The high technology and the costs involved in critical care disclose the implausibility of applying the American standard version of bioethics in the developing world. The American standard version of bioethics was framed during the rapid secularization of the American culture, the emergence of a new image for the medical profession, the development of high technology medicine, an ever greater demand in resources, and a shift of focus from families and communities to individuals. This all brought with it a particular (...) ideology of health care which promised Americans (1) the best of care, (2) equal care, and (3) physician/patient choice, without (4) runaway costs. This essay argues that this moral project is impossible in practice. This impossibility is especially salient in developing countries. In addition to the fact that it is financially impossible to provide all in the developing world with the standard of care accepted by law, policy, and convention in developed countries, different moral perspectives with different orderings of values will seem more or less plausible in different cultures. Indeed, such an approach would be harmful. A concrete bioethics applicable across the world does not appear possible. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

H. Tristram Engelhardt, Jr.; Can Philosophy Save Christianity? Are the Roots of the Foundations of Christian Bioethics Ecumenical? Reflections on the Nature of.

Engelhardt invites readers to understand what it means to live in a world after God, where questions of sin and virtue have been replaced with life-and-death-style choices. After God provides a dark prophetic vision. But there is still hope. As Engelhardt argues, In this culture, children now grow up apart from and defended against a recognition of the God Who lives. They are nurtured in a social fabric that is structured so as to avoid a recognition of, much (...) less an encounter with, God. Nevertheless... a traditional Christianity has endured, even though its morality and bioethics have become ever more strongly counter-cultural. The source of this traditional Christian otherness over against the surrounding post-theistic culture lies in the origins of Christianity itself, in the Christianity of the Apostles and the Fathers, namely, in Orthodox Christianity. Against the tenor of the times, disregarding the animus to set traditional Christianity aside, and despite heretics prominent within its fold, Orthodox Christianity remains a light in a world after God. --! From back cover. (shrink)

The project of articulating a coherent, canonical, content-full, secular morality-cum-bioethics fails, because it does not acknowledge sin, which is to say, it does not acknowledge the centrality of holiness, which is essential to a non-distorted understanding of human existence and of morality. Secular morality cannot establish a particular moral content, the harmony of the good and the right, or the necessary precedence of morality over prudence, because such is possible only in terms of an ultimate point of reference: God. The (...) necessity of a rightly ordered appreciation of God places centrally the focus on holiness and the avoidance of sin. Because the cardinal relationship of creatures to their Creator is worship, and because the cardinal corporate act of human worship is the Liturgy, morality in general and bioethics in particular can be understood in terms of the conditions necessary, so as worthily to enter into Eucharistic liturgical participation. Morality can be summed up in terms of the requirements of ritual purity. A liturgical anthropology is foundational to an account of the content-full morality and bioethics that should bind humans, since humans are first and foremost creatures obliged to join in rightly ordered worship of their Creator. When humans worship correctly, when they avoid sin and pursue holiness, they participate in restoring created reality. (shrink)

Proceedings of the first trans-disciplinary symposium on philosophy and medicin held at Galveston, Texas, May 9-11,1974.

H. Tristram Engelhardt, Jr.; Conflicting Moralities and Theologies: The Culture Wars in Bioethics Reexamined, Christian bioethics: Non-Ecumenical Studies in Med.

H. Tristram Engelhardt, Jr.; Controversies, Conflicts, and Consensus: A Concluding, Untheological Postscript, Christian bioethics: Non-Ecumenical Studies in Med.

Bioethics is not merely a theoretical discipline but a practice as well. Indeed, bioethics is a sort of moral trade. Bioethicists serve on ethics committees, give expert testimony to courts, provide guidance for healthcare policy, and receive payment for these services. The difficulty is that their role as experts able to guide clinical choice and public policy formation is brought into question by the diversity of moral understandings regarding central moral issues at the heart of the culture wars in healthcare. (...) The disconfirmation of the expert role of bioethicists by their apparent actual role as partisans of particular moral schools and perspectives could be set aside, were there an avenue to moral consensus, a door to a common moral vision to guide this new profession of moral experts. This brief article addresses the hunger for consensus in bioethics, its impossibility with respect to the controversial issues that mark the field, and the inclination nevertheless to deny this manifest diversity by appeals to a consensus that could allow bioethicists to function as ethics experts able substantively to guide clinical choices and public policy. (shrink)

