The Principle of Credulity: 'It is basic to human knowledge of the world that we believe things are as they seem to be in the absence of positive evidence to the contrary' [Swinburne 1996: 133]. This underlies the Evidential Problem of Evil, which goes roughly like this: ‘There appears to be a lot of suffering, both animal and human, that does not result in an equal or greater utility. So there's probably some pointless suffering. As God's existence precludes pointless suffering, (...) theism is implausible.’ CORNEA is the principle that observation O raises hypothesis H's probability only if O is more probable given H than it is given not-H. Theists sometimes maintain that apparently pointless suffering is just as likely given theism as atheism (I support this claim by appealing to a Lewisian account of the relevant counterfactuals). Given CORNEA, therefore, what we see of suffering does not make theism unlikely. I maintain that a consequence of so deploying CORNEA is that CORNEA and the Principle of Credulity are incompatible. We are left with a skeptical paradox. CORNEA is a consequence of Bayes’s Theorem, I argue; but it is incompatible with a presupposition of empirical science, namely, that appearances create epistemic warrant, ceteris paribus. External-world probability skepticism follows. I treat the paradox as real. First, I offer an account of how we strike a balance in practice between CORNEA, on the one hand, and the Principle of Credulity and the scientific enterprise on the other. Second, I try to resolve the paradox outright by rejecting the Principle of Credulity and maintaining that the scientific project remains well motivated even allowing probability skepticism. On either response to the paradox, the Evidential Problem of Evil continues to have serious, but defeasible, force against theism. (shrink)

One of the primary tools in the theist’s defense against “noseeum” arguments from evil is an epistemic principle concerning the Conditions Of ReasoNableEpistemic Access (CORNEA) which places an important restriction on what counts as evidence. However, CORNEA is false because it places too strong acondition on what counts as inductive evidence. If CORNEA is true, we lack evidence for a great many of our inductive beliefs. This is because CORNEA amounts to a sensitivity constraint on evidence, (...) and inductive evidence is often insensitive. So unless a theist is also an inductive skeptic, she must abandon CORNEA in responding to this sort of argument from evil. (shrink)

Could our observations of apparently pointless evil ever justify the conclusion that God does not exist? Not according to Stephen Wykstra, who several years ago announced the “Condition of Reasonable Epistemic Access,” or “CORNEA,” a principle that has sustained critiques of atheistic arguments from evil ever since. Despite numerous criticisms aimed at CORNEA in recent years, the principle continues to be invoked and defended. We raise a new objection: CORNEA is false because it entails intolerable violations of (...) closure. (shrink)

Graham and Maitzen think my CORNEA principle is in trouble because it entails “intolerable violations of closure under known entailment.” I argue that the trouble arises from current befuddlement about closure itself, and that a distinction drawn by Rudolph Carnap, suitably extended, shows how closure, when properly understood, works in tandem with CORNEA. CORNEA does not obey Closure because it shouldn’t: it applies to “dynamic” epistemic operators, whereas closure principles hold only for “static” ones. What the authors (...) see as an intolerable vice of CORNEA is actually a virtue, helping us see what closure principles should—and shouldn’t—themselves be about. (shrink)

Skeptical theists have been charged with being committed to global skepticism. I consider this objection as it applies to a common variety of skeptical theism based on an epistemological principle that Stephen Wykstra labeled “CORNEA.” I show how a recent reformulation of CORNEA (provided by Stephen Wykstra and Timothy Perrine) affords us with a formal apparatus that allows us to see just where this objection gets a grip on that view, as well as what is needed for an (...) adequate response. I conclude by arguing that, given some plausible, modest, and independently motivated anti-skeptical principles, this objection poses no threat to Wykstra’s brand of skeptical theism. (shrink)

This essays assesses Steve Wykstra's original CORNEA.

