In this volume, written in honour of the eightieth birthday of Professor Shimon Glick, world renowned experts in the field of medical ethics struggle with the question of how to weigh the respective values of autonomy, altruism and authority in dealing with real life bioethical dilemmas.

Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes (...) of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited. (shrink)

The recent essay by Schuklenk and Smalling opposing respect for physicians’ conscientious objections to providing patients with medical services that are legally permitted in liberal democracies is based on several erroneous assumptions. Acting in this manner would have serious harmful effects on the ethos of medicine and of bioethics. A much more nuanced and balanced position is critical in order to respect physicians’ conscience with minimal damage to patients’ rights.

To illustrate dramatically the progress and potential in the field of synthetic biology, one can begin the story with the 2011 winner of the Lasker Clinical Medical Research Award (Youyou 2011). She was an 81-year-old Chinese scientist, Dr. Tu Youyou, who was given an assignment in 1969 by the Chinese government to find a treatment for malaria from among Chinese herbal medicines. She investigated more than 2,000 Chinese herbal preparations, winnowed them down to some 640 possibilities, obtained 380 extracts from (...) about 200 Chinese herbs, and tested them against a mouse model of malaria. She found one extract, of the Artemisia plant, effective in mice, but she could not reproduce the results consistently. So she .. (shrink)

I was deeply moved and inspired by Jason Dubroff’s article1 objecting to the source of the white coat distributed to the entering medical students at his school. The article stimulated me to ponder its implications and led to some thoughtful discussions with colleagues. Here was a busy medical student who was appropriately disturbed at what he regarded as a kind of ethical failure at the very ceremony, which was meant to exemplify and emphasise the values of humanism. However, unlike many (...) of us who notice evidence of ethical insensitivity, react with a sigh or a comment, and go on with our lives without significant alteration in our normal activities, Jason initiated an investigation of the issue, researched it in his own time, and even proposed remedial actions—a remarkable, unusual and impressive course of events. His article reinforced some of my personal prejudices. To those of my colleagues who nostalgically bewail the alleged decrease in idealism in today’s entering medical students, I can point to Jason as an example of the kind of ethical sensitivity, …. (shrink)

A few years ago, a Yemenite patient came to Maimonides Hospital in Brooklyn. The friendly, diminutive gentleman apologized for visiting the clinic in the first place because, as he explained, he was a devotee of Maimonides and invariably used the medical treatments recommended by him rather than current Western medicine. But for this patient’s problem, Maimonides had prescribed garlic. The patient told his doctor that if he ingested garlic, his wife would refuse contact with him. So, having no alternative, he (...) came to our clinic for consultation and to see if there were any other appropriate treatments.Moses Maimonides was one the most important Jewish scholars of all times. A popular folk saying.. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics (...) discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes (...) of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited. (shrink)

Introduction Outbreaks of serious communicable infectious diseases remain a major global medical problem and force healthcare workers to make hard choices with limited information, resources and time. While information regarding physicians’ opinions about such dilemmas is available, research discussing students’ opinions is more limited. Methods Medical students were surveyed about their willingness to perform medical procedures on patients with communicable diseases as students and as physicians. Students were asked about their opinions regarding the duty to treat in such cases. Results (...) 74% of respondents felt that by deciding to enter medical school they were morally obliged to treat any patient despite the risks. Students’ willingness to treat as physicians is significantly higher than their willingness to treat as students. HIV was significantly the most tolerated disease with respect to performing mouth to mouth resuscitation. Among preclinical students, we found that willingness to treat during the later years is significantly greater than during the earlier years. Among clinical students, the opposite was observed. Discussion Students’ greater willingness to treat as physicians is mostly attributed to perceptions of higher obligations as a qualified doctor. There is greater but not total willingness to perform resuscitation on patients with HIV relative to other diseases. The increased willingness of preclinical students and the decreased willingness of clinical students both emphasise the importance of patient–physician communication and ethics studies during medical school. (shrink)

Introduction Outbreaks of serious communicable infectious diseases remain a major global medical problem and force healthcare workers to make hard choices with limited information, resources and time. While information regarding physicians’ opinions about such dilemmas is available, research discussing students’ opinions is more limited. Methods Medical students were surveyed about their willingness to perform medical procedures on patients with communicable diseases as students and as physicians. Students were asked about their opinions regarding the duty to treat in such cases. Results (...) 74% of respondents felt that by deciding to enter medical school they were morally obliged to treat any patient despite the risks. Students’ willingness to treat as physicians is significantly higher than their willingness to treat as students. HIV was significantly the most tolerated disease with respect to performing mouth to mouth resuscitation. Among preclinical students, we found that willingness to treat during the later years is significantly greater than during the earlier years. Among clinical students, the opposite was observed. Discussion Students’ greater willingness to treat as physicians is mostly attributed to perceptions of higher obligations as a qualified doctor. There is greater but not total willingness to perform resuscitation on patients with HIV relative to other diseases. The increased willingness of preclinical students and the decreased willingness of clinical students both emphasise the importance of patient--physician communication and ethics studies during medical school. (shrink)

