This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition (...) and hydration, costs and benefits to the patient should be weighed. Ultimately, he argues in favor of leaving the decision to the patient, his caregivers, and others immediately involved in the case. (shrink)

Catholic hospitals seek to offer health care in accord with the example of Christ. They have several models to assist in this effort. The first model is the values portrayed in the Gospels. The Catholic Church has sought to embody these Gospel values in specific teachings. These teachings have been further specified for hospitals in the United States by the National Conference of Catholic Bishops in the Ethical and Religious Directives. Finally, the Gospels values are also expressed for individual Catholic (...) health care systems in mission statements and statements of Catholic identity. This article examines the worth of mission and identity statements, and explains that the statements must be put into practice through a process of internalization before they will be able to be of worth to the Catholic health care apostolate. (shrink)

Like Saint Paul, I was “born out of due time” insofar as the study of bioethics is concerned. I spent 15 years in teaching and administration at the Aquinas Institute of Theology, then in Dubuque, Iowa, now on the campus of Saint Louis University. I was given a sabbatical study year in 1972–1973 to refresh my mind and spirit. Though my major study and research emphasis prior to the sabbatical study had been in the field of Church law and religious (...) government, I determined to direct my attention to the study of moral theology and ethics, because at that time there was confusion in this area of discipline, especially insofar as the Catholic community was concerned. With this in mind, I chose the University of Chicago as the locale for my study and was awarded a postdoctoral fellowship. (shrink)

In the 2008 Instruction Dignitas personae (The Dignity of the Person), the Congregation for the Doctrine of the Faith presented once again the teaching of the Church on in vitro fertilization. Much of this teaching was contained in the earlier Instruction Donum vitae (The Gift of Life, 1987), but the new document brings the teaching of the Church up to date. Because the teaching is not accepted in the secular scientific community and is often unknown in the Catholic community, this (...) article explores the process of IVF, the view of the Church concerning it, and the fundamental principles underlying the Church’s teaching. National Catholic Bioethics Quarterly 10.4 (Winter 2010): 709–722. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:358 BOOK REVIEWS ing and his arguments seem more tentative and relativistic than those offered in his previously published works (Truth and Other Enigmas, 1978; The Interpretation of Frege's Phuosophy, 1981, etc.). Yet he uses his mastery of powerful logical techniques in order to support the chosen positions. This fact might give great satisfaction to a logician, hut the metaphysician may he somewhat disappointed by the meager results attained, (...) though Dummett himself modestly restricts his goals to those of forming only " a base camp for an assault on the metaphysical peaks...". One may also wonder whether Dummett remained faithful to his methodological requirement of the priority of meaningtheory with regard to logic and metaphysics. Doesn't Dummett's acceptance of intuitionistic logic (with its rejection of the principle of bivalence) dictate his preference for a certain meaning-theory, and not the other way around? To distill and extract metaphysical beliefs and insights which are contained (perhaps tacitly) in the working of our language is undoubtedly a legitimate goal of any philosophical enterprise. But our ambitions go beyond this goal: we are reaching after reality itself, not just after our opinions about reality and their semantical elucidation. In this respect Dummett's programmatic conception of metaphysics may face serious difficulties in attempts to climb the ahovementioned metaphysical peaks. On the other hand, is any metaphysical program exempt from such difficulties? The hook is beautifully printed; Harvard University Press has done an excellent job! The Index, which combines names and subjects, is a hit too economical, omitting certain references (for example, important remarks on God's omniscience on pp. 75-76). AUGUSTIN RISKA Saint John's University New York, New York Ethical Practice in Clinical Medicine. By WILLIAM J. ELLOS. New York: Routledge, 1990. Pp. 190. Medical ethics is an integral part of the science and art of medicine. Rather than being a set of norms or regulations added from external sources, such as the legal norms regulating the medicare program, the norms and maxims of medical ethics are integral elements of medicine arising from the relationship between physician and patient. In one way or another, most philosophers of ethics and medicine would agree with the foregoing statements. But once the role of ethics in medicine has BOOK REVIEWS 359 been established, a serious difficulty arises: What method should he used to define and delineate ethical norms for particular cases? More to the point, how should one go about solving problems in medical ethics? Father William Ellos, S.J., is concerned with resolving the difficulty of method in medical ethics. He seeks to develop and explain a method in medical ethics that will be both clinical and pragmatic. Joining with other specialists in the field, he opts for a virtue-centered approach to solving issues in medical ethics, as opposed to a rulecentered duty-based approach. While not rejecting the ethical method featuring the principles of autonomy, beneficence, and justice derived from W. D. Ross (an approach favored by so many contemporary scholars in the field of medical ethics), he does maintain that these principles are greatly overworked as well as simplistic. He proposes virtue-centered reasoning as a better method of ethical endeavor, especially attuned to the complexity and problematics of clinical ethics. In developing the notion of virtue·centered ethics, Ellos considers the contributions of the past and present thinkers to this method of ethical decision making. Hence, Plato, Aristotle, Thomas, the Scottish Enlightenment Philosophers, and American Pragmatists are the main sources of his reflections upon virtue ethics. Ellos finds a culmination of virtue ethics in the present-day tendency of many consultants in medical ethics to classify themselves as casuists, indicating that they are eclectic and pragmatic in their efforts to solve clinical cases. In the course of the historical and analytical sections of this work, Ellos demonstrates not only a wide acquaintance with classical and contemporary authors but also an ability to discern continuity of thought among these well.known philosophers and theologians. Especially significant is his recognition of the too often neglected contemporary authors Collen Clements and Roger Sider, whose accurate indictment of the principle of autonomy as interpreted by present-day medical ethicists restores the... (shrink)

