Reprint of paper first published in Philosophy and Phenomenological Research in 1984.

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

We commend Redish et al. for the progress they have made in bringing a measure of theoretical order to the processes that underlie drug addiction. However, incorporating information about situations in which drug users do not exhibit faulty decision-making into the theory would greatly enhance its generality and practical value. This commentary draws attention to the relevant human substance abuse literature.

Xenotransplantation pits clinical research ethics against public health needs because recipients must undergo long-term, perhaps life-long, surveillance for infectious diseases. This surveillance requirement is effectively an abrogation of the right to withdraw from a clinical trial. Ulysses contracts, which are advance directives for future care, may be an ethical mechanism by which to balance public health needs against limitation of individual rights.

Determining whether a research risk meets or exceeds a regulatory standard of risk acceptability is difficult. Recently a framework called the systematic evaluation of research risks (SERR) has been proposed as a method of comparing research risks with predetermined standards of acceptability. SERR purports to offer a systematic and largely determinate (definite) way to compare risks and say whether a specific research risk falls below or above an acknowledged standard of acceptable risk. Here the authors review some philosophical problems with (...) this framework, which they take to be representative of determinate approaches to risk comparison, and conclude that it should not be used in a stand-alone or determinate fashion. Instead, the authors suggest that a deliberative approach may be a more viable candidate for future development. Such an approach could be informed by methods such as SERR without being rigidly bound to them. (shrink)

Two groups of plant viruses have DNA in their genomes. One group, the caulimoviruses, are non‐integrating retroviruses that package dsDNA in virions. The other group, the geminiviruses, package small circular ssDNA and include the only DNA viruses known with bipartite genomes. The regulation of transcription of these viruses is not well characterized, but recent work is beginning to yield interesting results. Regulatory sequences from these viruses function in cells of species that are not hosts of the virus and are finding (...) use in constitutive expression of chimeric genes in transformed plants. Development of vectors based on plant viruses requires further characterization at the molecular level of viral life cycles. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the (...) event of pneumonia. (shrink)

Professionalism is demonstrated through attitudes and behaviors. Medical education is concerned with teaching and evaluating it among students. It is often bioethicists who teach professionalism to medical students. Most bioethics curricula use lectures and group discussions to introduce principles and theories, but there is variation in number of credit and contact hours, placement in the curriculum and alongside which courses bioethics is placed), the extent of individual mentoring, and the emphasis placed on any particular philosophical approach. Bioethics curricula also vary (...) in whether and how explicitly and extensively they address topics, including professionalism, cultural competence, medical humanities, spirituality, death and dying, and community service, and in the number and topics of vignettes, controversies, assignments, and course activities. (shrink)

Book reviewed in this article: The New Health Care For Profit: Doctors and Hospitals in a Competitive Environment. Edited by Bradford H. Gray The Healing Mission and the Business Ethic. By Robert M. Cunningham The Medical Industrial Complex. By Stanley Wohl.

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.1 (2003) 128-129 [Access article in PDF] Robert Crocker, editor. Religion, Reason and Nature in Early Modern Europe. Dordrecht: Kluwer, 2001. Pp. xix + 228. Cloth, $77.00. By describing the early modern period as such, we thereby avow a continuity with it that ill squares with the following, insufficiently appreciated fact. The early modern counterparts of the largely atheistic American Philosophical Association, (...) let's say, were to an even greater degree theistic, and, moreover, theism affected their description and explanation of the world in a profound way—certainly more so than it does their few theistic descendents. This is true even of authors, like Hobbes and Spinoza, who might be read as leading to later atheism. The fact of early modern theism and its centrality in early modern philosophy and science are amply demonstrated in one after another of the eleven essays of this book.An emblematic figure is Robert Boyle, who figures as a main player in three of the essays, and is at least mentioned in five of the others. Lotte Mulligan, for example, investigates the role of "right reason" in Boyle's argument that religion is illuminated and made [End Page 128] plausible by metaphorically expressed analogies with natural philosophy, and conversely. The upshot is that only the "Christian Virtuoso," endowed with right reason whereby he is inspired to notice and express these analogies, was in a position to interpret the codes expressed both in the book of revelation and in the book of nature, one being incomplete without the other.Luisa Simonutti treats Boyle's engagement with the theological and scientific work of Spinoza through Spinoza's correspondence with Oldenburg. And G. A. J. Rogers deploys the work of Boyle, as well as of Locke, Newton, and the Cambridge Platonists, against the once-standard view (vide Butterfield) that "a major feature of the seventeenth-century was a secularization of knowledge." (Given just the other papers in this volume, this may seem like shooting fish in a barrel. Even so, perhaps one or two of the shots appear to miss. Newton seems proleptically to answer Hume's skepticism about induction by invoking, not divine simplicity, but an argument to the best explanation.)These papers overlap with two others, forming the core of the book. Sarah Hutton and Robert Crocker take on Cambridge Platonism. The former deals with Ralph Cudworth's rejection of Cartesian voluntarism in favor of an intellectualism of goodness and wisdom that grounds both the providential governance of the world and its intelligibility to human inquiry. The latter deals with Henry More's doctrine of the soul's pre-existence, a prima facie unlikely doctrine, but one that is less problematic, according to More, than the orthodox alternatives (creationism and traducianism).Three other papers fall outside this core, but their topics are no less relevant. Perhaps the most undeniable connection between the natural and the supernatural is to be found in Grotius, here studied by Jacqueline Lagree. Likely the most unexpected player will be the eccentric esprit fort, Cyrano de Bergerac. His work of nearly pure fantasy, in the Rabelaisian tradition, might well have made later, more serious heterodoxies possible. James E. Force provides a nice case study in Newton's reliance on what he took to be providentially guided comets as sources for the replenishment of otherwise declining celestial motion and matter (a line which, ironically, was picked up by Hume as a premise of an argument designed to undo the argument from design). Richard H. Popkin outlines three views of Judaism in the period. There is little connection with nature, but an important one with reason via a problem that exercised Cudworth and Newton: most peoples are polytheistic despite the clear monotheism of revelation. One theory had it that Judaism was the original, pure religion, which degenerated into various forms of paganism. But this degeneracy was soon read by the English deists such that originally there was a natural religion, of which Judaism and all others were a degeneration. Transmitted to the Enlightenment by Spinoza... (shrink)