Long before skeptical theism was called “skeptical theism,” Stephen Wykstra (1984) defended a version of it based on an epistemological principle he called CORNEA. In this paper, I use elementary confirmation theory to analyze CORNEA’s core. This enables me to show precisely what is right about Wykstra’s very influential defense of skeptical theism and, perhaps more importantly, precisely what is wrong with it. A key premise of that defense is that, on the assumption that God exists, we wouldn’t (...) expect to know what God’s reasons for allowing certain evils are. I show that, while that premise together with CORNEA’s core shows that our inability to adequately explain the existence of those evils in terms of theism is not strong evidence against theism, it fails to show that the evils themselves are not strong evidence against theism. (shrink)

The problem of evil is best understood as an instance of what I call “the problem of defeated expectations.” These problems arise for theism when the world we experience does not conform to what we would expect to find in a world created and sustained by a being who is omnipotent, omniscient, and omnibenevolent. In this chapter, I explore skeptical theism, which is an approach to the evidential problem of evil that argues that, at least with respect to certain kinds (...) of evils we find, we simply should not have any firm expectation about whether the world would contain them or whether we would know why God permits them if it does. I focus on a particular variety of skeptical theism that makes use of a general epistemic principle to rebut the evidential problem of evil and defend it against criticisms. (shrink)

Skeptical theism is a family of responses to arguments from evil. One important member of that family is Stephen Wykstra’s CORNEA-based criticism of William Rowe’s arguments from evil. A cornerstone of Wykstra’s approach is his CORNEA principle. However, a number of authors have criticized CORNEA on various grounds, including that it has odd results, it cannot do the work it was meant to, and it problematically conflicts with the so-called common sense epistemology. In this paper, I explicate (...) and defend a CORNEA principle. After sketching a brief argument for it, I show how it can be acquitted of these recent charges. (shrink)

Segmentation of the medical image plays a significant role when it comes to diagnosis using computer aided system. This article focuses on the human corneal endothelium’s health, which is one of the filed research interests, especially in the human cornea. Various pathological environments fasten the extermination of the endothelial cells, which in turn decreases the cell density in an abnormal manner. Dead cells worsen the hexagonal design. The mutilated endothelial cells can no longer revive back and that gives room (...) for neighbouring cells to migrate and expand so that they can fill in the space. The latter results in cell elongation that is unpredictable as well as increase in size and thinning. Cell density and shape are therefore considered major parameters when it comes to explaining the health condition attributed to corneal endothelium. In this study, medical feature extraction was obtained depending on the segmentation of the endothelial cell boundary, and the task of segmentation of such objects especially the thin, transparent, and unclear cell boundary is considered challenging due to the nature of the image capture during endothelium layer examination by ophthalmologists using confocal or specular microscopy. The resulting image suffers from various issues that affect the quality of the image. Low quality is due to non-uniformity of illumination and the presence of a lot of noise and artefacts resulting from high amounts of distortion, and most of these limitations are present because of the nature of the imaging modality. Usually, images contain certain kind of noise and also continuous shadow. Furthermore, the cells are separated by poor border, thereby leading to great difficulty in the segmentation of the images. The irregular shape of cell and also the contrast of such images seem to be low as they possess blurry boundaries with diverse objects existing in addition to the lack of homogeneity. The main aim of the study is to propose and develop a totally automatic, robust, and real-time model for the segmentation of endothelial cells of the human cornea obtained by in vivo microscopy and computation of different clinical features of endothelial cells. To achieve the aim of this study a new scheme of image enhancement was proposed such as the Contrast-Limited Adaptive Histogram Equalisation technique to enhance contrast. After that, a new image denoising technique called Wavelet Transform Filter and Butterworth Bandpass for Segmentation is used. Subsequently, brightness level correction is applied by using the moving average filter and the CLAHE to reduce the effects of the non-uniform image lighting produced as a result of the previous step. The main aim of this article is the segmentation of endothelial cells, which involves precise detection of the endothelial contours. So a new segmentation model was proposed such that the shape of the cells will be extracted, and the contours were highlighted. This stage is followed by clinical feature extraction and uses the features for diagnosis. In this stage, several relevant clinical features such as pleomorphism mean cell perimeter, mean cell density, mean cell area, and polymegathism are extracted. The role of these clinical features is crucial for the early detection of corneal pathologies as well as the evaluation of the health of the corneal endothelium layer. The findings of this study were promising. (shrink)

With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from ‘opt‐in’ to ‘opt‐out’ systems for post‐mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained—at least partially—by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred—at least partially—from their not having recorded an objection to PMOD—on an official organ donation (...) register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt‐out frameworks, this paper draws attention to a set of previously unexplored problems for opt‐out organ donation arising in contexts where: (a) individuals demonstrate selective post‐mortem organ/tissue donation preferences, (b) legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt‐in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt‐out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt‐out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorization aspect of ‘opt‐out’ systems is framed (e.g. as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only). (shrink)

