As a bioethical and social issue, euthanasia has become in the 1990s what abor- tion was in the 1960s. Around the world, a de facto taboo on open discussion of the practice is seemingly falling by the wayside, as recognition increases that “active” euthanasia is taking place in spite of social and legal prohibitions. Euthanasia, or more specifically physician-assisted suicide, has become the most visible bioethical issue of the present era; and in the United States the debate has taken on (...) a prominence and urgency unprecedented in our nation's history. (shrink)

is a new campaign devoted to reducing the environmental harmsgenerated by the healthcare industry. One of the leading local proponents of this effort is Michael Lerner, founder of Commonweal, a Bolinas, Californiagenius grant”).

Although housed in an anonymous Victorian house in San Francisco, California, the Zen Hospice Project is world renowned for its pioneering model of training hospice volunteers, providing direct services to patients, and offering educational programs to the broader public.

Ram Dass is one of America's most renowned spiritual teachers. Born Richard Alpert, he received his Ph.D. in psychology from Stanford University and taught there and at Harvard University before going to India and receiving the name Ram Dass () from his guru. He has long been involved in many charitable service organizations, particularly those devoted to providing healthcare for underserved populations. Among his many books are BeHereNow, HowCanIHelp, and CompassioninAction; his newest book is StillHere:EmbracingAging,Changing,andDying.

It's a chilly winter night outside, but very warm inside the hospice guest house. All of the people gathered here have wished one another “Happy New Year” and settled on cushions in the big meeting hall. Both fireplaces are lit, and the many little white cards with the names of each person who died last year are arranged on the mantels over the fireplaces and on a table in the center of the room. Paul, our teacher for the evening, says (...) a few simple and wise words about impermanence and about being of service and then explains tonight's process: we, the volunteers in attendance, will pick up the cards, either by choosing a specific patient's name or at random, and take them one by one to the fires, dropping them in and saying something about each deceased person. The idea is to hear a litany of names being remembered and honored and sent onward as volunteers flow steadily to and from the fireplaces. (shrink)

I work at a large urban medical center. Our hospital has over 1,200 beds and was built in 1805 to take care of the poor. Our patients are still poor, but now so are the hospital and the doctors. Russian doctors are paid about one-third of what truck drivers are paid. The government historically allocates no more than 3% of the budget to medicine because this is not a means of production, like manufacturing.

Tom Koch's review of Jack Kevorkian's is a valuable look at this one (in)famous crusader's practices. The immediate question raised, and to which Koch provides his own perspectives, is what practical conclusions might be drawn from the final experiences and actions of this cohort of suffering individuals. My briefest and perhaps flippant answer is —including, unfortunately, those derived or hinted at by Koch himself.

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, Based on the old principle of the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care (...) of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question. (shrink)

A woman presents to her physician with a newly diagnosed condition that in her considered and informed judgment requires an elective surgical procedure. The physician, after speaking with her, agrees that this is an acceptable option. The procedure in question is in fact one of the commonest surgeries performed on American women. The physician is also aware that although the procedure is deemed elective in this and in most cases, research has shown that the consequences of not providing the procedure (...) when it is requested can be severe in terms of both physical and emotional sequelaewhich itself can add to the complexity and risk of the procedure. Presented with this option, the patient expresses dismay but also her resigned commitment to follow through with this referral, and leaves the office in tears. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

Busy physicians and scientists tend to be willfully naive about politics. Physics, chemistry, and biology are clean—that is, subject to relatively consistent and identifiable laws or at least trends and, certainly in the case of medicine, beneficial when properly applied. Politics, on the other hand, tend to be unpredictable, murky, and dirty—that is, too often all about self-serving power and, ultimately, money.

Garrett Hardin, Ph.D.—biologist, environmental ethicist, and lightning rod for controversy for over four decades—died in a double suicide with his wife in September 2003 at his longtime home in Santa Barbara, where he was a Professor Emeritus of Human Biology at the University of California. Both Hardins had been ill for some time and in fact were leaders in the local chapter of the Hemlock Society, the “right-to-die” advocacy organization.

The profession of medicine has developed codes of ethical conduct for thousands of years. From the Hippocratic Oath of ancient Greece onward to modern times, a universal and central element of such codes has expressed the imperative that a physician shall “Do no harm.”.

New beginnings give us the opportunity to do better “the next time.” In the rush to welcome the new millennium, it is fitting to take time to look more thoughtfully at issues not adequately covered in decades past. Robert Frost's musing about less traveled roads gives poetic life to the theme of this CQ Special Section, exploring some of the all too unknown territory between doctors and patients.

