As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may (...) be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree? (shrink)

Decision making during reproduction is complex for a variety of medical and social reasons. Anyone who has had a conversation with a family member about the “best time” to have a baby can attest to this — there is no “best time” or “best way.” Multiple pressures from any number of sources combine in a minefield of hazards made ever more complicated by restrictive laws in the US. Add to this a screening result of potential chromosomal aneuploidy and decision making (...) becomes ever more complex. Societal stigma and lack of adequate and accurate information during counseling certainly plays a role in the high number of terminations in the setting of diagnosed chromosomal aneuploidy, yet other factors also push families in this direction including medical considerations and the abysmal lack of social support programs. (shrink)

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair (...) for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report. (shrink)

The majority of obstetrician‐gynecologists in practice operate very infrequently. Most residents graduate with strong surgical skill sets, given residency requirements. Nonetheless, their practices become dominated by obstetrics, and their gynecologic surgical skills deteriorate. While cesarean sections are surgical in nature, the skill sets needed in these surgeries differ from the skills used in general gynecologic surgery. As gynecology has taken a back seat to obstetrics in our specialty, not only surgical skills but also diagnostic and management skills have deteriorated.

This book evaluates some of the most common ethical issues confronted by reproductive endocrinologists, embryologists, and their teams. The authors apply core ethical principles and approaches to problem solving to each of the cases raised. This work is a guide for both those on the front lines of patient care as well as for students in the field, whatever their background. By outlining sample cases, the book is an instigator for ethical discussions among ethicists, medical practitioners and students.

Reading Henry Greely's wonderful book, The End of Sex and the Future of Human Reproduction, while riding public transport sparked awkward looks and equally awkward discussions. I thought of removing the dust jacket, yet I was reminded that Greely's stated purpose in writing the book was to spark conversation. The title is, of course, intentionally provocative. Greely does not, in fact, believe that humans will stop having sex for the multitude of reasons that we do already. Quite the contrary; he (...) proposes that sex for reproduction will become a technical endeavor, while sex for pleasure or other purposes beyond reproduction will remain as it is. In a not-too-distant future, advances in genomics and assisted reproduction, especially preimplantation genetic diagnosis, will allow us to control the genetic makeup of embryos. To a limited degree, PGD already makes this possible, but what Greely proposes is slightly different. His vision of the future depends on the potential for further advances of today's already fairly complex biotechnology. Greely does an excellent job of making this cutting-edge science easy to understand. (shrink)

Is truth itself natural? This is an important question for both those working on truth and those working on naturalism. For theorists of truth, answering the question of whether truth is natural will tell us more about the nature of truth (or lack of it), and the relations between truth and other properties of interest. For those working on naturalism, answering this question is of paramount importance to those who wish to have truth as part of the natural order. In (...) this paper, we focus primarily on the kinds of theories of truth that occupy the central positions in current debates about truth, namely correspondence theories, deflationary theories, epistemic theories, and pluralist theories, and aim to discern the extent to which truth is a natural property on each view. (shrink)

Research involving human participants has been conducted in the Philippines since the beginning of the Spanish colonial period. Such studies are expected to adhere to internationally accepted ethical guidelines. This paper discusses trends in clinical research ethics in the Philippines during the American colonial period (1898‐1946). Specifically, studies were assessed on: 1) their observance of ethical protocols, including review; 2) identification of inclusion and exclusion criteria in the selection of participants; 3) use of vulnerable subjects; and 4) practice of the (...) informed consent process. Only the informed consent process had a significant logistic correlation with progression of years. Recruitment of vulnerable groups was common during this period; children and prisoners were the most common participants. Trends in medical ethics in the Philippines reflected those in the United States prior to the publication of the Nuremberg Code, which served as a milestone in the protection of human welfare in clinical research. (shrink)

The theories of reasoned action and planned behaviour have fundamentally changed the view that attitudes directly translate into behaviour by introducing intentions as a crucial intervening stage. Much research across numerous ethical contexts has drawn on these theories to offer a better understanding of how consumers form intentions to act in an ethical way. Persistently, researchers have suggested and discussed the existence of an intention–behaviour gap in ethical consumption. Yet, the factors that influence the extent of this gap and its (...) magnitude have not been systematically examined. We, therefore, contribute to the debate on the intention–behaviour gap by reviewing the empirical TRA/tpb studies that have assessed both intention and behaviour in ethical contexts. The findings from our review show that few studies assessed the intention–behaviour relationship and as a result, there is limited empirical evidence to date to quantify more accurately the intention–behaviour gap in ethical consumption. Our second contribution aims to provide an empirical case study which assesses the magnitude of the intention–behaviour gap in the context of avoidance of sweatshop clothing and to assess the roles of planning and actual behavioural control in potentially reducing the intention–behaviour gap. The findings of our case study suggest that there is indeed a large gap between intention and behaviour, and we conclude by calling for more empirical longitudinal studies to assess the complex nature of the relationship between intention and behaviour. (shrink)

