We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

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)

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)

Accounting ethics failures have seized headlines and cost investors billions of dollars. Improvement of the ethical reasoning and behavior of accountants has become a key concern for the accounting profession and for higher education in accounting. Researchers have asked a number of questions, including what type of accounting ethics education intervention would be most effective for accounting students. Some researchers have proposed virtue ethics as an appropriate moral framework for accounting. This research tested whether Smithian virtue ethics training, based on (...) Adam Smith’s “The Theory of Moral Sentiments”, is effective in improving accounting student’s cognitive moral development. This research used a pre-test, treatment, post-test, quasi-experimental design utilizing the Defining Issues Test 2 instrument to measure students’ CMD. Analysis of DIT-2 gain scores did show a significant improvement in subjects’ personal interest scores and a significant improvement in an overall measure of CMD, the DIT N2 index, whereas their DIT-2 post-conventional scores did not improve significantly. This research supports the proposition that the concepts contained in Smithian virtue ethics can contribute to an effective accounting ethics education intervention. However, further research is required to determine what concepts should be included to improve accounting students’ post-conventional moral reasoning. (shrink)

Rights of nature is an idea that has come of age. In recent years, a diverse range of countries and jurisdictions have adopted these norms, which involve granting legal rights to nature or natural objects, such as rivers, forests, or ecosystems. This book critically examines the idea of natural objects as right-holders, and analyses legal cases, policies, and philosophical issues relating to this development. -/- Drawing on contributions from a range of experts in the field, Rights of Nature: A Re-examination (...) investigates the potential for this innovative idea to revolutionize the concepts of rights, standing, and recognition as traditionally understood in many legal systems. Taking as its starting point Stone’s influential 1972 article ‘Should Trees Have Standing?’, the book examines the progress rights of nature have made since that time, by identifying central themes, unifying principles, and key distinctions in how rights of nature discourse has been operationalized in the disciplines of law, philosophy, and the social sciences. These themes and principles are illustrated through a wide variety of examples, including ecosystem services, indigenous thinking, and ecological restoration, demonstrating how the relationship between humanity and the natural world may be transforming. -/- Taking a philosophical, political, and legal perspective, this book will be of great interest to students and scholars of environmental law and policy, environmental ethics, and philosophy. (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)

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)

New Natural Law Theory and the Catholic medico-moral tradition often lead to similar conclusions in hard cases regarding end-of-life care. Considering the provision of artificial nutrition and hydration to patients suffering from post-coma unresponsive wakefulness, however, brings to light subtle ways in which NNL differs from the centuries-old natural law tradition. In this essay, I formalize the methodology embedded within the casuistry of the medico-moral tradition and show how it differs from NNL with respect to the role played by double-effect (...) reasoning and the perspective for analyzing cases regarding care for those who cannot speak for themselves. Importantly, the ordinary/extraordinary means distinction has never historically been understood as an application of double effect and logically cannot be so understood. Given the outsized role that double effect plays in NNL, the theory leads to conclusions that deviate from the Catholic medico-moral tradition and creates additional burdens and duties for the sick. (shrink)

My article, “Whole-brain death and integration: Realigning the ontological concept with clinical diagnostic tests”.

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. Disease (...) can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly (...) at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author’s individual position on palliative sedation, as developed in greater detail within his contribution. (shrink)

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

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)

The notion of the value of life is often invoked in discussions regarding medical care for the sick and the dying. This theme has figured in arguments about medical ethics for decades, but many of the phrases associated with this concept have received little serious scrutiny. It is true that some philosophers have declared a few commonly used phrases such as “the sanctity of life,” “the infinite value of life,” and “the value of life itself” to be unclear at best (...) or misguided at worst. Their hasty dismissal of these phrases, however, is not the end of the story. I generally agree with this philosophical judgment but for reasons very different from those typically given by others. Moreover, the reasons I wish to .. (shrink)

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

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)

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.

ABSTRACT ‘Facts remain robust only when … supported by a common culture,’ observes Bruno Latour. Current debates over the veracity of climate change are, in actuality, crises of facts. Questions of facticity have, moreover, precipitated a deeper issue – the prospects of unshared, ‘alternative’ worlds. Climate science believers have one world, climate change deniers another, creating what Latour calls ‘epistemological delirium.’ Following Latour, the paper turns to Pierre Hadot’s description of Stoic physics and understanding of philosophy as spiritual exercise. Finally, (...) taking up both Latour’s claims of ‘alternative worlds’ and Hadot’s notion of spiritual exercise, this paper explores the possibilities of shared practices in light of unshared realities. (shrink)

