The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and (...) futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care. (shrink)

Futility disputes are increasing and courts are slowly abandoning their historical reluctance to engage these contentious issues, particularly when confronted with inappropriate surrogate demands for aggressive treatment. Use of the judicial system to resolve futility disputes inevitably brings media attention and requires clinicians, hospitals, and families to debate these deep moral conflicts in the public eye. A recent case in Minnesota, In re Emergency Guardianship of Albert Barnes, explores this emerging trend and the complex responsibilities of clinicians and hospital administrators (...) seeking to replace an unfaithful surrogate demanding aggressive therapy. Use of the courts requires the coordinated commitment of significant institutional resources, management of intense media scrutiny and individual and organizational courage to enter the unpredictable world of litigation. Given the dearth of legislative guidance on medical futility, individual clinicians and institutions will continue to bear the difficult responsibility for resolution of individual futility disputes. The Barnes case illustrates how one institution successfully used the judicial system to replace an unfaithful surrogate, cease the provision of inappropriate aggressive care, and stimulate a community dialogue about appropriate care at the end of life. (shrink)

Though much progress has been made on inclusion of non-pregnant women in research, thoughtful discussion about including pregnant women has lagged behind. We outline resulting knowledge gaps and their costs and then highlight four reasons why ethically we are obliged to confront the challenges of including pregnant women in clinical research. These are: the need for effective treatment for women during pregnancy, fetal safety, harm from the reticence to prescribe potentially beneficial medication, and the broader issues of justice and access (...) to benefits of research participation. Going forward requires shifting the burden of justification from inclusion to exclusion and developing an adequate ethical framework that specifies suitable justifications for excluding pregnant women from research. (shrink)

Miles brings Plotinus' thought alive for the twenty-first century by relating it to present day concerns.

St. Augustine, pictured by Western painters holding in his hand his heart blazing with passionate love, consistently and repeatedly insisted―from his earliest writings until close to his death―that the essential characteristic of God is “God is love” (1 John 4:16). Yet he also insisted on the doctrines of original sin and everlasting punishment for the massa damnata. This article will not explore the rationale or semantics of his arguments, nor the detail and nuance of the doctrines of predestination and perseverance. (...) Rather, I seek to understand, from Augustine’s last writings, how he reconciled his strong conviction that God is love with doctrines requiring belief in a God who determined the fate of individuals to eternal reward or punishment “before the foundation of the world” (Eph. 1:4), a God indifferent to individuals’ actions, struggles, or longings. My primary interest is not on Augustine’s ability to render these two apparently opposing ideas of God intellectually compatible, but rather on his feeling, gathered from his last sermons, as he approached death. In brief, how could Augustine love the God in whom he believed? (shrink)

Beyond the Centaur questions the accuracy and usefulness of the virtually unquestioned ancient consensus that persons are composed of unequally valued, hierarchically stacked antagonistic components, usually soul or mind and body. Part I explores the gradual historical development of this notion of person. Part II consists of a thought experiment, examining an understanding of persons, not as stacked components, but as intelligent bodies -- one entity. It explores how a new understanding of persons can affect in important and fruitful ways (...) how we live: how we move, feel, think, believe, and die. (shrink)

In his last years, St. Augustine became impatient with the doctrinal questions and requests for advice on practical matters of ecclesiastical discipline frequently referred to in correspondence of his last decade. Scholars have often attributed his uncharacteristic reluctance to address these matters to the diminishing competence and energy of old age. This article demonstrates that his evident unwillingness to respond at length to such queries relates rather to his desire to sequester increased time for meditation. Throughout his Christian life, he (...) described and refined his practice of meditation; it gathered urgent importance as he neared death. Augustine’s lifelong search for “God and the soul,” articulated in his first writings, evolved through his meditation, changing from an intellectual effort to achieve a vision of God by the use of reason to a search for the truth of his own life. In meditation he sought to recall in detail God’s loving leading within the chaos and pain of his youthful desires and throughout his life. I explore his understanding of “God is love” from his earliest (extant) treatise, De beata uita (386 CE), his Easter sermons on First John (415 CE), to his Enchiridion (421 CE) as the core of his developing understanding of God’s activity in himself. (shrink)

In St. Augustine’s society, men’s tears were not considered a sign of weakness, but an expression of strong feeling. Tears might be occasional, prompted by incidents such as those Augustine described in the first books of his Confessiones. Or they might accompany a deep crisis, such as his experience of conversion. Possidius, Augustine’s contemporary biographer, reported that on his deathbed Augustine wept copiously and continuously. This essay endeavors to understand those tears, finding, primarily but not exclusively in Augustine’s later writings, (...) descriptions of his practice of meditation suggesting that a profound and complex range of emotions from fear and repentance to gratitude, love, rest in beauty, and delight in praise richly informed Augustine’s last tears. (shrink)

The perennial human need to ground the self in something greater than itself takes many forms. This article explores several values that are often considered worth dying for, from one’s country or religion, to—among the many that are often advocated in contemporary Western societies—one’s sexuality. Given the recent level of interest in Augustine’s early sexuality, I argue that, for Augustine, sex, when compulsively pursued, was a failed value. His experience revealed to him that the ultimate object with which the self (...) can be identified is God: “You [God] have made us for yourself, and our hearts are restless until they rest in you”. Augustine’s Confessiones narrate the long process by which his lust problem was transmogrified into the love project: “My weight is my love; by it I am carried wherever I am carried”. (shrink)

In this book philosophers, scholars of religion, and activists address the theme of responsibility. Barbara Darling-Smith brings together an enlightening collection of essays that analyze the ethics of responsibility, its relational nature, and its global struggle.

