Frank Koughan and Walt Bogdanich's response to my article, reminds me of the Shakespearean line, My article was not about the specifics of the 60Minutes April 13, 1997, story on NHBD at the Cleveland Clinic Foundation (CCF), even though the story formed the basis for the reflection. I did not attack the critics, though I do believe that bioethicists are accountable for their scholarly and public pronouncements. Although I do not see why the 60Minutes' story should be treated with deference, (...) my article was designed to raise questions for a primarily bioethics audience about the involvement of bioethicists in media coverage of bioethics topics. I am flattered that they took notice of my piece, but think their efforts to set the record straight only obfuscate matters further. (shrink)

Recent philosophical attention to the language of disease has focused primarily on the question of its value-neutrality or non-neutrality. Proponents of the value-neutrality thesis symbolically combine political and other criticisms of medicine in an attack on what they see as value-infected uses of disease language. The present essay argues against two theses associated with this view: a methodological thesis which tends to divorce the analysis of disease language from the context of the practice of medicine and a substantive thesis which (...) holds that disease language is evaluatively neutral. In particular, the essay critically focuses on the value neutral position adopted by Christopher Boorse, which he terms a functional theory of disease. The argument concerns whether or not one can have value neutral description of disease states or whether disease language essentially involves values. (shrink)

This paper offers an exposition of what the question of method in ethics consultation involves under two conditions: when ethics consultation is regarded as a practice and when the question of method is treated systematically. It discusses the concept of the practice and the importance of rules in constituting the actions, cognition, and perceptions of practitioners. The main body of the paper focuses on three elements of the question of method: canon, discipline, and history, which are treated heuristically to outline (...) what the question of method in ethics consultation fully involves. (shrink)

This important new work surveys the source and ramifications of the famed Nuremburg Code -- recognized around the world as one of the cornerstones of modern bioethics.

How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.

The realities of long‐term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

Authority is an uneasy, political notion. Heard with modern ears, it calls forth images of oppression and power. In institutional settings, authority is everywhere present, and its use poses problems for the exercise both of individual autonomy and of responsibility. In medical ethics, the exercise of authority has been located on the side of the physician or the health care institution, and it has usually been opposed by appeal to patient autonomy and rights. So, it is not surprising, though still (...) ironic, that ethics consultation, which develops from this patient rights-dominated ethic, should itself bring forth questions of authority. Nonetheless, it does.Insofar as authority has been discussed in ethics consultations, it has been understandably approached from the broad perspective of legitimation and power, which are common themes in social and political treatments of authority. These treatments have dominated twentieth-century discussions of authority, which primarily view authority as legitimate power. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis of the ethical concepts (...) associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

Authority is an uneasy, political notion. Heard with modern ears, it calls forth images of oppression and power. In institutional settings, authority is everywhere present, and its use poses problems for the exercise both of individual autonomy and of responsibility. In medical ethics, the exercise of authority has been located on the side of the physician or the health care institution, and it has usually been opposed by appeal to patient autonomy and rights. So, it is not surprising, though still (...) ironic, that ethics consultation, which develops from this patient rights-dominated ethic, should itself bring forth questions of authority. Nonetheless, it does. Insofar as authority has been discussed in ethics consultations, it has been understandably approached from the broad perspective of legitimation and power, which are common themes in social and political treatments of authority. These treatments have dominated twentieth-century discussions of authority, which primarily view authority as legitimate power. (shrink)

