The changing world of health care finance has led to a paradigm shift in health care with health care being viewed more and more as a commodity. Many have argued that such a paradigm shift is incompatible with the very nature of medicine and health care. But such arguments raise more questions than they answer. There are important assumptions about basic concepts of health care and markets that frame such arguments.

: Bioethics has focused on the areas of individual ethical choices--patient care--or public policy and law. There are, however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.

: During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and (...) health care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death: A Persistent Controversial StateKevin Wm. Wildes S.J. (bio)Along with the moral questions surrounding research and experimentation, the moral questions of death and dying have ranked among the most central and formative sets of issues for the field of bioethics. While the questions of death and dying have a long history (Wildes 1996), the attempt to address them as secular questions is an element of what established (...) bioethics as a field of inquiry.The controversies of death and dying are not only formative of bioethics, but also are among the most persistent bioethical controversies. Today, almost 30 years after the Harvard Ad Hoc Committee’s definition of death and 20 years after the Quinlan decision, the questions of death and dying are still with us. Recently, the question of physician-assisted suicide once again gained national [End Page 378] attention with the trials of Dr. Kevorkian and the decisions of the Ninth and Second Circuit Courts on the constitutionality of the Washington and New York state laws prohibiting physician-assisted suicide. At the same time, questions and controversies about the appropriate extent of treatment and the determination of death in relationship to treatment continue to be problematic in health care.As I reviewed the literature in the area of death and dying, one central question emerged: Why, after so much reflection, energy, and discussion, do the problems around death and dying continue to persist? There is a recurring character to these questions that is indeed a wonder. In reviewing these moral controversies, one might ask what these controversies and their persistent character tell us about bioethics that can help us to understand the issues and the field.Some might blame the development of medical technology for the persistence of these issues of death and dying. The development and use of technological resources certainly is an important element of these continuing controversies. The use of medical technologies at the end of life allows us the possibility to sustain lives that would have been lost just a few decades ago. However, while medical technology certainly opens new horizons and possibilities, the development and deployment of technology does not sufficiently explain why these issues are so difficult and persistent. The question underlying the use of medical technology at the end of life is the question about which criteria are to be used to make judgments about the appropriate use of such technology. If the use of medical technology depends on the moral views one holds about death, suffering, and the appropriate use of resources, then such issues will be morally controversial in a society that is morally pluralistic.To address these questions, it is important to remember what is all too obvious and yet often forgotten. Death is not only a medical event. In this century, particularly in the last 40 years, we have reduced death to a medical event, yet, the medical meanings do not exhaust the event (see Engelhardt 1996, pp. 189–238). Death is also a social, cultural, and often religious event and the medical realities of death must be interpreted within these different contexts. As such, death will be the locus of different meanings and interpretations. By keeping these different structures of interpretation in mind, we are better able to understand why controversies around death and dying persist. Just as the meaning of death will vary from culture to culture, so too will the criteria of death vary. Different moral communities have different criteria for death—e.g., pulmonary or cognitive function. Put another way, different communities and cultures will have different views of what constitutes a good life, and those views influence the way death is understood. How one understands the obligations to support life also varies according to one’s moral commitments and values.One’s view of what counts as death, or what counts as a good death, is influenced [End Page 379] by the moral commitments that one holds. The persistent controversies over death and dying are a symptom of deep, widespread moral and cultural pluralism. These views are controversial because, in many ways, our deaths are no longer private. That is, the way we die often is tied to a health... (shrink)

At its root meaning a “crisis” is a separation. In our everyday lives we use the term crisis to designate a period of decision. A crisis is a moment of separation when one must make a decision about a direction. To make a crisis decision, a person needs some criteria or set of norms to guide the decisions that are made. Sometimes, at a moment of crisis decisionmaking, there is chaos when one does not know which norm to use in (...) making a decision. Without some norm a crisis is a significant loss of direction because there are different criteria for deciding which way to turn or how to decide. It is in this most fundamental sense that one can say that contemporary medicine is in crisis. (shrink)

Several recent attempts to develop models of moral reasoning have attempted to use some form of casuistry as a way to resolve the moral controversies of clinical ethics. One of the best known models of casuistry is that of Jonsen and Toulmin who attempt to transpose a particular model of casuistry, that of Roman Catholic confessional practice, to contemporary moral disputes. This attempt is flawed in that it fails to understand both the history of the model it seeks to transpose (...) and the morally pluralistic context of secular, postmodern society. The practice of casuistry which Jonsen and Toulmin wish to revive is a practice set in the context of a community with a shared set of moral values and structures of moral authority. Without a set of common moral values and rankings, and a moral authority to interpret cases the casuistry of the postmodern age will be pluralistic; that is, there will be many casuistries not just one. Keywords: casuistry, common morality, kinetics, moral authority, moral pluralism, morphology, paradigm cases, taxonomy CiteULike Connotea Del.icio.us What's this? (shrink)

Kevin Wm. Wildes, S.J.; Living out the Tradition, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 9, Issue 2-3, 1 January 2003, Pages 29.

