In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval.

To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to American bioethics.

Written by a sociologist and a biologist and science historian, this text considers the social aspects of organ transplantation and chronic hemodialysis. Their research, begun in 1968, focused on the experience of research physicians engaged in this work, the "gift- exchange" social dimensions of these practices, and the impact of these technologies on society as a whole. This reprint of the 1978 edition includes a new introduction by the authors. c. Book News Inc.

Twelve narratives written by surgeons on ethical decision-making are analyzed in this commentary. Several major themes in their narratives are discussed: the preponderance of end-of-life issues; the struggle to be inclusively empathetic, even under emotionally alienating circumstances; social justice; and the disagreement among colleagues about how to deal with patients in situations of medical uncertainty. The commentary not only discusses the areas of stress that the surgeons identify in their accounts. It also highlights phenomena and themes that are missing from (...) them, and calls for more work to be done gathering stories from surgeons to explore and explain the “gaps” in this narrative collection. (shrink)

They have watched, as insiders, the first fumbling attempts to transplant kidneys, then hearts, then live‐donated lobes of liver and lung. Now the two sociologists most closely identified with organ transplantation have concluded that they must leave the field.

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

“Bioethics is not just Bioethics.” This is the aphoristic way in which I have recurrently expressed my historical and social perspective on the significance of bioethics, whose import I regard as extending beyond the emergence, development, and establishment of an intellectual field that is primarily concerned with advances in biology and medicine, their relationship to illness and health, and their ethical concomitants. In my view, although they are expressed through the medium of medicine, some of the value and belief questions (...) with which bioethics has been preoccupied since its inception are connected with broad and deep moral issues that are integral to what the illustrious French sociologist Émile Durkheim... (shrink)

In the expanding repertoire of practices designed to increase the supply of organs for transplantation, non-heart-beating cadaver organ donation has generated an ongoing debate in the literature. The continuing stream of articles is disquieting in part because it documents a troubling "trial-and-error ethics" approach to the formulation of organ procurement policy, and because it raises serious questions about the reasons that the development of this policy is being mediated by published communication. In the light of concerns about the implicit support (...) and credibility that professional publications give to organ procurement policies, restraint in publishing articles about non-heart-beating organ donation as well as in devising such policies is strongly advocated. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

Religion has become a vital resource for attempts to rethink the meaning of the political. This article rehearses the efforts of two recent figures, René Girard and Giorgio Agamben, to transform the political by renewing its connection to religion. Both thinkers struggle to escape politics as defined by Carl Schmitt's friend/enemy distinction. Girard and Agamben do clash ideologically, but their inquiries into sacrifice and messianism take similar courses. Regarding origins, Girard argues for the sacrificial crisis as the common parent to (...) religion and politics. Conversely, for Agamben, the Roman figure of homo sacer distinguishes politics from religion. With respect to the future, Girard's messianism installs Christian belief as the only way to move beyond violence. By contrast, Agamben steers Pauline messianism toward the efforts to displace sovereignty and reopen the political. I conclude that Agamben breaks with Schmitt while Girard reinscribes his politics at a higher level. Key Words: Giorgio Agamben • Rey Chow • Christianity • René Girard • homo sacer • messianism • politics • sacred • sacrifice • Carl Schmitt. (shrink)

Rereading Renée C. Fox's “A Sociological Perspective on Organ Transplantation and Hemodialysis,” published in 1970, one is likely to be struck more by continuity than by change. The most pressing of the social, policy, and ethical concerns that Fox raised remain problematic fifty years later. We still struggle with scientific and clinical uncertainty, with the boundary between experimentation and therapy, and with the cost of organ replacement therapies and disparities in how they are allocated. We still have an imperfect understanding (...) of transplant immune responses. We still debate when a potential donor “actually” dies, and we still seem to think better empirical criteria could harmonize the diverse religious, cultural, and socioeconomic values of patients, providers, third‐party payers, and policy‐makers. Organ transplantation was for Fox both a particular case unfolding in time and an entryway for discussing the difficult moral questions presented by many new medical technologies in a context of high demand and limited resources. (shrink)

We are sad to say that Advisory Board member Renée Fox died on September 23rd. Renée was an extraordinary friend of Perspectives in Biology and Medicine, celebrating and contributing to its uniqueness over many years.Renée was a pioneer in medical sociology who spent most of her career at the University of Pennsylvania. Her research used participant-observation to explore the work of physicians. In Experiment Perilous, she examined troubling practices of doctors who conducted research on their own patients at the Peter (...) Bent Brigham Hospital in Boston. In The Courage to Fail, written with Judith Swazey, she focused on dangers to patients as their physicians used them as experimental subjects to develop... (shrink)

Several authors have recently suggested that moral factors and norms `encroach' on the epistemic, and because of salient parallels to pragmatic encroachment views in epistemology, these suggestions have been dubbed `moral encroachment views'. This paper distinguishes between variants of the moral encroachment thesis, pointing out how they address different problems, are motivated by different considerations, and are not all subject to the same objections. It also explores how the family of moral encroachment views compare to classical pragmatic encroachment accounts.

