The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BALTHASAR'S USE OF THE THEOLOGY OF AQUINAS }AMES J. BUCKLEY Loyola College in Maryland Baltimore, Maryland T HE AIM OF THIS essay is to raise some questions about the internal consistency of Hans Urs von Balthasar's use of the theology of Thomas Aquinas. These are genuine questions. That is, they are not questions ("Is Balthasar's use of Aquinas consistent?") disguising or masking answers ("Balthasar's use of Aquinas is inconsistent"). (...) While I hope the questions set an agenda for disputations between students of these two theologians, my aim is not to settle the many disputations between the theologies of Aquinas and Balthasar, but to propose some quaestiones disputatae. In Balthasar's terms, the aim is to set up the theater and put some characters on the stage, not to stage the drama itself. Why bother? First, Balthasar's theology arises out of a tradition critical of the theology of Aquinas, and students of Aquinas can only ignore such objections at the price of abandoning Aquinas's habit of responding to such criticisms. The locus classicus of this critique is Balthasar's claim that he omits Aquinas from his canon of theological aestheticians because Aquinas is one of those whose "deep and lucid philosophical aesthetics" has "failed to achieve a theological translation, that is, to be seen as the unfolding of a theology based on biblical revelation" (GL II, 21).1 Thomas Aquinas (Balthasar later says) "was more of a philosopher than a theologian" (GL III, 9). We shall see later that ' I shall use the following abbreviations: ST = Summa Theologiae. Latin text and English translation, ed. Thomas Gilby, various translators (New York: McGraw-Hill; London: Eyre & Spottiswoode, 1964-80). GL =The Glory ofthe Lord: A Theological Aesthetic, ed. Joseph Fessio, S.J., and John Riches, various translators, 7 vols. (San Francisco: Ignatius Press; New York: Crossroad Publications, 1982-91). 517 518 JAMES J. BUCKLEY Balthasar also mentions other objections to Aquinas. In fact, part of my argument will be that this central criticism of Thomas's aesthetics is intelligible only against the background of other even more important criticisms of Aquinas's theology. I ought also to note at this early stage, however, that Balthasar 's criticisms of Aquinas are almost always carefully qualified. For example, in the locus classicus just cited, Balthasar objects to Aquinas's aesthetics, not his ethics or metaphysics; indeed, it is a criticism of Aquinas's theological aesthetics, not his philosophical aesthetics. Still further, Balthasar even says it "would perhaps" be possible to develop the "implicit" theological aesthetics in Thomas's philosophical aesthetics; however, Balthasar (inexplicably, some would say at this point) thinks this could only be done "witn uncertain success" (GL II, 21). One reason for the frequent allusiveness of Balthasar's objections to Aquinas is a second reason for bothering with Balthasar's use of Aquinas: in and with the firmness of Balthasar 's criticisms of Aquinas, the vast majority of Balthasar's uses of Aquinas are constructive rather than critical. Indeed, if taking the measure of theological disputation were primarily a matter of weighing quotations, it could easily be shown that Balthasar's use of Aquinas is by far more positive than negative. More importantly, I shall propose that Balthasar notices features of Aquinas's theology not often noted (or still not noted often enough) by many students of Aquinas. This common ground between Balthasar and Aquinas recalls how, among Roman Catholics in the first part of this century, there was a sort of alliance among Catholic reformers-over against strains of Catholic traditionalisms-between some forms of Thomism and TD= Theodramatik, 4 vols. (Einsiedeln: Johannes Verlag, 1973-83). T-D =Theo-drama: Theological Dramatic Theory, various translators, 5 vols. planned (San Francisco: Ignatius Press, 1988-). TL= Theologik, 3 vols. (Einsiedeln: Johannes Verlag, 1985-87). For a summary of Balthasar's trilogy on beauty and goodness and truth, see his Epilog (Einsiedeln/Trier: Johannes Verlag, 1987) as well as My Work: In Retrospect, trans. Cornelia CapoI (San Francisco: Ignatius Press, 1993). BALTHASAR'S THEOLOGY OF AQUINAS 519 what was known as la nouvelle theologie (including Balthasar).2 It is this common ground that ought to make us wary of... (shrink)

