This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." (...) It involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences. (shrink)

This essay, published shortly before the 2020 U.S. presidential election (mired in controversy over a potential judicial appointment to the Supreme Court), celebrates Daniel Callahan's prescient book Abortion: Law, Choice and Morality. Nothing could be timelier. Callahan's central question was the “moral and social” struggle requisite for coherent policies and laws regulating abortion. He rejected “one‐value” positions and strove to develop an expansive middle ground. He decried emotion untutored by reason, crude polemics, and bludgeoning: his recipe for a (...) “noxious brew.” Callahan's way of thinking preceded the development of a critical health humanities, the advent of moral foundations theory in psychology, and the philosophical concept of a moral imagination. Each of these inheres in his rigorous approach to the abortion problem. His honesty and humility led to a sea change in his position on abortion. Fifty years later, much can still be learned from Callahan's arguments—about abortion and other bioethics issues—most importantly, in how we address wider social issues in these polarized times. (shrink)

Daniel Callahan has not simply proposed alterations of important features of the health economy. He has constructed a blue print for society drawing on concepts of what is natural and appropriate to human beings. He is, in effect, establishing a new social order. Like any social order, Callahan's system has its justificatory schemes or founding myths. This paper offers a feminist examination of the functions that these four myths – the concept of a whole of life; the stages (...) of life; a tolerable death; and a reconstruction of the meaning of the aged in terms of sacrifice – fulfill in Callahan's new social order. Callahan's concept of a whole of life reflects the power he assigns to nature, and the futility and harm he associates with attempts to repudiate biological imperatives. It introduces the stages of human life, tolerable death, and aging. The paper critically examines these concepts. Keywords: feminist medical ethics, aging, allocation of medical resources CiteULike Connotea Del.icio.us What's this? (shrink)

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics (...) has an obligation to discuss that history and to help us as a society take responsibility for it.We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same‐sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen‐Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

The social sciences playa variety of multifaceted roles in the policymaking process. So varied are these roles, indeed, that it is futile to talk in the singular about the use of social science in policymaking, as if there were one constant relationship between two fixed and stable entities. Instead, to address this issue sensibly one must talk in the plural about uses of dif ferent modes of social scientific inquiry for different kinds of policies under various circumstances. In some cases, (...) the influence of social scientific research is direct and tangible, and the connection between the find ings and the policy is easy to see. In other cases, perhaps most, its influence is indirect-one small piece in a larger mosaic of politics, bargaining, and compromise. Occasionally the findings of social scientific studies are explicitly drawn upon by policymakers in the formation, implementation, or evaluation of particular policies. More often, the categories and theoretical models of social science provide a general background orientation within which policymakers concep tualize problems and frame policy options. At times, the in fluence of social scientific work is cognitive and informational in nature; in other instances, policymakers use social science primarily for symbolic and political purposes in order to le gitimate preestablished goals and strategies. Nonetheless, amid this diversity and variety, troubling general questions persistently arise. (shrink)

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and (...) Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)

The decline in the interest in ethical theory is first outlined, as a background to the author’s discussion of principlism. The author’s own stance, that of a communitarian philosopher, is then described, before the subject of principlism itself is addressed. Two problems stand in the way of the author’s embracing principlism: its individualistic bias and its capacity to block substantive ethical inquiry. The more serious problem the author finds to be its blocking function. Discussing the four scenarios the author finds (...) that the utility of principlism is shown in the two scenarios about Jehovah’s Witnesses but that when it comes to selling kidneys for transplantation and germline enhancement, principlism is of little help. (shrink)

American bioethics began in the late 1960s, stimulated by a plethora of new medical technologies and biological knowledge and by a scandal-induced interest in human subject research. Although it was understood that there would be ethical debate , no one thought the disputes would be ideological in character, as if part of one's voting pattern as liberal or conservative, Democrat or Republican. There were arguments, often sharp, but no culture wars.