RECENT PHILOSOPHICAL ATTENTION TO THE LANGUAGE OF DISEASE HAS FOCUSED PRIMARILY ON THE QUESTION OF ITS VALUE-NEUTRALITY OR NON-NEUTRALITY. PROPONENTS OF THE VALUE-NEUTRALITY THESIS SYMBOLICALLY COMBINE POLITICAL AND OTHER CRITICISMS OF MEDICINE IN AN ATTACK ON WHAT THEY SEE AS VALUE-INFECTED USES OF DISEASE LANGUAGE. THE PRESENT ESSAY ARGUES AGAINST TWO THESES ASSOCIATED WITH THIS VIEW: A METHODOLOGICAL THESIS WHICH TENDS TO DIVORCE THE ANALYSIS OF DISEASE LANGUAGE FROM THE CONTEXT OF THE PRACTICE OF MEDICINE AND A SUBSTANTIVE THESIS WHICH (...) HOLDS THAT DISEASE LANGUAGE IS EVALUATIVELY NEUTRAL. IN PARTICULAR, THE ESSAY CRITICALLY FOCUSES ON THE VALUE NEUTRAL POSITION ADOPTED BY CHRISTOPHER BOORSE, WHICH HE TERMS A FUNCTIONAL THEORY OF DISEASE. THE ARGUMENT CONCERNS WHETHER OR NOT ONE CAN HAVE VALUE NEUTRAL DESCRIPTION OF DISEASE STATES OR WHETHER DISEASE LANGUAGE ESSENTIALLY INVOLVES VALUES. (shrink)

The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differentiate and fully explicate these dimensions contributes (...) to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation. (shrink)

This paper discusses the importance of Richard M. Zaners work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is (...) bound up with the normative commitments of medicine as a therapeutic enterprise. (shrink)

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

This anthology brings together many of the more significant contributions to Cartesian scholarship, some of which reach far back as the 1930s. Altogether, there are well over 100 detailed analyses and discussions of salient aspects of Descartes' Promethean legacy. Because Descartes intended his system to embrace not only philosophy but also a complete scientific corpus, this collection covers both philosophical issues and scientific views: Volume 1 is devoted to questions of Cartesian Method and epistemology; Volumes 2 and 3 concentrate on (...) his metaphysics; and Volume 4 discusses Descartes' scientific views and achievements. The lucidity and originality of the essays, a number of which are already classics of Cartesian scholarship, will ensure that this anthology becomes a standard in Cartesian philosophy. An invaluable resource, Rene;e Descartes provides a large variety of introductions, analyses, criticisms, and appraisals of the problems which preoccupied Descartes and the solutions he propounded. (shrink)

This two-volume work bridges the gap between introductory expositions of logic or set theory on one hand, and the research literature on the other. It can be used as a text in an advanced undergraduate or beginning graduate course in mathematics, computer science, or philosophy. The volumes are written in a user-friendly conversational lecture style that makes them equally effective for self-study or class use. Volume II, on formal (ZFC) set theory, incorporates a self-contained 'chapter 0' on proof techniques so (...) that it is based on formal logic, in the style of Bourbaki. The emphasis on basic techniques will provide the reader with a solid foundation in set theory and provides a context for the presentation of advanced topics such as absoluteness, relative consistency results, two expositions of Godel's constructible universe, numerous ways of viewing recursion, and a chapter on Cohen forcing. (shrink)

While there is no denying the relevance of ethical knowledge and analytical and cognitive skills in ethics consultation, such knowledge and skills can be overemphasized. They can be effectively put into practice only by an ethics consultant, who has a broad range of other skills, including interpretive and communicative capacities as well as the capacity effectively to address the psychosocial needs of patients, family members, and healthcare professionals in the context of an ethics consultation case. In this paper, I discuss (...) how emotion can play an important interpretive role in clinical ethics consultation and why attention to the role of defense mechanisms can be helpful. I concentrate on defense mechanisms, arguing first, that the presence of these mechanisms is understandable given the emotional stresses and communicative occlusions that occur between the families of patients and critical care professionals in the circumstances of critical care; second, that identifying these mechanisms is essential for interpreting and managing how these factors influence the way that the “facts” of the case are understood by family members; and, third, that effectively addressing these mechanisms is an important component for effectively doing ethics consultation. Recognizing defense mechanisms, understanding how and why they operate, and knowing how to deal with these defense mechanisms when they pose problems for communication or decision making are thus essential prerequisites for effective ethics consultation, especially in critical care. (shrink)

This paper discusses the importance of Richard M. Zaner’s work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is (...) bound up with the normative commitments of medicine as a therapeutic enterprise. (shrink)