Surgery is an important part of health care worldwide. Without access to surgical treatments, morbidity and mortality increase. Access to surgical treatment is a significant problem in global public health because surgical services are not equally distributed in the world. There is a disproportionate scarcity of surgical access in low-income countries. There are many charitable organizations around the world that sponsor surgical missions to under served nations. One such organization is Operation Smile International, a group with which both authors have (...) volunteered. This paper will describe the purpose and processes involved in Operation Smile and identify some of the key ethical issues that arise in short term medical volunteer work highlighting the importance of sustainability. (shrink)

In the Summa Theologiae ‘simplicity’ is treated as pre–eminent among the terms which may properly be used to describe the divine nature. The Question in which Thomas demonstrates that God must be ‘totally and in every way simple’ immediately follows the five proofs of God's existence, preceding the treatment of His other perfections, and being frequently used as the basis for proving them. Then in Question 13 ‘univocal predication' is held to be ‘impossible between God and creatures’ so that at (...) best ‘some things are said of God and creatures analogically’ because of the necessity of using ‘various and multiplied conceptions’ derived from our knowledge of created beings to refer to what in God is simple for ‘the perfections flowing from God to creatures… pre–exist in God unitedly and simply, whereas in creatures they are received divided and multiplied’ . In line with this, in the De Potentia Dei the treatment of analogical predication is integrated into that of ‘the Simplicity of the Divine Essence’ . Moreover, it lies at the root of Thomas's rejection of any possibility of a Trinitarian natural theology such as, for instance, St Anselm or Richard of St Victor had attempted to develop, on the grounds that ‘it is impossible to attain to the knowledge of the Trinity by natural reason’ since ‘we can know what belongs to the unity of the essence, but not what belongs to the distinction of the persons’ . Even modern minds sympathetic to Thomas have clearly found it difficult to understand his concern for the divine simplicity: in his Aquinas Lecture Plantinga speaks for many in stating that it is ‘a mysterious doctrine’ which is ‘exceedingly hard to grasp or construe’ and ‘it is difficult to see why anyone should be inclined to accept it’. Not surprisingly, therefore, some of the most widely read twentieth–century commentators on Aquinas have paid little attention to it. Increased interest has recently been shown in it, but a number of discussions pay insufficient attention to the historical context out of which Thomas's interest in the doctrine emerged, and consequently tend to misconstrue its nature. (shrink)

Assesses the ethical problems that doctors face every day and advocates a more universal code of medical ethics, one that draws on the traditions of religion and philosophy.

