(2001). Making the Things of the World: Narrative Construction and the Project of Bioethics. The American Journal of Bioethics: Vol. 1, No. 1, pp. 59-61.

This essay addresses the questions, “what good is religious ethics for?” and “what justification exists for the field?” in three steps. First, it canvases how religious ethicists have offered reasons for carrying out work in the field to identify anAnti‐Reductive Paradigmthat is guided by anEgalitarian Imperative. That imperative functions as a thin, minimal morality of inclusivity and equal respect that guides work in the field. Second, the essay considers the field's ends. Here the focus shifts from values that shape the (...) field'smethodsto values that can describe the field'spurposes. That shift requires us to think in terms of a thick rather than a thin morality, one with substantive rather than procedural virtues in mind. The essay offers a constructive, substantive proposal under the rubric ofCritical Humanism. Critical Humanism justifies the study of religious ethics as an enterprise that can expand the moral imagination through its encounter with difference. It is shaped by four values: post‐critical reasoning, social criticism, cross‐cultural fluency, and environmental responsibility. Third, the essay brings the two parts of the argument together by explaining how to connect such purposes to the thin morality of inclusivity and equal respect. One upshot of the essay is to have us think not only about values, but also about power as it pertains to scholarship in the guild; hence the attention to the ethics and politics of religious ethics. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

Work on analogy has been done from a number of disciplinary perspectives throughout the history of Western thought. This work is a multidisciplinary guide to theorizing about analogy. It contains 1,406 references, primarily to journal articles and monographs, and primarily to English language material. classical through to contemporary sources are included. The work is classified into eight different sections (with a number of subsections). A brief introduction to each section is provided. Keywords and key expressions of importance to research on (...) analogy are discussed in the introductory material. Electronic resources for conducting research on analogy are listed as well. (shrink)

What does autonomy mean from a moral point of view? Throughout Western history, autonomy has had no less than four different meanings. The first is political: the capacity of old cities and modern states to give themselves their own laws. The second is metaphysical, and was introduced by Kant in the second half of the 18th century. In this meaning, autonomy is understood as an intrinsic characteristic of all rational beings. Opposed to this is the legal meaning, in which actions (...) are called autonomous when performed with due information and competency and without coercion. This last meaning, the most frequently used in bioethics, is primarily legal instead of moral. Is there a proper moral meaning of the word autonomy? If so, this would be a fourth meaning. Acts can only be called moral when they are postconventional (using the terminology coined by Lawrence Kohlberg), inner-directed (as expressed by David Riesman), and responsible (according to Hannah Arendt). Such acts are autonomous in this new, fourth, and to my mind, the only one proper, moral meaning. The goal of ethics cannot be other than forming human beings capable of making autonomous and responsible decisions, and doing so because they think this is their duty and not because of any other nonmoral motivation, like comfort, convenience, or satisfaction. The goal of ethics is to promote postconventional and mature human beings. This was what Socrates tried to do with the young people of Athens. And it is also the objective of every course of ethics and of any process of training. (shrink)

Given the current organ shortage, a prevalent alternative to the altruism-based policy is a market-based solution: pay people for their organs. Receiving much popular and scholarly attention, a salient normative argument against neoliberal pressures is the preservation of human dignity. This article examines how advocates of both the altruistic status quo and market challengers reason and weigh the central normative concept of dignity, meant as inherent worth and/or rank. Key rhetorical strategies, including motivations and broader social visions, of the two (...) positions are analyzed and evaluated, and the separation of morally normative understandings of dignity from market encroachment is defended. (shrink)

Purpose With the increasing sophistication of neuroimaging technologies in medicine, new language is being sought to make sense of the findings. The aim of this paper is to explore whether the brain-reading metaphor used to convey current medical or neurobiological findings imports unintended significations that do not necessarily reflect the genuine findings made by physicians and neuroscientists. Methods First, the paper surveys the ambiguities of the readability metaphor, drawing from the history of science and medicine, paying special attention to the (...) sixteenth through nineteenth centuries. Next, the paper addresses more closely the issue of how metaphors may be confusing when used in medicine in general, and neuroscience in particular. The paper then explores the possible misleading effects associated with the contemporary use of the brain-reading metaphor in neuroimaging research. Results Rather than breaking new ground, what we see in current scientific language is a persistence of both a constraining and expansive set of language practices forming a relatively continuous tradition linking current neuroimaging to past scientific investigations into the brain. Conclusions The use of the readability metaphor thus carries with it both positive and negative effects. Physicians and neuroscientists must resort to the use of terms already laden with abstracted meanings, and often burdened by tradition, at the risk of importing through these words connotations that do not tally with the sought-after objectivity of empirical science. (shrink)

