Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

This collection of essays, Global Bioethics: The Collapse of Consensus, deals with the issue of the repeated failure of attempts to derive a universal set of ...

The prospect of germ-line genetic engineering, the ability to engineer genetic changes that can be passed on to subsequent generations, raises a wide range of moral and public policy questions. One of the most provocative questions is, simply put: Are there moral reasons that can be articulated in general secular terms for accepting human nature as we find it? Or, at least in terms of general secular moral restraints, may we reshape human nature better to meet our own interests, as (...) we define them? This question in turn raises the further question of whether human nature as it now exists has a moral standing akin to sacredness that can be understood in nonreligious terms. This essay will take as a given that it is not possible to show in general secular moral terms that human nature has a sanctity or special moral standing that should guide secular health-care policy. In addition, as this essay shows, it is not possible through appeals to considerations of authorizing consent or beneficence toward others to remedy this failure to establish a sanctity or special moral standing for human nature. Absent a religious or culturally normative understanding of human nature and given the availability of germline genetic engineering, there is a plurality of possibilities for refashioning our nature. The unavailability of substantive secular moral constraints on germ-line genetic engineering discloses a secularly licit plurality of possibilities for human nature. The likelihood that we will be able to refashion our human nature reveals how few general secular moral constraints there are to guide us. Paradoxically, the more we are able to reengineer our human nature, the less guidance is available. The plurality of possible conceptions of human well-being that can be pursued through germ-line genetic engineering challenges our self-understanding as humans. Given human freedom, and in the absence of taken-for-granted religious or cultural moral constraints, the likelihood of germ-line genetic engineering opens the possibility of human nature in the plural. (shrink)

In his 1993 health-care reform proposal, Bill Clinton offered health care as a civil right. If his proposal had been accepted, all Americans would have been guaranteed a basic package of health care. At the same time, they would have been forbidden to provide or purchase better basic health care, as a cost of participating in a national system to which they were compelled to contribute. A welfare entitlement would have been created and an egalitarian ethos enforced. This essay will (...) address why such egalitarian proposals are morally unjustifiable, both in terms of the establishment of a uniform health-care welfare right, and in terms of the egalitarian constraints these proposals impose against the use of private resources in the purchase of better-quality basic health care, not to mention luxury care. (shrink)

H. Tristram Engelhardt has made profound contributions to both philosophical and religious bioethics, and his philosophical and religious works may be read in mutually illuminating ways. As a philosopher, Engelhardt has mustered a powerful critique of secular efforts to develop a shared substantive morality. As a religious scholar, Engelhardt has affirmed a Christian bioethics that does not emanate from human rationality but from the experience of God found in Orthodox Christianity. In this collection of essays, both (...) defenders and critics of Engelhardt's religious bioethics have their say, and the spirited nature of their discussion attests, in its own right, to Engelhardt's enduring influence. (shrink)

Arising from four conferences held in Europe and the United States, this volume contains eighteen essays written mostly by Roman Catholics with the exception of select contributions from Jewish, Protestant, and Orthodox perspectives. Most essays pay particular attention to the distribution of scarce medical resources in terms of intensive care units (ICUs) which use some 38% of all medical expenditures in the U.S. each year, one percent of the GNP. The essays often make reference to one another and a wide (...) variety of Catholic perspectives are represented. The essays offer a good reflection of the contemporary state of Catholic moral thought with its strengths and diversity and are nicely framed by the ‘outside voices’ of the non-Catholics represented. Philosophers will find some essays almost exclusively theological. (shrink)

This review essay examines H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics, a contemporary nonfeminist text in mainstream biomedical ethics. it fo-cuses upon a central concept, Engelhardt's idea of the moral community and argues that the most serious problem in the book is its failure to take account of the political and social structures of moral communities, structures which deeply affect issues in biomedical ethics.

