This paper reviews the concept of professional autonomy from anhistorical perspective. It became formalised in the United Kingdom onlyafter a long struggle throughout most of the nineteenth century. In itspure form professional autonomy implies unlimited powers to undertakemedical investigations and to prescribe treatment, irrespective of cost.Doctors alone should determine the quality of care and the levels ofremuneration to which they should be entitled. In the second half of thetwentieth century a steady erosion of professional autonomy occurred inthe United Kingdom. The (...) level of remuneration has been restricted formost doctors for nearly fifty years, whilst the costs of health carehave steadily reduced the doctor's ability to provide unrestricted carewithin the health care system. Reorganisation of the National HealthService in 1983 and 1991 has substantially eroded professional autonomy,to the point where research developments, clinical judgement and ethicalstandards are all now being placed at risk. (shrink)

This paper applies theory and research examining errors in complex organizational systems to the problem of individual and collective morality in organizations. It is proposed that because of the nature of complex organizations, unjust outcomes can (and will) result from organizational actions even when all organization members have acted responsibly. The argument that complex organizations are therefore immoral is considered and rejected. Instead, the paper argues that morality in complex organizations begins with "heedful interrelating" among individual organization members. The paper (...) concludes with a discussion of organizational processes and structures that promote heedful interrelating. (shrink)

Originally published in 1957, this book collects together large sections of important tracts from a variety of political documents, particularly those concerned with democracy, communism, Protestantism or Catholicism. The extracts come from a wide range of authors including Bertrand Russell, Karl Marx, John Locke and Pope Pius XII. This book will be of value to anyone seeking an overview of the key political divisions in the late 20th century or who is interested in political theory generally.

We explore psychological contracts as mechanisms by which individuals gain influence in organizations. Using two distinct research settings and longitudinal analysis, we demonstrate that ideological contracts endow individuals with increased centrality in the organization’s influence network. More generally, we propose that an important outcome of different psychological contract types may be how they affect the nature of influence in organizations.

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practised only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated and helped regulate it. Some of them have themselves (...) practised euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practised and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

Over the past decade, public discussion has focused on the ethics of issuing Do‐Not‐Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions (...) in the critical care setting. (shrink)

The transplantation and procurement of human organs has become almost routine in American society. Yet, organ transplantation raises difficult ethical and psychosocial issues in the context of “controlled” death, including the blurring of boundaries between life and death, self and other, healing and harming, and killing and letting die. These issues are explored in the context of the actual experiences of organ donors and recipients, brain death, the introduction of non‐heartbeating donor protocols, and the increasing reliance on living donors. The (...) author draws on a thematic analysis of the way that organ transplantation is presented in the media, films, and science fiction and on his clinical experience as a psychiatrist working with transplant patients, their families, and the nurses and physicians who care for them. (shrink)

Working within the tradition of continental philosophy, this article argues in favour of a phenomenological understanding of language as a crucial component of bioethical inquiry. The authors challenge the ‘commonsense’ view of language, in which thinking appears as prior to speaking, and speech the straightforward vehicle of pre-existing thoughts. Drawing on Maurice Merleau-Ponty's (1908–1961) phenomenology of language, the authors claim that thinking takes place in and through the spoken word, in and through embodied language. This view resituates bioethics as a (...) matter of bodies that speak. It also refigures the meaning of ethical self-reflexion, and in so doing offers an alternative view on reflexivity and critique. Referring to the Kantian critical tradition and its reception by Hannah Arendt and Michel Foucault, we advance a position we call ‘critical ethical reflexivity’. We contend that Merleau-Ponty's phenomenology of language offers valuable insight into ethical reflexivity and subject formation. Moreover, his understanding of language may foster new qualitative empirical research in bioethics, lead to more nuanced methods for interpreting personal narratives, and promote critical self-reflexion as necessary for bioethical inquiry. (shrink)

How can we be certain that software is reliable? Is there any method that can verify the correctness of software for all cases of interest? Computer scientists and software engineers have informally assumed that there is no fully general solution to the verification problem. In this paper, we survey approaches to the problem of software verification and offer a new proof for why there can be no general solution.

