Is it ethical to perform a surgery whose purpose is to make a male look like a female or a female to appear male? Is it medically appropriate? Sexual reassignment surgery (SRS) violates basic medical and ethical principles and is therefore not ethically or medically appropriate. (1) SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, “first, do no harm.” (2) Candidates for SRS may believe (...) that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion. SRS, therefore, is a “category mistake”—it offers a surgical solution for psychological problems such as a failure to accept the goodness of one’s masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent. (3) SRS does not accomplish what it claims to accomplish. It does not change a person’s sex; therefore, it provides no true benefit. (4) SRS is a “permanent,” effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition. National Catholic Bioethics Quarterly 9.1 (Spring2009): 97–125. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 21.1 (2001) 147-151 [Access article in PDF] Book Review Philosophical Meditations on Zen Buddhism Philosophical Meditations on Zen Buddhism. By DaleS.Wright. Cambridge, Great Britain: Cambridge University Press, 1998. xv +227 pp. In a work brimming with unobtrusive erudition and centered on the figure of Huang Po (d. 850), Dale Wright offers a seasoned account of a topic that is still very much in need of clarification, (...) namely, the roles of language, conceptuality, textuality, interpretation, and historical development in Zen Buddhism. Some recent critics tend to see Zen as incoherent or even hypocritical in that this "special transmission outside the sutras, not dependent on language and texts, pointing directly to mind" (quoted, p. 64) in reality developed complex and varied textual and ritual traditions from [End Page 147] which the supposedly pure enlightenment experience cannot be siphoned out. Wright argues that the critics themselves are often naive, giving an inverted reflection of the naiveté of earlier scholars such as John Blofeld, who saw Zen as centered on an ineffable Supreme Experience, quite independent of the language used to point to it. Nonetheless, Wright himself is in basic agreement with the critics and in radical opposition to Blofeld (and to D. T. Suzuki). But he points out that the early Chinese Zen masters speak in many voices, often anticipating the most sophisticated insights of their critics.Wright's style is very unlike that of Bernard Faure, being slow, serene, reflective, scrupulous, and imbued with the deepest respect for the Zen tradition. Yet his thought rejoins Faure's at many points.The thrust of Wright's argument is to demystify Zen enlightenment by reinserting it in its varied linguistic, social, institutional, and historical contexts. He gives a realistic and holistic account of what Zen experience must have been like for disciples of Huang Po (pp. 187-192). His stress on the linguisticality of all experience certainly illuminates the texture of Huang Po's world. But I am left wondering if there is not another aspect of Zen that is missed here. Modern philosophers have derived much insight from the realization that thought and perception are deeply embedded in language. But I do not know that anyone has proven that there can never be a thinking or perception that is independent of language. Even the supposedly pan-textualist Derrida states somewhere that he does not exclude the possibility of nonlinguistic thought. In most fields of inquiry this abstruse question makes no practical difference, but in the case of Zen it is of crucial import. The presupposition of universal linguisticality, especially if it hardens into a dogma, may block access to the core of Zen experience.Wright argues that though some Zen masters sought prelinguistic immediacy, the majority were deeply aware of the inseparability of experience and the language in which it is grasped. But could it not be that prelinguistic immediacy was so much taken for granted in Zen that the masters scarcely needed to insist on it? Wright says that enlightenment itself is a linguistic event, since it is often occasioned by a verbal statement and given immediate expression in another verbal statement. But to recognize the indispensability of language for conveying experience is not necessarily to imply that the experience itself is dependent on language. Although a certain poem of Huang Po "strives to make its anti-textual point, the master must enter into the textual world to do so, thus abandoning the position of 'no dependence on texts'" (p. 22). Is it really necessary to see a contradiction here, given that, as Wright himself points out, "no unanimity on the meaning of the mandate against 'words and letters' existed" (p. 26)? Let us suppose that the point is nonattachment to texts and a realization of the intrinsic independence of enlightenment from the limited perspectives of textuality, language, and conceptual thought. This is quite compatible with intensive use of texts in practice.Blofeld explains that texts were useful to the learner but cast aside when enlightenment was reached. Wright argues that the enlightened experience must "continue to hold within it, and... (shrink)

