Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

Money plays a powerful role in modern medicine, both in terms of how health services are organized and delivered and increasingly in how physicians understand themselves and their work. The phrase “the hegemony of money” is intended to capture that power.

It is commonplace to point out that Alfred Kinsey's taxonomic work on gall wasps provided a methodology for his studies of human sexual behavior. It is equally commonplace to point out that, when researching and presenting his sexual studies, Kinsey's professedly neutral scientific data were constrained by a social agenda. What I have done in this paper is to join these two claims and demonstrate, with particular reference to Kinsey's Sexual Behavior in the Human Male, how his zoology helped guide (...) Kinsey to a naturalistic ethics that, despite contrasts to, shared certain parallel logical failures with the traditional ethics of his critics. (shrink)

Care ethics takes as central the discerning of needs in those being cared for and attempts to meet those needs. Perceptive caring agents are more likely to be able to identify needs in those for whom they are caring. The identification of needs is no small matter, not least in teaching encounters. This paper modestly proposes that at least some of the needs a caring agent should attempt to meet are a function of the identity of the patient of caring (...) action. Taking Nel Noddings’ account of care ethics as representative, I present it in outline. This leads to the needs-identification problematic. Following this I turn to Soran Reader’s account of needs. I interpret this to offer what I designate as identity as ‘what-ness’. Such an understanding of identity-based needs is a starting point for the caring agent but a more nuanced account, of identity as ‘who-ness’, is argued to be preferable. Identity as ‘who-ness’, as expressed in Paul Ricoeur’s work, advances the discussion, culminating in his concept of the ‘capable human being’. Having brought this aspect of Ricoeur’s thought into conversation with care ethics, I offer an account of identity-based needs conducive to the broader aims of the care ethical project. Finally, I consider what this bolstered account of care ethics might say about a brief and illustrative teaching encounter. (shrink)

Wittgenstein's insistence in his later philosophy that explanation comes to an end in the explication of what it is to follow a rule provides a locus for the awakening of wonder, analogous to the mystical awe referred to in the "Tractatus". While Wittgenstein did not explore this analogy, it provides a point of entry into the examination of the relevance of his work to religious concerns. Every regular practice is built on capacities of reaction, uptake, and response which are the (...) endpoints of explanation, whose sheer givenness in their relation to our physical and social environment can bring on amazement. This wonder at the end of explanation has been explored -- from quite a different perspective -- by Stephen Gould, whose conclusions complement Wittgenstein's own. (shrink)

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility (...) carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically. (shrink)

We will argue here that after more than 30 years of talk, theory, and clinical practice, we bioethicists still know far too little about what patients, subjects, and healthcare professionals are up to, morally. Bioethics is still near the beginning in grasping what it means to understand, much less to honor fully, the moral power and perspicacity of those bioethics is designed to serve. This is, of course, a serious charge, but one we will endeavor to show has merit. However, (...) we want to be clear from the start that we do not gainsay the important work that has been done in and through the influence of bioethics, both as a field of practical engagement and as a cultural movement, in improving how healthcare is delivered and how human subjects are treated. Thirty or 40 years—depending on how one marks the beginning point—is a very short time, and it is hard to imagine that wholesale changes, all of them in the right direction, could be the outcome for a field this young. Hence, we do not intend the title, “One Cheer for Bioethics,” as a wholesale indictment, but as an indication that there is a great deal of work yet to be done, and that following the currently dominant direction of the field is not likely to get us there. Our aim is to indicate just where future work should be focused, and to do so we will need to be critical of some of the preoccupations of the last three decades. a. (shrink)

Societies emerging from severe internal bloodshed along ethnic, racial or religious lines face significant problems of reconciliation. A particularly “deep” form of recognition between former victims and offenders is necessary to end enmity and achieve solidarity. Yet it appears that deep reconciliation is logically incoherent as it requires that forgiveness be asked and be given for acts that are inexcusable and unforgivable. I argue, however, that toleration, understood as moral attitudes and dispositions, helps us understand why deep reconciliation is logically (...) coherent. Dispelling the apparent paradox lies in understanding the role of toleration in forming what I call relationships of “acknowledgment and forbearance.” Relationships of acknowledgement and forbearance overcome elements of enmity and estrangement, and such relationships are necessary, in turn, for deep reconciliation. (shrink)

The dynamic of religious expression employs symbolic language, actions, and art. These symbols are symbols of transcendence because it is transcendence which is the unique referent that sets apart symbols which give rise to religious understanding from symbols which do not. The main objective of this book is to demonstrate that in Louis Dupre's work all religious expression, insofar as it has a transcendent reference, is intrinsically symbolic. Religious language is never purely objective nor purely subjective, but a dialectical relation (...) with a transcendent dimension. True to the teachings of Dupre, this book uncovers that without a transcendent referent, religious symbols lose their religious significance. This is the plight of the (late-post)modern condition which resulted from the fracturing of nature into its cosmic, human and transcendent components. To regain a sense of transcendence the believer is forced to make an inward turn akin to the mystical practice of past ages. This does not recover a sense of transcendence for culture but can do so for the believer's personal spiritual life. (shrink)