This third edition has been updated to incorporate the statements issued since the second edition, including the papal encyclicals Splendor Veritatis & Evangelium Vitae.

This article critically examines the recent papal allocution on patients in a persistent vegetative state with regard to the appropriate conditions for considering “reformable statements.” In the first part of the article, the purpose and meaning of the allocution are assessed. O'Rourke concludes that given consideration of the individual patient's best interest, prolonging artificial nutrition and hydration is not, in every case, the best option. Although he stresses favorability for preservation of the life of the patient through artificial nutrition (...) and hydration, costs and benefits to the patient should be weighed. Ultimately, he argues in favor of leaving the decision to the patient, his caregivers, and others immediately involved in the case. (shrink)

The arguments advanced in the second chapter of On Liberty have become the touchtstone of discussions of freedom of speech, yet the broader development of his ideas has been ignored. This book attempts to redress this lacuna.

James Walsh and Moira McQueen accurately conclude that the early delivery of anencephalic fetuses is morally acceptable, but the reasoning they use to reach that conclusion is flawed. First, the principle of double effect does not require a weighing of good and evil, but rather seeks a sufficient reason for tolerating the physical evil indirectly intended. Second, the principle of double effect requires a clear distinction between physical and moral causality. Third, the Catholic moral tradition will not admit direct and (...) intended killing of the innocent. Rather, early delivery of anencephalic fetuses is permissible because of the pathology associated with delivery of anencephalic fetuses at full term. Thus, the early delivery of an anencephalic infant is acceptable if the purpose of the moral act is avoiding a pathological condition on the part of the mother. (shrink)

From Harry and Louise through the McCaughey septuplets, this book explains stories and issues in health care ethics that have appeared in the news media.