Practices such as physician assisted suicide, even if legal, engender a range of moral conflicts to which many are oblivious. A recent proposal for physician assisted suicide provides an example by calling upon physicians opposed to suicide to refer patients to other, more sympathetic, physicians. However, the proposal does not address the moral concerns of those physicians for whom such referral would be morally objectionable. Keywords: collaboration, euthanasia, intrinsic evil, material cooperation, projects, referral, toleration CiteULike Connotea Del.icio.us What's this?

Kevin Wm. Wildes, S.J.; Religion in Bioethics: A Rebirth, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 2, 1 January 2002, Pa.

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect.

Bioethics evolved from traditional physician ethics and theological ethics. It has become important in contemporary discussions of Medicine and ethics. But in contemporary secular societies the foundations of bioethics are minimal in their content and often rely on procedural ethics. The bioethics of particular communities, particularly religious communities, are richer than the procedural ethics of a secular society. Religious bioethics, situated within religious communities, are richer in content in general and in the lived reality.

When many people think of bioethics, they think of gripping issues in clinical medicine such as end-of-life decision-making, controversies in biomedical research such as that over work with stem cells, or issues in allocating scarce health-care resources such as organs or money. The term “bioethics” may evoke images of moral controversies being discussed on news programs and talk shows. But this “controversy of the day” focus often treats ethical issues in medicine superficially, for it addresses them as if they could (...) be examined and discussed in isolation from the context in which they are situated. Such a focus on the latest controversies fails to take into account that medicine is a social institution and that the controversies in bioethics often reflect deeper social and moral issues that transcend the boundaries of medicine and ethics. If one moves beyond the issue-of-the-day approach to bioethics, one can see that the field must address these deeper issues. (shrink)

In the last 25 years, Roman Catholic moral theology has debated issues ranging from the sources of moral theology to the role of ecclesiastical authority in moral theology. In 1993, Pope John Paul II issued his encyclical letter Veritatis Splendor, which addresses issues in fundamental moral theology. The encyclical must be understood against the background of ongoing debates since Pope Paul VI's 1968 encyclical on birth control (Humanae Vitae). It is not clear what the impact of Veritatis Splendor will be. (...) However, it seems safe to say that it will be deployed in debates about issues such as birth control, artificial reproduction, sterilization, and abortion. (shrink)

James Tallmon has argued that my criticisms of Jonsen and Toulmin are ill founded. Tallmon argues that Jonsen and Toulmin argue for a method of rhetorical reasoning and not for a particular content. He argues that if one distinguishes the content and method of casuistry the Jonsen-Toulmin model can work. But Tallmon, like Jonsen and Toulmin, cannot escape the need for casuistry to have a content. Tallmon's response evidences that need since he assumes that there is a ‘Medical Community’ which (...) has a moral vision. Keywords: casuistry, content, Jonsen, method, rhetoric, Tallmon, Toulmin CiteULike Connotea Del.icio.us What's this? (shrink)

In the postscript to Wittgenstein and the Mystical, Sontag notes that while most philosophers attend to Wittgenstein's technical work in logic and the philosophy of language, there is little attention given to his "life situation." Yet, Sontag argues throughout this fine book, understanding many of Wittgenstein's philosophical insights depends on understanding how the wider concerns of his life influenced and related to his philosophical concerns. While Wittgenstein was concerned with the clarity of philosophical language, he recognized that beyond the confines (...) of such language was what Sontag calls "the mystical" and much of what makes human life meaningful. Put another way, Wittgenstein's logical and linguistic concerns were but a part of his larger concerns about human life and the logical and linguistic interests are better understood when seen as part of this wider context. (shrink)

In 1994, the National Conference of Catholic Bishops revised the "Ethical and Religious Directives for Catholic Health Care Services." A goal of the Directives is to maintain the moral integrity of Catholic health care institutions and to address controversies in bioethics and health care. The Directives represent a shift to an exclusively principle-based approach to moral reason. This shift threatens to undermine the very tradition that the bishops seek to protect.

In the last 25 years, Roman Catholic moral theology has debated issues ranging from the sources of moral theology to the role of ecclesiastical authority in moral theology. In 1993, Pope John Paul II issued his encyclical letter Veritatis Splendor, which addresses issues in fundamental moral theology. The encyclical must be understood against the background of ongoing debates since Pope Paul VI's 1968 encyclical on birth control (Humanae Vitae). It is not clear what the impact of Veritatis Splendor will be. (...) However, it seems safe to say that it will be deployed in debates about issues such as birth control, artificial reproduction, sterilization, and abortion. (shrink)

James R. Thobaben; “Pleased to Make Your Acquaintance: A review of Kevin Wm. Wildes' Moral Acquaintances: Methodology in Bioethics”, Christian bioethics: Non-Ec.