The possibility of human cloning first surfaced in the 1960s, stimulated by the report that a salamander had been cloned. James D. Watson and Joshua Lederberg, distinguished Nobel laureates, speculated that the cloning of human beings might one day be within reach; it was only a matter of time. Bioethics was still at that point in its infancybioethicsand cloning immediately caught the eye of a number of those beginning to write in the field. They included Paul Ramsey, Hans Jonas, and (...) Leon Kass. Cloning became one of the symbolic issues of what was, at that time, called a biology that would be dominated by molecular genetics. Over a period of five years or so in the early 1970s a number of articles and book chapters on the ethical issues appeared, discussing cloning in its own right and cloning as a token of the radical genetic possibilities. (shrink)

Steven Pinker, a cognitive psychologist and linguist at Harvard and a savant of big ideas, is one of the latest to take on the idea of progress. He does it under the aegis of “enlightenment,” which comes down to a kind of holy trinity of reason, science, and humanism. His new book, Enlightenment Now: The Case for Reason, Science, Humanism, and Progress, is ambitious and cantankerous and heady with hope. On the whole, Pinker makes a good case for the benefits (...) of progress, but with an overdose of feel‐good prose. His greatest failure comes in exaggerating the threats to science and in avoiding some problems altogether. He ignores its complexity, its shadows, its creation of new problems raised by its solutions to old ones. Pinker has a particular animus against bioethics, and he misses what has been, I would argue, at the heart of bioethics from its beginning fifty or so years ago. Bioethics was prompted by a new class of medical dilemmas that require a difficult balancing of harms and benefits. Most of them are still with us, and most of them are the result of the progress of postwar medical research and fast‐changing clinical practices. (shrink)

Feminist philosophy emerged in earnest in the 1970s. With that emergence and the latest surge of the Women's Movement now a quarter of a century old and with the turn of the century approaching quickly, the Society for Philosophy and Public Affairs and the Pacific Society for Women in Philosophy invited a group of feminist philosophers to reflect on feminism and philosophy as we approach the millennium. A roundtable was held at the 1995 meeting of the Pacific Division of the (...) American Philosophical Association, and much of the content of that session is included in this Symposium. The discussants include scholars with research interests across the traditional areas of philosophy (e.g., metaphysics and epistemology, ethics, social and political philosophy, history of philosophy, and philosophy of science), as well as not so traditional areas (e.g., lesbian philosophy). Each participant was asked to take ten minutes to focus on whatever she thought might be useful to discuss in a forum designed for taking stock of feminism and philosophy in the mid‐1990s. The contributors are Louise Antony, Joan Callahan (introduction), Claudia Card, Ruth Ginzberg, Martha Nussbaum, Naomi Scheman, Laurie Schrage, Nancy Tuana, Margaret Walker, and Charlotte Witt. (shrink)

When the Karen Ann Quinlan case emerged in the mid-1970s and the New Jersey Supreme Court made mention of the role that ethics committees might play in such cases, no one could have predicted at the time what the consequences of that observation might be. It took a while for momentum to build, but we are now seeing the flowering of what is an important movement in the field of bioethics: the interplay of ethics committees and broader societal issues.

This book provides an overview of some of the most important critics of “Enlightenment rationalism.” The subjects of the volume—including, among others, Burke, Kierkegaard, Nietzsche, T.S. Eliot, Wittgenstein, Heidegger, C.S. Lewis, Gabriel Marcel, Russell Kirk, and Jane Jacobs—do not share a philosophical tradition as much as a skeptical disposition toward the notion, common among modern thinkers, that there is only one standard of rationality or reasonableness, and that that one standard is or ought to be taken from the presuppositions, methods, (...) and logic of the natural sciences. The essays on each thinker are intended not merely to offer a commentary on that thinker, but also to place that thinker in the context of this larger stream of anti-rationalist thought. Thus, while this volume is not a history of anti-rationalist thought, it may contain the intimations of such a history. (shrink)