This book explores the differences and similarities between Sartrean existentialism and French poststructuralism.

I was first taken to Mr Gurdjieff's flat at a time very different from the present. Paris during the war, under German occupation, was in the grip of the ...

A dual-language edition presenting Descartes's original Latin text of his greatest work, with a facing-page authoritative English translation.

I have always considered that the two questions respecting God and the Soul were the chief of those that ought to be demonstrated by philosophical rather than ...

Hydrogen is troublesome in any periodic table classification. This being so it may as well be placed in a position that confers desirable attributes to the arrangement of the elements, while notionally recognising its lineage to the group 1 alkali metals and the group 17 halogens. Since the noble gases bridge the halogens and the alkali metals, and hydrogen encompasses the transition from the alkali metals to the halogens, there is more to the idea of hydrogen over helium. (Meyer 1870, (...) p. 357) (Proust 1927, p. 559). (shrink)

Machine ethics and robot rights are quickly becoming hot topics in artificial intelligence and robotics communities. We will argue that attempts to attribute moral agency and assign rights to all intelligent machines are misguided, whether applied to infrahuman or superhuman AIs, as are proposals to limit the negative effects of AIs by constraining their behavior. As an alternative, we propose a new science of safety engineering for intelligent artificial agents based on maximizing for what humans value. In particular, we challenge (...) the scientific community to develop intelligent systems that have human-friendly values that they provably retain, even under recursive self-improvement. (shrink)

Based on interviews with 40 first-time mothers, the authors develop an argument that supplements the critique of medicalized childbirth by focusing on the social context in which women give birth. Particularly important about that context is women's privatized responsibility for babies' well-being, and a dearth of social supports for mothering, including the sharing of that responsibility by fathers. Contextualizing childbirth in this way makes clearer not only why many women are favorable toward medical intervention but also the decisions women make (...) during hospital births. The women we interviewed displayed widely ranging reactions to giving birth in the hospital. Describing their experiences, these women often emphasized pain and anxiety. Both conditions appear to have been relieved as effectively by social support as by medical assistance. Furthermore, women who had generally supportive partners were less likely to receive medical intervention during the birth and less likely to suffer postpartum depression. (shrink)

The Meditations, one of the key texts of Western philosophy, is the most widely studied of all Descartes' writings. This authoritative translation by John Cottingham, taken from the much acclaimed three-volume Cambridge edition of the Philosophical Writings of Descartes, is based upon the best available texts and presents Descartes' central metaphysical writings in clear, readable modern English. As well as the complete text of the Meditations, the reader will find a thematic abridgement of the Objections and Replies (which were originally (...) published with the Meditations) containing Descartes' replies to his critics. These extracts, specially selected for the present volume, indicate the main philosophical difficulties which occurred to Descartes' contemporaries and show how Descartes developed and clarified his arguments in response. This edition contains a new comprehensive introduction to Descartes' philosophy by John Cottingham and the classic introductory essay on the Meditations by Bernard Williams. (shrink)

I argue that inferences from highly probabilifying racial generalizations are not solely objectionable because acting on such inferences would be problematic, or they violate a moral norm, but because they violate a distinctively epistemic norm. They involve accepting a proposition when, given the costs of a mistake, one is not adequately justified in doing so. First I sketch an account of the nature of adequate justification—practical adequacy with respect to eliminating the ~p possibilities from one’s epistemic statespace. Second, I argue (...) that inferences based on demographic generalizations tend to disproportionately expose group members to the risks associated with mistakenly assuming stereotypical propositions, and so magnify the wrong involved in relying on such inferences without adequate justification. (shrink)

This article explores the principles of interaction that shape grammatical practices of conversational speech cross-linguistically. Seven such principles are explored, and the grammatical practices they give rise to are illustrated. The role of these principles in shaping non-linguistic behavior is also touched on.