The inductive argument from evil to the non-existence of God contains the premise that, probably, there is gratuitous evil. Some skeptical theists object: one's justification for the premise that, probably, there is gratuitous evil involves an inference from the proposition that we don't see a good reason for some evil to the proposition that it appears that there is no good reason for that evil, and they use a principle, "CORNEA," to block that inference. The common sense problem of (...) evil threatens the CORNEA move, because the common sense problem of evil does not involve any inference to justify the belief that there is gratuitous evil. In this paper, I argue that the common sense problem of evil doesn't avoid CORNEA. CORNEA, or a reformulated version of it, can still prevent one from having justification for the belief that there is gratuitous evil. (shrink)

The problem of evil is the most prominent argument against the existence of God. Skeptical theists contend that it is not a good argument. Their reasons for this contention vary widely, involving such notions as CORNEA, epistemic appearances, 'gratuitous' evils, 'levering' evidence, and the representativeness of goods. We aim to dispel some confusions about these notions, in particular by clarifying their roles within a probabilistic epistemology. In addition, we develop new responses to the problem of evil from both the (...) phenomenal conception of evidence and the knowledge-first view of evidence. (shrink)

The limbus is a narrow band of tissue that encircles the cornea, the transparent ‘window’ into the eye. The outermost layer of the cornea is the epithelium, which is necessary for clear vision. The limbus acts as a ‘reservoir’ for limbal stem cells which maintain and regenerate the corneal epithelium. It also functions as a barrier to the conjunctiva and its blood vessels. Limbal stem cell deficiency is a general term for diseases which are characterised by the impairment (...) of the limbus, limbal stem cells and their ability to replenish the corneal epithelium through proliferation and differentiation. Consequently, sufferers experience chronic pain and progressive blindness. This paper will highlight the salient milestones of limbal stem cell biology and potential future treatments for limbal stem cell deficiency. (shrink)

The cornea was the first human solid tissue to be transplanted successfully, and is now a common procedure in ophthalmic surgery. The grafts come from deceased donors. Corneal therapies are now being developed that rely on tissue from living-related donors. This presents new ethical challenges for ophthalmic surgeons, who have hitherto been somewhat insulated from debates in transplantation and donation ethics. This paper provides the first overview of the ethical considerations generated by ocular tissue donation from living donors and (...) suggests how these might be addressed in practice. These are discussed in the context of a novel treatment for corneal limbal stem cell deficiency. This involves limbal cell grafts which are transplanted, either directly or after ex vivo expansion, onto recipient stem cell-deficient eyes. Where only one eye is diseased, the unaffected eye can be used as a source of graft tissue. Bilateral disease requires an allogenic donation, preferably from a genetically related living donor. While numerous papers have dealt with the theory, surgical approaches and clinical outcomes of limbal stem cell therapies, none has addressed the ethical dimensions of this form of tissue donation. (shrink)

Cornea (2012) argues that I (2011) was wrong to use the analogy between morality and motion to defend cultural relativism. I reply that the analogy can be used to clarify what cultural relativism asserts and how a cultural relativist can reply to the criticisms against it. Ockham’s Razor favours the relativist view that there are no moral truths, and hence no culture is better than another. Contrary to what Cornea claims, cultural relativism does not entail that we cannot (...) protect ourselves from those who attack us, and that the ruling of an international court lacks moral legitimacy. (shrink)

This article offers a new theory about how using lotteries to distribute scarce benefits satisfies beneficiaries' claims. In the first section of the article I criticize John Broome's view and on the basis of these criticisms set out four desiderata for a philosophically adequate account of claim satisfaction by lottery. In section II I propose and defend a new view called the dual structure view, so called because it posits that claimants have two types of claims in the relevant scarce (...) benefit distribution cases under discussion. This view meets all the desiderata set out in section I. Section III draws out the practical implications of my view for a variety of temporally extended cases, including the distribution of corneas to patients who have suffered corneal degeneration. (shrink)

Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders issued fatwa, or religious rulings, in favor (...) of organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthcare outcomes, prevent poor people from being coerced into selling their organs to rich recipients, and protect the solidarity and progeny of Bangladeshi families. (shrink)