Wrestling and arguing with God: between insider and outsider African perspectives -- Introduction to Richard Kearney's intellectual autobiography: where do you come from, Richard Kearney? -- Where I speak from: a short intellectual autobiography -- Phenomenology in South Africa: an indirect encounter with Richard Kearney -- Transcendence and anatheism -- Response to Richard Kearney's Anatheism: Anatheism and holy folly -- Kearney between poles: is too much lost in the middle? -- Strangers, Gods and Africa: in dialogue with Richard Kearney on (...) Otherness -- Approaching the threshold: hospitality as a pedagogical wager in the work of Richard Kearney -- God-talk, the biblical prophets and Richard Kearney -- 'Strange' theology: engaging with Richard Kearney -- Trinitarian theology and Richard Kearney's anatheism: an engagement -- After God but behind the Cross: the procession as a way to re-encounter God in a culture beyond classical liturgy -- Touch gives rise to thought: Paul Ricoeur and Pumla Gobodo-Madikizela on mutual recognition and carnal hermeneutics -- Towards hospitality between enemies -- Across oceans: a conversation on otherness, hospitality and welcoming a strange God. (shrink)

Male-male competition is involved in inter- and intrasexual selection, with both endocrine and psychological factors presumably contributing to reproductive success in human males. We examined relationships among men’s naturally occurring testosterone, their self-perceived mate value, self-esteem, sociosexuality, and expected likelihood of approaching attractive women versus situations leading to child involvement. We then monitored changes in these measures in male rowers from Cambridge, UK, following a manipulated “win” or “loss” as a result of an indoor rowing contest. Baseline results revealed that (...) men with heightened testosterone and SPMV values typically had greater inclinations toward engaging in casual sexual relationships and a higher likelihood of approaching attractive women in a hypothetical social situation. As anticipated, both testosterone and SPMV increased following a manipulated “victory” and were associated with heightened sociosexuality, and increased expectations toward approaching attractive women versus individuals who would involve them in interacting with children after the race. SPMV and self-esteem appeared to mediate some of the effects of testosterone on post-race values. These findings are considered in the broader context of individual trade-offs between mating and parental effort and a model of the concurrent and dynamic androgenic and psychological influences contributing to male reproductive effort and success. (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)

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...

Health care has increasingly come to be understood as a commodity. The ethical implications of such an understanding are significant. The author argues that health care is not a commodity because health care (1) is non-proprietary, (2) serves the needs of persons who, as patients, are uniquely vulnerable, (3) essentially involves a special human relationship which ought not be bought or sold, (4) helps to define what is meant by necessity and cannot be considered a commodity when subjected to rigorous (...) conceptual analysis. The Oslerian conception that medicine is a calling and not a business ought to be reaffirmed by both the profession and the public. Such a conception would have significant ramifications for patient care and health care policy. (shrink)

Pellegrino was there at the beginning of the field. In the 1950s and 60s, before there was a Kennedy Institute of Ethics or a Hastings Center; before the word ‘bioethics’ itself was coined, Pellegrino was writing articles such as "Ethical Considerations in the Practice of Medicine and Nursing," published in 1964. He was among those who started the Society for Health and Human Values—a precursor organization to the American Society for Bioethics and Humanities. He was the founding editor of the (...) Journal of Medicine and Philosophy at a time when the notion that there was a relationship between philosophy and medicine was foreign to both physicians and philosophers. The authors of the articles published in the very .. (shrink)

Epistemology is a branch of philosophy that studies the origin, nature and limits of human knowledge. Contemporary epistemology is a theory of knowledge in terms of reasons, evidence, justification and explanation. This book shows how Anglo-American philosophers captivated by the power of modern science and concomitant advances in logic and mathematics mistook knowledge itself to be reducible to the propositions of science and logic. Ethics, along with metaphysics and religion, were cast off as mere expressions of sentiment at best, or (...) as utter nonsense at worst. Is science the only source of knowledge? Can ethics count as knowledge? Are there kinds of knowledge beyond epistemology? This book develops innovative answers to these and other related questions. (shrink)

Some secrets are fine to keep to ourselves, and others are not. At first glance, Clark’s secret seems to be fine, but it may not be if we look further into it. We all know Clark’s big secret: he is Superman. Secrets always belong to someone. This is one of the things that distinguish secrets from information we simply don’t have. Secrecy is morally neutral and can be used for good or bad ends. One other closely linked concept we must (...) distinguish from secrecy is privacy. Clark Kent is a citizen (sort of), but Superman is purely a public persona. In Superman, vol. 2, #2 (February 1987), Lex Luthor figured out Superman’s secret. Superman has confided his true identity to the Kents and Lana. In Clark’s case, there are several reasons for his secret, but the most compelling one is to protect his loved ones. (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)

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)

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)