First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Reissue from the classic Muirhead Library of Philosophy series (originally published between 1890s - 1970s).

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

The role of power in healthcare can raise many ethical challenges. Power is ownership, whether given, ceded, or taken of another person’s autonomy. When a person has power over someone else, they can control or strongly influence the decision-making freedom of that person. From the principalist perspective1,2 of healthcare ethics, denying a person their freedom to choose, should only occur when justifying conditions related to beneficence and nonmaleficence are sufficiently satisfied. In healthcare, it is rare to be able to identify (...) situations where paternalism is justified. However, experience suggests that abusive power in healthcare is used too frequently without justifying criteria. (shrink)

The emergence of Abstract Expressionism as a predominant artistic style in the early 1950s was accompanied by a new critical image of the artist as a heroic individualist. This myth, according to which the artist created great works primarily by looking into the profound depths of his own soul rather than by responding to the world and society around him, has become the standard description of the Abstract-Expressionist artistic process. By such an account, the Abstract-Expressionist artist was an apolitical being, (...) unconcerned with the conflicts in society due to his overriding concern with the explorations of the self. This treatment of Abstract Expressionism began with the writing of two critics, Clement Greenberg and Harold Rosenberg. (shrink)

Three different models are described of the relationship of bioethics to the press. The first two are familiar: bioethicists often are interviewed by journalists seeking background and short quotes to insert in a story; alternately, bioethicists sometimes themselves act as journalists of a sort, writing op-eds, articles or even longer works designed for wide readership. These models share the notion that bioethicists can provide information and ideas that increase the quality of people's thinking on moral matters. They share also a (...) common difficulty: do the constraints the media impose on bioethical discourse keep bioethicists from deepening public reflection, and if not, how can those constraints be most effectively kept from distorting what bioethicists wish to say? The third model reverses — in part — the presupposition that bioethics bestows moral sophistication on a public naive about ethical issues, holding rather that matters run both ways; bioethicists stand to learn a great deal from their interactions with various publics and the media that serve them. On this view, the constraints imposed by media conventions constitute opportunities for new and potentially important forms of bioethical writing. Various concerns generated by the first two models are surveyed. It is concluded that while none of the difficulties constitute knock-down arguments against these forms of collaborating with the press, the worries are problematic enough to provide some support for considering the less familiar third approach. Further reason for taking the third model seriously draws on moral theoretic considerations. (shrink)

There is reason to believe that procuring organs from recently dead people who did not explicitly refuse to provide them—here referred to as “opt-out” arrangements—would ease growing shortages, thus extending the lives of many who otherwise would die soon. There is also a simple, apparently powerful argument—the “easy rescue requirement”—for believing that many people have strong moral reason to provide such life-extending support to others, thus bolstering the case for implementing optout systems. Here I consider two broad types of feminist (...) reservations about opt-out arrangements, one concerning the motivating argument, the other concerning ways in which opt-out practices might disproportionately burden women. I conclude that both reservations can be answered sufficiently so as to encourage further feminist reflection on opt-out proposals and easy rescue arguments. (shrink)

In the portion of their reply directed to me, Professor Asch and Dr. Wasserman helpfully develop the synecdoche argument by highlighting its connections to stigma. I understand them to distinguish the situation of a woman making a decision concerning her pregnancy informed by prenatal testing from a woman making a similar decision informed by considerations of, for example, poverty, like so: In testing contexts, it will characteristically be the case that the woman's decision will be distorted by the stigma associated (...) with impairment: She will consider only the fact that, should her pregnancy come to term, the child would be impaired; she will not be able to attend in a satisfactory manner to a fuller range of possible features, both good and bad, that may characterize the child's life and her experience of being the child's parent. The woman considering whether to terminate her pregnancy due to, say, poverty will, in contrast, typically be able to deliberate in ways more responsive to a broader range of relevant matters, as the possible child's poverty will not be the only thing she is in a position to take into account about her or his life and their life together. Further, even where poverty or some other factor influencing decisions about terminating or continuing pregnancy are stigmatizing, they are not as thoroughly stigmatizing as are impairment-related conditions, due to prevalent confusions about the immutability of traits seen as biological rather than social. (shrink)

Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down (...) slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America's youth.The concurrent travesty underlying childhood obesity is the relative societal failure to slow and reverse its spread. (shrink)

Obesity is the definitive epidemic of the modern era in the United States. Its well-documented public health impacts, especially related to children and adolescents, are horrific. Nearly one-third of American minors are overweight; over 50% of them are obese. Already, these kids suffer from multiple adverse physical and mental health conditions. Sadly, absent serious communal and individual interventions, their lives may be cut short compared to their own parents’ life expectancy. While recent surveillance suggests childhood obesity may be trending down (...) slightly in some populations, public health experts remain concerned about the threat obesity poses to the health of America's youth.The concurrent travesty underlying childhood obesity is the relative societal failure to slow and reverse its spread. (shrink)

