Since at least the advent of Jack Kevorkian’s “suicide machine” the major argument against adopting physician-assisted suicide laws has been that they will lead us down a slippery slope to state-sa...

How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.

The law has therefore had two conflicting impacts on medical ethics: the positive effect of eroding paternalism and replacing it with a patient-centered ethic; and the negative effect of encouraging physicians to be more concerned with avoiding litigation than doing the "right" thing.

RECENT PHILOSOPHICAL ATTENTION TO THE LANGUAGE OF DISEASE HAS FOCUSED PRIMARILY ON THE QUESTION OF ITS VALUE-NEUTRALITY OR NON-NEUTRALITY. PROPONENTS OF THE VALUE-NEUTRALITY THESIS SYMBOLICALLY COMBINE POLITICAL AND OTHER CRITICISMS OF MEDICINE IN AN ATTACK ON WHAT THEY SEE AS VALUE-INFECTED USES OF DISEASE LANGUAGE. THE PRESENT ESSAY ARGUES AGAINST TWO THESES ASSOCIATED WITH THIS VIEW: A METHODOLOGICAL THESIS WHICH TENDS TO DIVORCE THE ANALYSIS OF DISEASE LANGUAGE FROM THE CONTEXT OF THE PRACTICE OF MEDICINE AND A SUBSTANTIVE THESIS WHICH (...) HOLDS THAT DISEASE LANGUAGE IS EVALUATIVELY NEUTRAL. IN PARTICULAR, THE ESSAY CRITICALLY FOCUSES ON THE VALUE NEUTRAL POSITION ADOPTED BY CHRISTOPHER BOORSE, WHICH HE TERMS A FUNCTIONAL THEORY OF DISEASE. THE ARGUMENT CONCERNS WHETHER OR NOT ONE CAN HAVE VALUE NEUTRAL DESCRIPTION OF DISEASE STATES OR WHETHER DISEASE LANGUAGE ESSENTIALLY INVOLVES VALUES. (shrink)

Friedrich Nietzsche has emerged as one of the most important and influential modern philosophers. For several decades, the book series Monographien und Texte zur Nietzsche-Forschung (MTNF) has set the agenda in a rapidly growing and changing field of Nietzsche scholarship. The scope of the series is interdisciplinary and international in orientation reflects the entire spectrum of research on Nietzsche, from philosophy to literary studies and political theory. The series publishes monographs and edited volumes that undergo a strict peer-review process. The (...) book series is led by an international team of editors, whose work represents the full range of current Nietzsche scholarship. (shrink)

Fraudulent financial reporting, financial statements with errors so material as to require restatement, and biased reporting marred by defects such as managed earnings have plagued financial reporting in many countries in recent years. All of those failures are ethics failures that represent breaches of fiduciary duties by individuals who accepted responsibilities but did not fulfill them. The financial reporting system practiced in America is viewed by the parties involved in it as generally satisfactory. However, according to another view, the interests (...) of those primarily and secondarily responsible for those reports conflict with the interests of the intended beneficiaries, or users, of the corporate financial statements. A more realistic view of the actual operation of that reporting system shows that it is fundamentally flawed. Primary responsibility for failures rests with top management and financial management of the reporting corporation who are so strongly motivated to render favorable reports on their stewardship that they neglect their fiduciary responsibilities to investors. Secondary responsibility falls on independent auditors who are so heavily influenced by enterprise management that they, too, fail in carrying out their responsibilities to users of the audited financial statements. Ethics compromises are also found in the performances of academic accountants and members of accounting standards-setting bodies. The conflict between managements interest in reporting its performance in a favorable light and investors interest in decision-useful financial information will always exist and require regulation. However, changes in those regulations and in the basic governance arrangements involving shareholders, management, and auditors could reduce the opportunities and temptations for failures in carrying out fiduciary responsibilities. Most importantly, the close relationships between auditors and management must be loosened in favor of closer relationships between auditors and investors. (shrink)

