In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care Setting Part I:Survey of the LiteratureMary Carrington Coutts (bio)The last twenty years have brought important changes to health care and health care education. Educators and students alike face an enormous number of new fields of study and new medical technologies. Health care professionals and institutions are also facing new challenges in the form of shrinking economic resources, and the AIDS epidemic. They (...) must also respond to increased patient participation in health care decisions, and public concern about abortion and euthanasia. These challenges to the health care professional have compelled educators to accommodate ethics within their already overcrowded curriculum. Those same dilemmas have influenced health care institutions to become active in health care ethics education.Medical ethics education gained a foothold in the United States during the late 1960s, when the medical schools of Pennsylvania State University, the University of Florida, and the State University of New York at Stonybrook established programs in the humanities (Pellegrino 1982). In 1978 Robert Veatch noted that formal teaching in medical ethics was rare; most institutions that taught medical ethics used "informal instruction in the apprenticeship mode" (Veatch 1978). However, by 1982 a survey by the American Medical Association (AMA) revealed that all but one of the 127 medical schools had courses that included medical ethics. Thirty eight of these had medical ethics as a required course (Pellegrino 1985). And by 1989, 43 of the 127 medical schools had separate courses in medical ethics, while 100 covered medical ethics within required courses. Medical ethics is now an accepted part of medical curriculum, though it is not fully mature, and its future remains somewhat unclear (Miles 1989).The evolution of ethics in the nursing curriculum has essentially mirrored that of the medical curriculum. A 1977 survey of baccalaureate nursing programs revealed that only 7 percent of nursing programs required courses in ethics [End Page 171] (Aroskar 1977). A decade later a second survey of undergraduate programs identified 85 percent of responding nursing schools as teaching nursing ethics either in separate ethics courses or within other required courses (Cassells and Redman 1989).Though the precise future of health care ethics may be unpredictable, there is little thought that the role of ethics will diminish in importance as the 21st century approaches. Ethics is seen as part of a larger plan to develop and enhance the health professional's human values, social conscience, and interpersonal skills. "This broader effort derives from concerns about the personal attributes and humanistic sensitivity of physicians, the recent overly 'scientized' trend in premedical education, the selection of medical students, and the socialization and cynicism engendered by medical education" (Miles 1989, p. 705).While nearly every medical and nursing school in the United States now teaches ethics in one form or another, the degree to which ethics is integrated into the curriculum varies from school to school. Some ethics courses are required elements of the students' education; some institutions require attendance at seminars and ethics grand rounds. Other schools offer an array of elective courses in topics that relate to ethics in medicine and nursing (including medical humanities, medicine and the law, literature and medicine, history of medicine, patient advocacy, and human values in nursing.) "Brown bag" seminars and journal clubs are also common.There is much debate over how health care ethics should be taught. Some argue that medical professionals should be conversant with theories of ethics and principles of biomedical ethics. Others think that a theoretical approach will alienate already over-worked medical or nursing students, and that instruction in ethical theory should be kept to a minimum. Case studies are frequently cited as a way to involve students in medical decision making, forcing them to analyze problems that they can relate to their own experiences.Additional concerns center around who should teach health care ethics. Frequently, physicians and nurses interested in ethics teach courses. Some commentators see this as the most desirable arrangement, asserting that practicing health care professionals best understand the conflicts faced by physicians and nurses-in-training. However, there is a growing pool of professionals who are undergoing training as medical ethicists. These individuals study ethical theory and bioethical... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Basic Resources in Bioethics*Mary Carrington Coutts (bio)OrganizationsKennedy Institute of Ethics Georgetown University Washington, DC 20057 National Reference Center for Bioethics Literature 800-MED-ETHX or 202-687-3885The Hastings Center 255 Elm Road Briarcliff Manor, NY 10510 914-762-8500Society for Health and Human Values 6728 Old McLean Village Drive McLean, VA 22101 703-556-9222NOTE: There are numerous organizations in the United States and abroad that deal with bioethical issues. For a more comprehensive (...) listing of those organizations, see:American Hospital Association. Directory of Biomedical Ethics Organizations. Chicago: American Hospital Association, 1989.National Reference Center for Bioethics Literature. International Directory of Bioethics Organizations edited by Robert Iosco. Washington, DC: Georgetown University, 1986.Encyclopedia and DictionaryDictionary of Medical Ethics. Edited by A.S. Duncan, G.R. Dunstan, and R.B. Welborn. New rev. ed. New York: Crossroad, 1981. [End Page 75]Encyclopedia of Bioethics. Edited by Warren T. Reich. 4 vols. New York: Macmillan-Free Press, 1978; or 1982 reprint in 2 volumes available to members of the Kennedy Institute of Ethics through the membership office, 202-687-8099.Online DatabaseBioethicsline. Produced by the Kennedy Institute of Ethics for the National Library of Medicine. Searchable through the MEDLARS system. Focuses on questions of ethics and public policy in the fields of health care and biomedical research. Searches available upon request to the National Reference Center for Bioethics Literature. For information on securing a personal access code from the National Library of Medicine, call 800-638-8480.BibliographiesBibliography of Bioethics. Edited by LeRoy Walters and Tamar Joy Kahn. Washington, DC: Kennedy Institute of Ethics, Georgetown University. Issued annually since 1975. Corresponds to the BIOETHICSLINE database. Provides references to resources on ethical and public policy issues in medicine and biomedical research. Includes abstracts; arranged by broad subject categories.Ethics in Nursing. Edited by Terry Pence. 2nd ed. New York: National League for Nursing, 1986. An annotated bibliography of nursing ethics. Includes author and subject indexes.Goldstein, Doris M. Bioethics: A Guide to Information Sources. Detroit: Gale Research, 1982. A selected, annotated bibliography to the literature of bioethics.The Hastings Center's Bibliography of Ethics, Biomedicine and Professional Responsibility. Compiled by the staff of the Hastings Center. Frederick, MD: University Publications of America, 1984.Medical Ethics: An Annotated Bibliography. Edited by Mark Siegler, Peter A. Singer and David L. Schiedermayer. Philadelphia: American College of Physicians, 1988.Current Awareness ServicesNOTE: Several journals have sections where they highlight new publications. See, for example, the "In The Literature" section of the Hastings Center Report, or the "Medicolegal Reference Shelf" section of Law, Medicine and Health Care. Other services include:BioLaw. Edited by James F. Childress and Ruth D. Gaare. Frederick, MD: [End Page 76] University Publications of America, 1983 to present. Annual with bimonthly updates. (Previous title: Bioethics Reporter.) A compendium of articles and legal documents on ethical and legal issues in medicine, health care administration and human experimentation. Includes the text of important legal decisions in the Resources section.New Titles in Bioethics. Edited by Luanda Fitch Huttlinger. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. Published monthly 1975-1989; quarterly 1990—present. List of acquisitions by the National Reference Center for Bioethics Literature. Organized by subject categories. Includes ordering information for difficult-to-find items. Annual cumulation available.Scope Notes Series. Washington, DC: National Reference Center for Bioethics Literature, Kennedy Institute of Ethics, Georgetown University. A series of issue briefs including annotated bibliographies on the following popular bioethical topics:No 1. Dangerousness, September 1982, 5 p.No 2. Living Wills and Durable Powers of Attorney: Advance Directive Legislation and Issues, Revised February 1990, 15 p.No 3. Ethics Committees in Hospitals, Revised June 1989, 12 p.No 4. Diagnosis Related Groups and the Prospective Payment System, June 1984, 11 p.No 5. Baby Fae, January 1985, 19 p.No 6. Surrogate Mothers, Revised January 1988, 12 p.No 7. Withholding or Withdrawing Nutrition or Hydration, Revised September 1988, 12 p.No 8. AIDS: Law, Ethics and Public Policy, April 1988, 12 p.No 9. Bioethics Audiovisuals 1982 to Present, September 1988, 12 p.No 10. Ethical Issues in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Gene TherapyMary Carrington Coutts (bio)On September 14, 1990, researchers at the U.S. National Institutes of Health (NIH) performed the first approved gene therapy procedure on a four-year-old girl named Ashanti DeSilva. Born with a rare genetic disease, severe combined immune deficiency (SCID), Ashanti lacked a healthy immune system and was extremely vulnerable to infection. Children with SCID usually develop overwhelming infections and rarely survive to adulthood; even (...) a common childhood illness like chicken pox is life-threatening. Ashanti led a cloistered existence, avoiding contact with people outside her family, remaining in the sterile environment of her home, and battling frequent illnesses with massive amounts of antibiotics.In Ashanti's gene therapy procedure, her own white blood cells were genetically modified and then infused back into her bloodstream. Laboratory tests show that the therapy has strengthened Ashanti's immune system. She no longer has recurrent colds, has been allowed to attend school, and has been immunized against whooping cough. This gene therapy procedure is not a cure, however. The genetically-treated white blood cells only survive for a few months and must then be replaced, but Ashanti's future is much brighter because of the new therapy (VI, Thompson [The First] 1993).Although this simplified description of Ashanti's gene therapy procedure sounds like a happy ending, it is little more than an optimistic chapter in a long story. The road to the first approved gene therapy procedure was rocky and fraught with controversy. The biology of human gene therapy is very complex, and there are still many techniques that need to be developed and diseases that need to be understood more fully before gene therapy is well established. The public policy debate surrounding the possible use of genetically engineered material in human subjects is equally complex. Major participants in the debate come from the fields of