In lieu of an abstract, here is a brief excerpt of the content:LettersJames L. Walsh, Moira M. McQueen, Kevin O'Rourke, and Jean deBloisEarly Delivery of the Anencephalic InfantMadam:In the March 1994 issue of the Kennedy Institute of Ethics Journal, Kevin O'Rourke and Jean deBlois have replied to an article of ours (KIEJ, December 1993) on the early induction of the anencephalic fetus. They agree with our conclusion that such early delivery may be morally acceptable, but argue (...) that our justification is flawed. Exchanges on the subject probably could continue ad nauseam; here we simply state some of the elements of their article that leave us perplexed.1. The phrase "prolonging the life of" (p. 49) has one meaning in the case of artificial life supports, which may be unwarranted interventions, but it has a different meaning when it refers to not interfering with a person's enjoyment of necessary natural means of preserving his or her life. Inducing labor prior to viability, which denies the natural means of life support without a possible substitute, has more in common with smothering a dying patient than the nonemployment of or withdrawing of artificial means of life support. To refer to the death of the fetus here as an effect is rather like saying that I suffocated you and the effect of the suffocation is your death. This is quite different from induction after viability where the induction can have different effects.2. If the authors were correct that "the prohibition on inducing delivery before viability is predicated upon the assumption that the fetus in utero is a human being with the potential for further development" (p. 49) and the anencephalic has none, why is there need to employ the principle of double effect? They say that there is no moral obligation to prolong the life of the anencephalic fetus. Just as there is no need for the principle in cases of withdrawing unwarranted artificial life support, so there would be no need for it here. Because the authors seem to perceive a complete disjunction between direct and indirect killing (allowing to die being in the category of indirect killing), it seems that they are unable to let their argument rest here, but have to justify the death that occurs.3. The example concerning smothering and the nonemployment of aggressive interventions (p. 49) explains well the difference between killing and allowing to die. But allowing to die is not indirectly killing since it occurs as a result of the disease and not from the causality of the agent.4. How can we cause something and not intend it? There are instances in which we simply "permit" evil events, but where we are not the cause. For example, evil events may be attributable to the bad will of others. Legislators make just laws knowing that some people of bad will will break them for their own advantage. Here the legislators really do permit evil. Neither are we the cause of death when we allow a person to die by not imposing unwarranted means of life support; we permit his or her death. But can we so readily designate by "permit" [End Page 184] what we knowingly choose to bring about? O'Rourke and deBlois use interchangeably "indirectly intended" and "unintended" for what is caused by our actions; "indirectly intended" is a better designation than "unintended." The whole package, including all foreseen effects, is intended. Evil "happening" (p. 51) as a result of an action that I place can refer either to evil as caused by my action or to evil as arising from a cause apart from my action. Only in this latter sense do I permit evil and not intend it, either directly or indirectly.5. The fourth condition of the principle of double effect is given as follows: "There must be a proportionately grave reason for placing the act. The greater the evil, the more cogent the reason must be for performing the act" (p. 50). How the authors can abstract from balancing goods and evils here is beyond us.6. We cannot follow the authors' use of the term "morally good" with respect to the induced delivery (p. 50). The problem is concerned with the morally right... (shrink)

El autor comienza con una breve reseña de su propio involucramiento en la (-uestión, centrándose en la reunión defilósofos morales, teólogos, doctores, abogados y enfermeras que él presidió en 1986 para discutir este tema en prnfÚndidad, después de que la declaración de 1985 de la Pontificia Academia de Ciencias dijo que no se requiere el tratamiento de la persona permanentemente inconsciente, aunque si se les Jebe todo el cuidado, incluyendo la alimentación. Este encuentro lo llevó a él y a otros (...) a cambiar sus posturas iniciales, las cuales consideraban que la alimentación no era obligatoria, y a preparar un escrito, publicado en Temas de la ley y Medicina, en 1987, y.firmado por más de 90 estudiosos, aportando las razones por las cuales se requiere moralmente la alimentación. Después, el autor revisa las posturas desde diferentes fuentes, incluyendo a obispos católicos y estudiosos, desde los primeros años ochenta hasta la declaración de Juan Pablo II del 20 de marzo de 2004. En particular, presenta el argumento que ha tenido mucha influencia presentado por Kevin O 'Rourke, OP, sosteniendo que una lectura adecuada del escrito de 1957. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 545 Haroutunian, would have balked at the notion that their " empiricism " could be abstracted from the christological and trinitarian confession 0£ the church. In general, it would seem that a genuinely " empirical" approach would seek to engage the actual truth claims of religious com· munities on their own terms-even when those claims conflict with historicist suppositions. Second, in so far as Dean thinks there (...) is a uniquely American reli· gious experience or style of thought, privileging that style seems a dangerous move indeed. Dean is not unaware of the dangers. He specifically denies that he is engaging in any form of " American exceptionalism " (p. 25) ; it is simply that an " appropriately American historicism, centering on American culture, would have a greater chance of suggesting practices that work for and are true for America " (p. 24). But I am skeptical that such disclaimers address the real problem. Near the very end of the book, Dean suggests that a modi· fied naturalism might lead to " a notion of God that was more genuinely American than anything earlier," culminating in the recognition that " American thought about God is really the thought of a national com· munity" (p. 144). Descriptively that may well be the case; but then the Christian theologian must seek norms elsewhere. History Making History does not show us how historicist insigh~ might be incorporated into ecumenical, trinitarian theology, but that does not mean the attempt will prove unfruitful. Meanwhile, this bit of philosophical tale-telling will hold the interest of readers theological and otherwise. JOSEPH L. MANCINA Yale University New Haven, Connecticut Medical Ethics: Sources of Catholic Teaching. By KEVIN D. O'ROURKE, O.P. and PHILIP BOYLE, O.P. St. Louis: Catholic Health Associa· tion, 1989. Medical Ethics: Common Ground for Understanding. By KEVIN D. O'RouRKE, O.P. and DENNIS BRODEUR. St. Louis: Catholic Health Association, 1989. Healthcare Ethics: A Theological Analysis. By KEVIN D. O'RouRKE, O.P. and BENEDICT ASHLEY, O.P. 3rd ed. St. Louis: Catholic Health Association, 1989. Sources of Catholic Teaching is a compendium of recent "official" statements by Roman Catholic ecclesiastical bodies on issues concern· ing medical ethics. Arranged alphabetically according to topics, this col- 546 BOOK REVIEWS lection of statements from the papacy, the Roman Congregations, and the conferences of Catholic bishops could prove to he a very helpful reference tool. It contains a brief introduction which seeks to explain the role of these statements in the Catholic moral theology and Catholic medical ethics, a table of contents of the statements included, and then the statements themselves. In most instances it does not contain the entire document or statement hut only excerpts therefrom. There are some weaknesses in this work. First, these statements are not self-explanatory; they are in need of interpretation and explanation in many instances. But the authors present only the bald text and do not offer any explanatory comments. They apparently presume that these statements are pellucid to the reader, hut this is an unwarranted pre· sumption. For example, clarifying comments should have been added to the statement from the Declaration on Euthanasia because the allocution of Pius XII about giving lethal doses of analgesia is not entirely clear. A second difficulty with this work is the brief and somewhat insubstantial introduction on conscience and the role these statements should play in the formation of conscience. This sort of work invites a substantial and extended commentary on the nature of moral judgments, the relationship of conscience to the natural law, and the authority of these statements. The authors note that not all of the official statements issued by various organs of the Church are of equal authority, hut they do not try to identify the specific authoritative status of the various statements they include in their work. The reader is thus left to his or her own devices to determine, for example, the relative weight of statements of the administrative hoard of the NCCB versus statements of state episcopal conferences. A still further problem is that some of the statements are of virtually no significant authority for Catholics. For example, the statement of the administrative hoard of the NCCB on AIDS is of questionable... (shrink)