We generally accept that medicine’s conceptual and ethical foundations are grounded in recognition of personhood. With patients in vegetative state, however, we’ve understood that the ethical implications of phenomenal consciousness are distinct from those of personhood. This suggests a need to reconsider medicine’s foundations. What is the role for recognition of consciousness (rather than personhood) in grounding the moral value of medicine and the specific demands of clinical ethics? I suggest that, according to holism, the moral value of medicine is (...) secured when conscious states are recognized in everyday medical science. Moreover, consciousness fully motivates traditional principles of clinical ethics if we understand respect for autonomy as respect for the dominion of an experiencer in the private, inescapable realm of bodily experience. When medicine’s foundations are grounded in recognition of consciousness, we understand how patients fully command respect even when they lack capacity to exercise their bodily dominion through decision-making. (shrink)

The need to address our question arises from two sources, one in Kant and the other in a certain type of response to so-called Reformed epistemology. The first source consists in a tendency to distinguish theoretical beliefs from practical beliefs , and to treat theistic belief as mere practical belief. We trace this tendency in Kant's corpus, and compare and contrast it with Aquinas's view and a more conservative Kantian view. We reject the theistic-belief-as-mere-practical-belief view: it is bad descriptive anthropology, (...) it embraces a misguided ideal of a fragmented self unattainable by human beings, and it will deter people from the most desirable sort of faith. The second source consists in the idea that since theistic beliefs function as answers to why-questions, their epistemic status hangs on whether they meet certain distinctively explanatory standards, whatever support they might receive from other sources. We argue that this is a non-sequitur and suggest questions for further research. (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

This paper addresses the question of the relationship between happiness and things (by which I mean the small objects that populate our everyday lives). I draw on Beckett, who formulated the question ‘what is the correct attitude to adopt towards things?’, and many of whose characters have a heightened sense of both the importance and the disposability of things. I bring Beckett into conversation with one of the core texts of Chinese Daoism – the Zhuangzi – in which things are (...) approached as requiring a particular attitude, which one could characterize as a very ‘light touch’. My aim is to show what, in our world of escalating consumption, can be learned from this modern Western, and this ancient Chinese, reflection on things and their relation to happiness. (shrink)

This paper provides a detailed study of fraud in practice through an empirical investigation of B.P.Sayers, a family-owned stockbroking firm that had been in existence for over 100 years and that collapsed due to the fraudulent activities of the firm's junior partner. An interpretive narrative methodology has been employed which has resulted in the development of a detailed understanding of fraud and moral breakdown in organizations, resulting from a failure of responsibility that arises from a dysfunctional work identification and its (...) moral implications. In developing this account of fraud, the conceptual framework utilized is drawn from the moral philosophical work of Emmanuel Levinas who explicated how the breakdown of social relations of responsibility results, in turn, in moral breakdown. (shrink)

Those who call themselves ‘scientific realists’ have been concerned to defend one or more of the following cluster of theses: The scientific enterprise’s primary goal is to discover a theory that correctly describes a mind-independent reality. Scientists believe that many of the central claims of current scientific theories correctly describe a mind-independent reality. Moreover, in forming such beliefs, they do not take themselves to be going beyond the bounds of science. If scientific activity continues, science will eventually succeed in providing (...) an account of mind-independent reality that is at least approximately true. Many of the central claims of current scientific theories correctly describe reality. Clearly, and are pieces of scientific sociology, in that they express judgements about the attitudes of scientists towards their theories, while and express judgements about the extent to which science is able to discover the way the world is. and the ‘Sociological Theses’ and the ‘Non-Sociological Theses’.) In this paper, I shall discuss what Bas van Fraassen’s work has to tell us about these claims. I shall argue that at best, he has pointed to one important respect in which defenders of scientific realism may have been on the wrong track. Such defenders have, historically, attempted to provide decisive reasons for believing one or more of the above theses. Van Fraassen has given grounds for thinking that no such rationally compelling reasons are to be had. But since that hardly implies that anyone who subscribes to either the Sociological or Non-Sociological Theses is irrational, it follows that van Fraassen’s polemic fails to undermine scientific realism in any serious way. Correspondingly, I shall argue that van Fraassen’s defence of an alternative to scientific realism, his so-called ‘constructive empiricism’, has only limited success. (shrink)

