findings. (shrink)

In Nicomachean Ethics, Aristotle’s two forms of human happiness correspond to two forms of human virtue (moral and intellectual) and, I argue, to two forms of virtuous friendship (active and contemplative). I propose that the most properly human form of happiness is achieved in contemplative friendship. This friendship is a genuinely contemplative approximation of divine life and still a specifically human life consisting in discursivespeech with others. Contemplative friends wish the good to one another as human beings and thus fulfill (...) what friendship is more completely than do friends occupied with moral virtue. Aristotle’s text shows, first, that discussion and thinking can be shared more perfectly than can moral action and, second, that intellectual virtue completes human nature more fully than does moral virtue. (shrink)

This article explores the relationship between Karl Rahner’s well-known supralapsarian approach to the doctrine of the incarnation and the theme of social salvation. It examines his distinctive supralapsarian approach to the Incarnation of the Word and the implications that Christological emphasis has for understanding not just individual salvation, but corporate or social salvation, including the whole of creation—human and nonhuman alike. First, we situate Rahner’s supralapsarianism within the broader tradition of this Christological approach. Second, we highlight the cosmic significance of (...) Rahner’s supralapsarian argument for the divine ratio for the Incarnation through the lens of “deep incarnation” theology. Finally, we argue that Rahner’s supralapsarian Christology gestures toward a form of “social salvation” understood in a more cosmic and capacious sense. (shrink)

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health: We have become (...) aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”. (shrink)

The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

This chapter presents a historical analysis of pseudoscience, tracking down the coinage and currency of the term and explaining its shifting meaning in tandem with the emerging historical identity of science. The discussions cover the invention of pseudoscience; science and pseudoscience in the late nineteenth century; pseudoscience in the new century; and pseudoscience and its critics in the late twentieth century.

The Beatitudes have long functioned as a cornerstone for spiritualities of nonviolence. In that tradition, this essay explores how active nonviolence, rooted in the hope of the third Matthean beatitude—“Blessed are the meek for they will inherit the earth”—can be understood as a response to the interrelated cries of the earth and the oppressed within history. To concretize the demands of a political ecology of nonviolence, the essay then examines how the legacies of Western extractive colonialism have shaped the contours (...) of the contemporary planetary emergency, an emergency that is social, cultural, economic, and ecological in nature. The essay concludes by considering how the practice of meekness, in response to the interrelated cries of the earth and the oppressed, might be lived out within the contemporary historical moment. (shrink)

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of rape. (...) Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

... We will turn our attention to the current state of pain relief technology and the ethical questions surrounding the use of advanced technology, otherwise referred to as "high-tech," pain relief. It is obvious that pain may decrease the quality of life for cancer patients. The availability of long-acting narcotics, such as MS Contin or methadone, affords cancer patients long-duration pain relief at minimal cost. The use of adjuvant medications may also be important. Clinical examples of the effective use of (...) adjuvant medications include the addition of a nonsteroidal, anti-inflammatory agent to help patients cope with bone pain and the use of a serotonin blocking agent to reduce the transmission of pain impulses in the spinal cord. Only a small percentage of patients are good candidates for high-tech delivery systems for narcotic administration. In our pain management clinic, all patients are initially placed on oral medications. When the side effects of oral medications become excessive, or the patient becomes unable to take oral medications, high-tech modalities are considered for use. (shrink)

Shortly after the Presidential Commission for the Study of Bioethical Issues was constituted in 2010 and days before the commission members were to join a conference call to discuss possible topics for their deliberation, Craig Venter held a press conference announcing that his lab had created a synthetic chromosome for a species of mycoplasma and had inserted this genetic material into organisms of another species of mycoplasma (the genes of which had been deactivated), transforming the host species into the donor (...) species. While not overtly claiming to have “created life in the test tube,” Venter's publicity seemed cleverly designed to provoke the media into reporting his discovery in just that way. The resulting uproar caused President Obama to give his new bioethics commission the assignment of investigating the ethics of the emerging field of synthetic biology. The commission went right to work. It formed working groups to deliberate about parts of the report, feeding ideas and language to the staff members who would do the actual writing, and then present the working group suggestions to the commission as a whole for public deliberation at open meetings. One of those working groups was charged with coming up with ethical principles that would guide the analysis. Having served as a member of that working group, I report here on the process by which these principles emerged and reflect upon the suitability of that process for the work of public bioethics commissions. (shrink)

This article re-visits the critiques of anthropocentricism levied against John Dewey by his contemporaries and offers a reading of this critique through the lens of nonhuman agency using the theoretical work of Bruno Latour and Jane Bennett, particularly the latter’s coverage of Dewey’s theory of democracy. This work culminates into an argument for envisioning Dewey’s publics as constituted by human and nonhuman bodies, anticipating in some ways the work of contemporary posthumanists and new materialists. This leads us to not only (...) re-think Dewey’s typecasting as unabashedly anthropocentric but also reinvigorates the use value of Dewey’s thinking in the context of contemporary ecological issues. (shrink)

In recent years, dozens of human rights non-governmental organizations (NGOs) across the globe have begun to advocate for economic and social rights, which represents a significant expansion of the human rights movement. This article investigates a central strategy that NGOs have pursued to realize these rights: legalization. Legalization involves specifying rights as valid legal rules and enforcing them through judicial or quasi-judicial processes. After documenting some of the progress made toward legalization, the article analyzes five unique challenges involved in legalizing (...) economic and social rights. It is important to identify these challenges because they must be overcome if the human rights movement wishes to refute the notion that economic and social rights are inherently non-justiciable (and therefore, to some, invalid as rights). These challenges also point to the possibility that legalization is not the only, or even the best, strategic pathway to realize economic and social rights effectively. (shrink)

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine’s distinction between (...) martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent’s actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. (shrink)

This conference proceedings would be of interest to theoretical and experimental physicists in the areas of foundations of physics, nature of time, foundations of quantum mechanics, quantum measurement, quantum computation. Philosophers of science and physics. Retrocausation, the process whereby the future affects its past, is central to the modern movement to understand the fundamental physical nature of time. This conference volume presents the most recent theoretical and experimental results at the forefront of the nascent field of physical chronology.