To find adequate answers to a changing reality heavily influenced by advances in technology, medical professionals have developed and adopted an array of terms that have brought new concepts into the profession. “Dignity,” “vegetative state,” “futility,” “double effect,” and “brain death” have become indispensable words in the medical setting. In the following discussion, the attention is on terminology. If we believe in phenomenology, the assumption is that we should closely reflect on the words we use in all spheres of life, (...) especially in those that concern life and death. This article calls for a sincere discussion about these terms and concepts. The thesis put forward is that the language in the medical setting serves primarily the physicians, at times at the expense of the patients’ best interests. This language and the concepts it describes have generated an unhealthy atmosphere for patients, which might lead to undesirable actions at the end of patients’ lives. (shrink)

: Moral frameworks for evaluating non-donation strategies to increase the supply of cadaveric human organs for transplantation and ways to overcome barriers to organ donation are explored. Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices. From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible but then turn out to be ineffective and perhaps (...) even counterproductive because of inadequate attention to these rich and complex features of human body parts. Excessively rationalistic policies neglect deep beliefs, symbols, sentiments, and emotions and the like, and that deficiency marks many actual and proposed policies. In addition, policies are often too individualistic and too legalistic. (shrink)

This essay appreciatively and critically engages the late Robert Veatch’s extensive and important contributions to transplantation ethics, in the context of his overall ethical theory and his methods for resolving conflicts among ethical principles. It focuses mainly on ways to obtain and allocate organs from deceased persons, with particular attention to express donation, mandated choice, and presumed consent/routine salvaging in organ procurement and to conflicts between medical utility and egalitarian justice in organ allocation. It concludes by examining the unclear relations (...) between Veatch’s ideal moral theory and his nonideal moral theory, especially in organ allocation. (shrink)

Tom Beauchamp and I were asked by the editors of The Journal of Medicine and Philosophy to prepare “intellectual autobiographies,” with particular attention to sources and influences on our work, including but not limited to Principles of Biomedical Ethics. Of course, it is artificial and even impossible to try fully to separate the “intellectual” from other aspects of our lives. So, while emphasizing the “intellectual” aspects of my autobiography, I have attended to other aspects, too. The huge debts of gratitude (...) I owe also mix the “intellectual” and other aspects of life. (shrink)

In the wake of two recent developments in stem cell research, it is a fitting time to reassess the claim that stem cells will radically transform the concept and function of medicine. The first is the U.S. Food and Drug Administration’s decision in January 2009 to approve Geron Corporation’s Phase I clinical trial using human embryonic stem cells for patients with spinal cord injuries. The second is the National Institutes of Health’s decision to permit federal funding of research using donated (...) IVF human embryos in their July 2009 Guidelines on Human Stem Cell Research. We are now poised to see whether stem cell research can deliver on what it promises. However, what exactly does it promise and how? Moreover, who is doing the promising? Turning to the use of metaphor can help us to answer these questions and enable us to develop a better appreciation of the unique features of promised stem cell therapies. Indeed, metaphors have exerted profound influence in medicine, and it is fitting that we seek new metaphors for new therapies where appropriate. In this case, other metaphors such as magic bullets or the Holy Grail cannot capture what is unique about stem cells. Accordingly, I propose a new metaphor: the stem cell superhero. Stem cell superheroes are characterized by the following traits: they are seemingly capable of fighting the evil of virtually all disease and they seem to be our only hope of doing so, although to summon them we must make difficult moral choices. In the course of assessing the merits of three recent yet covert references to the superhero metaphor, I conclude that this powerful new paradigm employs a problematic logic, but that the aspiration as such is a good one. (shrink)