It was in the course of one particular clinical encounter that I came to realize the power of narrative, especially for expressing clinically presented ethical matters. In Husserlian terms, the mode of evidence proper to the unique and the singular is the very indirection that is the genius of story-telling. Moreover, the clinical consultant is unavoidably changed by his or her clinical involvement. The individuals whose situation is at issue have their own stories that need telling. Clinical ethics is in (...) this sense a way of helping patients, families, and, yes, health providers to discover and give voice to those stories. In this way, clinical ethics is an evoking of meaning. Kierkegaard understood this well: Indirect communication is the language for the unique and the otherwise inexpressible. (shrink)

1. Conferences on the subject of need are lamentably rare. All the more honour then for this one to the Royal Institute of Philosophy (an organisation long dedicated to saving philosophy’s better self from its worse), to the Philosophy Department at Durham, and to Soran Reader, the organizer and editor.1. Conferences on the subject of need are lamentably rare. All the more honour then for this one to the Royal Institute of Philosophy (an organisation long dedicated to saving philosophy’s better (...) self from its worse), to the Philosophy Department at Durham, and to Soran Reader, the organizer and editor. (shrink)

Wittgenstein, in his famous critique of philosophy, noted that the influence of an idea can be such that it alters the way that we see the world. “It is like a pair of glasses on our nose through which we see whatever we look at,” he said. “It never occurs to us to take them off.” This view of the power of an idea suggests that the interpretation of an event, and what response this event calls for, can depend upon (...) the view one has of the world. A person who is naive about medical facts may, for example, interpret chest pain upon exertion as a sign that he is “overdoing it”; were he more medically knowledgeable, the same symptom might be interpreted as a possible indicator of coronary artery disease. The naive interpretation calls for rest; the informed interpretation calls for medical attention as well. (shrink)

Sister (Sr.) Marie Simone Roach, of the Sisters of St. Martha of Antigonish, Nova Scotia, died at the Motherhouse on 2 July 2016 at the age of 93, leaving behind a rich legacy of theoretical and practical work in the areas of care, caring and nursing ethics. She was a humble soul whose deep and scholarly thinking thrust her onto the global nursing stage where she will forever be tied to a central concept in nursing, caring, through her Six Cs (...) of Caring model. In Canada, she was the lead architect of the Canadian Nurses Association's first code of ethics, and her influence on revisions to it is still profound more than 35 years later. In this paper, four global scholars in nursing and ethics are invited to reflect on Sr. Simone's contribution to nursing and health‐care, and we link her work to nursing and health‐care going forward. (shrink)

The author argues that to explore what is distinctly Christian about Christian bioethics requires clarity about what is Christian. He distinguishes between the Christian (that which can be identified as authentically Christian), Christianity (the sum of that which is authentically Christian), and ecclesiastical traditions (the historic communities of faith and practice that are predicated upon both Christian and extra-Christian tradition) to critically assess what is to be declared Christian. In addition to exploring the role of New Testament scripture in identifying (...) the Christian, the author emphasizes the need to recognize the extent to which the content of Christianity is Hebraic and Jewish. (shrink)

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

Human experimentation can have different meanings: indeed, with the development of medical research, therapeutic acts have to be distinguished from acts of cognitive values. For each kind of acts, specific conditions of acceptability and specific protections of human beings have to be defined.Human experimentation must be envisaged at different levels to evaluate ethical aspects: its scientific value, the risks, benefits envisaged, the populations implicated, etc…The individual consent must be present too in the relationship between the subject and the doctors. In (...) fact, is a real consent possible?Instead to insist on problems in terms of medical research, one would have to insist perhaps more on the fact that the medical practice in general would have to answer more to ethical grounds and to scientific rules. It is the non scientific medicine which is immoral and dangerous, as well the medicine with financial interests, or also the medecine without experimentation.The main arguments must remain at the level of the dignity of the persons, autonomy and freedom of choice must remain the fundamental values. (shrink)

Value-freedom or value-neutrality is a well-known topic in the philosophy of science. But what about the value-neutrality of technology, medical or other? Is it too far-fetched to imagine technology as in some sense value-neutral — in view of its intimate connection with purposeful human action? No; unexpected perhaps, but less far-fetched than expected. If we try to conceive of technology as a cognitive possibility abstracted from each and every specific social context, we shall find three senses in which it may (...) be regarded as value-neutral: neutral vis-à-vis different possible uses and ends; neutral before action; neutral qua cognitive object, analogous to the cognitive core of science. The further meanings and implications of these three senses of value-neutrality are discussed.What is this exercise good for? The nature of technology is indeed worth pondering in its own right, not least from this rather unusual angle. But beyond that: as the possible meanings of value-neutrality are tried out, the radical nature of human responsibility for the social implementation of technology will be highlighted. (shrink)