Chris Tweedt has offered a solution to the “common sense problem of evil,” on which that there is gratuitous evil is justified non-inferentially as a trivial inference from non-inferentially justified premises by invoking versions of CORNEA. Tweedt claims his solution applies not only to the versions of the common sense problem of evil offered by Paul Draper and Trent Dougherty, but also to that offered by me in this journal in 1992. Here I argue that Tweedt fails to defeat (...) this version of the problem. So even if Tweedt’s response to Draper and Dougherty is successful, a version of the common sense problem of evil survives. (shrink)

Corneal transplantation is the most common form of organ transplantation performed globally. However, of all organs, eyes have the highest rate of refusal of donation. This study explored the reasons why individuals decide whether or not to donate corneas. Twenty-one individuals were interviewed who had made a donation decision (13 refused corneal donation and eight consented). Analysis was performed using Grounded Theory. Refusal of corneal donation was related to concerns about disfigurement and the role of eyes in memory and communication. (...) The request for donation therefore raised concerns about a potential adverse change in the ongoing relationship with the deceased, even in death. For those who refused donation, these concerns overshadowed awareness of need or benefit of transplantation. Adjusting the donation message to be more congruent with the real, lived experience of corneal donation may to some extent “prepare” individuals when the donation question is raised. (shrink)

Some skeptical theists use Wykstra’s CORNEA constraint to undercut Rowe-style inductive arguments from evil. Many critics of skeptical theism accept CORNEA, but argue that Rowe-style arguments meet its constraint. But Justin McBrayer argues that CORNEA is itself mistaken. It is, he claims, akin to “sensitivity” or “truth-tracking” constraints like those of Robert Nozick; but counterexamples show that inductive evidence is often insensitive. We here defend CORNEA against McBrayer’s chief counterexample. We first clarify CORNEA, distinguishing it (...) from a deeper underlying principle that we dub “CORE.” We then give both principles a probabilistic construal, and show how, on this construal, the counterexample fails. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM (...) report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for... (shrink)

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a racket of human traffickers who lure (...) rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies. (shrink)

Chris Tweedt has offered a solution to the “common sense problem of evil,” on which that there is gratuitous evil is justified non-inferentially as a trivial inference from non-inferentially justified premises by invoking versions of CORNEA. Tweedt claims his solution applies not only to the versions of the common sense problem of evil offered by Paul Draper and Trent Dougherty, but also to that offered by me in this journal in 1992. Here I argue that Tweedt fails to defeat (...) this version of the problem. So even if Tweedt’s response to Draper and Dougherty is successful, a version of the common sense problem of evil survives. (shrink)

The version uploaded to this site is a late draft. The paper arises both from William L. Rowe's classic 1979 discussion of the problem of evil, argues that there exist instances of intense suffering which an omnipotent, omniscient being could have prevented without thereby losing some greater good or permitting some evil equally bad or worse, and also from Steven Wykstra's response, in the course of which he argues for the following Condition of Reasonable Epistemic Access (CORNEA): "On the (...) basis of cognized situation s, human H is entitled to claim 'It appears that p' only if it is reasonable for H to believe that, given her cognitive faculties and the use she has made of them, if p were not the case, s would likely be different in some way discernible by her." My paper discusses CORNEA, and proposes a replacement principle. (shrink)