biology, government, law, medicine, philosophy, politics, and religion, each bringing different views to the discussion.In studying the ethics of gene therapy, one should draw a distinction between [End Page 63] therapy on somatic (non-reproductive) cells and germ (reproductive) cells. Only the germ cells carry the genes that will be passed on to the next generation. Reactions to gene therapy have varied widely. Some commentators on gene therapy object to any form of genetic manipulation, no matter how well-intentioned (VI, Rifkin 1983). Another reaction is to allow the use of somatic-cell therapy, but not to approve the use of germ-line therapy, which could have unforeseeable effects on future generations. A different stance is that, with proper regulation and safeguards, germ-line gene therapy is a logical extension of the progress made to date and that it is an ethically acceptable procedure.TechniquesTo date, 43 research protocols have been approved for somatic-cell gene therapy in the United States. The techniques employed in each protocol vary, but in general a virus is used as a "vector" to insert the desired gene into the DNA of the patient's cells, in order to compensate for a defective gene. For Ashanti's gene therapy, this technique involved obtaining white blood cells and introducing properly functioning genes into as many of the cells as possible. The normal genes were delivered through the use of a specially-engineered virus.Although similar techniques are used in germ-line gene therapy, the procedure is more difficult. There are two basic ways to perform germ-line gene therapy: (1) to treat a preimplantation embryo that carries a serious genetic defect before its implantation in the mother, which necessitates the use of in vitro fertilization techniques; or (2) to treat the germ cells (sperm or egg cells) of afflicted adults so that the genetic defects would not be passed on to their offspring, which requires the technical expertise to delete the defective gene and insert a properly functioning replacement. Because of the complexity of the procedures involved and the attendant ethical controversy, germ-line therapy is not currently performed.Candidate Diseases for Gene TherapyAt present, gene therapy is likely to be most successful in treating diseases that are caused by single-gene defects and has been approved for treating diseases such... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Fetal Tissue ResearchMary Carrington Coutts (bio)I. IntroductionThe use of tissue from fetal remains for transplantation and biomedical research has become a controversial issue in recent years, involving scientists, doctors, patients, and the federal government. Fetal tissue is potentially useful in a wide range of treatments for a number of serious diseases, some of them affecting millions of people. Despite the promise, transplantation research using fetal tissue from induced (...) abortion slowed dramatically in the U.S. in 1988, when a moratorium was declared on federal funding for such research involving humans. That moratorium was lifted by President Clinton on January 21, 1993. Though the future of fetal tissue transplantation research is brighter, public debate on the issue is likely to continue, exacerbated by the "acrimonious abortion debate" (VI, Post 1991, p. 14).Using fetal tissue in biomedical research and in transplantation is not a new practice. As early as 1928 unsuccessful attempts were made to transplant fetal pancreas cells into diabetics (VII, Fichera 1928). Fetal tissue was used effectively in biomedical research during the 1950s, and was instrumental in the culture of the polio virus, which led to the development of the polio vaccine. Fetal tissue cultures were also essential in the development of the rubella vaccine, and continue to be used in virology research. Transplantation of fetal thymus cells into patients with DiGeorge Syndrome has been recognized as effective therapy since the late 1960s.Many of the therapeutic applications involving fetal tissue are still experimental, so it is difficult to pinpoint fetal tissue transplantation's therapeutic potential. One promising application is the transplantation of human fetal brain cells into the substantia nigra of patients with Parkinson's disease to restore motor function. Fetal neural transplants have also shown promise for patients suffering from Alzheimer's disease, spinal cord and other neural tissue injuries, and possibly some forms of cortical blindness. Fetal liver cells may be useful for treatment of some kinds of bone marrow disease seen in leukemia and aplastic anemia patients. [End Page 81] Fetal tissue transplantation may also help those suffering from blood clotting disorders, such as sickle cell anemia, thalassemia, and hemophilia. Fetal pancreatic tissue has potential applications in the treatment of diabetes, especially juvenile onset diabetes. Human gene therapy may also employ embryonic and early fetal cells.The Center for Biomedical Ethics at the University of Minnesota reports that more than 1,000 patients have received transplanted fetal tissue worldwide. Countries where fetal tissue transplantation has occurred include: Australia, Canada, China, the Commonwealth of Independent States (formerly the U.S.S.R.), Cuba, Czechoslovakia, Finland, France, Germany, Great Britain, Hungary, India, Italy, Mexico, Norway, Spain, Sweden, and Yugoslavia (IV, Vawter 1992, p. 2; I, Spain 1988; VII, Reinikainen 1989).Fetal tissue has unique characteristics that make it especially valuable in some treatments. Fetal cells develop much faster than adult cells, hastening the therapeutic effect—a potentially significant benefit for gravely ill patients. They are also less likely to be rejected by transplant recipients because they are less antigenic than adult cells. This reduces the need for the exact tissue matches that can be so difficult to obtain. Fetal tissue is also easier to culture and proliferates more readily than comparable adult tissue. Furthermore, fetal tissue is in greater supply, due to the number of elective abortions.Questions about the use of fetuses and fetal tissue in biomedical research were raised in the United States in the early 1970s. Between 1969 and 1973, all 50 states enacted the Uniform Anatomical Gift Act, allowing for the donation of all or part of the body of a dead fetus for research or therapeutic research. Prospects for the use of fetal tissue increased after the Supreme Court decision in Roe v. Wade legalized abortion. As the availability of fetal tissue increased so did the concern over the potential for controversial research on living, soon-to-be-aborted fetuses, and anxiety over maltreatment of dead abortuses. Vivid examples include Geoffrey Chamberlain's 1968 report of an experiment on a fetus of 26 weeks gestational age. Delivered by hysterotomy from a 14-year-old patient, the fetus was attached to an "artificial placenta" and kept alive for more than... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:EugenicsMary Carrington Coutts (bio) and Pat Milmoe McCarrick (bio)The word eugenics (from the Greek eugenes or well-born) was coined in 1883 by Francis Galton, an Englishman and cousin of Charles Darwin, who applied Darwinian science to develop theories about heredity and good or noble birth (I, Kevles 1985, p. x).The entry under "eugenics" in the Encyclopedia of Bioethics notes that the term has had different meanings in different (...) eras: "a science that investigates methods to ameliorate the genetic composition of the human race; a program to foster such betterment; a social movement; and in its perverted form, a pseudo-scientific retreat for bigots and racists" (V, Ludmerer 1978, p. 457). Kevles, who places a stronger emphasis than Ludmerer on the degeneration of eugenics, says that by 1935 it "had become 'hopelessly perverted' into a pseudoscientific facade for 'advocates of race and class prejudice, defenders of vested interests of church and state, Fascists, Hitlerites, and reactionaries generally'" (I, Kevles 1985, p. 164).Phrases such as "survival of the fittest" and "struggle for existence" came into use at the end of the nineteenth century when eugenics societies were created throughout the world to popularize genetic science. "Negative eugenics" utilized marriage restriction, sterilization, or custodial commitment of those thought to have unwanted characteristics. "Positive eugenics" tried to encourage the population perceived as "superior" to have more offspring (V, Ludmerer 1978, p. 459).In the United States, after World War I, new information, such as the importance of environmental influences and the more complex concept of multi-gene effects in inheritance, diminished the scientific justification for eugenics, but this knowledge did not decrease the pressure for legislation, judicial action, or immigration controls. The U.S. Immigration Restriction Act of 1924 favored immigration from northern Europe and greatly restricted the entry of persons from other areas referred to as "biologically inferior." Between 1907 and 1937, 32 [End Page 163] states required sterilization of various citizens viewed as undesirable: the mentally ill or handicapped; those convicted of sexual, drug, or alcohol crimes; and others viewed as "degenerate" (V, Larson 1991).In Germany, interest in eugenics flourished after the turn of the century when Dr. Alfred Ploetz founded the Archives of Race-Theory and Social Biology in 1904 and the German Society of Racial Hygiene in 1905. The German term Rassenhygiene or race hygiene encompassed more than the word "eugenics;" it included all attempts to improve hereditary qualities as well as measures directed at population increase (III, Weiss 1987). By the 1920s, various German textbooks incorporated ideas of heredity and racial hygiene, and German professors were participating in the international eugenics movement. The Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics was founded in 1927; by 1933 a sterilization law, the Law for the Prevention of Congenitally Ill Progeny, which originally was entitled "Eugenics in the Service of Public Welfare," indicated compulsory sterilization "for the prevention of progeny with hereditary defects" in cases of "congenital mental defects, schizophrenia, manic-depressive psychosis, hereditary epilepsy... and severe alcoholism." (III, Müller-Hill 1988, p. 10).The co-mingling of science, politics, and Weltanschauung (ideological or religious world view) caused the darkest period for eugenics when Nazi Germans embarked on their "final solution" to the Jewish "problem", or the Holocaust. The Nazi racial-hygiene program began with involuntary sterilizations and ended with genocide. Beginning with the 1933 Law for the Prevention of Congenitally Ill Progeny, 350,000 schizophrenic and other mentally ill persons were involuntarily sterilized, and marriage or sexual contact between Jews and other Germans was banned. Several hundred black children and 30,000 German Gypsies were sterilized. By 1945, when the allies liberated those remaining in Nazi concentration camps, six million Jews, 750,000 Gypsies, and 70,000 German psychiatric patients had been killed by the Nazis (III, Müller-Hill 1992, p. 47). As a result of the German experience, eugenic thought dropped to its nadir, and to the present day, the term "eugenics" invokes a sense of horror in some people.Great Britain, the United States, and Germany were the countries most involved with eugenic science in the first half of this century, but interest was present in Europe and other... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care SettingPart II: Sample SyllabusMary Carrington Coutts (bio)The National Reference Center for Bioethics Literature at the Kennedy Institute of Ethics receives many inquiries from instructors at institutions that are just beginning to teach medical ethics. In an effort to assist those individuals, we have devised a syllabus that could be adapted for many uses. This is intended to be an introductory level syllabus, (...) perhaps one that would be appropriate for continuing staff education in a hospital or for an undergraduate college course. Of course, every instructor has his or her own style and preference for course content. This is offered merely as a place to start.Recognizing that participants bring a variety of backgrounds to a course, four possible text books and two casebooks have been selected as texts for a course in health care ethics. There are a number of other books that also could have been chosen. Some of these are listed in Scope Note 15: Basic Resources in Bioethics (published in the Kennedy Institute of Ethics Journal 1 (1): 75-90, March 1991). Other video selections are listed in Scope Note 9: Bioethics Audiovisuals: 1982-Present (1988); (available directly from the National Reference Center for Bioethics Literature). Additional recommendations for works that provide cross-cultural or international views of medical ethics appear in the supplemental readings list at the end of this syllabus.TextbooksBiomedical Ethics. Edited by Thomas A. Mappes and Jane S. Zembaty. 3rd ed. New York: McGraw-Hill, 1990, 641 pp. Cited: (M&Z). This text is well-suited for undergraduate education, with selected readings by philosophers, lawyers, and physicians. Includes 45 brief case studies to [End Page 263] illustrate various units of readings.Contemporary Issues in Bioethics. Edited by Tom L. Beauchamp and LeRoy Walters. 3rd ed. Belmont, CA: Wadsworth Pub. Co., 1989, 655 pp. Cited: (B&W). Appropriate for upper-level undergraduate or graduate education, this text includes selected readings by important philosophers, lawyers, physicians, and organizations. Includes the abridged texts of many significant court cases and government or organizational documents. Does not include case studies.Ethical Issues in Modern Medicine. Compiled by John Arras and Nancy K. Rhoden. 3rd ed. Mountain View, CA: Mayfield, 1989, 585 pp. Cited: (A&R). This text is suitable for upper-level undergraduate or graduate studies. It includes selections from well-respected lawyers, philosophers, and a few physicians. Includes excerpts from important court cases and policy documents. Provides only a few hypothetical case studies but does relate some authentic cases that are relevant to the various sections.Taking Sides: Clashing Views on Controversial Bioethical Issues. Edited by Carol Levine. 3rd ed. Guilford, CT: Dushkin Pub. Group, 1989, 370 pp. Cited: (L). A compilation of contrasting readings from the popular Hastings Center Report, this book is appropriate for undergraduate or continuing health care education. It does not include an introduction to basic biomedical ethical theory. Perhaps less systematic in its approach to bioethics than the previous textbooks, this book covers twenty topics relating to reproduction, death and dying, human and animal experimentation, and selected public policy issues. Provides pro and con arguments for each issue.CasebooksCases in Bioethics: Selections from the Hastings Center Report. Edited by Carol Levine. Rev. and updated ed. New York: St. Martin's Press, 1989, 291 pp. Cited: (HCR). This text includes cases studies taken from the well-known Hastings Center Report. Two or three commentaries usually accompany each case.Pence, Gregory E. Classic Cases in Medical Ethics: Accounts of the Cases That Have Shaped Medical Ethics, With Philosophical, Legal, and Historical Backgrounds. New York: Mc-Graw-Hill, 1990, 398 pp. Cited: (CC). This book describes a collection of famous (and infamous) cases from the history of biomedical ethics. The accounts of the cases here are more detailed than in other texts, and the style is more casual. [End Page 264]Course OutlineBelow are possible topics for discussion, listed with the relevant portions for each book. It is anticipated that only one textbook and one casebook would be chosen for a course. Whenever possible, price information for video purchase or rentals has been included, however this information is subject to change.Session 1... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part 2Laura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part Two of a two part Scope Note on Religious Perspectives on Bioethics. Part One was published in the June 1994 issue of this Journal. This Scope Note has been arranged in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1I.GeneralVI.HinduismII.African Religious TraditionsVII.IslamIII.Bahá'í FaithVIII.JainismIV.Buddhism and ConfucianismIX.JudaismV.Eastern (...) OrthodoxyPart 2I.Native American ReligiousChristian Scientist TraditionsEpiscopal/AnglicanII.ProtestantismEvangelicalGeneralJehovah's WitnessAnabaptist (Church of theLutheranBrethren, Friends SocietyMethodist/Wesleyan(Quaker), and Mennonite/NazareneAmish/Hutterite)Presbyterian/ReformedAssemblies of GodSeventh-day AdventistBaptistUnitarian UniversalistChurch of Jesus Christ of theUnited Church of Christ Latter-day SaintsIII.Roman CatholicismChristian Church (Disciples of Christ)[End Page 357]IntroductionThe many religions of the world bring diverse, and occasionally divergent attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine for these faith traditions in the United States, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing on bioethics, for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Native North American ShamanismAvery, Charlene. Native American Medicine: Traditional Healing. Journal of the American Medical Association 265 (17): 2271, 2273, 1 May 1991. A brief description of the general principles of Southwestern Native American religions is provided. Most tribes believe that health and religious well-being are interconnected.Day, Thomas W. Cross-Cultural Medicine at Home. Minnesota Medicine 75 (3): 15-17, March 1992. The Ojibwe tribe's view of health incorporates spiritual health and emphasizes a holistic approach to health care that encompasses a harmonious balance between the individual, community, and nature, as well as between body, mind, and spirit.Hirschfelder, Arlene B., and Molin, Paulette. The Encyclopedia of Native American Religions. New York: Facts on File, 1992. 367 p. A survey of Native American religions is provided, including tribal histories, descriptions of religious ceremonies, and biographical sketches.Hultkrantz, Åke. Health, Religion, and Medicine in Native North American Traditions. In Healing [End Page 358] and Restoring: Health and Medicine in the World's Religious Traditions, ed. Lawrence Sullivan, pp. 327-58. New York: Macmillan, 1989. Hultkrantz summarizes the Native American attitude toward medicine and health care, explaining that belief in the supernatural and its powers is one of the most important tenets of life. Ailing persons are aided by those who have been trained to act as mediators between the sick individual and the supernatural powers. Attitudes toward health and disease, and the role of the medicine man are demonstrated through the use of examples taken from many tribes.Hultkrantz, Åke. Shamanic Healing and Ritual Drama: Health and Medicine in Native North American Religious Traditions. New York: Crossroad, 1992. 197 p. Hultkrantz surveys the varied traditions of Native North Americans and their outlook on medical care, health, and religion, and emphasizes that Native American medical beliefs... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part ILaura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part One of a two part Scope Note on Religious Perspectives on Bioethics. Part Two will be published in the December 1994 issue of this Journal. This Scope Note has been organized in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1Part 2I.GeneralI.Native AmericanII.African Religious TraditionsReligious (...) TraditionsIII.Bahá'í FaithII.Protestantism—willIV.Buddhism and Confucianisminclude a general sectionV.Eastern Orthodoxyand sections focused onVI.Hinduismspecific denominations.VII.IslamIII.Roman CatholicismVIII.JainismIX.JudaismIntroductionThe many religions of the world bring diverse, and occasionally divergent, attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and [End Page 155] health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing in bioethics; for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith, but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.Specific citations about a region or country were chosen because of the predominance of a religious tradition within the population. In all cases, variation in spelling represents author usage. This Scope Note treats only the literature published in English, and every attempt has been made to identify English language sources for these faiths.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Dictionaries and EncyclopediasMelton, J. Gordon, ed. Encyclopedia of American Religions. Fourth edition. Detroit: Gale Research, 1993. 1217 p. Basic information about the history, sacred texts, membership, educational facilities, publications, and North American addresses are provided for 1,730 churches, denominations, sects, and cults. Bibliographies for many faiths supplement this extensive resource.Reich, Warren T., ed. Encyclopedia of Bioethics. New York: Free Press, Macmillan, 1978. 4 volumes. Articles on all the major religions as they relate to bioethics are included in this highly-regarded encyclopedia. In addition, many of the topical essays feature a section on the views of various faiths on the topic under discussion. For the best use of the Encyclopedia, see the subject index in volume 4. (Note: a revised, second edition is due to be published by Macmillan in late 1994.)GeneralAmerican Psychiatric Association. Committee on Religion and Psychiatry. Guidelines Regarding Possible Conflict Between Psychiatrists' Religious Commitment and Psychiatric Practice. American Journal of Psychiatry 147 (4): 542, April 1990. The American Psychiatric Association recommends that psychiatrists respect their patients' religious beliefs and that they not impose their own [End Page 156] beliefs on their patients.Bankowski, Z., and Bryant, J. H. Health Policy, Ethics and Human Values: Proceedings of the XVIIth CIOMS Round Table Conference, Athens Greece. Geneva: Council for International Organizations of Medical Sciences, 1985. 336 p. Many sections of this volume address issues where religion impacts health policymaking. Africa, the Middle East, Europe, Latin America, and Asia are highlighted for the varied ways in which their religions and cultures are integrated into the provision of health care.Batchelor, Edward, ed. Abortion: The Moral Issues. New York: Pilgrim Press, 1982. 246 p. Batchelor compiles a collection of essays by experts on religious ethics as they relate to abortion. Includes... (shrink)