This paper offers an exposition of what the question of method in ethics consultation involves under two conditions: when ethics consultation is regarded as a practice and when the question of method is treated systematically. It discusses the concept of the practice and the importance of rules in constituting the actions, cognition, and perceptions of practitioners. The main body of the paper focuses on three elements of the question of method: canon, discipline, and history, which are treated heuristically to outline (...) what the question of method in ethics consultation fully involves. (shrink)

In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I (...) analyze several definitions of the physician's professional obligation and discuss four conditions that morally qualify the obligation. And fourth, I explore why the views of economists and physicians differ so strikingly on the question of economic incentives. In the process of this analysis, I argue that criticisms of prospective payment systems which are premised primarily on the conflict between economic incentives to contain cost and the professional obligation of beneficence are probably as much a matter of rhetoric as serious argumentation. Keywords: autonomy, beneficence, cost containment, economic incentives, moral obligation, prospective payment CiteULike Connotea Del.icio.us What's this? (shrink)

While there is no denying the relevance of ethical knowledge and analytical and cognitive skills in ethics consultation, such knowledge and skills can be overemphasized. They can be effectively put into practice only by an ethics consultant, who has a broad range of other skills, including interpretive and communicative capacities as well as the capacity effectively to address the psychosocial needs of patients, family members, and healthcare professionals in the context of an ethics consultation case. In this paper, I discuss (...) how emotion can play an important interpretive role in clinical ethics consultation and why attention to the role of defense mechanisms can be helpful. I concentrate on defense mechanisms, arguing first, that the presence of these mechanisms is understandable given the emotional stresses and communicative occlusions that occur between the families of patients and critical care professionals in the circumstances of critical care; second, that identifying these mechanisms is essential for interpreting and managing how these factors influence the way that the “facts” of the case are understood by family members; and, third, that effectively addressing these mechanisms is an important component for effectively doing ethics consultation. Recognizing defense mechanisms, understanding how and why they operate, and knowing how to deal with these defense mechanisms when they pose problems for communication or decision making are thus essential prerequisites for effective ethics consultation, especially in critical care. (shrink)

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

George J. Stack traces the sources of ideas and theories that have long been considered the exclusive province of Friedrich Nietzsche to the surprisingly radical writings of the American essayist and poet, Ralph Waldo Emerson. Nietzsche and Emerson makes us see Emerson's writings in a new, more intensified light and presents a new perspective on Nietzsche's philosophy. Stack traces how the rich theoretical ideas and literary images of Emerson entered directly into the existential dimension of Nietzsche's thought and hence (...) into the stream of what has been considered a distinctively European intellectual movement. Book jacket. (shrink)

Volume 20, Issue 7, July 2020, Page 167-169.

Central to much medical ethical analysis is the concept of the role of the physician. While this concept plays an important role in medical ethics, its function is largely tacit. The present paper attempts to bring the concept of a social role to prominence by focusing on an historically recent and rather richly contextured role, namely, that of consultation liaison psychiatry. Since my intention is primarily theoretical, I largely ignore the empirical studies which purport to develop the detailed functioning of (...) the role. My limited intent is to draw attention to the theoretical complexity of the consultation liaison role as an example of the general relevance of role concepts to medical ethics. For this reason, consultation liaison psychiatry will function as an illustration of fundamental concepts of medical ethics rather than as a subject of analysis in its own right. Similarly, the concept of the social role will be developed only as is necessary to explore the general relationship between the consultation liaison role and ethical analysis. Keywords: medical ethics, consultation liaison psychiatry, social role, autonomy, institution CiteULike Connotea Del.icio.us What's this? (shrink)

This piece offers a retrospective review of a plenary speech at the 1969 Annual Meeting of the American Public Health Association by the leading environmentalist of the Nixon administration, attorney and judge Russell Train. Train's talk, titled “Prescription for a Planet,” can be seen as an early argument for uniting environmental health and public health as the two main determinants of both individual and population health and for the inclusion of these fields in the then‐new field of “bioethics.”.