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

Cognitive agents, whether human or computer, that engage in natural-language discourse and that have beliefs about the beliefs of other cognitive agents must be able to represent objects the way they believe them to be and the way they believe others believe them to be. They must be able to represent other cognitive agents both as objects of beliefs and as agents of beliefs. They must be able to represent their own beliefs, and they must be able to represent beliefs (...) as objects of beliefs. These requirements raise questions about the number of tokens of the belief representation language needed to represent believers and propositions in their normal roles and in their roles as objects of beliefs. In this paper, we explicate the relations among nodes, mental tokens, concepts, actual objects, concepts in the belief spaces of an agent and the agent's model of other agents, concepts of other cognitive agents, and propositions. We extend, deepen, and clarify our theory of intensional knowledge representation for natural-language processing, as presented in previous papers and in light of objections raised by others. The essential claim is that tokens in a knowledge-representation system represent only intensions and not extensions. We are pursuing this investigation by building CASSIE, a computer model of a cognitive agent and, to the extent she works, a cognitive agent herself. CASSIE's mind is implemented in the SNePS knowledge-representation and reasoning system. (shrink)

SNePS, the Semantic Network Processing System 45, 54], has been designed to be a system for representing the beliefs of a natural-language-using intelligent system (a \cognitive agent"). It has always been the intention that a SNePS-based \knowledge base" would ultimatelybe built, not by a programmeror knowledge engineer entering representations of knowledge in some formallanguage or data entry system, but by a human informing it using a natural language (NL) (generally supposed to be English), or by the system reading books or (...) articles that had been prepared for human readers. Because of this motivation, the criteria for the development of SNePS have included: it should be able to represent anything and everything expressible in NL; it should be able to represent generic, as well as speci c information; it should be able to use the generic and the speci c information to reason and infer information implied by what it has been told; it cannot count on any particular order among the pieces of information it is given; it must continue to act reasonably even if the information it is given includes circular de nitions, recursive rules, and inconsistent information. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionStuart J. Youngner (bio), Laura A. Siminoff (bio), and Renie Schapiro (bio)This issue of the Kennedy Institute of Ethics Journal (KIEJ) centers on a piece of empirical research. The motivation behind the study of Laura Siminoff, Christopher Burant, and Stuart Youngner (2004) was to find out more about what the general public understands and believes about when a person is dead. More specifically, the study tried to determine (...) how members of the public define death, especially their acceptance and interpretation of the medical concept of "brain death," and their attitudes toward the so-called "dead donor rule," an informal but powerful social and legal norm insisting that the taking of organs for transplantation not cause the death of the source of those organs.As the demand for organs increases and the waiting list grows, the United States has explored multiple ways to expand the pool of potential donors. One approach has been to gerrymander (coherently or not) the line between life and death to shift patients who are extremely compromised but traditionally considered to be in the living category into the dead category. In this way, the dead donor rule remains technically intact. This reasoning is explicit in the report of the Harvard Medical School Ad Hoc Committee (1968) that "introduced" "brain death" to the American culture. Since then, other efforts to redraw the line have been proposed and rejected.One alternative to gerrymandering is to consider under what conditions, if any, it is morally acceptable to violate the dead donor rule. Some would argue that this alternative is the more "honest" approach. Rather than sidestepping moral problems by calling people dead, it brings the moral problems to the surface where the necessity of sticking to the rule can be considered on its own merits. However, when the Journal of the American Medical Association printed a position paper that proposed making anencepahlic newborns an exception to the dead donor rule, along with arguments about why this was acceptable, the outcry was so great that the proposal was retracted (AMA 1995).Clearly, our society has identified organ transplantation as a priority, although two papers in this volume (those by Courtney Campbell and by Megan Crowley-Matoka and Robert Arnold) take issue with that prioritization. The fact that the donor pool has remained relatively stable (and inadequate) despite massive efforts [End Page 211] to increase it speaks, at least in part, to the cultural and legal resistance to "new" ways to procure more organs. Voluntarism seems to have peaked. Financial incentives clash with the heavily endorsed notion of the "gift of life" and seem to many to violate the dignity of the human body. Presumed consent or eminent domain, in which the community has a greater claim to a person's organs than that person or his/her family, go against the grain of American individual freedom and the ethos of patient autonomy.Abandoning the dead donor rule generally is regarded as an even tougher sell to the American public and its legislators. The study by Siminoff and colleagues attempts, among other things, to gauge just how tough this sell would be. What the data actually demonstrate is a matter of interpretation, and this issue of the KIEJ is devoted to some of those interpretations. The authors, with the exception of Daniel Hausman, came together for a meeting in Cleveland, Ohio, during which the study's methods and data were presented with time for questions, clarifications, and general discussion. The authors then worked with the editors to generate the papers printed in this volume.The issue begins with a presentation of the study conducted by Siminoff and colleagues. The same paper also appears in the journal Social Science and Medicine, where it includes the conclusions of the authors (Siminoff, Burant, and Youngner 2004). In the current volume, we present only the methodology of and data from the study, allowing a number of distinguished commentators to offer their own conclusions and reflections.The first response comes from Tracy Schmidt, Executive Director of Intermountain Donor Services, one of our nation's organ procurement organizations (OPOs). For years, organ procurement professionals have reported anecdotal stories about families who wished to donate organs of... (shrink)

