As a bioethical and social issue, euthanasia has become in the 1990s what abor- tion was in the 1960s. Around the world, a de facto taboo on open discussion of the practice is seemingly falling by the wayside, as recognition increases that “active” euthanasia is taking place in spite of social and legal prohibitions. Euthanasia, or more specifically physician-assisted suicide, has become the most visible bioethical issue of the present era; and in the United States the debate has taken on (...) a prominence and urgency unprecedented in our nation's history. (shrink)

I work at a large urban medical center. Our hospital has over 1,200 beds and was built in 1805 to take care of the poor. Our patients are still poor, but now so are the hospital and the doctors. Russian doctors are paid about one-third of what truck drivers are paid. The government historically allocates no more than 3% of the budget to medicine because this is not a means of production, like manufacturing.

Tom Koch's review of Jack Kevorkian's is a valuable look at this one (in)famous crusader's practices. The immediate question raised, and to which Koch provides his own perspectives, is what practical conclusions might be drawn from the final experiences and actions of this cohort of suffering individuals. My briefest and perhaps flippant answer is —including, unfortunately, those derived or hinted at by Koch himself.

is a new campaign devoted to reducing the environmental harmsgenerated by the healthcare industry. One of the leading local proponents of this effort is Michael Lerner, founder of Commonweal, a Bolinas, Californiagenius grant”).

Although housed in an anonymous Victorian house in San Francisco, California, the Zen Hospice Project is world renowned for its pioneering model of training hospice volunteers, providing direct services to patients, and offering educational programs to the broader public.

In mid-1996, the United States Supreme Court agreed to hear arguments and rule on two lower court cases that would, if upheld, legalize physician-assisted suicide in twelve states, including California. At about the same time, at a national meeting dealing with this controversial topic, several participants from the San Francisco Bay Area got together to ask, Based on the old principle of the suggestion was made that the local ethics committee network might be interested in developing guidelines for the care (...) of patients at the end of life in the unlikely event that laws would change by Supreme Court action. Thus the coordinator of the Bay Area Network of Ethics Committees (BANEC) and several BANEC members began to discuss this question. (shrink)

Ram Dass is one of America's most renowned spiritual teachers. Born Richard Alpert, he received his Ph.D. in psychology from Stanford University and taught there and at Harvard University before going to India and receiving the name Ram Dass () from his guru. He has long been involved in many charitable service organizations, particularly those devoted to providing healthcare for underserved populations. Among his many books are BeHereNow, HowCanIHelp, and CompassioninAction; his newest book is StillHere:EmbracingAging,Changing,andDying.

It's a chilly winter night outside, but very warm inside the hospice guest house. All of the people gathered here have wished one another “Happy New Year” and settled on cushions in the big meeting hall. Both fireplaces are lit, and the many little white cards with the names of each person who died last year are arranged on the mantels over the fireplaces and on a table in the center of the room. Paul, our teacher for the evening, says (...) a few simple and wise words about impermanence and about being of service and then explains tonight's process: we, the volunteers in attendance, will pick up the cards, either by choosing a specific patient's name or at random, and take them one by one to the fires, dropping them in and saying something about each deceased person. The idea is to hear a litany of names being remembered and honored and sent onward as volunteers flow steadily to and from the fireplaces. (shrink)

A woman presents to her physician with a newly diagnosed condition that in her considered and informed judgment requires an elective surgical procedure. The physician, after speaking with her, agrees that this is an acceptable option. The procedure in question is in fact one of the commonest surgeries performed on American women. The physician is also aware that although the procedure is deemed elective in this and in most cases, research has shown that the consequences of not providing the procedure (...) when it is requested can be severe in terms of both physical and emotional sequelaewhich itself can add to the complexity and risk of the procedure. Presented with this option, the patient expresses dismay but also her resigned commitment to follow through with this referral, and leaves the office in tears. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

New beginnings give us the opportunity to do better “the next time.” In the rush to welcome the new millennium, it is fitting to take time to look more thoughtfully at issues not adequately covered in decades past. Robert Frost's musing about less traveled roads gives poetic life to the theme of this CQ Special Section, exploring some of the all too unknown territory between doctors and patients.

The profession of medicine has developed codes of ethical conduct for thousands of years. From the Hippocratic Oath of ancient Greece onward to modern times, a universal and central element of such codes has expressed the imperative that a physician shall “Do no harm.”.

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these (...) infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called “neonatologist,” seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. What was to be the cost in dollars and in anguish to save the Patrick Kennedys of the world? Triumphs led to grave concerns as we approached the edge. However, no advancement in neonatology has ever changed the ultimate questions. (shrink)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors (...) take brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these (...) infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. WhatwastobethecostindollarsandinanguishtosavethePatrickKennedysoftheworld?Triumphsledtograveconcerns asweapproachedtheedge.However,noadvancementinneonatologyhaseverchangedtheultimatequestions. (shrink)