Many philosophers of language have held that a truth-conditional semantic account can explain the data motivating the distinction between referential and attributive uses of definite descriptions, but I believe this is a mistake. I argue that these data also motivate what I call “dual-aspect” uses as a distinct but closely related type. After establishing that an account of the distinction must also explain dual-aspect uses, I argue that the truth-conditional Semantic Model of the distinction cannot. Thus, the Semantic Model cannot (...) explain the data for which it is developed and so fails as an account of the referential/attributive distinction. (shrink)

Few of us are free of all prejudices, however subtle and subconscious, and they may affect both patient care and teaching. Here I use reflection about a patient with HIV infection, from the points of view of two doctors caring for him and the patient himself, to explore prejudice against lifestyles that are considered “dangerous”. The paper then goes on to discuss research about physicians' attitudes to such cases, the teaching of ethics in a clinical environment and the need to (...) support junior medical staff. (shrink)

Abstract In this essay, I critically discuss a theory of utterance content and de re communication that Anne Bezuidenhout has recently developed in a series of articles. This theory regards the significance of utterances as more pragmatic in nature than allowed by traditional accounts; further, it downplays logical considerations in explaining de re communication, choosing instead to emphasize its psychological character. Included among the implications of this approach is the rejection of what can be called ?common content?, or utterance content (...) that is held in common by speaker and listener. After describing this theory, I argue that Bezuidenhout does not supply a compelling reason to prefer her account of utterance content over more traditional alternatives that make room for elements of content held in common between speaker and listener. Further, I argue that her account of de re communication supplies even more reason to reject the view of content to which she subscribes. In the end, it will be clear that she has no principled reason for rejecting common content. (shrink)