Devant le constat du déclin toujours plus rapide de la diversité biologique et les limites des res- sources disponibles pour l’enrayer, il est nécessaire de déterminer quels moyens devraient être engagés dans sa protection. Pour ce faire, une méthode efficace serait d’évaluer les bénéfices tirés de la biodiversité afin d’estimer rationnellement les coûts légitimes de sa protection. L’évaluation économique, qui se présente d’emblée sur un mode quantitatif, serait alors un outil précieux. Dans ce texte, nous présentons différentes méthodes d’évaluation économique (...) de la biodiversité ainsi que certaines de leurs limites méthodologiques. Par la suite, nous montrons qu’en dépit de ses avantages pratiques, l’évaluation économique échoue à représenter l’ensemble des valeurs en jeu dans la protection de la biodiversité. Nous décrivons alors trois types de valeurs incommen- surables avec des bénéfices économiques : la valeur de legs, qui renvoie aux obligations de trans- mission du patrimoine naturel dont nous avons hérité ; la valeur d’existence, qui renvoie à la considération morale d’intérêts autres que ceux des êtres humains ; la valeur de transformation, qui renvoie à la capacité d’examiner et de critiquer nos préférences et inclinaisons afin d’inclure celles-ci dans une vision du monde rationnelle et cohérente. Pour conclure, nous plaidons en faveur de l’élaboration de méthodes de concertation et d’évaluation participatives et pluralistes permettant de rendre compte de la diversité et de l’hétérogénéité des valeurs de la biodiversité. (shrink)