There is a widely acknowledged shortage of and an increasing demand for transplantable human organs and tissues (e.g., kidney, heart, lung, liver, cornea) in developed and developing countries around the world. In response to this need, Lott and Savulescu (2007) propose the creation of a human embryonic stem (hESC) bank to facilitate the equitable and efficient dissemination of human leukocyte anti- gen (HLA) matched tissues and organs to patients in need of replacement. Although not an unreasonable proposal, the authors (...) go on to make a much stronger claim. They argue that hESCs are such important tools for addressing the massive unmet global need for organs that it is ethically justified to require mandatory banking of spare embryos, and they argue for the use of financial (or other) inducements to procure embryos for the derivation of hESCs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethan’s GiftMichelle BurgessEthan was your average boy next door. He loved everything most 8–year–old boys do including playing baseball, swimming, and watching his favorite baseball team, the Philadelphia Phillies.On December 3rd 2008, life for our family changed forever when Ethan was diagnosed with Diffuse Intrinsic Pontine Glioma, a rare inoperable brainstem tumor. DIPG is in essence a death sentence. There are no survivors and life expectancy after diagnosis is (...) only 9–12 months. Our family was devastated.For the next 14 months, we lived life to the fullest, never taking a single moment or day for granted. As Ethan’s condition worsened, and it became clear that he was close to passing, I spoke with Ethan’s doctor about my desire to be able to donate Ethan’s corneas and his brain tumor for research. He informed me that because of Ethan’s type of tumor that he may be a candidate for donation of other organs as well if that is something we wanted to do.Knowing that there was nothing we could do to save Ethan, it was something that we felt we could do to help others so we decided to explore the option of donating Ethan’s other organs. We were put in contact with the Gift of Life.Two representatives from Gift of Life came to our home and discussed at length with us what would have to happen to make organ donation possible at the time of Ethan’s passing. Specifically that Ethan would have to pass away at the hospital and in the operating room. This was very different than the hospice environment that we had planned. They also had told us that Ethan was only the second young person that they had ever dealt with that the families had planned ahead of time to donate organs. The other person was a teenager who planned his own organ donation.On January 26th 2010, Ethan’s pain had become unmanageable at home and his breathing had become very labored. I spoke with his oncologist and he advised me to bring Ethan to the hospital to try and get his pain under control.We loaded Ethan up in the car for the one–hour car ride to the hospital. On the way to the hospital Ethan fell asleep while being cuddled by me in the backseat. When we arrived at the hospital we noticed that his fingers and toes had turned purple. The nurses immediately checked his oxygen and it had fallen to only 10 %.The doctors advised that he had slipped into a coma in the car, one that he would never awake from. He was immediately placed on life support. A scan was done and it was evident that the progressing tumor was placing pressure on the areas of the brain that controlled basic life functions such as breathing. Ethan could not recover.The decision was made to begin to look for recipients for Ethan’s organs. Because Ethan had not reached the point of brain death, his donation would have to be a post cardiac death transplant, meaning, life support would be removed, when his heart stopped beating and he passed away, the organ procurement would begin. However, he [End Page E1] would not be able to donate his heart. This was very sad for us, knowing how strong his little heart was, but we did understand the process.On January 28th 2010, our family spent the day saying goodbye to Ethan. Even though he could not respond, we know that he could hear us. The nurse was wonderful, doing everything possible to accommodate our large family and despite all the tubes and machines, make it so that I could cuddle with my little boy one last time.Ethan was moved to the operating room and with his stepfather and I on one side and his father and stepmother on the other, life support was removed. Watching my son take his last breath, while I held his hand, kissed his cheeks, told him I loved him and that it was okay to let go and go to Heaven was the hardest moment of... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 51-52 [Access article in PDF] Congress Considers Incentives for Organ Procurement Alexander S. Curtis [Tables]During the 108th Congressional session, several bills pertaining to ethical incentives for organ donation likely will be introduced. In some cases, they will be similar to bills before the 107th Congress (see Table 1). Bills in both the House of Representatives and the Senate address the establishment and (...) maintenance of donor registries, financial reimbursements for medical and nonmedical expenses incurred by qualifying donors, the presentation of commemorative medals, and tax credits.A bill entitled "Gift of Life Congressional Medal Act" (introduced last year by Senate majority leader Bill Frist (R-TN) as Senate Bill 325), and its corresponding bill of the same title (passed in the House of Representatives last year as H.R. 708), would establish a congressional commemorative medal honoring "any organ donor, or the family or family member of any organ donor." The medal is to be designed and struck with "suitable emblems, devices, and inscriptions" by the Secretary of the Treasury. The eligible donor or donor's family member would be presented with the medal by the Secretary of Health and Human Services. This bill would establish qualifying donations as those of human kidneys, livers, hearts, lungs, pancreases, or any other organ, but excludes corneas and eyes.Another bill, introduced by Representative Michael Bilirakis (R-FL) entitled "Organ Donation Improvement Act" (H.R. 624), would award grants or contracts to states, transplant centers, and qualified organ procurement organizations for the purpose of providing travel, subsistence, and incidental nonmedical expenses to individuals who make living donations. In order to receive reimbursement, the donating individuals must reside in states other than the states in which the intended recipients reside and the annual income of those receiving the organs cannot exceed $35,000. The bill also would appropriate $15,000,000 to make grants to states and public and nonprofit entities for the purpose of carrying out studies, public education demonstrations, and outreach activities "designed to increase the number of organ donors within the state." The bill would be effective from time of enactment through 2005. [End Page 51]Two other bills proposed within the House of Representatives in 2002 called for amendment to the Internal Revenue Code. The "Gift of Life Tax Credit Act (introduced as H.R. 1872 by Representative James Hansen (R-UT)) and the "Help Organ Procurement Expand Act" (introduced as H.R. 2090 by Representative Chris Smith (R-NJ)) present a refundable credit to individuals or to the estates of those who agree either to be living donors or to donate their organs upon death. The "Gift of Life Tax Credit Act" refunds $10,000 to the estates of eligible individuals "for the taxable year which includes the date of the individual's death." The "Help Organ Procurement Expand Act" offers a refund of $2,500 to qualified persons. Donations of kidneys, livers, pancreases, islet cells, lungs, and intestines are accepted, however several conditions restrict permissible donors. The "Gift of Life Tax Credit Act" requires that the legally competent individual's death not be due to a suicide and that the intention to donate was clearly declared. The "Help Organ Procurement Expand Act" prohibits donations from individuals who were killed with physician assistance, died as a result of a suicide, have been indicted or convicted of a felony or a misdemeanor offense, or are actively under criminal investigation for a possible felony offense. The "Help Organ Procurement Expand Act" also restricts procuring organs from unborn children or human fetuses and under circumstances in which the living donor would be subject to "unacceptable levels of medical risk of death or permanent debilitation." Alexander S. Curtis is a research assistant at the Kennedy Institute of Ethics, Georgetown University, Washington, DC. He received his bachelor's degree from Miami University.... (shrink)