This casebook features ten distinctive and provocative essays in addition to a generous sampling of Ellison's comments on the novel. A number of the latter are from letters never before published; also published here for the first time is Part II of Ellison's "Working Notes on Invisible Man," an undated exposition of his authorial intentions, probably written in 1946 or 1947. The ten essays are a selection of the most perceptive and comprehensive essays written on Invisible Man during the last (...) thirty-five years, including an essay by Kenneth Burke, which began as a letter to Ellison about the novel, written before its publication in 1952. Also among the essays is Larry Neal's "Ellison's Zoot Suit," in which he finds the novel an exemplary enactment in fiction of the "black aesthetic." The essays explore topics of narrative form, classical and vernacular points of reference, and the relationship between the themes of love and politics. Taken together with Ellison's "Working Notes" and later commentary on the novel, these essays account for the continuing appeal of Invisible Man more than fifty years after its publication. An editor's introduction and a full bibliography accompany the essays, selections from Ellison's writings, and informal statements on his novel. The volume offers a rich variety of interpretations of Invisible Man for students and scholars of Ellison. (shrink)

Sample quotes from emails sent by visitors to Mary Klages's successful literary theory web pages on which this book is based: 'Finding your course was a godsend ...

A quintessential challenge for any perceptual system is the need to focus on task-relevant information without being blindsided by unexpected, yet important information. The human visual system incorporates several solutions to this challenge, one of which is a reflexive covert attention system that is rapidly responsive to both the physical salience and the task-relevance of new information. This paper presents a model that simulates behavioral and neural correlates of reflexive attention as the product of brief neural attractor states that are (...) formed across the visual hierarchy when attention is engaged. Such attractors emerge from an attentional gradient distributed over a population of topographically organized neurons and serve to focus processing at one or more locations in the visual field, while inhibiting the processing of lower priority information. The model moves towards a resolution of key debates about the nature of reflexive attention, such as whether it is parallel or serial, and whether suppression effects are distributed in a spatial surround, or selectively at the location of distractors. Most importantly, the model develops a framework for understanding the neural mechanisms of visual attention as a spatiotopic decision process within a hierarchy and links them to observable correlates such as accuracy, reaction time, and the N2pc and PD components of the EEG. This last contribution is the most crucial for repairing the disconnect that exists between our understanding of behavioral and neural correlates of attention. (shrink)

In the Philippines, all transplant centers are mandated by the Department of Health (DOH) to have a Hospital Transplant Ethics Committee (HTEC) to ensure that donations are altruistic, voluntary and free of coercion/commercial transactions. This study was undertaken primarily to describe the organizational and functional profile of existing HTECs and identify areas for improvement. This is a descriptive cross‐sectional study. There was variation in their logistical arrangements (support from hospital, filing systems, office spaces), operations (length and frequency of meetings, number (...) of referrals) and membership (composition, qualifications, occupation, training). The approval rate for donor‐recipient pairs is high with the majority of cases made by living non‐related donors. Appropriate reasons were cited for rejection. The perception of HTECs is that they are competent and confident in their decision‐making. However, there is a need to standardize HTEC composition, provide operating procedures and additional training which can be done by the DOH. (shrink)

En quoi consiste, ou devrait consister, l'éthique professionnelle en enseignement? Comment se manifeste-t- elle dans les gestes pédagogiques? Selon quels critères peut-on la juger? Comment développer l'éthique professionnelle dans le cadre des formations initiale et continue en enseignement? En tenant compte du contexte social et culturel du Québec, des principes éthiques déjà énoncés par le ministère de l'Education ainsi que des lois, codes et conventions ayant des incidences sur la pratique enseignante, les auteures présentent des éléments à considérer pour la (...) réflexion éthique sur l'agir professionnel. Elles proposent des clarifications conceptuelles et un certain nombre de repères et de balises afin de guider les enseignants et de stimuler la discussion sur l'éthique professionnelle, non seulement dans la classe, mais aussi dans l'école et dans la société. (shrink)