How should one think about innovation in medicine and surgery? Increasingly, the answer to this question has involved reference to what might be called the regulatory ethics paradigm (REP). The regulatory ethics paradigm holds that deviations from standard care involve a degree or kind of experimentation that requires the application of a set of procedures designed to assure the protection of the rights and welfare of the subjects of research. In REP, innovative treatments are regarded as questionable until they are (...) framed in a research protocol with formal mechanisms of informed consent. The protocol must be reviewed and approved by an Institutional Review Board (IRB) or equivalent. The regulatory ethics paradigm in effect imposes the condition that clinical innovations be conducted according to scientific research methodologies. It creates the presumption that without review by an IRB, innovation cannot be conducted in an ethically defensible fashion. The regulatory ethics paradigm also requires the preparation of investigational protocols according to sound evidentiary and methodological standards. In so doing, it creates a presumption that innovations that are not rigorously validated are ethically dubious. These assumptions have deep roots. The Belmont Report, for example, articulated the orienting intuition that “radically new procedures... should... be made the object of formal research at an early stage [emphasis added] in order to determine whether they are safe and effective”.1 The Belmont Report takes the view that formal research to establish safety and efficacy of new interventions is usually feasible at an early stage in the development of a novel intervention. It thus establishes a bias that innovative treatments be conducted and evaluated under a research protocol that has passed muster at an IRB review. Given the …. (shrink)

Since at least the advent of Jack Kevorkian’s “suicide machine” the major argument against adopting physician-assisted suicide laws has been that they will lead us down a slippery slope to state-sa...

The law has therefore had two conflicting impacts on medical ethics: the positive effect of eroding paternalism and replacing it with a patient-centered ethic; and the negative effect of encouraging physicians to be more concerned with avoiding litigation than doing the "right" thing.

Georges J. D. Moyal - Deux notes sur l' «imparfaite science» du geometre athee - Journal of the History of Philosophy 43:3 Journal of the History of Philosophy 43.3 277-300 Deux notes sur l'« imparfaite science » du géomètre athée Georges J. D. Moyal Deux questions. La Ve Méditation de Descartes vise à démontrer que l'existence d'un Dieu vérace est la condition nécessaire de toute science. En effet, Descartes y écrit ceci : « . . . je remarque que la (...) certitude de toutes les autres choses en dépend si absolument [sc. de l'existence de Dieu], que sans cette connaissance il est impossible de pouvoir jamais rien savoir parfaitement. » Ce qui le mène, bien entendu, d'abord à reconnaître que « . . . si j'ignorais qu'il y eût un Dieu [ . . . ] je n'aurais jamais une vraie et certaine science d'aucune chose que ce soit, mais seulement de vagues et inconstantes opinions » et par là même, à refuser ensuite cette parfaite science au géomètre athée : « Or, qu'un athée puisse connaître clairement que les trois angles d'un triangle sont égaux à deux droits, je ne le nie pas ; mais je maintiens seulement qu'il ne le connaît pas par une vraie et certaine science, parce que toute connaissance qui peut être rendue douteuse ne doit pas être appelée science . . . » Il faut reconnaître qu'il y a à nos yeux, aujourd'hui, quelque chose de surprenant à ce que le géomètre athée se voie ainsi refuser cette parfaite science.. (shrink)

American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.

This work examines the complex relationship between two influential modern thinkers, G.W.F. Hegel and Ernst Troeltsch, one of Hegel's interpreters and a figure who has not received the attention he deserves.

George J. Stack traces the sources of ideas and theories that have long been considered the exclusive province of Friedrich Nietzsche to the surprisingly radical writings of the American essayist and poet, Ralph Waldo Emerson. Nietzsche and Emerson makes us see Emerson's writings in a new, more intensified light and presents a new perspective on Nietzsche's philosophy. Stack traces how the rich theoretical ideas and literary images of Emerson entered directly into the existential dimension of Nietzsche's thought and hence (...) into the stream of what has been considered a distinctively European intellectual movement. Book jacket. (shrink)