This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Comparative environmental philosophy is valuable in many ways. Perhaps it is most valuable because it reveals some of the foundational assumptions that run so deep in the poles of comparison that they might otherwise have gone unnoticed. These revelations may invite us to challenge those assumptions that have led to the kind of thinking responsible for much of the environmental degradation that we see today. Japanese Environmental Philosophy gathers papers focused on the environmental problems of the twenty-first century. Drawing from (...) Japanese philosophical traditions they investigate our relationships with other humans, nonhuman animals, and the environment. The heart of the book consists of chapters written by fifteen top scholars from Japan, the United States, Europe, and Australia. The essays cover a broad range of topics drawn from various strains of Japanese thought—including Zen Buddhism, Shintoism, the Kyoto school, and Japanese philosophy of art and aesthetics—as well as from traditional Japanese culture and the contemporary science of planning for natural disasters. These articles demonstrate that Japanese scientific, philosophical, religious, and cultural traditions can provide meaningful insight to address the current global environmental crisis. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Selected Letters by William, Henry JamesWilliam James EarleWilliam and Henry James. Selected Letters. Edited by Ignas K. Skrupskelis and Elizabeth M. Berkeley. Introduction by John J. McDermott. Charlottesville VA: University Press of Virginia, 1997. Pp. xxxi + 570. $ 39.95.Almost fifty years of letters to and from the very diversely brilliant James brothers: in this volume a generous, and probably ample, selection of 216 from (...) a total of 740 surviving letters or postcards, from an original total, according to the present editors, of twice as many. This volume of correspondence reflects the deep, unquestioned, unshakable familial (and virtually statutory) closeness of William and Henry who happened, as adults, to be seldom in the same place. There is, it must be said, very little explicit philosophy, narrowly or broadly defined, in these letters, but the philosophical reader will—or ought to—find much raw material for philosophical reflection. For example, a reasonable historicist thesis of how brotherhood, or family connection generally, plays itself out is supported by these documents. The nineteenth century is not the same as the twentieth. For example, here is William’s comment on the will of his sister, Alice, who left more to her companion and care-giver, Katherine Loring, a [End Page 479] women of extraordinary virtue and burden, than to her brother Robertson: “I can well sympathize with Alice’s desire to leave her something handsome; but I must say that her own consent (being apparently privy to the will) strikes me as tant soit peu lacking in delicacy. Surely no one of us would like to be in such a position in her family or any other” (271). This would be, in 1998, a rather unenlightened and ungenerous attitude, but is natural enough in 1892, even if not quite inevitable, not being shared by Alice herself. There is, incidentally, much discussion of wills and bequests, for the Jameses were of the genteel class, people with small family money and modest private incomes for whom the wherewithal to maintain homes with servants and to provide themselves with country houses and recuperative European vacations was always a faintly embarrassing, and occasionally a pressing, problem.It is probably also true that the much-discussed question of Henry’s homosexuality has, somehow, to be recast in historically relative terms. Here is an early report—1869—of Henry’s from Oxford: “As I walked along the river I saw hundreds of the mighty lads of England, clad in white flannel & blue, immense, fair-haired, magnificent in their youth, lounging down the stream in their punts or pulling in straining crews & rejoicing in their godlike strength” (41). This could not, the point is, be said by anyone, gay or straight, in 1998. Yet Henry is neither generally naive nor uncritically anglophile. He says of the Warwickshire scenery, which in a way he likes, that it is “too monotonously sweet & smooth—too comfortable, too ovine, too bovine, too English in a word.” And he adds, a little surprisingly: “It seems like a vast show region kept up at the expense of the poor” (41). This is only one of many appealing comments not sparsely scattered, but unpredictably, in letters of more ordinary news. Here’s one I liked occasioned by seeing theater in Paris: “We talk about it & write about it & criticize & dogmatize & analyse to the end of time: but those brave players stand forth & exemplify it & act—create—produce!” (66).Of course the “wit and wisdom” are not the monopoly of Henry. Here is William being wise: “We all learn sooner or later that we must gather ourselves up and more or less arbitrarily concentrate our interests, throw much overboard to save any” (55–56). Again: “It is a sweet world, in the interstices of its bedevilment & brutality” (321). And William being funny: “Boils are surely the most slowly evolving things in nature—Christian doctrine is nothing to them” (393). He is talking about his own boils and was subject, at every period, to ailments and infirmities: “Since writing to you, I have been swimming in deep seas of influenza, gout and Erysipelas of the face” (443). Or as he, in 1900, sums it up: “My... (shrink)