Despite the advent of CRISPR, safe and effective gene editing for human enhancement remains well beyond our current technological capabilities. For the discussion about enhancing human beings to be worth having, then, we must assume that gene-editing technology will improve rapidly. However, rapid progress in the development and application of any technology comes at a price: obsolescence. If the genetic enhancements we can provide children get better and better each year, then the enhancements granted to children born in any given (...) year will rapidly go out of date. Sooner or later, every modified child will find him- or herself to be “yesterday’s child.” The impacts of such obsolescence on our individual, social, and philosophical self-understanding constitute an underexplored set of considerations relevant to the ethics of genome editing. (shrink)

Ever since the publication of Derek Parfit’s Reasons and Persons, bioethicists have tended to distinguish between two different ways in which reproductive technologies may have implications for the...

The recent crises of BSE and FMD in the United Kingdom have revealed widespread concerns on the part of farmers and consumers about government regulations and handling of animal movements, animal welfare, and food safety. Both crises raised issues of government accountability and the lack of openness in public debate. The issues of democratic process and decision-making were especially strong in relation to the mass slaughter policy of the government to control FMD. This article explores public disquiet about these matters, (...) as expressed through the reports of two public inquiries, and the perceived links between government decision-making and the needs of global agribusiness, to the detriment of family farms and animal welfare. In light of the growing evidence about the environmental and economic costs of agribusiness, the argument is made that strong programs of citizen action, such as the Devon Foot and Mouth Inquiry, that are grounded in an ethical stance on animal welfare can challenge the perspectives of central governments about concepts of cost, efficiency, and safety in agriculture. (shrink)

What is or should be the place of the ethical dimension in a general enactive theory of sociality? How should such a dimension be understood and articulated within the more general picture of the enactive approach to social life? In this paper, building on Emmanuel Levinas’ philosophy, we argue that ethics should be understood as a distinct dimension of the complex and multidimensional phenomenon of sociality; a dimension of radical otherness that intertwines with but does not reduce to the intersubjective (...) dynamics of social life. In showing the particular place that the ethical dimension occupies in the general picture of sociality, we show, following Levinas, why sociality is more than intersubjectivity and how enactivism, if interested in a comprehensive account of ethics, would benefit from this insight. (shrink)

In this paper, I would like to argue that brain-dead small children have a natural right not to be invaded by other people even if their organs can save the lives of other suffering patients. My basic idea is that growing human beings have the right to grow in the form of wholeness, and dying human beings also have the right to die in the form of wholeness; in other words, they have the right to be protected from outside invasion, (...) unless they have declared their wish to abandon that right beforehand. I call this the principle of wholeness. Natural rights, which were discussed by Hobbes and Locke in the 17th century, have to be extended to include the right to grow and die in the form of wholeness in the age of scientific civilization, where peripheral human lives are being threatened by aggressive biomedicine and other advanced technologies. (shrink)

Die Medikalisierung des Sterbens hat dazu geführt, dass ein „guter Tod“ zunehmend auch von medizinischen Interventionen erwartet wird. Die Möglichkeiten einer „terminalen Sedierung“ bis zum Tode werden von vielen als Ausweg angesehen, wenn bei unerträglichem Leid und aussichtsloser Prognose der Wunsch nach aktiver Sterbehilfe angesprochen wird. Durch eine Sedierung können zwar bei schwerstkranken Patienten schwerste therapierefraktäre Leidenszustände effektiv gelindert werden. Diese Therapieoption kann aber auch in der Absicht angewendet werden, den Todeseintritt medizinisch zu beschleunigen, so dass im Zusammenhang mit der (...) Euthanasiedebatte auch das Thema der terminalen Sedierung kontrovers diskutiert wird. Richtlinien zu Indikation, Technik und Dokumentation sind notwendig, um Stellenwert und Grenzen der terminalen Sedierung im Rahmen der palliativen Betreuung am Lebensende zu verdeutlichen und durch Transparenz Fehlentwicklungen zu vermeiden. (shrink)

Following the revival in the last decades of the concept of “organism”, scholarly literature in philosophy of science has shown growing historical interest in the theory of Immanuel Kant, one of the “fathers” of the concept of self-organisation. Yet some recent theoretical developments suggest that self-organisation alone cannot fully account for the all-important dimension of autonomy of the living. Autonomy appears to also have a genuine “interactive” dimension, which concerns the organism’s functional interactions with the environment and does not simply (...) derive from its internal organisation. Against this background, we focus on a family of natural philosophical approaches that historically have already strongly taken in account this aspect of autonomy, notably going beyond Kant’s perspective on self-organisation. We thus review Hegel, Plessner, and Jonas’ different perspectives on living beings, focussing in particular on four points: the distinction between organic and inorganic, the theory of biological organisation, the processuality of the living, and the “boundary” between inside and outside, through which the organism establishes its relationship to the environment. We, then, compare the three perspectives on these four points, and finally address the question of what advantages their contribution present—especially compared to Kant’s theory—with respect to the topic of organism’s autonomy. This could help—we hope—to better understand what is at the stake still today. (shrink)

