Moral and legal notions engaged in clinical ethics should not only possess analytic clarity but a sound basis in empirical findings. The latter condition brings into question the expansion of the mature minor exception. The mature minor exception in the healthcare law of the United States has served to enable those under the legal age to consent to medical treatment. Although originally developed primarily for minors in emergency or quasi-emergency need for health care, it was expanded especially from the 1970s (...) in order to cover unemancipated minors older than 14 years. This expansion initially appeared plausible, given psychological data that showed the intellectual capacity of minors over 14 to recognize the causal connection between their choices and the consequences of their choices. However, subsequent psychological studies have shown that minors generally fail to have realistic affective and evaluative appreciations of the consequences of their decisions, because they tend to over-emphasize short-term benefits and underestimate long-term risks. Also, unlike most decisionmakers over 21, the decisions of minors are more often marked by the lack of adequate impulse control, all of which is reflected in the far higher involvement of adolescents in acts of violence, intentional injury, and serious automobile accidents. These effects are more evident in circumstances that elicit elevated affective responses. The advent of brain imaging has allowed the actual visualization of qualitative differences between how minors versus persons over the age of 21 generally assess risks and benefits and make decisions. In the case of most under the age of 21, subcortical systems fail adequately to be checked by the prefrontal systems that are involved in adult executive decisions. The neuroanatomical and psychological model developed by Casey, Jones, and Summerville offers an empirical insight into the qualitative differences in the neuroanatomical and neuropsychological bases of adolescent versus adult decision making. These and other data, as well as developing law bearing on the culpability of juvenile criminal offenders, argue for critically re-evaluating the expansion of the mature minor exception with regard to medical decision making, as well as in support of a rebuttable presumption in favor of treating minors as immature decisionmakers. The clinical ethics of adolescent medical decision making will need foundationally to be reconsidered. (shrink)
The United Nations Convention on the Rights of the Child risks harm to adolescents insofar as it encourages not only poor decision making by adolescents but also parenting styles that will have an adverse impact on the development of mature decision-making capacities in them. The empirical psychological and neurophysiological data weigh against augmenting and expression of the rights of children. Indeed, the data suggest grounds for expanding parental authority, not limiting its scope. At the very least, any adequate appreciation of (...) the moral claims regarding the authority of parents with respect to the decision-making capacity of adolescents needs to be set within an understanding of the psychological and neurophysiological facts regarding the development of adolescent decision-making capacity. (shrink)
An attempt is made here to examine the analysis three political thinkers - Thomas Paine, William Godwin, and Jeremy Bentham have offered of the idea of equality. The inquiry underrtaken is philosophical and not historical in character, since no attempt is made either at tracing the influence ht the biographical-cum-intellectual level of one of them upon the other or at treating their ideas on equality as born out of their preoccupation with the same problem to which they give various answers (...) and which can therefore be considered within a single overall framework. Instead, each thinker is considered independently. And a study is undertaken of the way he understands equality, the way he justifies it, the sort of equality he considers most important and his reasons for this, the area of life he takes the idea of equality to illuminate, the manner in which he relates it to other ideas, etc.. In each case, a fairly coherent philosophy of equality is sought to be constructed out of their respective writings. These three thinkers are selected for two reasons. The idea of equality looms quite large in their thought; as such, it was felt that looking at their writings from the standpoint of equality may illuminate their certain features that may otherwise remain obscure or relatively underemphasized. Further, as they consider equality from different philosophical positions it was believed that a critical examination of their writings could, perhaps, point to the general merits and limitations of their respective positions in terms of equality. in chapter I, it is argued that there are distinct views of God discernible in Paine's writings, and that corresponding to them are three distinct views of equality, though only two of them are discussed by Paine at any length. in chapter II, it is argued that, though Godwin begins as a thoroughgoing rationalist, three are shifts in his general philosophical position, and that, with each shift, his ideas on truth, rationality and equality undergo important changes. Finally, in chapter III, it is argued that there are two distinct theories of equality in Bentham and that tension between them remains unresolved. (shrink)
According to both deontologists and consequentialists, if there is a reason to promote the general happiness – or to promote any other state of affairs unrelated to one's own projects or self-interest – then the reason must apply to everyone. This view seems almost self-evident; to challenge it is to challenge the way we think of moral reasons. I contend, however, that the view depends on the unwarranted assumption that the only way to restrict the application scope of a reason (...) for action is by restricting it to those agents whose interests or projects are involved in the reason. In fact normative theories may coherently restrict application scopes in other ways. Thus we must take seriously the possibility that the reason to promote the general happiness, although genuine, does not apply to everyone. (shrink)
In this useful edition, Popkin selects, translates, and annotates thirty-nine articles from the Dictionnaire, with the aim of preserving in miniature the overall character of Bayle's magnum opus. Included are the historically important articles, "David," "Manicheans," "Paulicians," "Pyrrho," "Rorarius," "Spinoza," "Zeno of Elea," and Bayle's "Clarifications." Some inevitable omissions are regrettable, but Popkin has caught Bayle in a variety of his moods, sarcastic, skeptical, and scholarly.—R. B. C.