Recent accounting scandals involving the collapse of large corporate firms have brought into question the adequacy of ethics education within accounting programs. This paper investigates the ethical decisions of accountancy students and in particular analyses the effect of group (as opposed to individual) decision-making on ethical decisions. Final year accountancy students (sample size of 165) were randomly allocated into two experimental conditions. The participants were then presented with five (5) ethical vignettes. One experimental condition involved completing the ethical decisions as (...) individuals (60). The other involved completing the ethical decision-making as a group of 3–4 participants (34). A consistent pattern of behaviour was observed in the analysis of individual versus group responses. Individuals displayed stronger tendencies than groups to take the extreme actions of acting either unethically or ethically (whistleblowing), whereas groups displayed stronger tendencies to take the safer (neutral) options. It was concluded that groups reached consensus decisions, in an ethical context, probably as a result of peer pressure. The significant implication of this finding is in relation to the emphasis accounting programs place on group work. Group work may enhance students’ abilities to work as a team. However, as revealed in this study’s results, group work may not be an effective means of producing the optimal decision in all subject matter areas, especially complex areas such as ethical decision-making. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

After nearly fifty years of mea culpas and explanatory additions, the biopsychosocial model is no closer to a life of its own. Bolton and Gillett give it a strong philosophical boost in The Biopsychosocial Model of Health and Disease, but they overlook the model’s deeply inconsistent position on dualism. Moreover, because metaphysical confusion has clinical ramifications in medicine, their solution sidesteps the model’s most pressing clinical faults. But the news is not all bad. We can maintain the merits of holism (...) as we let go of the inchoate bag of platitudes that is the biopsychosocial model. We can accept holism as the metaphysical open door that it is, just a willingness to recognize the reality of human experience, and the sense in which that reality forces medicine to address biological, psychological, and social aspects of health. This allows us to finally characterize Engel’s driving idea in accurate philosophical terms, as acceptance of consciousness in the context of medical science. This will not entirely pin down medicine’s stance on dualism, but it will position it clearly enough to readily improve patient care. (shrink)

Apocalyptic expectations of Armageddon and a New Age have been a fixture of the American cultural landscape for centuries. With the approach of the year 2000, such millennial visions seem once again to be increasing in popularity. Stephen O'Leary sheds new light on the age-old phenomenon of the End of the Age by proposing a rhetorical explanation for the appeal of millennialism. Using examples of apocalyptic argument from ancient to modern times, O'Leary identifies the recurring patterns in apocalyptic texts and (...) movements and shows how and why the Christian Apocalypse has been used to support a variety of political stances and programs. The book concludes with a critical review of the recent appearances of doomsday scenarios in our politics and culture, and a meditation on the significance of the Apocalypse in the nuclear age. Arguing the Apocalypse is the most thorough examination of its subject to date: a study of a neglected chapter of our religious and cultural history, a guide to the politics of Armageddon, and a map of millennial consciousness. (shrink)

In this article, Joseph S. O’Leary recounts the origin and inspirations behind the 1979 Colloquium Heidegger et la Question de Dieu, and reflects on why it became such a key moment in the development of many of those who took part in it. In addition to the contingent factors of a particular time and place, and the deep personal and intellectual significance that Heidegger bore for many of them, O’Leary identifies the perennial philosophical questions which the participants were (...) able to address in original and controversial ways. O’Leary also reflects on the way this Colloquium served as a subsequent influence on his own original work as well as the critical dialogue he engaged in with many of the other participants, culminating in his most recent work on interreligious dialogue which further amplifies the central problematics here concerning the nature of the quest for truth. (shrink)

The final book of O'Leary's trilogy, Conventional and Ultimate Truth deals with the nature of theological rationality today, drawing on Buddhist ideology.