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

Global cycles of rising and declining hegemonies within the world-system have been associated with periods of war and peace, free trade and protectionism, and economic expansion and contraction. Periods of hegemonic decline are also associated with the cultural production of a certain strain of self deprecating, or even self-hating, literary output. And, because we are dealing with the world-system, the popularity of such icons of national self-deprecation should be gappreciated within other countries. We see this in the fact that (...) Don Quixote, poking fun at Spanish chivalry was an immensely popular book outside as well as inside Spain. Similarly, the James Bond books, and particularly the movies had a huge audience world wide, and, the same could be said for the Rambo movies which poked fun at the chivalric Green Beret American military figure. We see, then, three instances of hegemonic decline—Spain, Britain, United States—and three instances of self-deprecating literary figures—Don Quixote, James Bond, and Rambo. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dictionary of Scripture and Ethics ed. by Joel B. GreenTimothy J. SandovalDictionary of Scripture and Ethics Edited by Joel B. Green grand rapids, mi: baker academic, 2011. 912 pp. $60.00.An important addition to the scholarly literature that relates the Bible and ethics, the Dictionary of Scripture and Ethics (DSE) stands as a marker of how far that scholarly enterprise has come in the last forty years. As the (...) volume’s editor notes, if a generation ago James Gustafson lamented the paucity of efforts to link scripture and ethics, this is no longer the case in either ethics or biblical studies (1).DSE (to which I contributed one entry) is comprehensive, containing entries on a range of ethical topics and every biblical book. The volume includes an introduction delineating the organizational principles of the dictionary and three fine essays sketching the ethical shape of scripture, the history of relating scripture to ethics, and methodological issues in this endeavor. Published by a Christian press with entries betraying a mix of conservative (Catholic, evangelical) and liberal perspectives, DSE is oriented toward Christian scripture and Christian ethics. This is no criticism but an observation about DSE’s scope in relation to its title (21).In its approximately nine hundred pages, DSE contains some entries on ethical topics that barely allude to the biblical tradition while other entries on biblical material read not much differently from a standard Bible dictionary entry. Yet most articles on topics in ethics helpfully point to key biblical texts associated with the topic. Many others also deftly relate the history of thinking on an ethical issue and its biblical foundations. Most entries on the Bible likewise successfully sketch how biblical texts explore moral matters, and these articles regularly point out ethical “problems” that many biblical texts evoke for contemporary readers (e.g., concerning nationalism, violence, sexuality, and the like).Those of us in biblical studies who seek to articulate what Hans Frei called the “abiding significance” of the Bible sometimes falter in this effort, offering [End Page 222] stale, strained, or canned ideas about what passage X or Y “might mean for us today.” We falter, perhaps, because we have been deeply formed by the historical-critical study of the Bible. We thus often lack a vocabulary and logic, a different sort of discourse that does not merely translate into ethical and theological terms the exegetical findings we arrive at as classically trained biblical scholars but also engages in a quite different sort of exegetical work. In particular, the entries in DSE that treat broader topics in ethics will expose biblical scholars to different modes of relating critically to the texts than we are accustomed to. DSE will thus prove particularly useful for those of us who wish to explore and cultivate an exegetical practice as well as an identity as exegetes that is distinct from what emerges when we apply the historical and other critical tools that our training has bequeathed us (33).Ethicists can be assured that the entries on the Bible reliably sketch basic, current discussions in biblical studies although inevitably specialists will quibble over details and occasionally over broader issues—something the editor notes happens even between entries within DSE (2). As one of those quibbling specialists, I hoped to find an entry on “hermeneutics” or “biblical hermeneutics” in a volume so concerned with biblical interpretation, though a number of articles do, more or less, address such issues. I must leave it to ethicists to discern the quality and consistency of DSE entries on ethics.In short, DSE may offer only a first step for students and scholars seeking to relate scripture and ethics, but it is an important step.Timothy J. SandovalBrite Divinity SchoolCopyright © 2016 Society of Christian Ethics... (shrink)

Emotion regulation has the odd distinction of being a wildly popular construct whose scientific existence is in considerable doubt. In this article, we discuss the confusion about whether emotion generation and emotion regulation can and should be distinguished from one another. We describe a continuum of perspectives on emotion, and highlight how different (often mutually incompatible) perspectives on emotion lead to different views about whether emotion generation and emotion regulation can be usefully distinguished. We argue that making differences in perspective (...) explicit serves the function of allowing researchers with different theoretical commitments to collaborate productively despite seemingly insurmountable differences in terminology and methods. (shrink)

This authoritative volume provides a comprehensive road map of the important and rapidly growing field of emotion regulation.