The main thesis of this excellent little book is that "contrary to widespread misapprehensions, two formally different kinds of utilitarianism, simple and general, and along with the latter one kind of rule-utilitarianism, are extensionally equivalent; that is, analogous principles of the various kinds necessarily yield equivalent judgments in all cases; or, in other words, it makes no difference in theory whether the simple or generalization test is applied to acts or—within limits—whether an appeal is made to rules grounded in utility." (...) The "misapprehension" is dispelled in the particularly valuable third chapter, "Extensional Equivalence," by means of an a priori causal analysis of action situations and an exacting consideration of action descriptions. Furthermore, Lyons argues that other rule-utilitarian theories not extensionally equivalent to the simple utilitarianism of tradition differ from it in the wrong ways. As a result of these two findings the author holds that "any appeal to generalization or to rules consequently fails to escape the force of traditional arguments against utilitarianism." Utilitarian readers who accept Lyons' argument and particularly his interspersed but incisive criticisms of the works of Broad, Harrison, Singer, Harrod, Brandt, and Rawls, are likely to feel that it is best to go back to Mill! But in his final chapter Lyons' analysis of promising and fairness throws doubt on the adequacy of any purely utilitarian moral theory. However this may be, to read Lyons' book is to follow a precise and rigorous intellect, free of current dogmas about value statements, while it threads its way through a maze of conceptual complexities toward substantive philosophic conclusions.—R. B. C. (shrink)
Without extensive argument or elaboration of implications, the author presents Smith's views on ethical matters peculiarly important to our own era. Having previously assumed that Smith's statement alone is sufficient, the author permits him to speak extensively.--C. E. B.
Presents with mature sense and sensibility the thesis that the image-creating activity of the artist is presupposed by the cognitive systems of the scientist and philosopher. The argument is given in the form of a history of the visual image in seven roughly chronological stages, from paleolithic vitalism to modern constructivism; the application to philosophy is rather suggested than carried out. This account of visual art as the primary mode of cognition should prove suggestive not only to aestheticians, but also (...) to those interested in the theory of emotive meaning, the history of thought, and the problem of "beginning to know."--C. B. (shrink)
An attempt to evolve a puristic definition of poetry in which the poem itself serves as the point of departure. The examination is systematically conducted throughout the three parts of the book: "Phonétique," "Sémantique," and "Ontologie." Frequent textual examples are offered; the accompanying analyses are often illuminating, particularly in the case of the cryptic "sonnet du Cygne" by Mallarmé. A key concept in the discussion is "la conversion poétique du langage": the means by which a word is freed from its (...) accepted meaning and enabled to acquire a multiplicity of meanings. The hierarchy of symbol and object-symbolized is always destroyed by "la conversion": that which is poetic cannot be symbolic. "Symbolist poetry" is, therefore, a misnomer. By modifying or totally eliminating traditional literary formulae, Champigny arrives at and ably defends his own concept of "le genre poétique."—B. B. C. (shrink)
Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)