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these (...) infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called “neonatologist,” seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. What was to be the cost in dollars and in anguish to save the Patrick Kennedys of the world? Triumphs led to grave concerns as we approached the edge. However, no advancement in neonatology has ever changed the ultimate questions. (shrink)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors (...) take brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these (...) infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. WhatwastobethecostindollarsandinanguishtosavethePatrickKennedysoftheworld?Triumphsledtograveconcerns asweapproachedtheedge.However,noadvancementinneonatologyhaseverchangedtheultimatequestions. (shrink)

Despite Kant's belief in a universal causal determinism among phenomena and his rejection of any noumenal agency in brutes, he nevertheless rejected Descartes's hypothesis that brutes are machines. Explaining Kant's response to Descartes forms the basis for this discussion of the nature of consciousness and matter in Kant's system. Kant's numerous remarks on animal psychology-as found in his lecture notes and reflections on metaphysics and anthropology-suggest a theory of consciousness and self-consciousness at odds with that traditionally ascribed to him.

The thesis of this work is that in both modern Japanese philosophy and American pragmatism there has been a paradigm shift from a monological concept of self as an isolated "I" to a dialogical concept of the social self as an "I-Thou relation," including a communication model of self as individual-society interaction. It is also shown for both traditions all aesthetic, moral, and religious values are a function of the social self arising through communicative interaction between the individual and society. (...) However, at the same time this work critically examines major ideological conflicts arising between the social self theories of modern Japanese philosophy and American pragmatism with respect to such problems as individualism versus collectivism, freedom versus determinism, liberalism versus communitarianism, and relativism versus objectivism. (shrink)

This is a draft of the introduction to a forthcoming volume that brings together all of J. G. Herder's student notes from Immanuel Kant's lectures. It is intended as a volume in Kant's gesammelte Schriften (de Gruyter). These are the earliest notes (1762-64) we have from Kant's lectures (which span from 1755 to 1796) and the only notes before his professorship began in 1770. Included are improved transcriptions of Herder's notes on metaphysics, moral philosophy, logic, physics, and mathematics, and the (...) first transcription of his notes from Kant’s physical geography lectures. (shrink)

This book represents emerging alternative perspectives to the "constructivist" orthodoxy that currently dominates the field of science and technology studies. Various contributions from distinguished Americans and Europeans in the field, provide arguments and evidence that it is not enough simply to say that science is "socially situated." Controversial Science focuses on important political, ethical, and broadly normative considerations that have yet to be given their due, but which point to a more realistic and critical perspective on science policy.

Artistic Detachment in Japan and the West takes up the notion of artistic detachment, or psychic distance, as an intercultural motif for East-West comparative aesthetics. The work begins with an overview of aesthetic theory in the West from the eighteenth-century empiricists to contemporary aesthetics and concludes with a survey of various critiques of psychic distance. Throughout, the author takes a highly innovative approach by juxtaposing Western aesthetic theory against Eastern aesthetic theory. Weaving between cultures and time periods, the author focuses (...) on a remarkably wide range of theories: in the West, the Kantian notion of disinterested contemplation, Heidegger's Gelassenheit, semiotics, and pragmatism; in Japan, Zeami's notion of riken no ken, the Kyoto School's intepretation of nothingness, D. T. Suzuki's analysis of the function of no-mind, and the writings of Kuki Shuzo on Buddhist detachment. "Portrait of the artist" fiction by such writers as Henry James, James Joyce, Mori Ogai, and Natsume Soseki demonstrates how the main theme of detachment is expressed in literary traditions. The role of sympathy or pragmatism in relation to disinterest is examined, suggesting conflicts within or challenges to the notion of detachment. Researchers and students in Eastern and Western areas of study, including philosophers and religionists, as well as literary and cultural critics, will deem this work an invaluable contribution to cross-cultural philosophy and literary studies. (shrink)

Abbreviations Works by Alfred North Whitehead 1) Adventures of Ideas. New York: Macmillan Co., 1967 AI 2) Concept of Nature. Cambridge: Cambridge University Press, 1971 CN 3) Modes of Thought. New York: Macmillan Co., 1968 MT 4) Process ..

This paper is a study of four subscripted Gentzen systems G u R +, G u T +, G u RW + and G u TW +. [16] shows that the first three are equivalent to the semilattice relevant logics u R +, u T + and u RW + and conjectures that G u TW + is, equivalent to u TW +. Here we prove Cut Theorems for these systems, and then show that modus ponens is admissible — which (...) is not so trivial as one normally expects. Finally, we give decision procedures for the contractionless systems, G u TW + and G u RW +. (shrink)