Despite its many strengths, Engelhardt’s After God displays two surprising features: an affinity for voluntaristic ethics and a tendency to oppose Eastern Orthodoxy to philosophy. Neither of these is in keeping with the mainstream of Eastern Orthodox tradition. Here, I offer a modest corrective. I begin with the figure of Socrates as presented in the Apology and Phaedo, highlighting the role that faith plays for Socrates and the reasons why he was widely admired by the early Church. I then (...) describe more broadly the attitude of the Greek Church Fathers to philosophy, showing that, although they were cautious of its potential errors, they nonetheless embraced the ideal of philosophy as a way of life dedicated to the pursuit of wisdom. For many, in fact, Christianity is itself simply the true philosophy, an attitude that led many of the most eminent patristic and Byzantine theologians to draw extensively on philosophical sources. Finally, I discuss the Euthyphro dilemma, contrasting the voluntaristic approach favored by Engelhardt with the Platonic approach adopted by the mainstream of Orthodox tradition. (shrink)

Tris' request for a leave that interrupted his clinical c1erkships, so that he could undertake his graduate studies in Austin. The field, not just Tris, owes Jim Knight a hearty "thank you" for his decision to approve Tris' request, which was unusual, to say the least, in the conservative world ofmedical education at the time. Whenhereturned toTulane to complete his medical degree, Tris undertook withRichardZanerthe translationofAlfred Schutz'sandThomas Luckmann's 6 The Structures of the Life-World. Tris did this work while on his (...) clinical rotations, including obstetrics and gynecology. In between delivering babies, most of whom were delivered by medical students at New Orleans' Charity Hospital, he worked on this translation. Tris once told me that, as a medical student, he had delivered scores ofbabies alone. Ican see him sitting with a patient in the labor area or maybe in the hall, attending to her, monitoring her progress in labor and the fetus' status, and translating from German, which is his first language, as well as thatofhis children. As this translation indicates, Tris believes in texts and scholarship about texts in a way that is decidedly not post-modem. This is also plain to anyone who has read his work. Forexample, the two editions of The Foundations of Bioethies, whateverelse one might thinkofthem, are monuments ofscholar ship in the historiesofphilosophy, medicine, theology, and ideas generally, not to mention excellent primers on Texana. These books are packed with re ferences and footnotes. (shrink)

In this article I offer a critique of certain moral perspectives that are found in the second edition of Engelhardt’s Foundation of Bioethics. These views are spelled out in explicit detail in his second edition, and follow on the heels of a profound religious conversion. I question some of the conclusions that Engelhardt reaches as they touch upon moral frameworks, pluralism, and a ‘secular’ bioethics.

This paper is a tribute to H.T. Engelhardt Jr. for the intellectual resources he provided to challenge cosmopolitan liberalism as the foundation for an overarching global bioethics in the post-modern world. It is a also a tribute to the moral pluralism and cultural diversity which he argued so forcefully in all his works and which have inspired the flourishing of fierce bioethical debates across the world, including in the non-Western and Asian societies.

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been (...) dedicated to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

The philosophy of medicine cum bioethics has become the socially recognized source for moral and epistemic direction in health-care decision-making. Over the last three decades, this field has been accepted politically as an authorized source of guidance for policy and law. The field's political actors have included the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the Department of Health, Education, and Welfare, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research, the National Bioethics Advisory Commission, and the new Council on Bioethics; these groups and agencies have set forth rules on issues ranging from the role of humans in biomedical research to the production of human embryos for research, the definition of death, and the permissibility of human cloning. The members of the field are not just scholars and teachers in an academic realm directed to both theoretical and applied issues. They are, in addition, practitioners of a conceptual and moral trade that possesses a legal and political standing. This essay critically addresses the sudden emergence of bioethics as a societally recognized source of moral guidance, a source replete with authorized moral experts. Attention is directed to moral and conceptual assumptions that have led the philosophy of medicine, and especially bioethics, to acquire a quasi-juridical/political role in guiding clinical choices, framing health-care policy, and directing court holdings. (shrink)

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

The high technology and the costs involved in critical care disclose the implausibility of applying the American standard version of bioethics in the developing world. The American standard version of bioethics was framed during the rapid secularization of the American culture, the emergence of a new image for the medical profession, the development of high technology medicine, an ever greater demand in resources, and a shift of focus from families and communities to individuals. This all brought with it a particular (...) ideology of health care which promised Americans (1) the best of care, (2) equal care, and (3) physician/patient choice, without (4) runaway costs. This essay argues that this moral project is impossible in practice. This impossibility is especially salient in developing countries. In addition to the fact that it is financially impossible to provide all in the developing world with the standard of care accepted by law, policy, and convention in developed countries, different moral perspectives with different orderings of values will seem more or less plausible in different cultures. Indeed, such an approach would be harmful. A concrete bioethics applicable across the world does not appear possible. (shrink)