“Why is there something rather than nothing?” This is perhaps one of the most annoying questions posed in recent times by and to philosophers. It has troubled at least two major thinkers in the last and in this century, namely the romantic idealist Friedrich Schelling and the contemporary existentialist Martin Heidegger, since it was first formulated by Leibniz. We can easily get rid of the question as being simplistic; since although it may be true that nothing is simpler than something, (...) we have no notion of what the simplicity of nothing might consist in. Or we can say that the question is related to the theological answer of a benevolent creator, and hence is not able even to be asked within the ambient of the finite human understanding. Or we may say that the question is supremely hypothetical, in that it would presuppose what is not, in fact, the case; and philosophy can be concerned only with what is. Furthermore, to ask the question in any genuine fashion, the nonexistence of the questioner would seem to be required. The question, therefore, appears Zen-like: “What is the answer to a question posed by a nonexistent questioner?”. (shrink)

Underlying Husserl’s complex analyses of phenomenology, and specifically his conception of transcendental subjectivity, is a relatively unexamined description of the notion of persons. What I will be concerned with here is a critical analysis of Husserl’s concept of persons as it emerges in his various attempts to characterize the nature of constituting subjectivity and to distinguish the transcendental ego from the natural self. An attempt will be made to indicate that there is a tension in Husserl’s thought between his apparent (...) desire to avoid psychologism and the naturalistic standpoint on the one hand, and, on the other hand, his intention to preserve the notion of personal existence. This tension first presents itself in his endeavor to distinguish transcendental subjectivity from psychologistic subjectivity and, hence, it is at this point that we must begin to explore his phenomenology of persons. (shrink)

To the uninitiated, academic philosophy can be intimidating. Its extensive history (over two millennia) and seemingly all-encompassing breadth and depth of study makes knowing everything about philosophy impossible. Philosophers are fortunate because they are expected to specialize in specific areas, but librarians are not as fortunate. Librarians often have collection development responsibilities for a variety of academic disciplines. Collection development in philosophy can seem like a world unto itself in part because philosophical inquiry reaches into other academic disciplines. Amongst academic (...) philosophers, there are different approaches or methodologies for doing philosophy, including eastern and western philosophy, as well as a divide between analytic and continental philosophers. In addition to growing the collection, the philosophy subject librarian may be called upon by philosophers and aspiring philosophers (i.e., students) for research assistance. To make matters more intimidating, philosophers seem to think and speak differently than others. The complex ideas and esoteric terminology that rarely finds its way outside of the philosophy classroom can make collection development, research services, and even simple faculty-to-librarian communication difficult. To succeed as a librarian subject specialist, you should work hard to develop an adequate understanding of the types of materials that are most valuable to your community. Cultivating this knowledge is critical because budgets are limited. This volume will help librarians thrust into the position of philosophy subject specialist to get up to speed and begin excelling in their new roles. The goal of this guide is to simplify collection development and research assistance for philosophy. To accomplish this, I will provide a brief overview of philosophy as a field and share the information you need to succeed in your role as the new philosophy selector. This volume will help to alleviate some of the communication barriers between philosophers and librarians and will provide practical advice, recommendations, and resources for building a strong philosophy collection. (shrink)

To the uninitiated, academic philosophy can be intimidating. Its extensive history (over two millennia) and seemingly all-encompassing breadth and depth of study makes knowing everything about philosophy impossible. Philosophers are fortunate because they are expected to specialize in specific areas, but librarians are not as fortunate. Librarians often have collection development responsibilities for a variety of academic disciplines. Collection development in philosophy can seem like a world unto itself in part because philosophical inquiry reaches into other academic disciplines. Amongst academic (...) philosophers, there are different approaches or methodologies for doing philosophy, including eastern and western philosophy, as well as a divide between analytic and continental philosophers. In addition to growing the collection, the philosophy subject librarian may be called upon by philosophers and aspiring philosophers (i.e., students) for research assistance. To make matters more intimidating, philosophers seem to think and speak differently than others. The complex ideas and esoteric terminology that rarely finds its way outside of the philosophy classroom can make collection development, research services, and even simple faculty-to-librarian communication difficult. To succeed as a librarian subject specialist, you should work hard to develop an adequate understanding of the types of materials that are most valuable to your community. Cultivating this knowledge is critical because budgets are limited. This volume will help librarians thrust into the position of philosophy subject specialist to get up to speed and begin excelling in their new roles. The goal of this guide is to simplify collection development and research assistance for philosophy. To accomplish this, I will provide a brief overview of philosophy as a field and share the information you need to succeed in your role as the new philosophy selector. This volume will help to alleviate some of the communication barriers between philosophers and librarians and will provide practical advice, recommendations, and resources for building a strong philosophy collection. (shrink)

