The idea of a market in human organs has traditionally met with widespread and emphatic rejection from both secular and religious fronts alike. However, as numerous human beings continue to suffer an uncertain fate on transplant waiting lists, voices are beginning to emerge that are willing at least to explore the option of human organ sales. Anyone who argues for such an option must contend, however, with what seem to be largely emotional rejections of the idea. Often it seems that (...) rebuffs offered on a secular ground are rooted in nothing more than vague discomforts. We suspect that these discomforts are often based in religious sentiments that have wound their way into the fabric of secular America. Therefore, in order to contribute further to those voices heard in favor of human organ sales, it is worthwhile to show that from a religious perspective, it is just as possible to affirm the appropriateness of human organ sales as it is from a secular basis. Since Protestantism has historically had a powerful influence in American society it is a proper starting point for such an investigation. (shrink)

The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to (...) toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

Many teachers of bioethics often express concern, in their writings and otherwise, about the theoretical basis (or lack of it) of bioethics and the allied issue of relativism. The companion articles by Tong and Momeyer are in this vein and rightly address such issues within the context of a liberal arts education. This article addresses such issues in a different venue, i.e., bioethics teaching in the clinical sphere of health care institutions. It presumes to suggest that many of these theoretical (...) concerns, as well as the threat of relativism, seldom arise in this sphere. Rather, a broad based, well accepted body of moral truth has been fashioned over the last quarter century and it is this that clinical bioethics regularly keys to and to which most moral dilemmas are referred for resolution. The various forms of this pedagogy, e.g., case consultations or institutional policy statements, are charted out in this regard, as well as the often tactical character of much of this teaching, i.e., not "what should we do?", but "how might we best do it?". The article then goes on to conclude with a reflection on the use and abuse of power in clinical bioethics teaching and consultation. (shrink)

Although long touted as an ethical and legal requirement, some clinicians still seem to offer less than fully adequate informed consent processes; similarly the counseling of patients and families, particularly about post-intervention scenarios, is often perfunctory at best. Keyed to a narrative of a patient's experience with surgery for a deviated septum, this article reflects on why such less than adequate clinician behaviors tend to occur and what might be done about them. Certain legal misconceptions about informed consent are highlighted (...) in this reflection, as well as why certain clinicians seem to take such a narrow view of their responsibilities to patients. Further reference in this regard is also made to a recently constructed module on informed consent for medical residents. In it, though legal requirements for informed consent are reviewed, the basic perspective taken regards informed consent as a clinical intervention that pursues certain basic goods and values, only one of which lies in determining when legal closure for such processes has occurred. (shrink)

The randomization ingredient in double-blind controlled experiments may be objectionable to patients who, in their desperation, come to such trials seeking a last chance of cure. Minogue et al., who view such a situation as inherently exploitive and undermining of patient autonomy, propose that such “desperate volunteers” instead be enrolled in the active arm, while other patients, less desperate and more committed to medical progress, continue to be randomized. Their view is critiqued as destructive of medical progress, inappropriate in its (...) lack of clinical response to such patients, and fatally flawed by unrealistic notions of autonomy and voluntariness. (shrink)

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive (...) of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the living human body alone, but on the patientqua person. (shrink)

Jack Freer, Stephen Wear; Culture Wars in New York State: Ongoing Political Resistance by Religious Groups to the Family Health Care Decisions Act, Christian bi.

Based on a reading of Basil’s Ad Adulescentes and the epistles, it is clear that Basil finds moral value in Homer and Hesiod. The trickier issue is to what extent Basil uses Homer and Hesiod in his homilies. It seems that Basil does not abandon his respect for the utility of Hellenic paideia for the Christian in his homilies. Rather, he must approach Homer and Hesiod more gingerly because he fears that his uncultivated audience will have difficulty with reading texts (...) allegorically; at the literal level, Homer and Hesiod can potentially corrupt the unsophisticated listener. What we have in the homilies are less explicit references to Homer and Hesiod—they are the source of literary flourish, the origins of which probably went over the heads of Basil’s audience. As seen above, Basil also uses the poets—when read at the literary level—as counter-examples to Christian conduct. Basil in no way, then ‘lies’ or ‘changes his view’ on Greek paideia, as is oftentimes argued by scholars, but, rather, he adjusts his use of paideia depending on what his audience can handle at any given time. (shrink)

