Recent contributions to the literature on the topic of futility have focused primarily on two areas: 1) definitions of the term and 2) the suggestion that cardiopulmonary resuscitation may be futile in certain patients. This suggestion is based on “scientific” measures and analyses of outcomes, describing the low probability of success of CPR in patients over age 70, those with cancer, those with multiorgan failure, etc. The research reported suggests that with such patients the physician need not get the patient's (...) consent to withhold resuscitation; the physician need only inform either the patient or the surrogate that CPR will not be Instituted in the event of an arrest. (shrink)

As noted In Part II of this series, perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and (...) attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

A physician recently asked how to respond in the case of an 87-year-old patient with advanced Alzheimer's disease, who was unable to swallow or tolerate a nasogastric tube, when the family insisted a gastrostomy tube be inserted but the physician believed the intervention futile. That question encompasses some of the crucial issues in the concept of futility of the treatment goals of physician, patient, and family; the rights of patients and families to demand care; physician judgment; family values; and, to (...) the degree that it represents many similar dilemmas, justice. What are professionals saying when they pronounce treatment futile? What are patients' rights if they or their surrogates disagree?The word “futile” implies a precision about outcome probability that we do not have, and it ignores the wide range of treatments for a given diagnosis. Is futile the same as useless or the opposite of hope? Futile for what? Cure? Restora tion of function? Prolongation of life? Relief from pain? Relief from anxiety? Com fort? Reassurance? To satisfy or placate the patient or the family? The word “futile” is so imprecise that, rather than clarifying, it confuses and clutters the discussion. (shrink)

Moral and social arguments weigh heavily against performing medical procedures solely for purposes of sex selection. The medical profession has a responsibility to abandon its posture of ethical neutrality and take a firm stand now against sex selection.

The ArgumentA survey of 2901 genetics professionals in 36 nations suggests that eugenic thought underlies their perceptions of the goals of genetics and that directiveness in counseling after prenatal diagnosis leads to individual decisions based on pessimistically biaed information, especially in developing nations of Asia and Eastern Europe. The “non-directive counseling” found in English-speaking nations is an aberration from the rest of the world. Most geneticists, except in China, rejected government involvement in premarital testing or sterilization, but most also held (...) a pessimistic view of persons with genetic disabilities. Individual, but not state-coerced, eugenics survives in much modern genetic practice. (shrink)

The bibliography covers the years from january 1916 through february 1976. it lists, in philosophy, 14 books written or co-authored by charles hartshorne, six peirce volumes edited, with paul weiss, and 358 papers published in journals (approximately 100 different journals), symposia, anthologies, and "festschriften", including approximately 100 book reviews. in ornithology it includes one book and 12 papers published in ten different journals. the total number of items is 384.

We surveyed the approaches of 661 geneticists in 18 nations to 14 clinical cases and asked them to give their ethical reasons for choosing these approaches. Patient autonomy was the dominant value in clinical decision-making, with 59% of responses, followed by non-maleficence (20%), beneficence (11%) and justice (5%). In all, 39% described the consequences of their actions, 26% mentioned conflicts of interest between different parties and 72% placed patient welfare above the welfare of others. The U.S., Canada, Sweden, and U.K. (...) led in responses favoring autonomy. There were substantial international differences in moral reasoning. Gender differences in responses reflected women's greater attention to relationships and supported feminist ethical theories. (shrink)

After a period of inactivity, interest in explanationism as a thesis about the nature of epistemic justification has been renewed. Poston and McCain have both recently offered versions of explanationist evidentialism. In this paper, we pose two objections to explanationist evidentialism. First, explanationist evidentialism fails to state a sufficient condition for justification. Second, explanationist evidentialism implies a vicious regress.

Contributors to this volume demonstrate how the ethics of care factors into a variety of social policies and institutions, and can indeed be useful in thinking about a number of different social problems. Divided into two sections, the first looks at care as a model for an evaluative framework that rethinks social institutions, liberal society, and citizenship at a basic conceptual level. The second explores care values in the context of specific social practices or settings, as a framework that should (...) guide thinking. (shrink)

Debate persists over the place of conscience in medicine. Some argue for the complete exclusion of conscientious objection, while others claim an absolute right of refusal. This paper proposes that claims of conscientious objection can and should be permitted if they concern kinds of actions which fall outside of the normative standard of medicine, which is the pursuit of health. Medical practice which meets this criterion we call medicine qua medicine. If conscientious refusal concerns something consonant with the health-restoring aims (...) of medicine, it entails a desertion of professional duty. If, however, it relates to something other than medicine qua medicine, it can rightly be refused. It thus becomes possible to test instances of conscientious objection to determine their validity, and thereby conserve both the principle of conscientious objection and define its scope. This test of conscience prevents arbitrary discrimination, and preserves doctors’ agency. It is a theoretical razor rooted in the pra... (shrink)

This book offers a comprehensive critical survey of issues of historical interpretation and evaluation in Bertrand Russell's 1918 logical atomism lectures and logical atomism itself. These lectures record the culmination of Russell's thought in response to discussions with Wittgenstein on the nature of judgement and philosophy of logic and with Moore and other philosophical realists about epistemology and ontological atomism, and to Whitehead and Russell’s novel extension of revolutionary nineteenth-century work in mathematics and logic. Russell's logical atomism lectures have had (...) a lasting impact on analytic philosophy and on Russell's contemporaries including Carnap, Ramsey, Stebbing, and Wittgenstein. Comprised of 14 original essays, this book will demonstrate how the direct and indirect influence of these lectures thus runs deep and wide. (shrink)

In _Civilization and Its Discontents_ Freud extends and clarifies his analysis of religion; analyzes human unhappiness in contemporary civilization; ratifies the critical importance of the death drive theory; and contemplates the significance of guilt and conscience in everyday life. The result is Freud’s most expansive work, one wherein he discusses mysticism, love, interpretation, narcissism, religion, happiness, technology, beauty, justice, work, the origin of civilization, phylogenetic development, Christianity, the Devil, communism, the sense of guilt, remorse, and ethics. A classic, important, accessible (...) work, Freud reminds us again why we still read and debate his ideas today. Todd Dufresne’s introduction expands on why, according to the late Freud, psychoanalysis is the key to understanding individual and collective realities or, better yet, collective truths. The Appendices include related writings by Freud, contemporary reviews, and scholarly responses from Marcuse, Rieff, and Ricoeur. (shrink)

Work-family conflict has been examined quite often in human resources management and industrial/organizational psychology literature. Numerous statistics show that the magnitude of this employment issue will continue to grow. As employees attempt to balance work demands and family responsibilities, organizations will have to decide to what extent they will go to minimize this conflict. Research has identified numerous negative consequences of work-family stressors for organizations, for employees and for employees' families. There are however many options to reduce this strain, each (...) with advantages and disadvantages. An ethical analysis, from a virtue ethics perspective, is applied to this timely issue to present an alternative view in addressing this critical business decision. In addition, a strong connection between the virtue ethics analysis and a well-known management theory is given to provide a foundation for managerial implications for resolving work-family conflict. (shrink)