Throughout the 20th century, many doctors did not view pain management as an important aspect of their practice. Because pain cannot be objectively measured by the doctor, many doctors found it dif...

There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing (...) Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics. (shrink)

In the United States, patients have a clear right to determine what is done to them by doctors. Starting in the early 20th century, multiple court cases paved the way for our current understanding...

The American Journal of Bioethics, Volume 11, Issue 11, Page 22-23, November 2011.

Volume 20, Issue 3, March 2020, Page 19-21.

Volume 20, Issue 6, June 2020, Page 30-32.

The growing support for voluntary active euthanasia is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may (...) conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

Shocking. There seems no other response to the Fox findings. The bioethics community has been working for decades to improve the quality of, and access to, competent healthcare ethics consultation....

The American Society for Bioethics and Humanities promulgated standards for clinical ethics consultants and is currently developing a national Quality Attestation in Clinical Ethics Consultation to assist facilities in ensuring that those performing clinical ethics consultations meet minimum standards. As the field moves towards such professionalization, there is a need to provide access to qualified clinical ethicists at a broad range of medical facilities. Currently, however, there are insufficient numbers of trained clinical ethicists to staff all healthcare facilities, and many (...) facilities lack the necessary resources to hire staff clinical ethicists. In this review, we describe several models for providing expert clinical ethics support to remote facilities that lack access to qualified clinical ethicists. Based on this analysis, we recommend telemedicine as the optimal model providing expert support to local ethics committee members tasked with providing clinical ethics consultation services. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 41-42, June 2011.

The American Journal of Bioethics, Volume 12, Issue 8, Page 15-17, August 2012.

(2011). Life and Death Choices in Neonatal Care: Applying Shared Decision-Making Focused on Parental Values. The American Journal of Bioethics: Vol. 11, No. 2, pp. 35-36.

(2010). Ethical Rules for Human Subjects Research: A Case Where the “Is” Must Inform the “Ought”. The American Journal of Bioethics: Vol. 10, No. 6, pp. 14-15.

Recently, five major critical care professional organizations in North America and Europe published a consensus policy statement on how intensive care unit clinicians should respond to patient or surrogate requests for potentially inappropriate treatments. Subsequently, the Society for Critical Care Medicine, the largest multidisciplinary critical care organization and one of the authors of the Multiorganization Policy Statement, issued a companion statement defining futile and potentially inappropriate interventions. These statements support previous work published by the SCCM Ethics Committee 20 years ago. (...) The critical care... (shrink)

BackgroundThe emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated cases (RGCs) (...) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format.ResultsOf twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts.ConclusionBased on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education. (shrink)

Being the parents of a premature infant can be extremely stressful. Even when parents know that there is a high chance of premature birth, they are often in shock when their infant arrives too earl...

The posterior cortex, hippocampus, and prefrontal cortex in the Leabra architecture are specialized in terms of various neural parameters, and thus are predilections for learning and processing, but domain-general in terms of cognitive functions such as face recognition. Also, these areas are not encapsulated and violate Fodorian criteria for modularity. Anderson's terminology obscures these important points, but we applaud his overall message.

It is widely accepted that electoral representative democracy is better—along a number of different normative dimensions—than any other alternative lawmaking political arrangement. It is not typically seen as much of a competition: it is also widely accepted that the only legitimate alternative to electoral representative democracy is some form of direct democracy, but direct democracy—we are told—would lead to bad policy. This article makes the case that there is a legitimate alternative system—one that uses lotteries, not elections, to select political (...) officials— that would be better than electoral representative democracy. (shrink)

This paper takes on several distinct but related tasks. First, I present and discuss what I will call the “Ignorance Thesis,” which states that whenever an agent acts from ignorance, whether factual or moral, she is culpable for the act only if she is culpable for the ignorance from which she acts. Second, I offer a counterexample to the Ignorance Thesis, an example that applies most directly to the part I call the “Moral Ignorance Thesis.” Third, I argue for a (...) principle—Don’t Know, Don’t Kill—that supports the view that the purported counterexample actually is a counterexample. Finally, I suggest that my arguments in this direction can supply a novel sort of argument against many instances of killing and eating certain sorts of animals. (shrink)

This paper connects the question of the rationality of voting to the question of what it is morally permissible for elected representatives to do. In particular, the paper argues that it is rational to vote to increase the strength of the manifest normative mandate of one's favored candidate. I argue that, due to norms of political legitimacy, how representatives ought to act while in office is tied to how much support they have from their constituents, where a representative’s “support” is (...) a function of the percentage of adults living in the political jurisdiction who voted for her. In a representative system, whether a particular law or policy is legitimate is in part a function of how much support the particular representative government has, rather than simply being a function of the governmental structure or the normative content of the law or policy. Representatives with more support can permissibly act more like trustees (doing what they think is best) and less like delegates (doing what their constituents presently prefer). I argue that this fact provides a reason for individuals to vote, even given the incredibly small chance an individual voter has of casting a pivotal vote. (shrink)