This paper discusses the importance of Richard M. Zaners work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is (...) bound up with the normative commitments of medicine as a therapeutic enterprise. (shrink)

Thomasma and Pellegrino''s [3] focus on the healing relationship as the way to give medical ethics a philosophical foundation contains a number of difficulties. Most importantly, their approach focuses philosophical analysis on an idealized view of the healing relationship in which the ideal of health is seen as an uncontroversial norm in the individual case. medical ethics is then characterized as an intrinsic part of the medical act itself. Philosophical inquiry seems limited to a description of the practice of medicine (...) in which ethical norms are embodied. Insufficient attention to methodology leaves unclear how this vision is to be achieved in philosophical reflection. (shrink)

How should one think about innovation in medicine and surgery? Increasingly, the answer to this question has involved reference to what might be called the regulatory ethics paradigm (REP). The regulatory ethics paradigm holds that deviations from standard care involve a degree or kind of experimentation that requires the application of a set of procedures designed to assure the protection of the rights and welfare of the subjects of research. In REP, innovative treatments are regarded as questionable until they are (...) framed in a research protocol with formal mechanisms of informed consent. The protocol must be reviewed and approved by an Institutional Review Board (IRB) or equivalent. The regulatory ethics paradigm in effect imposes the condition that clinical innovations be conducted according to scientific research methodologies. It creates the presumption that without review by an IRB, innovation cannot be conducted in an ethically defensible fashion. The regulatory ethics paradigm also requires the preparation of investigational protocols according to sound evidentiary and methodological standards. In so doing, it creates a presumption that innovations that are not rigorously validated are ethically dubious. These assumptions have deep roots. The Belmont Report, for example, articulated the orienting intuition that “radically new procedures... should... be made the object of formal research at an early stage [emphasis added] in order to determine whether they are safe and effective”.1 The Belmont Report takes the view that formal research to establish safety and efficacy of new interventions is usually feasible at an early stage in the development of a novel intervention. It thus establishes a bias that innovative treatments be conducted and evaluated under a research protocol that has passed muster at an IRB review. Given the …. (shrink)

American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.

Abortion stories have always played a powerful role in advancing women’s rights. In the abortion sphere particularly, the personal is political. Following the Court’s reversal of Roe v. Wade, abortion politics, and abortion storytelling, take on an even deeper political role in challenging the bloodless judicial language of Dobbs with the lived experience of women.

"Berkeley's Analysis of Perception" is an internal analysis of the development and consequences of Berkeley's interpretation of the perceptual process. It seeks to show that the implications of Berkeley's understanding of perception lead to conclusions later formulated in phenomenalistic theories of perception.