I argue that the offense generation pattern of slurring terms parallels that of impoliteness behaviors, and is best explained by appeal to similar purely pragmatic mechanisms. In choosing to use a slurring term rather than its neutral counterpart, the speaker signals that she endorses the term. Such an endorsement warrants offense, and consequently slurs generate offense whenever a speaker's use demonstrates a contrastive preference for the slurring term. Since this explanation comes at low theoretical cost and imposes few constraints on (...) an account of the semantics of slurs, this suggests that we should not require semantic accounts to provide an independent explanation of the offense profile. (shrink)

Desde o ano de 1643, Descartes (1596-1650) e a princesa Elizabeth (1618-1680) já trocavam cartas a respeito da geometria, da metafísica e até da física cartesiana. Todavia, no ano de 1645, por conta de um grave estado melancólico da princesa, houve uma intensa correspondência entre ambos. À princípio, o debate se mantinha em torno das condições especificas da princesa. O tema central girava em torno de questões fisiológicas e morais (ou psicofisiológicas). À medida, porém, em que a troca de correspondência (...) se intensificava, o debate ia tornando-se cada vez mais teórico, passando pela discussão da Vida Beata, de Sêneca, até forçar Descartes a apresentar os primeiros esboços de sua própria concepção moral. Dessa troca de correspondência, escolhemos duas cartas de setembro de 1645: uma do filósofo a Elizabeth (carta CDIII) e outra da princesa a Descartes carta (CDVI). (shrink)

In Descartes's Meditations, one of the key texts of Western philosophy, the thinker rejects all his former beliefs in the quest for new certainties. Discovering his own existence as a thinking entity in the very exercise of doubt, he goes on to prove the existence of God, who guarantees his clear and distinct ideas as a means of access to the truth. He develops new conceptions of body and mind, capable of serving as foundations for the new science of nature. (...) Subsequent philosophy has grappled with Descartes's legacy, questioning many of its conclusions and even his basic approach, but his arguments set the agenda for many of the greatest philosophical thinkers, and their fascination endures.This new translation includes the Third and Fourth Objections and Replies in full, and a selection from the rest of Descartes's exchanges with contemporaries that helped to shape and expound his philosophy. (shrink)

Clinical bioethics is big business. There are now hundreds of people who bioethics in community and university hospitals, nursing homes, rehabilitation and home care settings, and some who play the role of clinical ethics consultant to transplant teams, managed care companies, and genetic testing firms. Still, there is as much speculation about what clinically active bioethicists actually do as there was ten years ago. Various commentators have pondered the need for training standards, credentials, exams, and malpractice insurance for ethicists engaged (...) in clinical consultation. Much of the discussion seems to accept an implicit presumption that all clinical ethics consultation practices look pretty much alike. But is this accurate? What do clinical ethicists do, how and where do they do it, and what kind of clinical ethics is useful in the hospital and in other settings? (shrink)

(Series copy) The new Oxford Readings in Feminism series maps the dramatic influence of feminist theory on every branch of academic knowledge. Offering feminist perspectives on disciplines from history to science, each book assembles the most important articles written on its field in the last ten to fifteen years. Old stereotypes are challenged and traditional attitudes upset in these lively-- and sometimes controversial--volumes, all of which are edited by feminists prominent in their particular field. Comprehensive, accessible, and intellectually daring, the (...) Oxford Readings in Feminism series is vital reading for anyone interested in the effects of feminist ideas within the academy. Can science be gender-neutral? In recent years, feminist critics have raised troubling questions about the practice and goals of traditional science, demonstrating the existence of a pervasive bias in the ways in which scientists conduct and discuss their work. This exciting volume gathers seventeen essays--by sociologists, scientists, historians, and philosophers--of seminal significance in the emerging field of feminist science studies. Analyzing topics from the stereotype of the "Man of Reason" to the "romantic" language of reproductive biology, these fascinating essays challenge readers to take a fresh look at the limitations--and possibilities--of scientific knowledge. (shrink)

The bearing of certain psychological doctrines upon ethical theory is important, and has been made use of especially by those who espouse empiricism in Ethics. It is the purpose of this paper to examine some of these leading doctrines and the ethical theory which has been connected with them. In doing so, it is appropriate to select for examination the views of Professor W. McDougall, as expressed principally in his Social Psychology and Outline of Psychology ; and this for two (...) reasons. One is, that these views are significant of much more than the opinions of one man. They may be taken quite fairly as representative, in the main, of a definite body of doctrine concerning the nature and development of moral experience. (shrink)