Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

Reprint of the original, first published in 1919.

Some people will confront Alzheimer's with a measure of resignation, a determination to struggle against the progressive debilitation and to extract whatever comforts and benefits they can from their remaining existence. They are entitled to pursue that resolute path. For other people, like myself, protracted maintenance during progressive cognitive dysfunction and helplessness is an intolerably degrading prospect. The critical question for those of us seeking to avoid protracted dementia is how best to accomplish that objective.One strategy is to engineer one's (...) own death while still mentally competent to do so (even in the stage of mild dementia). If I were to use a preemptive strategy in the face of a dementia diagnosis, I would probably choose to stop eating and drinking, a process known as voluntarily stopping eating and drinking. An alternative tactic for avoiding prolonged dementia would be to allow oneself to decline into moderate dementia—thus losing capacity to perform self‐deliverance or even to make serious medical decisions—but before getting to that point to provide advance instructions rejecting prospective life‐sustaining medical interventions. These advance instructions would authorize palliative but not curative measures. My current personal instructions define the point of intolerable cognitive decline triggering medical nonintervention as “mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.” These instructions dictate allowing my demise at a point of moderate dementia when I may not be perceptibly suffering, when I may still be getting some rudimentary satisfaction from my debilitated life, and when I no longer recall the preoccupation with personally intolerable indignity that motivated my instructions. Can I expect that my advance instructions will be implemented in those circumstances? Is it lawful, and is it moral for a surrogate decision‐maker and associated caregivers to allow an uncomprehending, ostensibly content but demented individual to die? My analysis herein contends that it is not only lawful and moral but also legally required to implement clear, considered advance instructions even at a stage of moderate dementia. (shrink)

Bioethics' traditional focus on clinical relationships and exotic technologies has led the field away from population health, health disparities, and issues of justice. The result: a myopic view that misses the institutional context in which clinical relationships operate and can overlook factors that affect health more broadly than do exotic technologies. A broader bioethics agenda would take up unresolved questions about the distribution of health and the development of fair policies that affect health distribution.

This new edition contains the complete text of fifty-seven letters that Wittgenstein wrote to the author over a period of eleven years.

Over-enthusiastic newborn screening has often caused substantial harm and has been imposed on the public without adequate information on benefits and risks and without parental consent. This problem will become worse when genomic screening is implemented. For the past 40 years, there has been broad agreement about the criteria for ethically responsible screening, but the criteria have been systematically ignored by policy makers and practitioners. Claims of high benefit and low risk are common, but they require precise definition and documentation, (...) which has often not occurred, undermining claims that involuntary testing is justified. Even when the benefits and risks are well established, it does not automatically follow that involuntary testing is justified, a position supported by the widespread tolerance for parental refusal of immunizations and newborn screening. (shrink)

This is the first of a three-volume anthology intended as a companion to The Cambridge History of Later Medieval Philosophy. Volume 1 is concerned with the logic and the philosophy of language, and comprises fifteen important texts on questions of meaning and inference that formed the basis of Medieval philosophy. As far as is practicable, complete works or topically complete segments of larger works have been selected. The editors have provided a full introduction to the volume and detailed introductory headnotes (...) to each text; the volume is also indexed comprehensively. (shrink)

In this paper I explore the role that the concept of the sacred can play in our moral thinking. I accept that the assertion that ‘human life is sacred’ can be one way of articulating the special value of individual human lives as in some sense inviolable. I cautiously allow that the idea of ‘sacred value’ might also apply to other things such as certain kinds of human commitments, uniquely precious art-works, and some other kinds of living things. In conclusion (...) I offer reasons for resisting the claim, made especially by Roger Scruton, that the experience of the sacred, when properly understood, draws us ineluctably into a religious view of the world. (shrink)