In times of social and moral crises, sport has often been called to boost individual moral development. By the same token, outdoor activities are viewed as good educational practices to enhance environmental responsibility. However, the present paper argues that these physical activities are currently following the same technological development trend as the mainstream society, and challenges this trend itself in terms of sustainability by critically asking this question: Do outdoor activities really enhance environmental responsibility? The research supporting this paper is (...) based on a qualitative inquiry using interviews with outdoor activities practitioners: mountain guides and white water sports instructors. The findings of this research show that environmental responsibility development depends on the sport contexts. It is fostered in slow and none-technological activities and lowered in fast and technological activities. The paper concludes with the following paradox reached by the preliminary research results: the birth of modern technology calls for greater need of environmental responsibility, but it may also prevent its development at the same time. (shrink)

Modern technology presents new challenges and possibilities to the environment and life on earth. It is argued that ecology as the science of the earth as a whole cannot provide the means for making technical decisions pertaining to the environment. An alternative means is suggested in which modern technology provides the medium for communicating with nature, so that a dialogue, an intruding in and listening to nature, becomes the basis both for seeing modern technology in a new light and for (...) living with modern technology in a new way. Some theological ramifications are also explored. (shrink)

The possibility of in-breakings of God in science is discussed. A realist philosophy of science is used as a framework in which new paradigms are seen as providing ever better approximations to the true underlying structure of nature, which will be revealed in the eschaton. It is argued that ecology–the study of the earth as a whole–cannot be treated as a natural science because there can be no paradigms for understanding the earth as a whole. Instead technology is used as (...) a means for interacting with God through nature. (shrink)

Abstract.This article examines an orientation for thinking theologically and ethically about the cultural pattern of technology and a vision for living responsibly within it. Building upon and joining select insights of philosophers Hans Jonas and Albert Borgmann, I recommend the analytic and evaluative leverage to be gained through development of an integrative biocultural theological anthropology.

Late antique Gnosticism and Heidegger’s Existentialism are usually counted among the main theoretical targets of Hans Jonas’s philosophy of life and responsibility, since they are supposed to share the dualistic and nihilistic attitude the philosopher deemed most mistaken and pernicious. In particular, Gnosticism is commonly understood as the exact opposite of what Jonas strove to accomplish in his work. However, I think it is simplistic to relegate Gnosticism to a merely antagonistic role in the development of Jonas’s philosophy. My claim (...) is that Gnosticism, being a non-nihilistic form of dualism, might have been a relevant source of inspiration – although not the only one – for amending the flaws of Heidegger’s Existentialism. By taking a closer look at the essay Gnosticism, Existentialism, and Nihilism, this article aims to clarify the critical and constructive role that Gnosticism might have played in shaping some of the major traits of Jonas’s thought. The first part of this essay deals with Jonas’s ‘gnostic reading’ of Heidegger’s Existentialism and highlights the positive insights drawn from such interpretative strategy. The second part focuses on three main motives in Jonas’s philosophy that may be traced back to the gnostic narrative: value objectivity and vulnerability, human responsibility and involvement in the history of being, and the sense of belonging to a wider dimension capable of providing orientation and meaning to human life. (shrink)

BackgroundThe nature of the relationship between a clinical investigator and a research subject has generated considerable debate because the investigator occupies two distinct roles: clinician and scientist. As a clinician, the investigator has duties to provide the patient with optimal care and undivided loyalty. As a scientist, the investigator has duties to follow the rules, procedures and methods described in the protocol.Results and conclusionIn this article, I present a contextual approach to the investigator-subject relationship. The extent of the investigator's duty (...) to provide the patient/subject with clinical care can vary from one situation to the next, as a function of several factors, including: the research design, benefits and risks of the research; the subject's reasonable expectations, motivations, and vulnerabilities; the investigator's ability to benefit the subject; and the investigator's prior relationship with the subject. These and other factors need to be considered when determining the clinical investigator's obligations to provide clinical care to human research subjects. In some research contexts, the investigator has extensive clinical obligations to the patient/subject; in others, the investigator has minimal ones. (shrink)