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical (...) students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless. (shrink)

How is hope to be found amid the ethical and political dilemmas of modern life? Writer and philosopher Mary Zournazi brought her questions to some of the most thoughtful intellectuals at work today. She discusses "joyful revolt" with Julia Kristeva, the idea of "the rest of the world" with Gayatri Spivak, the "art of living" with Michel Serres, the "carnival of the senses" with Michael Taussig, the relation of hope to passion and to politics with Chantal Mouffe and Ernesto (...) Laclau. A dozen stimulating minds weigh in with their visions of a better social and political order. The result is a collaboration - of writing, of thinking, and of politics - that demonstrates more clearly than any single-authored project could how ideas encountering one another can produce the vision needed for social change. (shrink)

Over the past several decades in which access to abortion has become increasingly restricted, parents' autonomy in medical decision‐making in the realms of fetal care and neonatal intensive care has expanded. Today, parents can decide against invasive medical interventions at gestational ages where abortions are forbidden, even in cases where neonates are expected to be seriously ill. Although a declared state interest in protecting the lives of fetuses and newborns contributes to justifications for restricting women's autonomy with regards to abortion, (...) it does not fully explain this discrepancy. We believe that social portrayals of women as complying with or shirking their reproductive function play a major role in explaining it. The growing divide between a woman's rights as a reproductive being and as a parent suggest that abortion restriction is rooted in a historical societal desire for women to serve as reproducers and in the corresponding fear of them abandoning this allotted role in pursuit of social equality. The Dobbs v. Jackson (2022) decision is not based in a view of abortion as a medical act occurring between a doctor and patient, as Roe v. Wade (1973) did, but decision‐making about fetal therapy or NICU care is still viewed as occurring between a doctor and patient or surrogate because in this act a woman is seen as fulfilling her role as mother. (shrink)

"Charming, interesting, thought-provoking and a great read." Rosalind Hursthouse The daughter of a pacifist rector who answered "No!" when his congregation asked him "Is everything in the bible true?", perhaps Mary Midgley was destined to become a philosopher. Yet few would have thought this inquisitive, untidy, nature-loving child would become "one of the sharpest critical pens in the west." This is her remarkable story. Probably the only philosopher to have been in Vienna on the eve of its invasion by (...) Nazi Germany in 1938 and dance in Trafalgar Square on VE day seven year later, she studied philosophy at Oxford in the same year as Iris Murdoch, Elizabeth Anscombe and Philippa Foot, all of whom became close friends. Midgley tells us in vivid and humorous fashion how they cut a swathe through the arid landscape of 1950s British philosophy, writing and arguing - often with each other - about the grand themes of character, beauty and the meaning of rudeness while the spectral figure of Ludwig Wittgenstein hovered in the background. She also charts the highs and lows of philosophy and academia in Britain. On joining the Reading philosophy department on £400 a year in 1949, she doubled its staff complement. But her many years at Newcastle University - where Mike Brearley, who later captained England at cricket, also used to teach - were rewarded with the closure of the philosophy department in the 1980s. The mother of three children, her journey is also one of a woman who in the 1950s and 1960s was fighting to combine a professional career with raising a family. In startling contrast to many of the academic stars of her generation, we learn that Midgley nearly became a novelist and started writing philosophy only when in her fifties, suggesting that Minerva's owl really does fly at dusk. Plainly told like her philosophy, this is an elegiac and moving account of friendships found and lost, bitter philosophical battles and of a profound love of teaching all too rarely acknowledged today. (shrink)

From the author of Setting Limits comes a challenging exploration of the proper goals of medicine in our rapidly changing society--a work destined to spark debate and influence policy for years to come.