The role of an expert witness in ethics, as part of a legal proceeding, is examined in this essay. The essay argues that the use of such expertise rests on confusions about normative and non-normative ethics compounded by misunderstandings about the challenges of moral argument in secular, morally pluralistic societies.

The advent of moral pluralism in the post-modern age leads to a set of issues about how pluralistic societies can function. The questions of biomedical ethics frequently highlight the larger issues of moral pluralism and social cooperation. Reflection on these issues has focused on the decision making roles of the health care professionals, the patient, and the patient's family. One species of actor that has been neglected has been those institutions which are part of the public, secular realm and which (...) have a particular moral heritage. Keywords: approval, compromise, condemnation, integrity, toleration CiteULike Connotea Del.icio.us What's this? (shrink)

A widespread perception is that carnivores are limited by the amount of prey that can be captured rather than their nutritional quality, and thus have no need to regulate macronutrient balance. Contrary to this view, recent laboratory studies show macronutrient‐specific food selection by both invertebrate and vertebrate predators, and in some cases also associated performance benefits. The question thus arises of whether wild predators might likewise feed selectively according to the macronutrient content of prey. Here we review laboratory studies demonstrating (...) the regulation of macronutrient intake by invertebrate and vertebrate predators, and address the question of whether this is likely to also occur in the wild. We conclude that it is highly likely that wild predators select prey or selectively feed on body parts according to their macronutrient composition, a possibility that could have significant implications for ecological and foraging theory, as well as applied wildlife conservation and management. (shrink)

Exhibition catalogue for the exhibition of drawings and paintings held as part of the Wilderness and Inner Space conference at the University of Kent, Canterbury 2008. The concept of Territorialization from Deleuze and Guattari is linked to ideas of wilderness to both describe the psychotherapeutic relationship and to critique the proposed state regulation of the psychotherapies. The transference and counter transference relation between client and psychotherapist is described as a process of territorialization and deterritorialization in which a dream of the (...) client led to the production of art works by the psychotherapist. This at work led to the production of imagery based around the therapeutic relationship involving key images of wild animals. The animal imagery is linked to Deleuze and Guattari's re-interpretation of Freud’s interpretation of the Wolfman dream, emphasizing the social and historical determinants of dream imagery. The interrelationships between Wilderness, Territorialization and the personal and the political in dream imagery suggest the psychotherapeutic space as located on the borders between the social and a wild or wilderness space. The need to recognise the wild dimension of psychotherapy highlights the necessity to resist the imposition of monocultures of therapeutic practice through possible state regulation. (shrink)

We develop a reading of Moore’s “Proof of an External World” that emphasizes the connections between this paper and Moore’s earlier concerns and strategies. Our reading has the benefit of explaining why the claims that Moore advances in “Proof of an External World” would have been of interest to him, and avoids attributing to him arguments that are either trivial or wildly unsuccessful. Part of the evidence for our view comes from unpublished drafts which, we believe, contain important clues concerning (...) Moore’s aims and intent. While our approach to PEW may be classified alongside other broadly "metaphysical" readings, we believe that a proper recognition of the continuity in Moore’s philosophical concerns and strategies across his philosophical career shows that the customary distinction between "epistemological" and "metaphysical" interpretative approaches to PEW is at best superficial. (shrink)

We tend to imagine revolution as a vivid tableau of uprisings and armed conflicts. Much less notice is taken of the complex layers of meaning that shape our understanding of these events: why some are seen as just expressions of a popular will, while others are condemned as wild disruptions of political order. A critical understanding of politics must grapple with these subtle, often unnoticed normative issues. This essay tries to understand some of the processes that create political normativity, investigating (...) the way revolutionary movements use time to endow themselves with normative value. I sketch a genealogy of revolution across three centuries, noting changes in its meaning, observing the rise of discourse as an important mode of revolutionary activity, and tracing a shifting mosaic of temporalities that are politicized in important ways. Time is instrumentalized to justify political insurgency in this history. Time, in short, becomes a tool of revolution. (shrink)

In this short note, we discuss several aspectsof dimensions and the related constructof factors. We concentrate on those aspectsthat are relevant to articles in this specialissue, especially those dealing with the analysisof the wild animal cases discussed inBerman and Hafner's 1993 ICAIL article. We reviewthe basic ideas about dimensions,as used in HYPO, and point out differences withfactors, as used in subsequent systemslike CATO. Our goal is to correct certainmisconceptions that have arisen over the years.

In this short note, we discuss several aspectsof “dimensions” and the related constructof “factors”. We concentrate on those aspectsthat are relevant to articles in this specialissue, especially those dealing with the analysisof the wild animal cases discussed inBerman and Hafner's 1993 ICAIL article. We reviewthe basic ideas about dimensions,as used in HYPO, and point out differences withfactors, as used in subsequent systemslike CATO. Our goal is to correct certainmisconceptions that have arisen over the years.