This paper aims at closing a gap in recent Weyl research by investigating the role played by Leibniz for the development and consolidation of Weyl's notion of theoretical (symbolic) construction. For Weyl, just as for Leibniz, mathematics was not simply an accompanying tool when doing physics – for him it meant the ability to engage in well-guided speculations about a general framework of reality and experience. The paper first introduces some of the background of Weyl's notion of theoretical construction and (...) then discusses particular Leibnizian inheritances in Weyl's Philosophie der Mathematik und Naturwissenschaft, such as the general appreciation of the principles of sufficient reason and of continuity. Afterwards the paper focuses on three themes: first, Leibniz's primary quality phenomenalism, which according to Weyl marked the decisive step in realizing that physical qualities are never apprehended directly; second, the conceptual relation between continuity and freedom; and third, Leibniz's notion of ‘expression’, which allows for a certain type of (surrogative) reasoning by structural analogy and which gave rise to Weyl's optimism regarding the scope of theoretical construction. (shrink)

_ The Blackwell Guide to Business Ethics, _written by international experts in the field, acquaints the reader with theoretical and pedagogical issues, ethical issues in the practice of business and exciting new directions in the field.

Philosopher Martin Heidegger’s writing on the essence of technology has often been seen as too abstract even though he illustrated his concerns with reference to technological developments of his day. While most in the immediate post-World War 2 period judged thermonuclear weaponry to be the most obvious technological threat to the future of humanity, Heidegger instead considered developments in the biological sciences to be more so. In the discussion presented here, Heidegger’s thinking is related to developments in biotechnology, specifically assisted (...) reproductive technology. The task here is (1) to illustrate how Heidegger’s disquiet is manifested in such technologies and (2) to emphasize the significance of his call for a “step back” from the calculative thinking dominant in the natural sciences to what he called, alternately, “essential,” “meditative,” or “commemorative” thinking. Only through this latter mode of thinking can we expect to enter into a “free” relationship to technology. (shrink)

A professor of mathematics offers an analysis of the roles science plays within American society, providing suggestions for a more effective interchange between scientists and key United States institutions.

I make no apology for what is by now a hackneyed title. It derives, of course, from Croce’s book on Hegel, and I choose it because I want to suggest that the question ‘What is living and what is dead in Marxism?’ is the right question to ask. The analytical approach is appropriate if it means distinguishing and discriminating between different aspects of Marxism, and refusing to reject or embrace it en bloc as a monolithic creed. However, this does not (...) mean that Marxism can be chopped up into a number of disconnected theses, with a view to producing an inventory of those which are true and those which are false. Marxism claims to be a systematic theory, whose various elements hang together in an organised way. Some would say that this creates an unbridgeable gulf between Marxist and analytical philosophies. Nevertheless, though Marxism’s claim to be systematic should be taken seriously, there are different readings of the theory and of how its components are connected, and different versions will see different elements as central. This is where the careful discrimination of meanings and interpretations is needed. It is not simply a question of deciding whether each of the various elements, in isolation, is true or false, more a matter of deciding where the emphasis should lie if Marxism is to continue to illuminate our understanding of the social world. It is in this sense that we can talk about Marxism or any other theory as ‘living’ — not just as containing true assertions, but as being capable of playing a vital and creative role in human thought and action. In what version, then, if any, is Marxism a living philosophy? (shrink)

1. Thoroughgoing TeleologyAquinas concludes his introductory chapter by announcing that his first task in Book III, a task to which he devotes sixty-two chapters, is to investigate “God himself in so far as he is the end of all things” (1.1867b). That compressed description of a very big topic is likely to arouse some misgivings. Why should we think that absolutely all things do have ends or goals? Even if we’re given good reasons to think that they do, why should (...) we think that all those ends or goals converge in a single end for all things? And even if we should be convinced of that, why should we think that that single universal end must be identified (somehow) as God himself? (shrink)

1. The Aims of the BookThis book is the third in a series of three volumes. In 1997 and 1999, Oxford’s Clarendon Press published my books The Metaphysics of Theism and The Metaphysics of Creation, which are related, respectively, to Books I and II of Thomas Aquinas’s Summa contra gentiles (SCG) as this book is to Book III.1.