Clinical ethics literature typically presents ethics consultations as having clear beginnings and clear ends. Experience in actual clinical ethics practice, however, reflects a different characterization, particularly when the moral experiences of ethics consultants are included in the discussion. In response, this article emphasizes listening and learning about moral experience as core activities associated with clinical ethics consultation. This focus reveals that responsibility in actual clinical ethics practice is generated within the moral scope of an ethics consultant's activities as she or (...) he encounters the unique and specific features that emerge from interactions with a specific patient, or family, or practitioner within a given situation and over time. A long-form narrative about an ethics consultant's interactions is interwoven with a more didactic discussion to highlight the theme of responsibility and to probe questions that arise regarding follow-up within the practice of clinical ethics consultation. (shrink)

Computational systems biologists create and manipulate computational models of biological systems, but they do not always have straightforward epistemic access to the content and behavioural profile of such models because of their length, coding idiosyncrasies, and formal complexity. This creates difficulties both for modellers in their research groups and for their bioscience collaborators who rely on these models. In this paper we introduce a new kind of visualization that was developed to address just this sort of epistemic opacity. The visualization (...) is unusual in that it depicts the dynamics and structure of a computer model instead of that model’s target system, and because it is generated algorithmically. Using considerations from epistemology and aesthetics, we explore how this new kind of visualization increases scientific understanding of the content and function of computer models in systems biology to reduce epistemic opacity. (shrink)

This Open Access book about the Zadeh Project demonstrates and explores a core question in clinical ethics: how can ethics consultants be accountable in the face of a robust plurality of ethical standpoints, especially those that underwrite practices and methods for doing ethics consultation as well as those viewpoints and values encountered in daily clinical ethics practice? Underscoring this question is the recognition that the field of clinical ethics consultation has arrived at a crucial point in its maturation. Many efforts (...) are underway to more formally “professionalize” the field, with most aimed toward stabilizing a specific set of institutional considerations. Stretched between these institutional and practical initiatives resides a crucial set of of ethical considerations, chief among them the meaning and scope of responsibility for clinical ethics consultants. Developed around a long-form case scenario, the Zadeh Project provides a multi-layered series of “peer-reviews”: critique of the actions of the case scenario’s ethics consultant; reflection on clinical ethics method; examination of the many ways that commitments to method and practice can, and do, intersect, overlap, and alter one another. The design and format of this book thus models a key element for clinical ethics practice: the need and ability to provide careful and thoughtful explanation of core moral considerations that emerge among diverse standpoints. Specifically designed for those studying to become and those who are ethics consultants, this book, with its innovative and multi-layered approach, allows readers to share a peer-review-like experience that shows accountability to be what it is, an ethical, not merely procedural or administrative, undertaking. (shrink)