The DSM-IV, like its predecessors, will be a major influence on American psychiatry. As a consequence, continuing analysis of its assumptions is essential. Review of the manuals as well as conceptually-oriented literature on DSM-III, DSM-III-R, and DSM-IV reveals that the authors of these classifications have paid little attention to the explicit and implicit value commitments made by the classifications. The response to DSM criticisms and controversy has often been to incorporate more scientific diversity into the classification, instead of careful inquiry (...) and assessment of the principal values that drive the nosologic process. Implications for psychiatric science and future DSM classifications are discussed. Keywords: DSM-III, DSM-III-R, DSM-IV, Psychiatric Classification, values CiteULike Connotea Del.icio.us What's this? (shrink)

Il est une question fondamentale dont il semble pourtant qu’elle n’ait pas été posée: celle de savoir ce qui fait que le cogito soit effectivement un principe métaphysique, c’est-à-dire une vérité première. Il semble aussi que ce qui d’ordinaire tient lieu de réponse à cette question dans l’esprit des lecteurs de Descartes, c’est le sentiment vague qu’il s’agit là de la première vérité qui surgisse après la dévastation laissée par le doute universel de la Première Méditation, ou peut-être qui surgisse (...) au cœur de ce doute, puisque le doute ne s’autodétruit que pour faire place à ego sumOr s’en tenir à cela pour justifier le statut de principe métaphysique du cogito, c’est confondre priorité chronologique et primauté métaphysique ou épistémique: en effet, qu’y aurait-il dans le seul fait de se présenter ainsi qui assure que le cogito doive fonder d’autres connaissances, d’éventuelles sciences? Qu’est-ce qui empêcherait aussi qu’il ne soit lui-même assujetti à d’autres connaissances, plus fondamentales, et dont le méditant ne se serait peut-être pas encore aperçu? Il est vrai que cette confusion est compréhensible, puisque la primauté métaphysique du cogito coïncide effectivement avec sa priorité dans l’ordre des connaissancesMais dans le doute ambiant, celle-ci n’est en réalité qu’un effet de celle-là, et le simple fait de constater l’une ne revient pas à être assuré de l’autre. Il ne peut s’agir donc que d’une coïncidence, et la question se pose dès lors de savoir comment se traduit sa primauté, c’est-à-dire comment doivent se concevoir ses rapports avec le reste de nos éventuelles connaissances. (shrink)

Si elles ne manquent pas de bienveillance, les Quatrièmes Objections formulées par Antoine Arnauld comptent parmi les plus rigoureuses et les plus pénétrantes qui aient été opposées aux Méditations de Descartes. On sait d'ailleurs en quelle haute et chaleureuse estime Descartes tint, dès lors, le jeune théologien.

L'absence d'une analyse quelconque du concept de vérité a de quoi surprendre dans un discours qui se propose de dire à quelles conditions s'obtient cette vérité. C'est pourtant bien de cette carence que souffrent les Méditations. A l'exception d'une brève allusion, dans la Cinquième Méditation, attribuable d'ailleurs à Clerselier, et dans une traduction remaniée par lui mais non approuvée par Descartes, le mot « vérité » n'y est défini nulle part.

Friedrich Nietzsche has emerged as one of the most important and influential modern philosophers. For several decades, the book series Monographien und Texte zur Nietzsche-Forschung (MTNF) has set the agenda in a rapidly growing and changing field of Nietzsche scholarship. The scope of the series is interdisciplinary and international in orientation reflects the entire spectrum of research on Nietzsche, from philosophy to literary studies and political theory. The series publishes monographs and edited volumes that undergo a strict peer-review process. The (...) book series is led by an international team of editors, whose work represents the full range of current Nietzsche scholarship. (shrink)