The dual-use issue is often framed as a series of paralyzing ‘dilemmas’ facing the scientific community as well as institutions which support innovation. While this conceptualization of the dual-use issue can be useful in certain contexts its usefulness is more limited when reflecting on the governance and politics of the dual-use issue. Within this paper, key shortcomings of the dilemma framing are outlined. It is argued that many of the issues raised in the most recent debates about ‘dual-use’ bird flu (...) research remain unresolved. This includes questions about the trajectories of certain lines of research, as well as broader trends in the practice and governance of science. This leads to difficult questions about current approaches to the dual-use issue within the US, as well as internationally. (shrink)

Plotinus’ famous treatise against the Gnostics (33), together with contemporary and thematically related treatises on Intelligible Beauty (31), on Number (34), and on Free Will and the Will of the One (39), can be seen as providing the essential components of a Plotinian defense of polytheism against conceptual moves that, while associated for him primarily with Gnostic sectarians overlapping with Platonic philosophical circles, will become typical of monotheism in its era of hegemony. When Plotinus’ Gnostics ‘contract’ divinity into a single (...) God, they not only devalue the cosmos for its multiplicity and diversity, but also multiply intelligible principles unreasonably. This is because they have foreclosed the distinction, which is to become increasingly explicit in the later antique Platonists, between the intelligible and that which is given existentially, the domain belonging to Plotinus’ indeterminate multiplicity of ‘intelligible Gods’, as opposed to the dialectically determinate number of intelligible principles. Plotinus is prescient in recognizing that incipient monotheism threatens to erase the distinction between philosophy and theology, and between both of these and psychology, the final outcome of which can only be solipsism or nihilism. The defense of polytheism is seen in this fashion to be essential to the preservation of the space for philosophical discourse. (shrink)

Noam Chomsky and other linguists and psychologists have suggested that human linguistic behavior is somehow governed by a mental representation of a transformational grammar. Challenges to this controversial claim have often been met by invoking an explicitly computational perspective: It makes perfect sense to suppose that a grammar could be represented in the memory of a computational device and that this grammar could govern the device's use of a language. This paper urges, however, that the claim that humans are such (...) a device is unsupported and that it seems unlikely that linguists and psychologists really want to claim any such thing. Evidence for the linguists' original claim is drawn from three main sources: the explanation of language comprehension and other linguistic abilities; evidence for formal properties of the rules of the grammar; and the explanation of language acquisition. It is argued in this paper that none of these sources provides support for the view that the grammar governs language processing in something like the way a program governs the operation of a programmed machine. The computational approach, on the contrary, suggests ways in which linguistic abilities can be explained without the attribution of any explicit representation of rules governing linguistic behavior. (shrink)

In this reading of the Euthyphro, Socrates and Euthyphro are seen less in a primordial conflict between reason and devotion, than as sincere Hellenic polytheists engaged in an inquiry based upon a common intuition that, in addition to the irreducible agency of the Gods, there is also some irreducible intelligible content to holiness. This reading is supported by the fact that Euthyphro does not claim the authority of revelation for his decision to prosecute his father, but rather submits it to (...) elenchus, and that Euthyphro does not embrace the ‘solution’ of theological voluntarism when Socrates explicitly offers it. Since the goal of this inquiry is neither to eliminate the noetic content of the holy, nor to eliminate the Gods’ agency, the purpose of the elenchus becomes the effort to articulate the results of this productive tension between the Gods and the intelligible on the several planes of Being implied by each conception of the holy which is successively taken up and dialectically overturned to yield the conception appropriate to the next higher plane, a style of interpretation characteristic of the ancient Neoplatonists. (shrink)