The mind-body relation or, more particularly, the mind-brain relation 1 has been a perennial puzzle for philosophers—how can things so different be intimately related? Husserl dealt with the mind-brain relation in Section 63 of Ideen II, “Psychophysischer Parallelismus and Wechselwirkung,” 2 where he gave a critique of psychophysical parallelism. For Husserl, the mind-brain relation is to be understood not as a material or metaphysical relation, but as a relation between the presented sense or significance of two varieties of appearances. Husserl’s (...) account in this section will be examined and the following points will be discussed: (1) Husserl’s argument that the significance of brain states is basic to the full sense of a mind operating in an objective world; (2) Husserl’s view that a strict parallelism between the psyche and brain is an eidetic impossibility; (3) Husserl’s treatment of these questions, in so far as he raises but does not adequately resolve the issue, whether states of consciousness precede or follow brain states; (4) Husserl’s somewhat Cartesian failure to distinguish the phenomenological priority of consciousness from the metaphysical question of the possibility of an existent mind apart from a body. (shrink)

The term `bioethics' was coined in 1971, just as interest in the medical humanities claimed a prominent place in medical education. Out of this interest, a substantial area of research and scholarship took shape: the philosophy of medicine. This field has been directed to the epistemological, ontological, and value-theoretical issues occasioned by medicine and the biomedical sciences. Bioethics is nested in this field and can only be fully understood in terms of the foundational issues it addresses. This collection of essays (...) in honor of Stuart F. Spicker, one of the individuals who gave shape to the philosophy of medicine, lays out the broad scope of concerns from the philosophy of embodiment, to issues of the role of ethics consultants, to concepts of disease, equity and the meaning of history. (shrink)

H. Tristram Engelhardt, Jr.; Generic Chaplaincy: Providing Spiritual Care in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

Contemporary Christians are separated by foundationally disparate understandings of Christianity itself. Christians do not share one theology, much less a common understanding of the significance of sin, suffering, disease, and death. These foundational disagreements not only stand as impediments to an intellectually defensible ecumenism, but they also form the underpinnings of major disputes in the culture wars, particularly as these are expressed in healthcare. There is not one Christian bioethics of sin, suffering, sickness, and death. In this article, the character (...) of the moral-theological visions separating the various Christianities and thus their bioethics is examined. Particular emphasis is placed on the differences that set contemporary Western theology at odds with the theology of the Christianity of the first millennium. As is shown, the ground for this gulf lies in the divide between traditional and post-traditional views of the appropriate role of philosophy in theology, a difference rooted in disparate understandings of the meaning of church and of the meaning of the logos, the Son of God. (shrink)

This collection of essays examines the ways in which disputes and controversies about the application of scientific knowledge are resolved. Four concrete examples of public controversy are considered in detail: the efficacy of Laetrile, the classification of homosexuality as a disease, the setting of safety standards in the workplace, and the utility of nuclear energy as a source of power. The essays in this volume show that debates about these cases are not confined to matters of empirical fact. Rather, as (...) is seen with most scientific and technical controversies, they focus on and are structured by complex ethical, economic, and political interests. Drs. Engelhardt and Caplan have brought together a distinguished group of scholars from the sciences and humanities, who sketch a theory of scientific controversy and attempt to provide recommendations about the ways in which both scientists and the public ought to seek more informed resolutions of highly contentious issues in science and technology. Scientific Controversies is offered as a contribution to the better understanding of the roles of both science and nonscientific interests in disputes and controversies pertaining to science and technology. (shrink)

Book reviewed in this article: Bioethics and Secular Humanism: The Search for a Common Morality. By H. Tristram Engelhardt, Jr.

H. Tristram Engelhardt, Jr.; The DeChristianization of Christian Health Care Institutions, or, How the Pursuit of Social Justice and Excellence can Obscure the.

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of (...) basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)