I argue that Hubert Dreyfus’ work on embodied coping, the intentional arc, solicitations and the background as well as his anti-representationalism rest on introspection. I denote with ‘introspection’ the methodological malpractice of formulating ontological statements about the conditions of possibility of phenomena merely based on descriptions. In order to illustrate the insufficiencies of Dreyfus’ methodological strategy in particular and introspection in general, I show that Heidegger, to whom Dreyfus constantly refers as the foundation of his own work, derives ontological statements (...) about the conditions of possibility of phenomena not merely from descriptions, but also from analyses. I further show that deriving ontological statements directly from descriptions entails implausible results. I do so by discussing representative cases. Based on these general methodological considerations, I show that Dreyfus’ work on action, skill and understanding is introspective. First, I demonstrate that Dreyfus’ influential claim that rules and representations do not govern skillful actions is the result of introspection, because it is merely founded on the absence of rules and representations in representative descriptions of skillful actions. Second, I show that Dreyfus’ work on embodied coping, the intentional arc, solicitations and the background is also based on introspection. These ontological structures are merely reifications of descriptions and are not further substantiated by analyses. (shrink)

In the paper, a detailed analysis of some new logical aspects of Cantor’s diagonal proof of the uncountability of continuum is presented. For the first time, strict formal, axiomatic, and algorithmic definitions of the notions of potential and actual infinities are presented. It is shown that the actualization of infinite sets and sequences used in Cantor’s proof is a necessary, but hidden, condition of the proof. The explication of the necessary condition and its factual usage within the framework of Cantor’s (...) proof makes, Cantor’s proof invalid. It’s shown that traditional Cantor’s proof has a second necessary, but hidden as well, condition which is teleological by its nature, i.e., is not mathematical. The explication of the second necessary condition makes Cantor’s statement on the uncountability of continuum unprovable from the point of view of classical logic.One of the most dramatic facts in history of science is connected just with the notion of actual infinity and consists in the following. On the one hand, Aristotle, Berkeley, Locke, Descartes, Spinoza, Gauss, Kant, Cauchy, Kronecker, Hermite, Poincaré, Bair, Borel, Brouwer, Quine, Wittgenstein, Weyl, Luzin, and a lot of other outstanding creators of classical logic and classical mathematics, during millenniums, stated categorically and insistently warned about that the actual infinity is a self-contradictory notion and its usage in mathematics is inadmissible (e.g., according to Poincare, “There is no actual infinity. - Cantorians forgot that and fell into contradictions. Later generations will regard Mengenlehre (set theory) as a disease from which one has recovered”). On the other hand, a lot of outstanding scientists of the XX c.c., such as Hilbert, Church, Turing, Gödel, etc., and modern axiomatic set theory as a whole ignored this (intuitive though) opinion of genii and accepted Cantor’s “transfinite paradise”, based on the actual infinity. In the paper some logical, philosophical, and psychological aspects of this historical “favorable opposition” are analyzed, and the fact that the scientific intuition of genii has won the historical battle against the mytho-’logic’ of Cantor’s transfinite ‘paradise’ is explained and logically justified. (shrink)

In the paper, a detailed analysis of some new logical aspects of Cantor’s diagonal proof of the uncountability of continuum is presented. For the first time, strict formal, axiomatic, and algorithmic definitions of the notions of potential and actual infinities are presented. It is shown that the actualization of infinite sets and sequences used in Cantor’s proof is a necessary, but hidden, condition of the proof. The explication of the necessary condition and its factual usage within the framework of Cantor’s (...) proof makes, Cantor’s proof invalid. It’s shown that traditional Cantor’s proof has a second necessary, but hidden as well, condition which is teleological by its nature, i.e., is not mathematical. The explication of the second necessary condition makes Cantor’s statement on the uncountability of continuum unprovable from the point of view of classical logic.One of the most dramatic facts in history of science is connected just with the notion of actual infinity and consists in the following. On the one hand, Aristotle, Berkeley, Locke, Descartes, Spinoza, Gauss, Kant, Cauchy, Kronecker, Hermite, Poincaré, Bair, Borel, Brouwer, Quine, Wittgenstein, Weyl, Luzin, and a lot of other outstanding creators of classical logic and classical mathematics, during millenniums, stated categorically and insistently warned about that the actual infinity is a self-contradictory notion and its usage in mathematics is inadmissible (e.g., according to Poincare, “There is no actual infinity. - Cantorians forgot that and fell into contradictions. Later generations will regard Mengenlehre (set theory) as a disease from which one has recovered”). On the other hand, a lot of outstanding scientists of the XX c.c., such as Hilbert, Church, Turing, Gödel, etc., and modern axiomatic set theory as a whole ignored this (intuitive though) opinion of genii and accepted Cantor’s “transfinite paradise”, based on the actual infinity. In the paper some logical, philosophical, and psychological aspects of this historical “favorable opposition” are analyzed, and the fact that the scientific intuition of genii has won the historical battle against the mytho-’logic’ of Cantor’s transfinite ‘paradise’ is explained and logically justified. (shrink)