In a previous paper it was suggested that specific concepts are needed in the psychological sciences and the basic mental triad was described as a useful tool to further our understanding of mentation. It was stated that the sensori-motor reflex principle cannot describe and explain mental phenomena, because the reflex is basically a mechanistic occurrence, while mental phenomena differ in essence from mechanisms. Since conditioned reflexes can be conceived as sensori-motor reflexes with another, non-mechanistic factor superimposed, similarities and contrasts between (...) reflexes and conditioned reflexes were taken as the material from which one can develop new thoughts about mentation. Reflex shutting of the eyelid, caused by direct contact between cornea and a small, invisible foreign body was compared with and contrasted to shutting the eye before a large, visible object thrusting toward the eye. It was shown that reflexes occur in response to a stimulus after the stimulus has been applied, while conditioned reflexes seem to anticipate the stimulus. This was taken as evidence that conditioned reflexes have a protensive character, have a relationship to the future, which sensori-motor reflexes lack. This difference in time relationship was developed into the statement that the difference between mechanisms and mental phenomena lies in their different relationship to the future. The need for specific concepts to describe mental phenomena stems from the inability of the reflex principle to deal with the protensive tendency of mental phenomena and to fill this need the concept of the basic mental triad was offered. This principle consists of three interdependent, interwoven phases: the triad connects with the past through condensation of some of the subject's past experience into a vaguely formed conglomerate; it connects with the future by projecting the condensed past into the future; the central phase of the triad is the act within the present instant, where a synthesis of past, present and future is accomplished. (shrink)

Cadaveric donation comprises organ donation—that is, taking organs from brain dead people, as well as tissue donation, meaning taking tissues from brain dead as well as heart dead people. The organ transplant procedure from brain dead patients is beyond the scope of the pathologist, as it is done by surgeons in the operating theatre. In a broader sense, however, pathologists are involved in cadaveric tissue donation as well as taking tissues from cadavers for diagnostic procedures within the framework of the (...) autopsy , and to gather material for research and training students and pathology residents . For cadaveric tissue donation, different ethical and practical issues must be considered, which we will try to review in this paper from the perspective of the pathologist.CADAVERIC TISSUE SAMPLING FOR TRANSPLANTATION PURPOSESSeveral tissues can be taken from “true” cadavers that may still be used for transplantation such as skin, corneas, tendons, bone. This is usually done in collaboration with the pathologist, who is in most countries responsible for the body after the death of the patient in the hospital. All these tissues can be harvested several hours after death, as they undergo only slow degradation. In The Netherlands, as dictated by law, patients must actively have given permission for donation during life by registering with the Transplantation Register. Since this procedure was implemented, the number of organs available for donation has not increased but decreased somewhat, while the number of tissues has increased. A great obstacle to the increase in the number of donations is that only 37% of the population is registered …. (shrink)

