The "new family" of disciples was formed by faith and commitment and included those who had traditionally been outsiders. Similarly, Christian ethics can support the bonding in covenant love of nonbiological families brought together by sometimes painful circumstances that can be redeemed by their actions. While the Christian tradition is supportive of the idea that birth parents should rear their children, it also relativizes the biological family by adding meaning to adoption. This is a creative tension.

Tube feeding is often presented as a nearly risk free and beneficial treatment for patients with dementia. But evidence shows that its benefits are illusory, while its risks are greater than many realize. Assisted oral feeding and good hospice care are better options.

The authority of the intact self over the future severely demented self is based on notions of integrity and precedent autonomy. Despite criticism of this authority, the principle of precedent autonomy in the care of people with Alzheimer disease or other progressive and irreversible dementias retains its moral significance.

The concept of altruism, or disinterested concern for another's welfare, has been discussed by everyone from theologians to psychologists to biologists. In this book, evolutionary, neurological, developmental, psychological, social, cultural, and religious aspects of altruistic behavior are examined. It is a collaborative examination of one of humanity's essential and defining characteristics by renowned researchers from various disciplines. Their integrative dialogue illustrates that altruistic behavior is a significant mode of expression that can be studied by various scholarly methods and understood from (...) a variety of perspectives in both the humanities and the sciences. Altruism and Altruistic Love establishes a framework for scholarship on altruism by presenting definitions, a historical overview, a review of contemporary research, and debates in various disciplines, as well as a discussion of directions for future work. (shrink)

The increased recognition and reported prevalence of autism spectrum disorders combined with the associated societal and clinical impact call for a broad grassroots community-based dialogue on treatment related ethical and social issues. In these Stony Brook Guidelines, which were developed during a full year of community dialogue with affected individuals, families, and professionals in the field, we identify and discuss topics of paramount concern to the ASD constituency: treatment goals and happiness, distributive justice, managing the desperate hopes for a cure, (...) sibling responsibilities, intimacy and sex, diagnostic ethics, and research ethics. The members of the dialogue core committee included doctors, ethicists, administrators, social workers, ministers, disability experts, and many family members of individuals with autism who were especially engaged in community activities on behalf of their constituency, including siblings, parents, and grandparents. Our guidelines are not based on “top-down” imposition of professional expertise, but rather on a “bottom-up” grass roots attention to the voices of affected individuals and families speaking from experience. These guidelines can inform clinical practice, but they also are meaningful for the wider social conversation emerging over the treatment of individuals with ASD. (shrink)

This article examines the role of two distinct forms of analogy in moral discourse. The use of analogy in moral discourse. The use of analogy in abortion debates in used as an example of the dominance of analogy in applied ethics.

The interface between religion, psychiatry, and ethics is often a locus for considerable controversy. This article focuses on the response of American psychiatry to religious nonconformism, and to religious conversion generally. At issue is the societal pressure against unpopular religious movements. The author argues for an ethic that conserves the freedom of religious conscience, and that guards against inquisitions in the guise of medical expertise and nosology.

Pediatricians provided expert testimony that, in the case of Baby K, provision of ventilator support goes beyond accepted standards of care for anencephalic infants and so is medically futile. This argument, however reasonable, does not persuade those who believe in the absolute value of even a fraction of human life. In Baby K, court records indicate that Ms. H, Baby K's mother, persistently adheres to the sanctity-of-life principle on religious grounds.While I think that quality-of-life considerations have a role in medical (...) decision making, those who reject such considerations must be respected. This article makes the following claims, on behalf of religious dissenters: the Baby K case should be interpreted in light of the freedom of religion guaranteed in the First Amendment ; religious beliefs should not be trivialized in clinical ethics, even if reason, not belief, is the language of the public forum; the time-honored free exercise clause is essential to the American experiment in liberty and should not be overridden in the name of a concept as vague as futility; and free exercise of religion deserves serious discussion in the futility debate, and significant religious accommodation must be included in any hospital or societal futility policies. In the concluding section, issues are raised regarding the balance between religious consideration and resource allocation. (shrink)

Pediatricians provided expert testimony that, in the case of Baby K, provision of ventilator support goes beyond accepted standards of care for anencephalic infants and so is medically futile. This argument, however reasonable, does not persuade those who believe in the absolute value of even a fraction of human life. In Baby K, court records indicate that Ms. H, Baby K's mother, persistently adheres to the sanctity-of-life principle on religious grounds.While I think that quality-of-life considerations have a role in medical (...) decision making, those who reject such considerations must be respected. This article makes the following claims, on behalf of religious dissenters: the Baby K case should be interpreted in light of the freedom of religion guaranteed in the First Amendment ; religious beliefs should not be trivialized in clinical ethics, even if reason, not belief, is the language of the public forum; the time-honored free exercise clause is essential to the American experiment in liberty and should not be overridden in the name of a concept as vague as futility; and free exercise of religion deserves serious discussion in the futility debate, and significant religious accommodation must be included in any hospital or societal futility policies. In the concluding section, issues are raised regarding the balance between religious consideration and resource allocation. (shrink)

Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the “good” provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies (...) and institutional goal setting, and of educational programs. We offer several practical suggestions for PPCC implementation, including structuring healthcare systems so as to nurture professional meaning, integrity, and inter-personal reflective emotional processing as a buffer against burnout and as a key to better patient care. It should not bring into question the primacy of practitioner commitment to the good of patients, nor should it be taken to suggest in any way a shift in focus away from patients’ values and respect for patient autonomy. PPCC asserts that the respect for patient’s values and autonomous choices properly remains the ethical benchmark of modern healthcare systems, along with altruistic professional commitment to the optimal care of patients. However, it enunciates an explicit commitment to structuring systems that allow for and actively encourage the professional well-being and wellness upon which good patient care depends. (shrink)

Ethicists who advocate the permissibility of infanticide often have misrepresented history in their arguments. The Western tradition supports the prohibition of active killing of congenitally impaired or premature newborns whose futures are uncertain.

The human life span has been extended considerably, and among the very old, women outnumber men by a large margin. Thus, the aging society cannot be adequately addressed without taking into account the experience of women in specific. This article focuses on women as caregivers for aging parents. It critically assesses what some women philosophers are saying about the basis and limits of these caregiving duties.

The Greater Cleveland community Dialogue on values and Health Care most recently took up the questions of health care rationing and of access to long-term care. The Dialogue, funded by the Cleveland Foundation, involves a Core Group of thirty community leaders representing major interest groups, joined together in an attempt to build consensus or acceptable compromise. The purpose of the dialogue is to identify moral values that can provide signposts for public policy regarding health care distribution.

This article focuses on the elderly patient with a progressive and irreversible dementia, most often of the Alzheimer type. However dementia, the decline in mental function from a previous state, can occur in all ages. For example, if Alzheimer's disease is the dementia of the elderly, increasingly AIDS is the dementia of many who are relatively young. I will not present the major ethical issues relating to dementia care following the progression of disease from the mild to the severe stages, (...) for I have done this elsewhere. Among the issues included are: presymptomatic testing, both psychological and genetic; responsible diag- nostic disclosure and use of support groups; restrictions on driving and other activities; preemptive assisted suicide; advance directives for research and treatment; quality of life in relation to the use of life-extending technologies; and euthanasia. (shrink)

Adoption, from the Latin opiate, “to choose,” means “to take into a relationship, especially another's child as one's own”. The word implies a permanent taking of responsibility. While the assumption that biological parents should rear their children is vital to society, adoption provides an alternative that is sometimes necessary.

The Clinton administration's revised rules regulating but not prohibiting the common practice in managed care of linking physician compensation with cost cutting and control of services demonstrates the complexity of ethical issues in managed care. As originally proposed, the federal guidelines on payment for Medicare and Medicaid services would have precluded any interrelationship between payment to physicians and delivery of services. Such a restriction would have gutted the primary mechanism in managed care plans to curb the unacceptably high cost of (...) healthcare delivery: making physicians directly responsible for cost control by placing them at direct financial risk. At first blush such a linkage seems to involve an obvious and irreconcilable conflict of interest. How can a physician be responsible for the well-being of a patient while at the same time aware that a proportion of his or her income is linked to the provision of cost-conscious care? (shrink)

Slowing the aging process would be one of the most dramatic and momentous ways of enhancing human beings. It is also one that mainstream science is on the brink of pursuing. The state of the science, together with its possible impact, make it an important example for how to think about research into all enhancement technologies.

Recent work on the ethics of love may be divided into norm-centered and affective-centered approaches. Norm-centered approaches, exemplified by Hallett and Outka, argue for either moral parity between self and other or for self-subordination; they regard self-love as legitimate within strict boundaries; and they sharply distinguish agape from other forms of love. Affective-centered approaches, exemplified by Vacek and Post, con- centrate on love for God as the central context for neighbor-love; they ac- cord a high status to friendship, marriage, (...) and other primary relationships; and they regard all forms of love as Christian in that they are transformed by grace and constitute cooperation with God. The re- maining agenda for both approaches is primarily theological, including especially the need to develop an extended application of the doctrines of creation and grace for the status of "special relations" in the ethics of love. (shrink)

Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.