In lieu of an abstract, here is a brief excerpt of the content:George J. Leonard EMERSON, WHITMAN, AND CONCEPTUAL ART The widespread abandoning of the art object at the end of the 1960s was taken as something radically, even frighteningly, new, by critics and artists alike. Objects, concept artist Joseph Kosuth was asserting by 1969, are "irrelevant" to art. Though an artist might choose, as in the past, to "employ" objects, "all art is finally conceptual." In fact it was (...) now time that the object, nothing more than the "physical residue" of the artist's mental activity, was dispensed with.1 "We / open our eyes and ears seeing life / each day excellent as it is," John Cage chanted: "This / realization no longer needs art...."2 Aestheticians as disparate as Murray Krieger and Harold Rosenberg reacted to this "transfiguration of the commonplace," as Arthur Danto has called it. Danto has gained a wide scholarly audience for his ideas about the 1960s as "the end of art," or at least as the beginning of "post-historical art."3 We know from such works as Renato Poggioli's TL· T^ry oftL· Avant-Garde that, in this century, particular movements have routinely declared themselves to be art's climax.4 Critics like Jacques Barzun and artists like Amedee Ozenfant had been saying for years that art was exhausted. Yet conceptualism's attack on the object struck most critics as something both alarming and new: Irving Sandler wrote in a special edition of the College Art Association's Art Journal devoted to the problem that it demolished "every notion of what art should be,"5 and Murray Krieger feared that this "leap beyond Pop Art" would "complete the obliteration of the realm of art, its objects, its museums...."6 But the conceptualist attacks on the art object were, in fact, not new. One can find attacks as scathing in Emerson and Whitman; so scathing, that criticism has rarely taken them seriously. The attacks the concep297 298Philosophy and Literature tualists mounted in the 1960s were only the culmination ofan intellectual tendency which appeared throughout the West one hundred and sixty years before. It has long been a scholarly commonplace that after 1800 an "intellectual tendency"—as M. H. Abrams finallytermed it—extolling the possibilities of this world emerged in all parts of Western culture. When itappears in literature we nowusually call it, withAbrams, Natural Supernaturalism; or, with Harold Bloom, the "visionary company." Man, Wordsworth decreed, can and must learn to find "Paradise" in "the common day."7 Surprisingly litde work has been done on what happened when this intellectual tendency, Natural Supernaturalism, confronted the art object. Emerson and Whitman can stand for many who were necessarily ill at ease with the idea of art objects as elite objects superior to the common things it was their mission to extol. Wordsworth works before these two; Ruskin develops similar ideas into greater complexity; but since Emerson writes clear expository prose and avoids fanciful terminology, he makes a good place to enter this dark wood. Let us begin with some straightfor-ward, overdue interdisciplinary history, reading Emerson on the art object, noticing similar passages in Whitman, and noting where Emerson has reworked Hegel for his own ends. For Emerson objects are but thought's "inert effect," as for the concept artist Kosuth they would be but the "physical residue" of the artist's activity. Emerson and Kosuth, opposite Shakespeare, do not applaud the art process as the giving to an airy nothing a local habitation and a name; rather they disdain the stuff as petrifactions, as dead mud footprints left by living thoughts diat have raced away.8 In his essay "Circles," Emerson derides our admiration for a work of architecture, directing us to the "litde waving hand" that built it, for "that which builds is better than that which is built." By the same logic, the invisible thoughts which truly wrought the object were even better than the hand and "nimbler."9 When such passages are discussed at all, they are usually considered Platonic,10 but, in his essay "Art," Emerson envisions a use for art objects Plato would have blinked at. For the time being, art objects have a particular "office" to fill. That office, Emerson wrote in... (shrink)

This article presents a comparative theory of subjective argument strength simple enough for application. Using the axioms and corollaries of the theory, anyone with an elementary knowledge of logic and probability theory can produce an - at least minimally rational - ranking of any set of arguments according to their subjective strength, provided that the arguments in question are descriptive ones in standard form. The basic idea is that the strength of argument A as seen by person x is a (...) function of three values: x ’s degree of belief in the premisses of A; x ’s degree of belief in the conclusion of A under the assumption that all premisses of A are true; and x ’s belief in the conclusion of A under the assumption that not all premisses of A are true. (shrink)

Frank Koughan and Walt Bogdanich's response to my article, “From Pittsburgh to Cleveland: NHBD Controversies and Bioethics,” reminds me of the Shakespearean line, “The lady protests too much, methinks.” My article was not about the specifics of the 60 Minutes April 13, 1997, story on NHBD at the Cleveland Clinic Foundation , even though the story formed the basis for the reflection. I did not attack the critics, though I do believe that bioethicists are accountable for their scholarly and public (...) pronouncements. Although I do not see why the 60 Minutes' story should be treated with deference, my article was designed to raise questions for a primarily bioethics audience about the involvement of bioethicists in media coverage of bioethics topics. I am flattered that they took notice of my piece, but think their efforts to set the record straight only obfuscate matters further. (shrink)