Nervous systems are formidably complex networks of nonlinear interacting components that self organise and continually adapt to enable flexible behaviour. Robust and reliable function is therefore non-trivial to achieve and requires a number of dynamic mechanisms and design principles that are the subject of current research in neuroscience. A striking feature of these principles is that they resemble engineering solutions, albeit at a greater level of complexity and layered organisation than any artificial system. I will draw on these observations to (...) argue that biological robustness in the nervous system remains a deep scientific puzzle, but not one that demands radically new concepts. (shrink)

Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, (...) this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions. (shrink)

Tout s’est passé très vite, prenant l’Église au dépourvu. Le mouvement pour la reconnaissance des mariages et des unions civiles entre personnes du même sexe a connu un succès extraordinaire. La hiérarchie de l’Église catholique oppose une fin de non-recevoir à toute reconnaissance positive des couples homosexuels, en invoquant une morale sexuelle qu’on dit ancienne et invariable,..

In After Virtue, Alasdair MacIntyre argues that in modern ethical discourse, moral principles have been replaced by “fragments” that only partially represent their original meaning as derived from theological contexts. Today’s debates surrounding physician assisted suicide (PAS) and abortion highlight that the “fragment” of autonomy has been championed over principles such as justice, beneficence, and nonmaleficence with little justification. This acceptance of patient autonomy as the ultimate good distracts from societal ills that drive contentious medical decisions, further muddles society’s image (...) of the human person, and subliminally redefines the medical profession. Medical professionals who oppose these practices must commit themselves to forming physician-patient covenants of trust, rather than accepting consumeristic models of patient care that foster an inappropriate focus on self-determination. (shrink)

Examining the ways in which two representatives of the “theological turn in French phenomenology” speak of the interrelationship between philosophy and theology, one may detect a number of tendencies which are deleterious both to philosophy and theology. The idea of an autonomous philosophy, pursued as an end in itself, needs to be defended against claims that philosophy can only flourish under theological tutelage. Again, the integrity of theology as a science of faith excludes any identification of theology as a kind (...) of philosophy. Interaction between the two disciplines, especially in the border areas of apologetics, fundamental theology, religious philosophy, and philosophy of religion, can be fruitful only if a keen sense of their radical difference of orientation is sustained. Behind the swamping of phenomenology by theological concerns lies a series of misunderstandings of metaphysics and its overcoming as well as a misguided notion that phenomenology allows revealed theology to re-enter the French university under the rubric of philosophy. (shrink)

Disordered sleep is strongly linked to future depression, but the reasons for this link are not well understood. This study tested one possibility – that poorer sleep impairs emotion regulation, which over time leads to increased depressive symptoms. Our sample contained individuals with a wide range of depression symptoms, who were followed clinically over six months and reassessed for changes in depressive symptom levels. As predicted, maladaptive ER mediated both cross-sectional and prospective relationships between poor sleep quality and depression symptoms. (...) In contrast, an alternative mediator, physical activity levels, did not mediate the link between sleep quality and depression symptoms. Maladaptive ER may help explain why sleep difficulties contribute to depression symptoms; implications for interventions are discussed. (shrink)

This paper discusses three cultural narratives that threaten the health of people with intellectual/developmental disabilities (IDD) and which have become more evident during the COVID-19 pandemic. These meta-narratives are the medical model of health/disability; the population health approach to health inequalities; and policies premised on the assumption of the importance of national economic growth as an incentive for reducing health inequalities. Evidence exists that health research is more likely to become policy if it fits within a medical model and addresses (...) national economic growth. These two criteria are particularly problematic for people who have IDD. The paper also proposes a research model to facilitate the inclusion of IDD related issues in future policy regarding health inequalities. (shrink)

Highlighting the applications and notations of basic mathematical concepts within the framework of logic and set theory, A First Course in Mathematical Logic and Set Theory introduces how logic is used to prepare and structure proofs and solve more complex problems.