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

On August 28, 2008, Michael Marmot, Chair of the Commission on Social Determinants of Health, formally handed over the Commission’s Final Report to Margaret Chan, the Director-General of the World Health Organization, at the Palais des Nations in Geneva. It was a significant moment. Dr. Chan addressed a hall packed with representatives of the world’s communications media in a speech that was remarkably direct. Dr. Chan reiterated the Commission’s position that to improve health and health equity action needs to (...) be taken not just across the health sector but across all social and economic policy areas, and stated, “Social deprivation is not a matter of fate. It is a marker of policy failure.” This was a bold statement from one of the world’s leading diplomats. Policy failure! The phrase echoes the Commission’s assertion that “a toxic combination of poor social policies, unfair economic arrangements and bad politics is killing people on a grand scale.” The Commission’s messages are far reaching. (shrink)

Ruth Boeker’s Locke on Persons and Personal Identity is a tightly argued and illuminating account, containing much to ponder. The presence of both terms, ‘persons’ and ‘personal identity’, in the t...

Stewart Duncan’s excellent book Materialism from Hobbes to Locke offers an insightful study of the debates concerning materialism during the seventeenth century. When we hear the expression ‘materialism’, we often associate with it the question of whether the human mind is an entirely material entity. Although the question of whether the human mind is material plays an important role throughout the seventeenth-century debates examined in this book, Duncan offers a broader understanding of materialism that is not restricted to the human (...) mind. According to Duncan, materialism is ‘a view about some object or a group of objects. Often that object is the human mind’ (2), but materialism can also concern other objects such as animal minds or God. This leads Duncan to introduce materialism as ‘the view that the thing in question is wholly material, and has no immaterial part’ (2). He deliberately leaves open what it means to be material, because different philosophers featured in his book disagree about this question. (shrink)

Methodological and philosophical foundations in the anthropology of Ruth Benedict and Margaret Mead.

Book reviewed in this article: Having Children: Philosophical and Legal Reflections on Parenthood. Edited by Onora O'Neill and William Ruddick.

Margaret Gilbert presents the first full-length treatment of a central class of rights: demand-rights. To have such a right is to have the standing or authority to demand a particular action of another person. Gilbert argues that joint commitment is a ground of demand-rights, and gives joint commitment accounts of both agreements and promises.

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

The English translation of Habermas's The Structural Transformation of the Public Sphere converges with a recent trend toward the revival of the "political culture concept" in the social sciences. Surprisingly, Habermas's account of the Western bourgeois public sphere has much in common with the original political culture concept associated with Parsonian modernization theory in the 1950s and 1960s. In both cases, the concept of political culture is used in a way that is neither political nor cultural. Explaining this peculiarity is (...) the central problem addressed in this article and one to follow. I hypothesize that this is the case because the concept itself is embedded in an historically constituted political culture (here called a conceptual network)-a structured web of conceptual relationships that combine into Anglo-American citizenship theory. The method of an historical sociology of concept formation is introduced to analyze historically and empirically the internal constraints and dynamics of this conceptual network. The method draws from new work in cultural history and sociology, social studies, and network, narrative, and institutional analysis. This research yields three empirical findings: this conceptual network has a narrative structure, here called the Anglo-American citizenship story; this narrative is grafted onto an epistemology of social naturalism; and these elements combine in a metanarrative that continues to constrain empirical research in political sociology. (shrink)

In this paper I adduce a new argument in support of the claim that IBE is an autonomous form of inference, based on a familiar, yet surprisingly, under-discussed, problem for Hume’s theory of induction. I then use some insights thereby gleaned to argue for the claim that induction is really IBE, and draw some normative conclusions.

Background In the UK, the solidaristic character of the NHS makes it one of the most trusted public institutions. In recent years, the introduction of data-driven technologies in healthcare has opened up the space for collaborations with private digital companies seeking access to patient data. However, these collaborations appear to challenge the public’s trust in the. Main text In this paper we explore how the opening of the healthcare sector to private digital companies challenges the existing social contract and the (...) NHS’s solidaristic character, and impacts on public trust. We start by critically discussing different examples of partnerships between the NHS and private companies that collect and use data. We then analyse the relationship between trust and solidarity, and investigate how this relationship changes in the context of digital companies entering the healthcare system. Finally, we show ways for the NHS to maintain public trust by putting in place a solidarity grounded partnership model with companies seeking to access patient data. Such a model would need to serve collective interests through, for example, securing preferential access to goods and services, providing health benefits, and monitoring data access. Conclusion A solidarity grounded partnership model will help establish a social contract or licence that responds to the public’s expectations and to principles of a solidaristic healthcare system. (shrink)

Brain–computer interfaces are a form of technology that read a user’s neural signals to perform a task, often with the aim of inferring user intention. They demonstrate potential in a wide range of clinical, commercial, and personal applications. But BCIs are not always simple to operate, and even with training some BCI users do not operate their systems as intended. Many researchers have described this phenomenon as “BCI illiteracy,” and a body of research has emerged aiming to characterize, predict, and (...) solve this perceived problem. However, BCI illiteracy is an inadequate concept for explaining difficulty that users face in operating BCI systems. BCI illiteracy is a methodologically weak concept; furthermore, it relies on the flawed assumption that BCI users possess physiological or functional traits that prevent proficient performance during BCI use. Alternative concepts to BCI illiteracy may offer better outcomes for prospective users and may avoid the conceptual pitfalls that BCI illiteracy brings to the BCI research process. (shrink)

Along the way, she calls upon us to recognize the mysteries that lie at the heart of our lives and the metaphysical reality that gives meaning to life.The ...