Why is there a felt asymmetry between cases in which agents defer to testifiers for certain moral beliefs, and cases in which agents defer on many other matters? One explanation influential in the literature is that having understanding of a proposition is both in tension with acquiring belief in the proposition by deferring to another's testimony and distinctively important when it comes to moral propositions, as compared with what we might think of as many ‘garden variety’ facts. My project in (...) this paper is to offer a new and more defensible version of this explanation. This will involve re-conceiving understanding as a richer state than it is commonly thought to be, requiring affective and motivational engagement with reasons as well as cognitive facility. I also offer a new explanation of the tension between understanding and deference to testimony. (shrink)

Subjectivist permissivism is a prima facie attractive view. That is, it's plausible to think that what's rational for people to believe on the basis of their evidence can vary if they have different frameworks or sets of epistemic standards. In this paper, I introduce an epistemic existentialist form of subjectivist permissivism, which I argue can better address “the arbitrariness objection” to subjectivist permissivism in general. According to the epistemic existentialist, it's not just that what's rational to believe on the basis (...) of evidence can vary according to agents’ frameworks, understood as passive aspects of individuals’ psychologies. Rather, what's rational to believe on the basis of evidence is sensitive to agents’ choices and active commitments. Here I draw on Chang's work on commitment and voluntarist reasons. The epistemic existentialist maintains that what's rational for us to believe on the basis of evidence is, at least in part, up to us. It can vary not only across individuals but for a single individual, over time, as she makes differing epistemic commitments. (shrink)

In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest (...) demand on health care resources. If age were to become a limiting factor, as Dr. Callahan suggests it should, the limits that will be set are limits that will affect women more drastically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)

Raymond Callahan's lively study exposes the alarming lengths to which school administrators went, particularly in the period from 1910 to 1930, in sacrificing educational goals to the demands of business procedures.

Bioethics education now takes place outside universities as well as within them. How should clinicians, ethics committee members, and policymakers be taught the ethics they need, and how may their progress best be evaluated?

Bioethics education now takes place outside universities as well as within them. How should clinicians, ethics committee members, and policymakers be taught the ethics they need, and how may their progress best be evaluated?

Is religious faith consistent with being an intellectually virtuous thinker? In seeking to answer this question, one quickly finds others, each of which has been the focus of recent renewed attention by epistemologists: What is it to be an intellectually virtuous thinker? Must all reasonable belief be grounded in public evidence? Under what circumstances is a person rationally justified in believing something on trust, on the testimony of another, or because of the conclusions drawn by an intellectual authority? Can it (...) be reasonable to hold a belief on a topic over which there is significant, entrenched disagreement among informed inquirers, or should such disagreement lead all parties to modify or suspend their own judgments? Is there anything about faith that exempts it from measurement against such epistemic norms? And if we would so evaluate it, how exactly should we understand the intellectual commitments faith requires? The volume's introduction provides a roadmap of the central issues and controversies as currently discussed by philosophers. In fourteen new essays written to engage nonspecialists as well as philosophers working in religion and epistemology, a diverse and distinguished group of thinkers then consider the place of intellectual virtue in religious faith, exploring one or more of the specific issues noted above. (shrink)

When (if ever) may a professional deceive a client for the client's own good? Under what conditions (if any) is whistle-blowing morally required? These are just some of the questions that scholars as diverse as Michael D. Bayles, Thomas Nagel, Sissela Bok, Jessica Mitford, and Peter A. French confront in this stimulating anthology. Organized around philosophical issues such as the moral foundations of professional ethics, models of the professional-client relationship, deception, informed consent, privacy and confidentiality, professional dissent, and professional virtue, (...) the volume illuminates the complex ethical issues that arise in journalism, law, health care, counselling, education, engineering, business, politics, and social science research. A variety of pedagogical aids--including clear introductions to and study questions for each set of readings, concrete cases designed to focus discussion, and an appendix on preparing cases and position papers--makes the text invaluable for both students and teachers of professional ethics. (shrink)