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, (...) whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity. (shrink)

Paving the way for modern feminist thinking, Mary Wollstonecraft dared to challenge traditional eighteenth-century attitudes towards women. First published in 1787, this book discusses how girls can best be educated to become valuable wives and mothers. It argues that women can offer the most effective contribution to society if they are brought up to display sound morals, character and intellect, rather than superficial social graces. Wollstonecraft later developed her ideas in A Vindication of the Rights of Woman, in which (...) she attacked the educational restrictions imposed upon women. Her writings formed a cornerstone of the battle for women's rights in the nineteenth and twentieth centuries. Prompting deeper reflection upon the role and status of women in modern society, the present work remains an instructive and provocative read for those seeking to learn about the roots of feminism in its social and historical context. (shrink)

Plato famously promised to complement the Sophist and the Statesman with another work on a third sort of expert, the philosopher--but we do not have this final dialogue. Mary Louise Gill argues that Plato promised the Philosopher, but did not write it, in order to stimulate his audience and encourage his readers to work out, for themselves, the portrait it would have contained. The Sophist and Statesman are themselves members of a larger series starting with the Theaetetus, Plato's investigation (...) of knowledge, and the whole series relies on the Parmenides, the second part of which presents a philosophical exercise, introduced as the first step in a larger philosophical program. Gill contends that the dialogues leading up to the missing Philosopher, though they reach some substantive conclusions, are philosophical exercises of various sorts designed to train students in dialectic, the philosopher's method; and that a second version of the Parmenides exercise, closely patterned on it, spans parts of the Theaetetus and Sophist and brings the philosopher into view. This is the exercise about being, the subject-matter studied by Plato's philosopher. Plato hides the pieces of the puzzle and its solution in plain sight, forcing his students (and modern readers) to dig out the pieces and reconstruct the project. Gill reveals how, in finding the philosopher through the exercise, the student becomes a philosopher by mastering his methods. She shows that the target of Plato's exercise is internally related to its pedagogical purpose. (shrink)