This paper argues that we are not just social epistemic creatures because we operate in social contexts. We are social epistemic creatures because of the nature of our epistemic cognitive capacities. In The Enigma of Reason, Hugo Mercier and Dan Sperber develop and defend the view that reasoning is a social competence that yields epistemic benefits for individuals through social interaction with others. I argue an epistemological consequence of their position is that, when beliefs are formed and sustained by dialogical (...) deliberation, the relevant justification-conferring process doesn’t occur solely within the cognition of the subject whose belief is under evaluation. Rather, it extends to include her interactive engagement with other deliberative participants. I argue this demonstrates that not all justification-conferring is evidential. As such, the analysis not only supports reconceiving the process reliabilist’s notion of justification-conferring processes; it also serves as an argument against evidentialism. A goal of this paper is to demonstrate that social epistemology isn’t merely a siloed offshoot of traditional epistemology. Even when approaching social epistemology using a conservative methodology, our investigation has serious implications for fundamental questions concerning epistemic normativity. (shrink)

This paper is concerned with changing social representations of the ``wild,'' in particular wild animals. We argue that within a contemporary Western context the old agricultural perception of wild animals as adversarial and as a threat to domestication, is being replaced by an essentially urban fascination with certain emblematic wild animals, who are seen to embody symbols of naturalness and freedom. On closer examination that carefully mediatized ``naturalness'' may be but another form of domestication. After an historical overview of the (...) human-animal, domestic-wild construction, an anthropological approach is used to interpret the social representation of wild animals held by different social actors – farmers, hunters, and tourists – within the context of an inhabited National Park, that of the Cévennes in south east France. Within the Park, the domestic and the wild, along with agriculture, hunting, conservation, re-introduced wild animals, and tourists co-habit. It is argued that changes in the representation of ``wildness'' may well be an important indicator ofchanges in the social representation of nature. (shrink)

À la croisée de la philosophie et de l’histoire de l’art, Bernard Teyssèdre a ouvert des champs de recherche très divers, ce qui a suscité l’enthousiasme de ses étudiants, mais aussi déconcerté ceux qui restaient attachés à leur pré carré disciplinaire. Présenter aujourd’hui son parcours intellectuel revient à faire redécouvrir certains de ses travaux oubliés en esthétique afin de montrer leur singularité et leur cohérence profondément hégélienne, bien que ses recherches aient pris des formes très différentes et abordés avec érudition (...) des domaines très éloignés les uns des autres. Sans oublier de situer philosophiquement des aspects moins connus de ses activités, littéraires, artistiques et aussi institutionnelles avec sa contribution déterminante au développement de la discipline esthétique et à l’introduction des arts plastiques à l’université. Ce panorama n’aurait pas été complet si n’était pas signalée la place de ses recherches en paléontologie restées longtemps secrètes et a priori fort éloignées de l’esthétique. Alors que Bernard Teyssèdre avait publié en 2007 une nouvelle édition de son Roman de l’Origine revue et augmentée (et que Thierry Savatier était sur le point de publier une nouvelle édition de L’Origine du monde, Histoire d’un tableau de Gustave Courbet ), Jean Da Silva lui apprit qu’une photographie du tableau exposé au musée d’Orsay avait circulé en France pendant une vingtaine d’années avant d’être publiée en 1953 dans des revues oubliées ; ce qui bouleversait l’idée que l’on avait encore en 2009 de la connaissance de ce tableau. S’ensuivit ensuite un jeu de piste à deux, sur le blog, par courriels et au téléphone. (shrink)

This paper considers combinations of frictionless mechanical amplifiers arranged in a cycle so that the amplified signal passes around through an endless chain of such systems the output of the last system being fed into the first. It appears that while each amplifier may be reversible in the absence of friction, the effect of the combination is such that the signal would be unable to pass around the cycle indefinitely, using the same energy over and over again. It is felt (...) that the assumptions upon which this cycle is based are related to some of the conditions met with in consideration of open thermodynamic systems such as heat engines and living organisms when in finite environments. (shrink)

The Toolbox dialogue method enables members of heterogeneous groups to identify, share, and compare their perspectives on topics of common interest, such as research questions or complex problems (Hubbs et al. 2020). These interactions occur in dialogue, typically in relatively brief (eg, two-to four-hour) workshop settings, where participants jointly consider their responses to abstract and often philosophical statements that express positions on the topics. By expressing positions on topics that matter to the group, these statements structure a dialogue that enhances (...) mutual understanding in valuable ways. The method is valuable for heterogeneous groups because it enhances both self-understanding and mutual understanding. It does this by transforming dialogue participants into teachers and learners: teachers of their own perspective to others and learners of the perspectives of others and, to some extent... (shrink)