In September 2010 at the Johns Hopkins Hospital, one of the nation's elite academic hospitals located in East Baltimore, Maryland, Paul Warren Pardus entered the facility to visit his mother, a patient. During a discussion with her doctor in a hospital hallway, Pardus became “overwhelmed” about the care and condition of his mother, pulled a handgun from his waistband, and shot the doctor in the chest. Pardus then locked himself and his mother in her room, shot and killed her, and (...) committed suicide.Dr. Gabe Kelen, a national expert on emergency preparedness and director of the Johns Hopkins emergency department, admitted several years later that this tragic event “really got us thinking in a very serious way.” Together with colleagues at the Johns Hopkins Office of Critical Event Preparedness and Response, Kelen conducted research on the threat and impact of “active shooters” in health care settings. (shrink)

Somatic or inherited mutations in the adenomatous polyposis coli (APC) gene are a frequent cause of colorectal cancer in humans. APC protein has an important tumor suppression function to reduce cellular levels of the signaling protein β‐catenin and, thereby, inhibit β‐catenin and T‐cell‐factor‐mediated gene expression. In addition, APC protein binds to microtubules in vertebrate cells and localizes to actin‐rich adherens junctions in epithelial cells of the fruit fly Drosophila (Fig. 1). Very little is known, however, about the function of these (...) cytoskeletal associations. Recently, Hamada and Bienz have described a potential role for Drosophila E‐APC in cellular adhesion,1 which offers new clues to APC function in embryonic development, and potentially colorectal adenoma formation and tumor progression in humans. BioEssays 24:771–774, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

In my previous thinking about the considerations that go under the heading of the “expressivist argument,” I have been fascinated chiefly by two of its features: its semantic commitments and its independence from disputes about the moral standing of fetuses. Abortions prompted by prenatal testing are undertaken because of indications that the fetus has physical features that would be configured as disabilities in the social world into which it would otherwise emerge. The expressivist argument's allegation, as I have understood it, (...) is that abortions so motivated convey semantic content—“send a message”—to people who are currently living with disabilities that is somehow insulting, hateful, dismissive, or disparaging. It is thus uncontroversial moral subjects who are wronged, not—or, at least, not necessarily—the aborted fetuses. So far as this argument goes, a person might hold strongly pro-choice views about abortion generally and still object to “selective” abortions. (shrink)

Evidence does not support the claim that observers universally recognize basic emotions from signals on the face. The percentage of observers who matched the face with the predicted emotion (matching score) is not universal, but varies with culture and language. Matching scores are also inflated by the commonly used methods: within-subject design; posed, exaggerated facial expressions (devoid of context); multiple examples of each type of expression; and a response format that funnels a variety of interpretations into one word specified by (...) the experimenter. Without these methodological aids, matching scores are modest and subject to various explanations. (shrink)

The Patient in the Family diagnoses the ways in which the worlds of home and hospital misunderstand each other. The authors explore how medicine, through its new reproductive technologies, is altering the stucture of families, how families can participate more fully in medical decision-making, and how to understand the impact on families of medical advances to extend life but not vitality.

On the usual account of moral reasoning, social science is often seen as able to provide “just the facts,” while philosophy attends to moral values and conceptual clarity and builds formally valid arguments. Yet disciplines are informed by epistemic values—and bioethics might do well to see social scientific practices and their attendant normative understandings about what is humanly important as a significant part of ethics generally.

The authority of surrogates—often close family members—to make treatment decisions for previously capacitated patients is said to come from their knowledge of the patient, which they are to draw on as they exercise substituted judgment on the patient’s behalf. However, proxy accuracy studies call this authority into question, hence the Patient Preference Predictor (PPP). We identify two problems with contemporary understandings of the surrogate’s role. The first is with the assumption that knowledge of the patient entails knowledge of what the (...) patient’s choice of treatment would be. The second is with the assumption that a good decision reproduces the content of that choice. If we are right, then the PPP, helpful though it might be in guiding surrogates’ decisions, nevertheless would hold them to the wrong standards and in that way could add to, rather than relieve, the stress they experience as they try to do their job. (shrink)

Medical decisionmaking would be a messier but better thing if it honored what is morally valuable about patients' families. The concerns of intimates have a legitimate call upon us even when we are ill.

We hypothesize that aspects of animal multicellularity originated before the divergence of metazoans from fungi and social amoebae. Polarized epithelial tissues are a defining feature of metazoans and contribute to the diversity of animal body plans. The recent finding of a polarized epithelium in the non‐metazoan social amoeba Dictyostelium discoideum demonstrates that epithelial tissue is not a unique feature of metazoans, and challenges the traditional paradigm that multicellularity evolved independently in social amoebae and metazoans. An alternative view, presented here, is (...) that the common ancestor of social amoebae, fungi, and animals spent a portion of its life cycle in a multicellular state and possessed molecular machinery necessary for forming an epithelial tissue. Some descendants of this ancestor retained multicellularity, while others reverted to unicellularity. This hypothesis makes testable predictions regarding tissue organization in close relatives of metazoans and provides a novel conceptual framework for studies of early animal evolution.Editor's suggested further reading in BioEssays Searching for Eve: Basal metazoans and the evolution of multicellular complexity Abstract. (shrink)

Our response to Sara Fry's paper focuses on the difficulty of understanding her insistence on the fundamental character of caring in a theory of nursing ethics. We discuss a number of problems her text throws in the way of making sense of this idea, and outline our own proposal for how caring's role may be reasonably understood: not as an alternative object of value, competing with autonomy or patient good, but rather as an alternative way of responding toward that which (...) is of value. (shrink)