A key takeaway from the recent volume Theistic Evolution: A Scientific, Philosophical, and Theological Critique is that no version of theistic evolution that adheres largely to consensus views in biology is a plausible option for orthodox Christians. In this paper we argue that this is false: contrary to the arguments in the volume, evolutionary theory, properly understood, is perfectly compatible with traditional Christian commitments. In addition, we argue that the lines between Intelligent Design and theistic evolution are not as sharp (...) as most scholars have assumed, such that many who self-identify as Intelligent Design adherents would also qualify as theistic evolutionists. (shrink)

Many philosophers judge that typical agent-causal accounts of freedom improperly sacrifice the possibility of rational explanation of the action for the sake of securing control, while others judge that the reverse shortcoming plagues typical event causal accounts. (Of course, many philosophers make both these judgments.) After briefly rehearsing the reasons for these verdicts on the two traditional strategies, we undertake an extended examination of Randolph Clarke's recent attempt to meet the challenge by proposing an original, "integrated agent-causal" account of human (...) free action. We argue that Clarke's account fails. In a final section, we sketch a more promising route to integration. (shrink)

Throughout the 1990s, Jaegwon Kim developed a line of argument that what purport to be nonreductive forms of physicalism are ultimately untenable, since they cannot accommodate the causal efficacy of mental states. We argue that, while the argument needs some tweaking, its basic thrust is sound. In what follows, we lay out our preferred version of the argument and highlight its essential dependence on a causal-powers metaphysic, a dependence that Kim does not acknowledge in his official presentations of the argument. (...) We then discuss two recent physicalist strategies for preserving the causal efficacy of the mental in the face of this sort of challenge, strategies that (ostensibly) endorse a causal powers metaphysics of properties while offering distinctive accounts of the physical realization of mental properties. We argue that neither picture can be satisfactorily worked out, and that seeing why they fail strongly suggests that nonreductive physicalism and a causal powers metaphysic are not compatible, as our original argument contends. Since we also believe that robust realism concerning mental causation should not be abandoned, we take the argument of this paper to strongly motivate an account on which the mental is unrealized by and ontologically emergent from the physical. In a final section, we sketch what an ontologically emergentist account of the mental might look like. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

When health care providers make decisions to use resources, their devotion to the patient at hand must be mediated by a framework that puts individual autonomy and social equity into focus simultaneously. The concept of citizenship yields such a framework.

Background Diversity in Institutional Review Board (IRB) membership is important for both intrinsic and instrumental reasons, including fairness, promoting trust, improving decision quality, and responding to systemic racism. Yet U.S. IRBs remain racially and ethnically homogeneous, even as gender diversity has improved. Little is known about IRB chairpersons’ perspectives on membership diversity and barriers to increasing it, as well as current institutional efforts to promote diversity, equity, and inclusion (DEI) within IRB membership.Methods We surveyed IRB chairpersons leading U.S. boards registered (...) with the Office for Human Research Protections. Here, we focus exclusively on responses from a subset of 388 chairpersons of IRBs at universities and academic medical centers (AMCs).Results Board chairs were predominantly white and evenly split between men and women. Only about half reported that their boards had at least one member who is Black or African American (51%), Asian (56%), or Hispanic (48%), with 85% of university/AMC boards comprised entirely (15%) or mostly (70%) of white members. Most IRB chairpersons (64%) reported satisfaction with the current diversity of their membership. Participants largely agreed that considering diversity in the selection of IRB members is important (91%), including to improve the quality of IRB deliberation (80%), with an emphasis on racial/ethnic (85%) and gender diversity (74%). Most participants (80%) reported some type of active DEI effort regarding board membership at their university/AMC and just over half (57%) expressed satisfaction with these efforts.Conclusions Our national survey found that although university/AMC IRB chairpersons report valuing diversity in board membership, it may be lacking in key areas. Going forward, it will be important to specify clear reasons for diversity in the IRB context, as well to establish targets for acceptable levels of board diversity and to match DEI efforts to those targets. (shrink)

This essay strives to bring together the institutional history of phenomenological psychology within the American academy from the middle of the 20th century to the current moment. Although phenomenological psychology has always been a dynamically international and interdisciplinary movement, the scope of this essay is limited to the different ways in which this new field expressed itself in certain psychology departments and educational institutions across the United States. After presenting this institutional history, and some individual contributors, a brief commentary is (...) offered. (shrink)

Much has been written about the importance of narrative in teaching ethics and humanities to medical students and residents, as well as the value of narratives in clinical care. Relatively little has been said about the essential role of narrative in bioethics consultations. For most consults, the interpretation of narratives is the central moral feature, and the ethics consultant is inevitably one of the narrators. In a recent consult in which I participated, at least three narratives were in play. The (...) medical record itself was a narrative, or really, a variety of narratives. A second distinct narrative was the story of why this case had come to be categorized as an ethical concern for the medical team. A third narrative was the tentative sketch running through my mind as a consultant‐partly factual, partly anticipatory and conjectural, inevitably personal‐about what was going on here. (shrink)