This article is concerned with two interrelated questions: what, if anything, distinguishes synthetic from natural organisms, and to what extent, if any, creating the former is of moral significance. These are ontological and ethical questions, respectively. As the title indicates, I address both from a broadly neo-Aristotelian perspective, i.e. a teleological philosophy of life and virtue ethics. For brevity’s sake, I shall not argue for either philosophical position at length, but instead hope to demonstrate their legitimacy through their explanatory power. (...) I firstly argue that synthetic organisms differ in kind from natural organisms and machines, and differ only by degree from genetically modified organisms. I then suggest that this is nevertheless sufficient to give us specific ethical reservations about synthetic biology: namely, that more than any other widely used biotechnology, it is characterised by a drive to mastery that stands opposed to due appreciation of the giftedness of life. (shrink)

Criticisms of patent laws for technological innovations in the United States reveal a multifaceted milieu of problems centered around the protection of short-term economic gain and individual property rights. In this article, we consider this a conflict between current patent laws and the innovation capabilities of organizations. We propose a solution that enables the company to assure its long-term survival in the face of these restrictions. This presumes that the firm will at least maintain its innovation capacities while preserving the (...) company's ethical values and those of its social environment. We offer a theoretical model that is designed to help managers and policymakers reorient their governance strategies for managing the innovation process, using the “ethics of responsibility,” which establishes the link to individual moral values at the beginning of a governance process as well as the consequences of a decision. Our integrated causal model of ethical innovation for patents is presented and implications for global organizations and possible solutions for patent law process failure are offered. (shrink)

BackgroundBeta thalassemia major is a severe inherited form of hemolytic anemia that results from ineffective erythropoiesis. Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative therapy. Unfortunately, the subgroup of adult thalassemia patients with hepatomegaly, portal fibrosis and a history of irregular iron chelation have an elevated risk for transplantation-related mortality that is currently estimated to be about 29 percent.DiscussionThalassemia patients may be faced with a difficult choice: they can either continue conventional transfusion and iron chelation therapy or (...) accept the high mortality risk of HSCT in the hope of obtaining complete recovery.Throughout the decision making process, every effort should be made to sustain and enhance autonomous choice. The concept of conscious consent becomes particularly important. The patient must be made fully aware of the favourable and adverse outcomes of HSCT. Although it is the physician's duty to illustrate the possibility of completely restoring health, considerable emphasis should be put on the adverse effects of the procedure. The physician also needs to decide whether the patient is eligible for HSCT according to the "rule of descending order". The patient must be given full details on self-care and fundamental lifestyle changes and be fully aware that he/she will be partly responsible for the outcome.SummaryOnly if all the aforesaid conditions are satisfied can it be considered reasonable to propose unrelated HSCT as a potential cure for high risk thalassemia patients. (shrink)

The Anthropocene is a term described by Earth Systems Science to capture the recent rupture in the history of the Earth where human action has acquired the power to alter the Earth System as a whole. While normative conclusions cannot be logically derived from this descriptive fact, this paper argues that law and philosophy ought to develop responses that are ordered around human beings. Rather than arguing for legal rights or extending rights to nature, this paper focuses on obligations. Drawing (...) on Hans Jonas, it argues that obligations are a more appropriate tool for cultivating human plurality, restraining human action and protecting future generations. (shrink)

It is sometimes asserted that Hans Jonas would have formulated the precautionary principle because of his awareness of the involuntary consequences of human activity as well as his profound respect for nature. Returning to the origins of the arguments regarding his contribution to 20th century ecological thought, I identify two principal themes in the philosophical enterprise of the German-born American Jewish philosopher. One is a critique of technology and a practical philosophy, i.e. an ethics, regarding mankind and nature. The other (...) is linked to the phenomenology of life and the fundamental ontology of its evolution according to a specific view. In line with this genealogy, I discuss the initial assertion that Jonas’ thinking actually articulates the precautionary principle. Qualifying the two kinds of precaution we are dealing with, I finally offer an analysis of their differences in a strong sustainability framework from the point of view of epistemology. (shrink)

The aim of this paper is to offer some philosophical remarks concerning the concept of moral application in applied ethics. In doing so, I argue in favour of a philosophical approach towards applied ethics as a unitary form of moral experience. In fact every form of applied ethics, no matter how specific, moves from a problem of application and tries to fill a gap between moral theory and practice. This essential unity of applied ethics as a moral phenomenon is of (...) great philosophical interest, since it belongs to the core problem from which moral thinking itself originates. For this reason, what applied ethics may reveal to a philosophical inquiry could provide valuable insight into the nature of moral experience itself. This is why it is important to reflect on what applied ethics is and whether the way in which application is usually framed be ts the properties of moral experience or not. In the first section I submit some preliminary remarks concerning the theoretical requirements to any philosophical approach to applied ethics. In the second section I present how application is commonly understood in the applied ethics debate by discussing the deductive and the procedural models of application. Both models, however, draw upon a technological conception of application which fails to t the structure of moral experience. Finally, I brie y sketch out the main features and the future tasks of what seems to me to be the most promising approach to the issue, i.e., the hermeneutic concept of application. (shrink)