"This volume brings together articles by sixteen leading scholars on a cross-section of Platonists authors-Christian and non-Christian-from early through late Byzantium philosophy, including the Capaddocians, Cyril, Proclus, Damascius, Dionysius, George of Pisidia, Nicetas Stethatos, Nikephoros Choumenos, Psellos, and George Palamas. The reception of Byzantine thought in the Latin tradition is also considered. The articles collectively show development in the Greek East on ontological issues such as the doctrine of the soul, as well as theological concepts of the One/God and Trinity (...) within a hierarchical universe. The volume considers exegetical questions relating to the use of Plato and the Platonists by Byzantine Christian authors"--. (shrink)

Contrary to the ecumenical spirit of our time, the differences among the Christian religions bring into question what one can say or do in common with fellow Christians. This issue, echoing the program of this journal, accentuates those differences, specifically when we focus on the Christian who is ill and suffering. At the bedside, it is the specifics of a religion, including not only its doctrines, but its informing and sustaining narratives, that must particularly be brought into play for the (...) sake of the patient. Given this, our focus in this article regards what such a view implies for the clinician who is caring for a Christian patient whose religion he mayor may not share, in general or in its specifics. Our basic conclusion is that the tendency for the clinician to act as both the patient's spiritual counselor, as well as his clinician, is generally neither prudent nor appropriate. Both hats should not be worn concurrently. This view is advanced not only because of concerns regarding patient vulnerability and the possible abuse of power, but also because the two roles may collide with or undermine each other. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)

This paper concerns itself with the concept of diminished competence with particular regard to the problems and options that mentally compromised patients raise for medical management. It proceeds through three general stages: (1) a restatement of the sense and grounds of the new patients' rights ethos which the existence of such patients calls into question; (2) a consideration of what expanded responsibilities and tactics physicians should embrace to protect and enhance such patients' autonomy; and (3) the standards, criteria, and mechanisms (...) by which paternalistic interventions might be justified in cases when the diminishment remains too substantial to merit acceptance of the patients' directives. (shrink)

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and (...) opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 17-20, December 2011.

Current bioethics scholarship and pedagogy suffers from an insufficient correlation with the realities and variables of clinical medicine, particularly in its dominant paradigm of patient autonomy. Reference to various basic clinical factors will be made here toward proposing certain conceptual, tactical and pedagogical modifications to this paradigm. Keywords: clinical reality, informed consent, paternalism, patient autonomy, physician beneficence CiteULike Connotea Del.icio.us What's this?

This article describes Syrianus' teachings on the One, as found in his testimonia on the Parmenides . In order to preserve the transcendence of the One, while still providing a fluid universe connected to the One, Syrianus shows how the nature of the One is seen in the structure of the Parmenides itself: the first hypothesis of the Parmenides outlines the primal God, while the intelligible universe is the subject of the second hypothesis, in so far as the intelligible universe (...) is a product of the One. Thus, whatever is negated of the One in the first hypothesis contains a positive analogue in the second hypothesis. With this description of the One in the Parmenides , Syrianus is able to create a complete, fluid universe. Readings of two lemmata, in particular, illuminate Syrianus' manner of interpreting the Parmenides to show how the One is both transcendent and connected to the universe. In his interpretations of Parmenides 137d and 138a, Syrianus shows how the One is partless with respect to itself, but contains parts with respect to the rest of the universe; and that the One is in itself and in another, again, with respect to itself and with respect to the rest of the universe. With his interpretation of the Parmenides , moreover, one can see how Syrianus differs from the interpretations of Porphyry and Iamblichus, and how he paves the way for Proclus' reading of the dialogue. (shrink)

This article describes Syrianus’ teachings on the One, as found in his testimonia on the Parmenides. In order to preserve the transcendence of the One, while still providing a fluid universe connected to the One, Syrianus shows how the nature of the One is seen in the structure of the Parmenides itself: the first hypothesis of the Parmenides outlines the primal God, while the intelligible universe is the subject of the second hypothesis, in so far as the intelligible universe is (...) a product of the One. Thus, whatever is negated of the One in the first hypothesis contains a positive analogue in the second hypothesis. With this description of the One in the Parmenides, Syrianus is able to create a complete, fluid universe. Readings of two lemmata, in particular, illuminate Syrianus’ manner of interpreting the Parmenides to show how the One is both transcendent and connected to the universe. In his interpretations of Parmenides 137d and 138a, Syrianus shows how the One is partless with respect to itself, but contains parts with respect to the rest of the universe; and that the One is in itself and in another, again, with respect to itself and with respect to the rest of the universe. With his interpretation of the Parmenides, moreover, one can see how Syrianus differs from the interpretations of Porphyry and Iamblichus, and how he paves the way for Proclus’ reading of the dialogue. (shrink)

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by (...) most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better. (shrink)