This 1997 book was the first English translation of all of Kant's writings on moral and political philosophy collected in a single volume. No other collection competes with the comprehensiveness of this one. As well as Kant's most famous moral and political writings, the Groundwork of the Metaphysics of Morals, the Critique of Practical Reason, the Metaphysics of Morals, and Toward Perpetual Peace, the volume includes shorter essays and reviews, some of which have never been translated before. The volume has (...) been furnished with a substantial editorial apparatus including translator's introductions and explanatory notes to each text by Mary Gregor, and a general introduction to Kant's moral and political philosophy by Allen Wood. There is also an English-German and German-English glossary of key terms. (shrink)

First Published in 1990. Routledge is an imprint of Taylor & Francis, an informa company.

Mary Astell's A Serious Proposal to the Ladies is one of the most important and neglected works advocating the establishment of women's academies. Its reception was so controversial that Astell responded with a lengthy sequel, also in this volume. The cause of great notoriety, Astell's Proposal was imitated by Defoe in his "An Academy for Women," parodied in the Tatler, satirized on the stage, plagiarized by Bishop Berkeley, and later mocked by Gilbert and Sullivan in Princess Ida.

We hypothesize that effective collaboration is facilitated when individuals and environmental components form a synergy where they work together and regulate one another to produce stable patterns of behavior, or regularity, as well as adaptively reorganize to form new behaviors, or irregularity. We tested this hypothesis in a study with 32 triads who collaboratively solved a challenging visual computer programming task for 20 min following an introductory warm‐up phase. Multidimensional recurrence quantification analysis was used to examine fine‐grained (i.e., every 10 (...) s) collective patterns of regularity across team members' speech rate, body movement, and team interaction with the shared user interface. We found that teams exhibited significant patterns of regularity as compared to shuffled baselines, but there were no systematic trends in regularity across time. We also found that periods of regularity were associated with a reduction in overall behavior. Notably, the production of irregular behavior predicted expert‐coded metrics of collaborative activity, such as teams' ability to construct shared knowledge and effectively negotiate and coordinate execution of solutions, net of overall behavioral production and behavioral self‐similarity. Our findings support the theory that groups can interact to form interpersonal synergies and indicate that information about system‐level dynamics is a viable way to understand and predict effective collaborative processes. (shrink)

This paper criticizes Langton's speech act account of MacKinnon's claim about (the subordinating force of) pornography and offers a different account of how speech might enact harmful norms and thus constitute harm.