Endothelial cells in culture have, in the past, been a valuable but capricious tool to test hypotheses on the role of components of the blood vessel wall in such functions as blood pressure homeostasis, hemostasis, permeability, transport of macromolecules and the processing of circulating biologically active substances. Now techniques are becoming available for raising long‐term, large‐scale cultures that can be maintained reproducibly and without loss of phenotypic characteristics. The outlook for establishing endothelial cell factories invites speculation on some far‐reaching possibilities, (...) such as endothelial cell banks that could be used for seeding autogenous cells on vascular prostheses, artificial kidney tubing, heart valves, or corneas, or for virus production, or for synthesis by endothelial cells of products at present beyond the reach of bacterial cells. (shrink)

William Rowe has offered one of the most simple and convincing evidential arguments from evil by arguing that the existence of gratuitous evil in our world serves as strong evidence against the claim that God exists. Stephen J. Wykstra attempts to defeat this evidential argument from evil by denying the plausibility of Rowe’s claim that there are gratuitous evils in the world. Wykstra sets up an epistemological test that he refers to as CORNEA, and he proceeds to demonstrate that (...) Rowe’s inference to his existential claim is unjustified in light of our particular epistemic situation. Specifically, this inference is unjustified because compensating goods that would be “connected to” any given evil lack what Wykstra calls ‘seeability.’ Without seeability, it is illicit to infer the nonexistence of an object simply from the fact that we cannot detect it, and thus Rowe is denied justification for his first premise. Wysktra’s principle defense of the non-seeability of compensating goods rests on an analogy comparing children and parents to humans and God. I will show that Wykstra’s conclusion regarding the seeability of compensating goods is unjustified given this analogy. Without justification for the claim that some compensating goods lack seeability, Wykstra’s defeater crumbles. (shrink)

Mrs. J was a 66-year-old Muslima who was brought to the hospital from the subacute unit where she had been living for the past 2 years because of intense pain caused by keratitis, an inflamed cornea of a nonfunctioning eye. In addition to her severe eye pain, Mrs. J suffered with a number of other difficult medical conditions, including amyotrophic lateral sclerosis. She was both gastric tube and ventilator dependent and had a history of multiple myleoma, chronic obstructive pulmonary (...) disease, and congestive heart failure. Mrs. J came from a large and traditional Muslim family with 6 children and 17 grandchildren. Although she had full decisionmaking capacity, she designated one of her sons to make her medical decisions for her. (shrink)

David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USA: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard to (...) pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets, neuronal cells, and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organs. (shrink)

Skeptical theism, broadly construed, is an attempt to leverage our limited cognitive powers, in some specified sense, against “evidential” and “explanatory” arguments from evil. Since there are different versions of these kinds of arguments, there are correspondingly different versions of skeptical theism. In this paper, I briefly explain three versions of these arguments from evil (two from William Rowe and one from Paul Draper) and the three versions of skeptical theism tailor-made to block them (from Stephen Wykstra, Michael Bergmann, and (...) Peter van Inwagen). (shrink)

Skeptical theism, broadly construed, is an attempt to leverage our limited cognitive powers, in some specified sense, against “evidential” and “explanatory” arguments from evil. Since there are different versions of these kinds of arguments, there are correspondingly different versions of skeptical theism. In this paper, I consider four challenges to three central versions of skeptical theism: (a) the problem of generalized skepticism, (b) the problem of moral skepticism, (c) the problem of unqualified modal skepticism, and (d) the challenge from Bayesian (...) epistemology. (shrink)

In a pair of recent articles, Jim Stone presents a new version of the Evidential Argument from Evil. I provide two arguments against Stone’s Evidential Problem of Evil, one from the dialectical standpoint of a theist, the second from a dialectical standpoint that is neutral between theism and atheism. In neither case, I argue, should an interlocutor accept all the premises of the argument.