Both the psychology of perception and the philosophy of perception seem to show a new face when the process is considered at its own level, distinct from that of sensation. Unfamiliar conceptions in physics, anatomy, physiology, psychology, and phenomenology are required to clarify the separation and make it plausible. But there have been so many dead ends in the effort to solve the theoretical problems of perception that radical proposals may now be acceptable. Scientists are often more conservative than philosophers (...) of science. I end, therefore, as I began, with a plea for help. (shrink)

Kant's Religion within the Boundaries of Mere Reason is one of the great modern examinations of religion's meaning, function and impact on human affairs. In this volume, the first complete English-language commentary on the work, James J. DiCenso explains the historical context in which the book appeared, including the importance of Kant's conflict with state censorship. He shows how the Religion addresses crucial Kantian themes such as the relationship between freedom and morality, the human propensity to evil, the status (...) of historical traditions in relation to ethical principles, and the interface between individual ethics and social institutions. The major arguments are clearly and precisely explained, and the themes are highlighted and located within Kant's mature critical philosophy, especially his ethics. The commentary will be valuable for all who are interested in the continuing relevance of religion for contemporary inquiries into ethics, public institutions and religious traditions. (shrink)

Modern emotion theories emphasise the adaptive value of emotions. Emotions are by no means always helpful, however. They often must be regulated. The study of emotion regulation has its origins in the psychoanalytic and stress and coping traditions. Recently, increased interest in emotion regulation has led to crucial boundary ambiguities that now threaten progress in this domain. It is argued that distinctions need to be made between (1) regulation of emotion and regulation by emotion; (2) emotion regulation in self and (...) emotion regulation in others; and (3) conscious and nonconscious emotion regulation. Using a process model of emotion generation, this review considers promising research on basic processes and individual differences in emotion regulation and poses five theoretical challenges. (shrink)

Individuals and businesses make numerous payments every day. They sometimes have choices about what forms of payment to make or accept, and at other times are effectively forced to use a particular form. Often there is an asymmetric power relationship between payer and payee that raises the issue of whether one side unfairly exploits the other. Is it unethical exploitation for an employer to pay employees with a fee-laden payroll card over other more convenient forms of payment? Does the fee (...) structure of payment networks such as Visa and MasterCard unfairly exploit merchants? The bitcoin payment system is an ethical as well as technological evolution as it was designed to be an electronic payment system that does not rely upon trust. Can an entire payment system like bitcoin be “evil,” as charged by Krugman? Payment tools as such are ethically neutral, but can be used in an ethical or unethical manner. (shrink)

In 2000 Bill Joy proposed that the best way to prevent technological apocalypse was to "relinquish" emerging bio-, info- and nanotechnologies. His essay introduced many watchdog groups to the dangers that futurists had been warning of for decades. One such group, ETC, has called for a moratorium on all nanotechnological research until all safety issues can be investigated and social impacts ameliorated. In this essay I discuss the differences and similarities of regulating bio- and nanotechnological innovation to the efforts to (...) regulate nuclear and biological weapons of mass destruction. I then suggest the creation of a global technology regulatory regime to ensure the safe and equitable diffusion of genetic, molecular and information technologies, and point out the principal political obstacles to implementing such a regime. (shrink)

In this article I consider the future of the field of emotion. My conclusion—borrowing the title of a little-remembered song from the 1980s—is that “the future’s so bright, I gotta wear shades.” I begin this article by considering some of the many daunting conceptual and empirical challenges here; this is clearly not a field for the faint of heart. I then turn to some of the incredible conceptual and empirical opportunities here; there are so many it’s easy to feel dizzy. (...) In the final section, I predict that the field of emotion will broaden and become more problem focused, and hazard a “top 10” list of hot topics. (shrink)

One of the most fundamental distinctions in the field of emotion is the distinction between emotion generation and emotion regulation. This distinction fits comfortably with folk theories, which view emotions as passions that arise unbidden and then must be controlled. But is it really helpful to distinguish between emotion generation and emotion regulation? In this article, we begin by offering working definitions of emotion generation and emotion regulation. We argue that in some circumstances, the distinction between emotion generation and emotion (...) regulation is indeed useful. We point both to citation patterns, which indicate that researchers from across a number of sub-areas within psychology are making this distinction, and to empirical studies, which indicate the utility of this distinction in many different research contexts. We then consider five ways in which the distinction between emotion generation and emotion regulation can be problematic. We suggest that it is time to move beyond debates about whether this distinction is useful to a more specific consideration of when and in what ways this distinction is useful, and in this spirit, we offer recommendations for future research. (shrink)

This paper analyzes the ethical-political dilemma in Kant’s work, sometimes expressed through the metaphor of the “crooked wood of humanity.” Kant separates external and internal freedom and the types of legislation each form of freedom requires (coercive and noncoercive). Yet, he also argues that corrupt political institutions adversely affect individual ethical development, and, reciprocally, corrupt inner dispositions of a populace adversely affect the establishment of just political institutions. I argue that a major way in which Kant addresses this vicious circle (...) is through ethical institutions, that is, noncoercive public resources for articulating and disseminating the principles of the moral law. I discuss the idea of an ethico-civil society or ethical community formulated in the Religion as an ideal model for ethical institutions mediating the ethical and the legal-political in a noncoercive, progressive manner. (shrink)