Thomas Kuhn's _Structure of Scientific Revolutions_ has sold over a million copies in more than twenty languages and has remained one of the ten most cited academic works for the past half century. In contrast, Karl Popper's seminal book _The Logic of Scientific Discovery_ has lapsed into relative obscurity. Although the two men debated the nature of science only once, the legacy of this encounter has dominated intellectual and public discussions on the topic ever since. Almost universally recognized as the (...) modern watershed in the philosophy of science, Kuhn's relativistic vision of shifting paradigms -- which asserted that science was just another human activity, like art or philosophy, only more specialized -- triumphed over Popper's more positivistic belief in science's revolutionary potential to falsify society's dogmas. But has this victory been beneficial for science? Steve Fuller argues that not only has Kuhn's dominance had an adverse impact on the field but both thinkers have been radically misinterpreted in the process. This debate raises a vital question: Can science remain an independent, progressive force in society, or is it destined to continue as the technical wing of the military-industrial complex? Drawing on original research -- including the Kuhn archives at MIT -- Fuller offers a clear account of "Kuhn vs. Popper" and what it will mean for the future of scientific inquiry. (shrink)

Steve Coutinho explores in detail the fundamental concepts of Daoist thought as represented in three early texts: the _Laozi_, the _Zhuangzi_, and the _Liezi_. Readers interested in philosophy yet unfamiliar with Daoism will gain a comprehensive understanding of these works from this analysis, and readers fascinated by ancient China who also wish to grasp its philosophical foundations will appreciate the clarity and depth of Coutinho's explanations. Coutinho writes a volume for all readers, whether or not they have a background (...) in philosophy or Chinese studies. A work of comparative philosophy, this volume also integrates the concepts and methods of contemporary philosophical discourse into a discussion of early Chinese thought. The resulting dialogue relates ancient Chinese thought to contemporary philosophical issues and uses modern Western ideas and approaches to throw new interpretive light on classical texts. Rather than function as historical curiosities, these works act as living philosophies in conversation with contemporary thought and experience. Coutinho respects the multiplicity of Daoist philosophies while also revealing a distinctive philosophical sensibility, and he provides clear explanations of these complex texts without resorting to oversimplification. (shrink)

The examination of the notion of science from a sociological perspective has begun to transform the attitudes to science traditionally upheld by historians and philosophers.

Corporate sustainability can be defined as organizations’ commitment to profitability, environment, and social well-being. This study uses a transactional culture analysis of CS reporting practices to explain why some Indian organizations conform to voluntary CS reporting guidelines and others do not. The literature contains two different perspectives on culture, defined broadly as a set of values that guide people’s behavior at a given time. Most past studies typically use national culture to explain differences in CS practices across nations. This concept (...) embeds corporate cultures within the larger national culture, neglecting intranation diversity. Conversely, according to the transactional culture approach used in this study, cultures are plural and independent of geoethnic boundaries, and emerge through social transactions. TCA encourages multilevel explorations of complex social phenomena. Since CS reporting preferences are the outcome of ongoing transactions among organizational stakeholders across different levels, TCA is more appropriate for this study. Since this application requires an understanding of social accountability, the authors use Mary Douglas’s Cultural Framework, a transactional framework of social accountability. A qualitative exploration of six Indian organizations using DCF reveals different dominant forms of social accountability in these organizations: either alone or as paired hybrids. Consequently, each organization prioritizes different stakeholders and reacts differently to voluntary CS reporting guidelines. Identifying the dominant form or forms of social accountability in their organizations and understanding their underlying reasons for resisting voluntary CS guidelines enables managers to secure better collaboration for their CS initiatives. (shrink)

This reply to Finn Collin’s critically sympathetic review of my Back to the University’s Future: The Second Coming of Humboldt, addresses some of the tensions involved in realizing “Humboldt 2.0” in today’s higher education environment. Its focus is largely on the academic’s sense of researcher as being one of learner. In other words, the Humboldtian sees research as the necessary complement to teaching, not something radically distinct from it.

Whether it would take one decade or several centuries, many agree that it is possible to create a *superintelligence*---an artificial intelligence with a godlike ability to achieve its goals. And many who have reflected carefully on this fact agree that our best hope for a "friendly" superintelligence is to design it to *learn* values like ours, since our values are too complex to program or hardwire explicitly. But the value learning approach to AI safety faces three particularly philosophical puzzles: first, (...) it is unclear how any intelligent system could learn its final values, since to judge one supposedly "final" value against another seems to require a further background standard for judging. Second, it is unclear how to determine the content of a system's values based on its physical or computational structure. Finally, there is the distinctly ethical question of which values we should best aim for the system to learn. I outline a potential answer to these interrelated puzzles, centering on a "miktotelic" proposal for blending a complex, learnable final value out of many simpler ones. (shrink)

Over the last century, psychoanalysis has transformed the ways in which we think about our relationships with others. Psychoanalytic concepts and methods, such as the unconscious and dream analysis, have greatly impacted on social, cultural and political theory. Reinterpreting the ways in which geography has explored people's mental maps and their deepest feelings about places, The Body and the City outlines a new cartography of the subject. Mapping key coordinates of meaning, identity and power across the sites of body and (...) city, author Steve Pile explores a wide range of critical thinking, particularly the work of Lefebvre, Freud and Lacan to present a pathbreaking psychoanalysis of space. (shrink)

This book introduces the history of third way ideology, surveys its various contrasting forms and locates it within the context of a recurrent crisis of modern European ideologies.

An affirmative answer is given to the question quoted in the title.

Comics writer and artist Frank Miller reinvented Batman, bringing greater emotional, moral, and political depth to the character. This chapter considers Batman’s ethics and politics, examining his rejection of utilitarianism, his embrace of the will to power, his Kantian dilemma when dealing with the Joker, and the distinction to be drawn between Miller’s own libertarianism and Bruce Wayne’s Bat-Libertarianism.

The essays complement one another to provide a tour of the complexities and richness of contemporary modes of critique.