Predictions about autonomous weapon systems are typically thought to channel fears that drove all the myths about intelligence embodied in matter. One of these is the idea that the technology can get out of control and ultimately lead to horrifi c consequences, as is the case in Mary Shelley’s classic Frankenstein. Given this, predictions about AWS are sometimes dismissed as science-fiction fear-mongering. This paper considers several analogies between AWS and other weapon systems and ultimately offers an argument that nuclear (...) weapons and their effect on the development of modern asymmetrical warfare are the best analogy to the introduction of AWS. The fi nal section focuses on this analogy and offers speculations about the likely consequences of AWS being hacked. These speculations tacitly draw on myths and tropes about technology and AI from popular fi ction, such as Frankenstein, to project a convincing model of the risks and benefi ts of AWS deployment. (shrink)

This is the first critically evaluative study of Gaston Bachelard's philosophy of science to be written in English. Bachelard's professional reputation was based on his philosophy of science, though that aspect of his thought has tended to be neglected by his English-speaking readers. Dr Tiles concentrates here on Bachelard's critique of scientific knowledge. Bachelard emphasised discontinuities in the history of science; in particular he stressed the ways of thinking about and investigating the world to be found in modern science. This, (...) as the author shows, is paralleled by those debates among English-speaking philosophers about the rationality of science and the 'incommensurability' of different theories. To these problems Bachelard might be taken as offering an original solution: rather than see discontinuities as a threat to the objectivity of science, see them as products of the rational advancement of scientific knowledge. Dr Tiles sets out Bachelard's views and critically assesses them, reflecting also on the wider question of how one might assess potentially incommensurable positions in the philosophy of science as well as in science itself. (shrink)

In “Constitutivism without Normative Thresholds,” Kathryn Lindeman raises two objections to what she aptly calls Threshold Constitutivism. My aim in this short discussion is to respond to her first objection. Although I will argue that this objection fails, I will also argue that thinking through how to respond to it reminds us of something important, namely, that many of the Norm-Governed Kinds that are directly related to intentional action are social kinds, that is, kinds whose existence conditions we ourselves collectively (...) write. Everyone, whether constitutivist or not, needs to think seriously about what those existence conditions should be. [1] Journal of Ethics and Social Policy 12 (3): 231-258 (2017). [2] Lindeman’s second objection depends on her view, which I do not share, that “Normative Constitutivism has ambitions to be an explanatory strategy for norms in general” (238, my emphasis). (shrink)

When deciding what disorders to screen newborns for, we should be guided by evidence of real effectiveness, take opportunity cost into account, distribute costs and benefits fairly, and respect human rights. Current newborn screening policy does not meet these requirements.

Renowned philosopher Mary Midgley explores the remarkable gap that has opened up between our own understanding of our sense of our self and today's scientific orthodoxy that claims the self to be nothing more than an elaborate illusion. Bringing her formidable acuity and analytic skills to bear, she exposes some very odd claims and muddled thinking on the part of cognitive scientists and psychologists when it comes to talk about the self. Well-known philosophical problems in causality, subjectivity, empiricism, free (...) will and determinsim are shown to have been glossed over by scientists claiming that the self is no more than a jumble of brain-cells. Midgley argues powerfully and persuasively that the rich variety of our imaginative life cannot be contained in the narrow bounds of a highly puritanical materialism that equates brain and self. The denial of the self has been sustained by the belief that physical science requires it, but there is not just one such pattern of thought but many others which all help to explain the different kinds of problems that arise in our life, argues Midgley. Physics' amazing contemporary successes spring from attacking problems that arise within physics, not from outside. It is no more sensible to give a physical answer to a moral problem than it is to give political answers to physical ones. 'Are you an Illusion?' is an impassioned defence of the importance of our own experiences - the subjective sources of thought - which are every bit as necessary for the world as the objective ones such as brain cells. (shrink)

This paper responds to John Burgess's ‘Mathematics and _Bleak House_’. While Burgess's rejection of hermeneutic fictionalism is accepted, it is argued that his two main attacks on revolutionary fictionalism fail to meet their target. Firstly, ‘philosophical modesty’ should not prevent philosophers from questioning the truth of claims made within successful practices, provided that the utility of those practices as they stand can be explained. Secondly, Carnapian scepticism concerning the meaningfulness of _metaphysical_ existence claims has no force against a _naturalized_ version (...) of fictionalism, according to which our ordinary standards of scientific evidence may show that we have no reason to believe the mathematical existence claims made within the context of our mathematical and scientific theories. (shrink)

Crude materialism, reduction of mind to body, extreme individualism. All products of a 17th century scientific inheritance which looks at the parts of our existence at the expense of the whole. Cutting through myths of scientific omnipotence, Mary Midgley explores how this inheritance has so powerfully shaped the way we are, and the problems it has brought with it. She argues that poetry and the arts can help reconcile these problems, and counteract generations of 'one-eyed specialists', unable and unwilling (...) to look beyond their own scientific or literary sphere. Dawkins, Atkins, Bacon and Descartes all come under fire as Midgely sears through contemporary debate, from Gaia to memes, and organic food to greenhouse gases. After years of unquestioned imperialism, science is finally forced to take a step back and acknowledge the arts. (shrink)

In this much-anticipated work, distinguished authors Mary Beth Ingham and Mechthild Dreyer present an accessible introduction to the philosophy of the thirteenth century Franciscan John Duns Scotus.

I aim to clarify the argument for space that Newton presents in De Gravitatione (composed prior to 1687) by putting Newton's remarks into conversation with the account of geometrical knowledge found in Proclus's Commentary on the First Book of Euclid's Elements (ca. 450). What I highlight is that both Newton and Proclus adopt an epistemic progression (or “order of knowing”) according to which geometrical knowledge necessarily precedes our knowledge of metaphysical truths concerning the ontological state of affairs. As I argue, (...) Newton's commitment to this order of knowing clarifies the interplay of the imagination and understanding in geometrical inquiry and illuminates how geometrical knowledge of space can lead to knowledge that space depends on and is related to God. In general, appreciating the Proclean elements of Newton's argument brings added light to the significance of geometrical inquiry for his general natural philosophical program and grants us insight into the philosophical grounding for the notion of absolute space that is presented in the Principia mathematica (1687). (shrink)

InWisdom, Information and Wonder, Mary Midgley tackles the question at the root of our civilization: What is knowledge for?

