The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...) DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations. (shrink)

Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when (...) the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. (shrink)

THE PURPOSE OF OUR LIVES is to undergo a gradual transformation. We are born with a self-centered nature, but we can acquire a nature in which the focus is on the other. Through spiritual work, we can slowly learn to overcome our innate desire to find some form of self-gratification in all we do. Union with God is the result of desiring to give to others with no interest in reward of any kind. This is the essential teaching of the (...) Kabbalah as portrayed in these essays by Baal Hasulam. Rabbi Gottlieb’s commentary adds details on the winding road toward spiritual transformation. (shrink)

There is a lack of consensus on whether the derivation and use of human embryonic stem cells (hESCs) from embryos remaining after infertility treatment morally require the informed consent of third-party gamete donors who contributed to the creation of the embryos. The principal guidelines for oversight and funding of hESC research in the United States make minimal or no demands for consent from gamete donors. In this article, I consider the arguments supporting and opposing gamete donor consent for hESC research (...) and embryo research more broadly. I argue that it is not morally permissible to use leftover embryos in research without the informed consent of gamete donors, and that we should place restrictions on the use of existing hESC lines that may have been derived without informed consent. While the standard argument for this position relies on an appeal to gamete donors’ interest in controlling what happens with their genetic material, I identify shortcomings with the standard approach and seek instead to locate the deeper moral foundations for gamete donor consent in rights to bodily integrity. (shrink)

The problem of evil might better be called "the problem of problems." That there is "evil" in the world can be expressed most generally by saying that there are problems with the way things are, that at least something is not the way it should be. I shall propose that the various possible resolutions of the problem of evil correspond to varying approaches that people generally take to the problems in their lives. In this way, a connection can be made (...) between the problem of evil as discussed by professional philosophers - a problem concerning the consistency of beliefs - and the problem as often discussed by other writers - a problem concerning the proper response to the "evil" that we find around and within us. In the course of demonstrating the parallel between the philosophical and the practical problem, I shall elaborate on the contrasting points of view of exoteric and esoteric religion, and I shall conclude with an attempt to explain why the problem remains a problem. (shrink)

The purpose of our lives is to grow step by step toward a fundamental transformation. Instead of always seeking some form of gratification, we can learn to give to others with no self-interest at all. The is the essential teaching of the Kabbalah portrayed in these essays by Baal Hasulam – the greatest modern explicator of Kabbalah. Rabbi Gottlieb provides an illuminating commentary as a living Chassidic rebbe devoted to the practice and teaching of Baal Hasulam’s spiritual path.

The quantum formalism ofdistinguishable, yetequivalent particles (with symmetric or antisymmetric wave functions) is here worked out. The result is an entirely explicit formulation of the way in which classical mechanics emerges from quantum mechanics for such particles. Distinguishability is achieved at the cost of dynamical precision; the two are, in fact, complementary.

It is shown here that the microcanonical ensemble for a system of noninteracting bosons and fermions contains a subensemble of state vectors for which all particles of the system are distinguishable. This “IQC” (inner quantum-classical) subensemble is therefore fully classical, except for a rather extreme quantization of particle momentum and position, which appears as the natural price that must be paid for distinguishability. The contribution of the IQC subensemble to the entropy is readily calculated, and the criterion for this to (...) be a good approximation to the exact entropy is a logarithmically strengthened form of the usual criterion for the validity of classical statistics in terms of the thermal de Broglie wavelength and the average volume per particle. Thus, it becomes possible to derive the Maxwell-Boltzmann distribution directly from the ensemble in the classical limit, using fully classical reasoning about the distinguishability of particles. The entropy is additive—theN! factor of the Boltzmann count cancels out in the course of the calculation, and the “N! paradox” is thereby resolved. The method of “correct Boltzmann counting” and the lowest term of the Wigner-Kirkwood series for the partition function are seen to be partly based on the IQC subensemble, and their partly nonclassical nature is clarified. The clear separation in the full ensemble of classical and nonclassical components makes it possible to derive the classical statistics of indistinguishable particles from their quantum statistics in a controlled, explicit way. This is particularly important for nonequilibrium theory. The treatment of molecular collisions along too-literally classical lines turns out to require exorbitantly high temperatures, although there are suggestions of indirect ways in which classical nonequilibrium theory might be justified at ordinary temperatures. The applicability of exact classical ergodic and mixing theory to systems at ordinary temperatures is called into question, although the general idea of coarse-graining is confirmed. The concepts on which the IQC idea is based are shown to give rise to a series development of thermostatistical quantities, starting with the distinguishable-particle approximation. (shrink)

The problem of identity across possible worlds is raised with the following questions: What does it mean to say of something in one possible world that it is identical with something in another possible world? How are we to decide whether an individual in one possible world is identical with an individual in another?1 Because the questions concern meaning and verification, it appears to be the case that they presuppose that there are one or more sentences whose meaning and method (...) of verification are in need of explanation. However, although it has been generally presumed to be easy, it turns out to be very difficult to produce a sentence that enables us to formulate the problem and that is not merely supposed to say, but really does say, of an individual in one world and of an individual in another world that the first individual is identical with the second. (shrink)

Forgotten Truth is primarily a presentation of the traditional esoteric view that reality consists of a hierarchy of Being. Within the hierarchy there are an indefinite number of worlds, but they can be classified into four levels: the terrestrial, psychic, and celestial planes, and the Infinite. The corresponding levels within the human microcosm are body, mind, soul, and spirit. “From the multiple heavens of Judaism to the storied structure of the Hindu temple and the angelologies of innumerable traditions, the view (...) was reached convergently and independently, as if by innate tropism, by virtually all known societies…” (18). The important exception is our current society, whose fundamental flaw is its inclination to reduce all reality to the terrestrial plane alone. Modernity is “captive of an outlook presumed to be scientific but in fact scientistic” (17); it goes beyond the actual findings of science to deny that other approaches to knowledge are valid and other truths true” (16). (shrink)

A sequence of theoretical models is constructed as an extension to Leszek Nowak's theory of socialist society to explain important characteristics of the violent party purges in Soviet Stalinism. According to these models, purges are a regular and systemic feature of a socialist system during a certain phase of development (modelled as the phase of social enslavement). Contrary to traditional conceptions which interpret the purges essentially as resulting from the actions of an almost omnipotent, and partly irrational, despot, the models (...) presented here provide an explanation which does not need to conceive Stalin as the architect of terror (Robert Conquest), i.e. as the long-term planner of the terror. However, the concepts presented here preserve the vital arguments of the traditional approach, thereby contradicting the revisionist pattern of interpretation. In particular the models seek to provide a theoretical base for an explanation of the moderation of inner-party terror from 1938. This moderation is interpreted as resulting from a modification of the then existing ideology (and corresponding habits of the party's leadership); a modification which in itself had been stimulated by the disastrous effects of the great purge in 1937/38. This modification can be theoretically conceived as a process of ideological learning. The historical fact that the post-war purges (i.e. the Leningrad affair in 1949 and the Mingrelian affair 1951/52) did not reach such an enormous extent as the purges of the late 1930s may thus be attributed to a process of ideological learning. (shrink)