QBism is an agent-centered interpretation of quantum theory. It rejects the notion that quantum theory provides a God’s eye description of reality and claims instead that it imposes constraints on agents’ subjective degrees of belief. QBism’s emphasis on subjective belief has led critics to dismiss it as antirealism or instrumentalism, or even, idealism or solipsism. The aim of this paper is to consider the relation of QBism to scientific realism. I argue that while QBism is an unhappy fit with a (...) standard way of thinking about scientific realism, an alternative conception I call “perspectival normative realism” may allow for a reconciliation. (shrink)

Intelligent systems are faced with the problem of securing a principled (ideally, veridical) relationship between the world and its internal representation. I propose a unified approach to visual representation, addressing both the needs of superordinate and basic-level categorization and of identification of specific instances of familiar categories. According to the proposed theory, a shape is represented by its similarity to a number of reference shapes, measured in a high-dimensional space of elementary features. This amounts to embedding the stimulus in a (...) low-dimensional proximal shape space. That space turns out to support representation of distal shape similarities which is veridical in the sense of Shepard's (1968) notion of second-order isomorphism (i.e., correspondence between distal and proximal similarities among shapes, rather than between distal shapes and their proximal representations). Furthermore, a general expression for similarity between two stimuli, based on comparisons to reference shapes, can be used to derive models of perceived similarity ranging from continuous, symmetric, and hierarchical, as in the multidimensional scaling models (Shepard, 1980), to discrete and non-hierarchical, as in the general contrast models (Tversky, 1977; Shepard and Arabie, 1979). (shrink)

The question of whether Everettian quantum mechanics (EQM) justifies the existence of metaphysical indeterminacy has recently come to the fore. Metaphysical indeterminacy has been argued to emerge from three sources: coherent superpositions, the indefinite number of branches in the quantum multiverse and the nature of these branches. This paper reviews the evidence and concludes that those arguments don’t rely on EQM alone and rest on metaphysical auxiliary assumptions that transcend the physics of EQM. We show how EQM can be ontologically (...) interpreted without positing metaphysical indeterminacy by adopting a deflationary attitude towards branches. Two ways of developing the deflationary view are then proposed: one where branches are eliminated, and another where they are reduced to the universal quantum state. (shrink)

Central to contemporary cognitive science is the notion that mental processes involve computations defined over internal representations. This view stands in sharp contrast to the to visual perception and cognition, whose most prominent proponent has been J.J. Gibson. In the direct theory, perception does not involve computations of any sort; it is the result of the direct pickup of available information. The publication of Gibson's recent book (Gibson 1979) offers an opportunity to examine his approach, and, more generally, to contrast (...) the theory of direct perception with the computational/representational view. In the first part of the present article (Sections 2direct perceptioncase study”: the problem of perceiving the three-dimensional shape of moving objects is examined. This problem, which has been extensively studied within the immediate perception framework, serves to illustrate some of the inherent shortcomings of that approach. Finally, in Section 5, an attempt is made to place the theory of direct perception in perspective by embedding it in a more comprehensive framework. (shrink)

In all the Alien films, the environments are gloomy settings originally inspired by Gothic architecture, but it's the creature design, which leaves the most profound mark on us. The interaction between these art‐horror monsters and the sterileturned‐ grotesque environments of the Alien films can produce disgust or revulsion in the viewer. In Alien a fair amount of time is spent on the relationships between the crew members. One of the most horrific moments of the series is the cry of “kill (...) me” that emerges from the half‐conscious hosts as the space Marines explore the former colony of Hadley's Hope. Central to Carroll's theory on art‐horror is revulsion at the suggestion of physical contact with the fusion‐figures. At the end of Alien: Resurrection, Ripley lies in the middle of the Queen's huge mass. It is the most striking image in an otherwise cartoonish film. (shrink)

Shanahan’s eloquently argued version of the global workspace theory fits well into the emerging understanding of consciousness as a computational phenomenon. His disinclination toward metaphysics notwithstanding, Shanahan’s book can also be seen as supportive of a particular metaphysical stance on consciousness — the computational identity theory.

Name der Zeitschrift: Naharaim Jahrgang: 8 Heft: 2 Seiten: 253-272.

Photographers John Shimon and Julie Lindemann use antique cameras, modern lens technology, artificial light, and contemporary pop culture to create portraits of the people in their native state amidst backyards, living rooms, parking lots, and the landscape of Wisconsin. These recent photographs are juxtaposed with portraits from the Milwaukee Art Museum’s permanent collections, including daguerreotype portraits, ambrotypes, and tintypes of anonymous people taken by nineteenth-century photographers, as well with photographs by such well-known artists as Alfred Stieglitz, Sally Mann, Larry (...) Clark, Walker Evans, Nan Goldin, Eugene von Beuenchenhein, and Francis Ford. The pairings of new and old illustrate the legacy of portraiture and the significance of “posing” before the lens, and each image is enriched by its proximity to another, unmasking sitter, photographer, and viewer. Unmasked & Anonymous: Shimon & Lindemann Consider Portraiture includes more than sixty color and black-and-white photographs plus essays by Shimon, Lindemann, and Milwaukee Art Museum curator Lisa Hostetler. (shrink)

Short essays that touch many topics-anxiety, consciousness, death, happiness, morality, stupidity, & truth-that make the case for realism & help set expectations with regard to the human condition.