"Multiverse" cosmologies imagine our universe as just one of a vast number of others. While this idea has captivated philosophy, religion, and literature for millennia, it is now being considered as a scientific hypothesis--with different models emerging from cosmology, quantum mechanics, and string theory. Beginning with ancient Atomist and Stoic philosophies, Mary-Jane Rubenstein links contemporary models of the multiverse to their forerunners and explores the reasons for their recent appearance. One concerns the so-called fine-tuning of the universe: nature's constants (...) are so delicately calibrated that it seems they have been set just right to allow life to emerge. For some thinkers, these "fine-tunings" are evidence of the existence of God; for others, however, and for most physicists, "God" is an insufficient scientific explanation. Hence the allure of the multiverse: if all possible worlds exist somewhere, then like monkeys hammering out Shakespeare, one universe is bound to be suitable for life. Of course, this hypothesis replaces God with an equally baffling article of faith: the existence of universes beyond, before, or after our own, eternally generated yet forever inaccessible to observation or experiment. In their very efforts to sidestep metaphysics, theoretical physicists propose multiverse scenarios that collide with it and even produce counter-theological narratives. Far from invalidating multiverse hypotheses, Rubenstein argues, this interdisciplinary collision actually secures their scientific viability. We may therefore be witnessing a radical reconfiguration of physics, philosophy, and religion in the modern turn to the multiverse. (shrink)

In the preface to the Principia (1687) Newton famously states that “geometry is founded on mechanical practice.” Several commentators have taken this and similar remarks as an indication that Newton was firmly situated in the constructivist tradition of geometry that was prevalent in the seventeenth century. By drawing on a selection of Newton's unpublished texts, I hope to show the faults of such an interpretation. In these texts, Newton not only rejects the constructivism that took its birth in Descartes's Géométrie (...) (1637); he also presents the science of geometry as being more powerful than his Principia remarks may lead us to believe. (shrink)

Published in 1785, Immanuel Kant's Groundwork of the Metaphysics of Morals ranks alongside Plato's Republic and Aristotle's Nicomachean Ethics as one of the most profound and influential works in moral philosophy ever written. In Kant's own words, its aim is to identify and corroborate the supreme principle of morality, the categorical imperative. He argues that human beings are ends in themselves, never to be used by anyone merely as a means, and that universal and unconditional obligations must be understood as (...) an expression of the human capacity for autonomy and self-governance. As such, they are laws of freedom. This volume contains Mary Gregor's acclaimed translation of the text into English, revised by Jens Timmermann, and an accessible, updated introduction by Christine Korsgaard. (shrink)

"This book is a nuanced discussion of contemporary feminist thought in a variety of religious traditions. It draws from both academic and popular writings and offers a rich selection of books to pursue on one's own." —Re-Imagining "This remarkable book examines American women's religious thought in many diverse faith traditions.... This is a cogent, provocative—even moving—analysis." —Publishers Weekly This study of the fruits of many different women’s religious thought offers insights into the ways women may be shaping American religious ideas (...) and world views at the end of the twentieth century. At its broadest, this book presents a multi-voiced response to the question: "When women across many traditions are heard speaking theologically, publicly and self-consciously as women, what do they have to say?". (shrink)

In this book, Mary Townsend proposes that, contrary to the current scholarship on Plato's Republic, Socrates does not in fact set out to prove the weakness of women. Rather, she argues that close attention to the drama of the Republic reveals that Plato dramatizes the reluctance of men to allow women into the public sphere and offers a deeply aporetic vision of women’s nature and political position—a vision full of concern not only for the human community, but for the (...) desires of women themselves. (shrink)

In 1989, Helga Wanglie, 86 years old, broke her hip. This began a medical downhill course that a year later caused her health care providers to conclude that she would not benefit from continued medical treatment. It would be futile, and therefore, should not be provided. Her husband disagreed, and the conflict eventually led to a lawsuit. The Wanglie case touched off an extended debate in the medical and bioethical literature about medical futility: what it means and how useful the (...) concept is in making ethical decisions about starting or stopping treatment. (shrink)

Metaphysics Θ treats potentiality (δύναμις) and actuality (ἐνέργεια), and many scholars think that Aristotle broaches these topics once he has answered his main questions in Ζ and Η. In Ζ he asked, what is primary being? After arguing in Ζ.1 that substance (οὐσία) is primary being—a being existentially, logically, and epistemologically prior to quantities and qualities and other categorial beings—he devotes the rest of the book to οὐσία itself, investigating what it is, to decide what entities count as primary substances. (...) I differ from the leading interpretative consensus that ΖΗ adequately answer the questions about primary substance, and contend instead that Metaphysics Θ continues the same investigation as ΖΗ and, using δύναμις and ἐνέργεια as tools, arrives at a striking new conception of hylomorphism, different from that in ΖΗ, which enables Aristotle to defend the substantial primacy of living organisms consisting of matter and form. (shrink)

Admirers of Whitehead who know him best have suggested that Wordsworth had possibly a greater influence upon him than anyone except Plato. Nowhere apparently has Whitehead admitted such an influence, as he has that of Plato and Locke and that of William James, Bergson, and Alexander among traditional and contemporary philosophers But he had a predilection for poetry, and attributes to the great poets philosophical importance. They capture uniquely, he says, “a fragrance of experience”; and “… express deep intuitions of (...) mankind penetrating into what is universal in concrete fact.” As observers of nature both Wordsworth and Whitehead ascribed to animate and inanimate life a degree of feeling or satisfaction in the course of being and becoming. Like the poet, Whitehead must have found “joy in widest commonalty spread.” The multiplication table, he noted at one time, “… is no good to the realist. It shuts him up with Plato's ideas out of space and out of time” when “… like Wordsworth and the rest of us he wants to hear the throstle sing.”. (shrink)