The essay explores the systematic relationship in the work of Giordano Bruno (1548-1600) between his monadology, his metaphysics as presented in works such as De la causa, principio et uno, the mythopoeic cosmology of Lo spaccio de la bestia trionfante, and practical works like De vinculis in genere. Bruno subverts the conceptual regime of the Aristotelian substantial forms and its accompanying cosmology with a metaphysics of individuality that privileges individual unity (singularity) over formal unity and particulars over substantial forms without (...) sacrificing a metaphysical perspective on the cosmos. The particular is individuated as a unique site of desire, continually transforming but able to entrain itself and others through phantasmatic ‘bonding’, the new source of regularity in Bruno’s polycentric universe. Bruno thus tries to do justice to the demands of intelligibility as well as transformative eros. The essay concludes with a note on Bruno’s geometry as it relates to his general conception of form. (shrink)

Continuing the systematic henadological interpretation of Proclus' Platonic Theology begun in "The Intelligible Gods in the Platonic Theology of Proclus" (Methexis 21, 2008, pp. 131-143), the present article treats of the basic characteristics of intelligible-intellective (or noetico-noeric) multiplicity and its roots in henadic individuality. Intelligible-intellective multiplicity (the hypostasis of Life) is at once a universal organization of Being in its own right, and also transitional between the polycentric henadic manifold, in which each individual is immediately productive of absolute Being, and (...) the formal intellective organization, which is monocentrically and diacritically disposed. Intelligible-intellective multiplicity is generated from the dyadic relationship of henads to their power(s), the phase of henadic individuality expressed in the second intelligible triad, and is mediated, unlike the polycentric manifold, but not by identity and difference, like the intellective organization. Instead, the hypostasis of Life is constituted by ideal motility and spatiality, figural dispositions, and the intersubjective relations depicted in the divine symposium of Plato's Phaedrus. (shrink)

At Epistles 2.2.87–9 Horace introduces an argument against writing poetry based on the unpleasant mutual admiration required in poetic society with an anecdote about an orator and a jurisconsult: †frater erat Romae† consulti rhetor, ut alter alterius sermone meros audiret honores, Gracchus ut hic illi, foret huic ut Mucius ille.

At Epistles 2.2.87–9 Horace introduces an argument against writing poetry based on the unpleasant mutual admiration required in poetic society with an anecdote about an orator and a jurisconsult: †frater erat Romae† consulti rhetor, ut alter alterius sermone meros audiret honores, Gracchus ut hic illi, foret huic ut Mucius ille.

Completing the systematic henadological interpretation of Proclus' Platonic Theology begun in "The Intelligible Gods in the Platonic Theology of Proclus" (Méthexis 21, 2008, pp. 131-143) and "The Second Intelligible Triad and the Intelligible-Intellective Gods" (Methexis 23, 2010, pp. 137-157), the present article concerns the conditions of the emergence of fully mediated, diacritical multiplicity out of the polycentric henadic manifold. The product of the activity of the intellective Gods (that is, the product of the intellective activity of Gods as such), in (...) resolving the contradiction between existential uniqueness and universalizable potencies in the divine natures, also grounds the human exercise of phi- losophical cognition in the founding self-analysis of divine individuals. (shrink)

The comparison drawn by the Neoplatonist Olympiodorus between the Stoic doctrine of the reciprocal implication of the virtues and the Neoplatonic doctrine of the presence of all the gods in each helps to elucidate the latter. In particular, the idea of primary and secondary “perspectives” in each virtue, when applied to Neoplatonic theology, can clarify certain theoretical statements made by Proclus in his Cratylus commentary concerning specific patterns of inherence of deities in one another. More broadly, the “polycentric” nature of (...) Neoplatonic theology provides a theoretical articulation for henotheistic practices within polytheism without invoking evolutionist notions of “monotheistic tendencies.” The Neoplatonic distinction between the modes of unity exhibited by divine individuals (“henads”) and ontic units (“monads”), which is integral to the polycentric theology, also provides a theoretical basis for the non reductive crosscultural comparison between deities. The polycentric theology thus offers a promising foundation for a polytheistic philosophy of religion. (shrink)

The Platonist Proclus (c. 412-485 CE) identifies the procession of the angels, daimons, and heroes as operating three universal temporal potencies through which we experience time in the forms of past, present, and future, respectively. This essay explicates the Proclean doctrine of the three forms of time in its context within his system and its wider implications, with particular reference to the form of temporality associated with the heroes. Proclus’ schematic account of heroic temporality offers a systematic metaphysical framework for (...) key themes in the Hellenic literature and cultus of heroes, in particular the dialectic of untimeliness and seasonality in the hero as discussed by Nagy. The heroes are seen to embody a universal relationship of mortal beings to time. In an excursus, the relationship of heroes to time is compared to that of cinema as image of time. (shrink)