Edited by Thomas A. Shannon, this series provides anthologies of critical essays and reflections by leading ethicists in four pivotal areas: reproductive technologies, genetic technologies, death and dying, and health care policy. The goal of this series is twofold: first, to provide a set of readers on thematic topics for introductory or survey courses in bioethics or for courses with a particular theme or time limitation. Second, each of the readers in this series is designed to help students focus more (...) thoroughly and effectively on specific topics that flesh out the ethical issues at the core of bioethics. The series is also highly accessible to general readers interested in bioethics. (shrink)

It is considered in some quarters that hypothesis‐driven methods are the only valuable, reliable or significant means of scientific advance. Data‐driven or ‘inductive’ advances in scientific knowledge are then seen as marginal, irrelevant, insecure or wrong‐headed, while the development of technology—which is not of itself ‘hypothesis‐led’ (beyond the recognition that such tools might be of value)—must be seen as equally irrelevant to the hypothetico‐deductive scientific agenda. We argue here that data‐ and technology‐driven programmes are not alternatives to hypothesis‐led studies in (...) scientific knowledge discovery but are complementary and iterative partners with them. Many fields are data‐rich but hypothesis‐poor. Here, computational methods of data analysis, which may be automated, provide the means of generating novel hypotheses, especially in the post‐genomic era. BioEssays 26:99–105, 2004. © 2003 Wiley Periodicals, Inc. (shrink)

This article compares and contrasts the interwar political commentary of the English historian Christopher Dawson (1889-1970) and the French philosopher Jacques Maritain (1882-1971), two of the most widely read Catholic writers of the 1930s. The reasons for the similarities and differences between their perspectives on democracy, fascism, and the Spanish civil war are discussed. The article concludes with a brief evaluation of how their views were reflected in post-World War Two Catholic thought, and a summary of their legacies as (...) twentieth-century Catholic intellectuals. (shrink)

We hypothesize that as one of the most consequential events in evolution, primary endosymbiosis accelerates lineage divergence, a process we refer to as the endosymbiotic ratchet. Our proposal is supported by recent work on the photosynthetic amoeba, Paulinella, that underwent primary plastid endosymbiosis about 124 Mya. This amoeba model allows us to explore the early impacts of photosynthetic organelle (plastid) origin on the host lineage. The current data point to a central role for effective population size (Ne) in accelerating divergence (...) post‐endosymbiosis due to limits to dispersal and reproductive isolation that reduce Ne, leading to local adaptation. We posit that isolated populations exploit different strategies and behaviors and assort themselves in non‐overlapping niches to minimize competition during the early, rapid evolutionary phase of organelle integration. The endosymbiotic ratchet provides a general framework for interpreting post‐endosymbiosis lineage evolution that is driven by disruptive selection and demographic and population shifts. Also see the video abstract here: https://youtu.be/gYXrFM6Zz6Q. (shrink)

Obesity is widely recognized as a preventable cause of death and disease. Reducing obesity among adults and children has become a national health goal in the United States. As one approach to the obesity epidemic, public health practitioners and others have asserted the need to provide consumers with information about the foods they eat. Some state and local governments across the United States have introduced menu labeling bills and regulations that require restaurants to post information, such as calorie content, (...) for foods offered on their menus or menu boards. A major dilemma is whether state and local menu labeling laws are preempted by the federal Nutrition Labeling and Education Act . While few courts have addressed this issue, ongoing litigation in New York City provides an early glimpse of judicial interpretation in this area. This article explores these preemption issues, arguing that appropriately written and implemented menu labeling laws should not be preempted by the NLEA. We offer guidance for states and localities that wish to develop and implement menu labeling laws. (shrink)

A wide literature in the sociology of agriculture has depicted the development of agricultural experiment stations at land grant colleges as part of a development project to improve agricultural productivity in particular commodities. Some experiment stations developed regional agricultural centers or stations to improve productivity and address local concerns, recognizing the importance of context in rural development. Through analysis of one such station, the Dixon Springs Agricultural Center in Southern Illinois, this paper describes how regional agricultural stations played a key (...) role in the often conflicting agricultural programs of and following the New Deal. Changes in university structure from the 1970s to present and the current national recession have led to financial crises that have put these stations in a precarious position. Still, we argue that these institutions ought to be recognized as regional resources for a new era of agricultural development, and we suggest approaching that new era by building on the existing literature of community–university partnerships. (shrink)

An examination of verbal hallucinations and thought insertion as examples of "alienated self-consciousness.".