Introduction: toward a theory of infrahumanity -- Bioexpansionism, 1900s-1930s -- Brief histories of time: nature, culture, and the making of modern childhood -- Ocular anthropomorphisms: eugenics and primatology at the threshold of the "almost human" -- Extraterrestriality, 1940s-1970s -- On alien ground: extraterrestrial sightings, atomic warfare, and the undoing of the human body -- Inner and outer spaces: exobiology, human genetics, and the disembodiment of corporeal difference -- Interiority, 1980s-2010s -- Of sodomy and cannibalism: disgust, dehumanization, and the rhetorics of (...) same-sex and cross-species contagion -- Everything except the squeal: porcine hybridity in the obesity epidemic and xenotransplantation research -- Conclusion. the plurality is near: techniques of symbiotic re-speciation. (shrink)

The author congratulates Dr Brian Hurwitz, who recently reported the successful “intimidation” of an elderly competent widow into accepting badly needed therapy for a huge ulcerated carcinoma. He reports approvingly of the Israeli Patients' Rights Law, enacted in 1996, which demands detailed informed consent from competent patients before permitting treatment. But the law also provides an escape clause which permits coercing a competent patient into accepting life-saving therapy if an ethics committee feels that if treatment is imposed the patient will (...) give his/her consent retroactively. He suggests this approach as an appropriate middle road between overbearing paternalism and untrammelled autonomy. (shrink)

The only viable formulation of perception, thinking, and action under uncertainty is statistical inference, and the normative way of statistical inference is Bayesian. No wonder, then, that even seemingly non-Bayesian computational frameworks in cognitive science ultimately draw their justification from Bayesian considerations, as enlightened theorists know fully well.

In a recent essay, Deery and Nahmias :1255–1276, 2017) utilize interventionism about causation to develop an account of causal sourcehood in order to defend compatibilism about free will and moral responsibility from manipulation arguments. In this paper, we criticize Deery and Nahmias’s analysis of sourcehood by drawing a distinction between two forms of causal invariance that can come into conflict on their account. We conclude that any attempt to resolve this conflict will either result in counterintuitive attributions of moral responsibility (...) or will undermine their response to manipulation arguments. (shrink)

Tim Maudlin has claimed that EPR’s Reality Criterion is analytically true. We argue that it is not. Moreover, one may be a subjectivist about quantum probabilities without giving up on objective physical reality. Thus, would-be detractors must reject QBism and other epistemic approaches to quantum theory on other grounds.

A well-known objection to prioritarianism, famously levelled by Mike Otsuka and Alex Voorhoeve, is that it wrongly ignores the unity of the individual in treating intra-personal cases like inter-personal cases. In this paper we accept that there should be a moral shift between these cases, but argue that this is because autonomy is a relevant consideration in intra-personal but not inter-personal cases, and one to which pluralist prioritarians ought to attend. To avoid this response, Otsuka and Voorhoeve must assume we (...) know nothing about the subjective information of the person being chosen for. But we show that this commits them to two controversial assumptions: that welfare consists in an objective list of goods, and – if one accepts an unorthodox but plausible account of the relationship between risk aversion and rationality – that there is only a narrow range of rational risk aversions. Only prioritarians who accept both these assumptions are on the hook of Otsuka and Voorhoeve’s objection; for all others, the examples have insufficient information, and so lose their sting. (shrink)

The strangeness of modern physics has sparked several popular books--such as The Tao of Physics--that explore its affinity with Eastern mysticism. But the founders of quantum mechanics were educated in the classical traditions of Western civilization and Western philosophy. In Nature Loves to Hide, physicist Shimon Malin takes readers on a fascinating tour of quantum theory--one that turns to Western philosophical thought to clarify this strange yet inescapable explanation of reality. Malin translates quantum mechanics into plain English, explaining its (...) origins and workings against the backdrop of the famous debate between Niels Bohr and the skeptical Albert Einstein. Then he moves on to build a philosophical framework that can account for the quantum nature of reality. He shows, for instance, how Platonic and Neoplatonic thought resonates with quantum theory. He draws out the linkage between the concepts of Neoplatonism and the more recent process philosophy of Alfred North Whitehead. The universe, Whitehead wrote, is an organic whole, composed not of lifeless objects, but "elementary experiences." Beginning with Whitehead's insight, Malin shows how this concept of "throbs of experience" expresses quantum reality, with its subatomic uncertainties, its constituents that are waves and also particles, its emphasis on acts of measurement. Once any educated person could explain the universe as a vast Newtonian web of cause and effect, but since quantum theory, reality again appears to be richer and more mysterious than we had thought. Writing with broad humanistic insight and deep knowledge of science, and using delightful conversations with fictional astronauts Peter and Julie to explain more difficult concepts, Shimon Malin offers a profound new understanding of the nature of reality--one that shows a deep continuity with aspects of our Western philosophical tradition going back 2500 years, and that feels more deeply satisfying, and truer, than the clockwork universe of Newton. (shrink)