One of our great behavioral scientists, the bestselling author of Behave, plumbs the depths of the science and philosophy of decision-making to mount a devastating case against free will, an argument with profound consequences Robert Sapolsky's Behave, his now classic account of why humans do good and why they do bad, pointed toward an unsettling conclusion: We may not grasp the precise marriage of nature and nurture that creates the physics and chemistry at the base of human behavior, but (...) that doesn't mean it doesn't exist. Now, in Determined, Sapolsky takes his argument all the way, mounting a brilliant (and in his inimitable way, delightful) full-frontal assault on the pleasant fantasy that there is some separate self telling our biology what to do. Determined offers a marvelous synthesis of what we know about how consciousness works-the tight weave between reason and emotion and between stimulus and response in the moment and over a life. One by one, Sapolsky tackles all the major arguments for free will and takes them out, cutting a path through the thickets of chaos and complexity science and quantum physics, as well as touching ground on some of the wilder shores of philosophy. He shows us that the history of medicine is in no small part the history of learning that fewer and fewer things are somebody's "fault"; for example, for centuries we thought seizures were a sign of demonic possession. Yet, as he acknowledges, it's very hard, and at times impossible, to uncouple from our zeal to judge others and to judge ourselves. Sapolsky applies the new understanding of life beyond free will to some of our most essential questions around punishment, morality, and living well together. By the end, Sapolsky argues that while living our daily lives recognizing that we have no free will is going to be monumentally difficult, doing so is not going to result in anarchy, pointlessness, and existential malaise. Instead, it will make for a much more humane world. (shrink)

It is not too great an exaggeration to claim that On the Origin of Species was, along with Das Kapital, one of the two most significant works in the intellectual history of the nineteenth century. As George Henry Lewes wrote in 1868, ‘No work of our time has been so general in its influence’. However, the very generality of the influence of Darwin’s work provides the chief problem for the intellectual historian. Most books and articles on the subject assert the (...) influence but remain very imprecise about its nature. It is very difficult indeed to assess what it was about the Darwinian theory which was so influential and how its influence was felt. This problem in Victorian intellectual history intersects with a related one in the history of science. There has been a tendency on the part of historians of science to isolate Darwin in two related ways. The first is to single him out from the mainstream of nineteenth-century naturalism in Britain and allow ‘Darwinism’ to stand duty for the wider movement of which it was in fact but a part. The second is the tendency to single out his evolutionary theory and to demarcate it sharply from those of his predecessors and contemporaries. According to this interpretation Darwin stood alone as a real, empirical scientist and provided the first genuinely scientific hypothesis for the process by which evolution might have occurred. The theories of the other main evolutionists—Erasmus Darwin, Lamarck, Chambers, Spencer, and Wallace—were more or less besmirched by ideological, anthropomorphic, or other ‘non-scientific’ factors or by the uses to which they were put by their authors. Charles Darwin is thus made to stand out as a figure of comparatively unalloyed scientific status and is treated in relative isolation from the social and intellectual context in which he worked and into which his theory was received. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

Modern historical criticism of the gospels and Christian origins began in the seventeenth century largely as an attempt to debunk the Christian religion as a pious fraud. The gospels were seen as bits of priestcraft and humbug of a piece with the apocryphal Donation of Constantine. In the few centuries since Reimarus and his critical kin, historical criticism has been embraced and assimilated by many Christian scholars who have seen in it the logical extension of the grammatico-historical method of the (...) Reformers. The new views of New Testament exegesis and of early Christian history are important and well known. Many New Testament scholars would now hold with Schweitzer and Bultmann that Jesus was a preacher of the imminent end of the world. He may have secretly considered himself to be the Messiah, or he may have simply sought to pave the way for another, the apocalyptic Son of Man. After his execution, his disciples' experiences of his resurrection forced on them a conclusion already implicit in his teachings and personal piety: that Jesus was indeed, or had become, the Messiah, and was in fact God's Son. They expected he would soon return as the Son of Man he had predicted. (shrink)

INTRODUCTION Five Questions of Ethics Medical ethics as a field presents a fundamental problem. As a branch of applied ethics, medical ethics becomes ...

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one to (...) ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

It is not too great an exaggeration to claim that On the Origin of Species was, along with Das Kapital, one of the two most significant works in the intellectual history of the nineteenth century. As George Henry Lewes wrote in 1868, ‘No work of our time has been so general in its influence’. However, the very generality of the influence of Darwin’s work provides the chief problem for the intellectual historian. Most books and articles on the subject assert the (...) influence but remain very imprecise about its nature. It is very difficult indeed to assess what it was about the Darwinian theory which was so influential and how its influence was felt. This problem in Victorian intellectual history intersects with a related one in the history of science. There has been a tendency on the part of historians of science to isolate Darwin in two related ways. The first is to single him out from the mainstream of nineteenth-century naturalism in Britain and allow ‘Darwinism’ to stand duty for the wider movement of which it was in fact but a part. The second is the tendency to single out his evolutionary theory and to demarcate it sharply from those of his predecessors and contemporaries. According to this interpretation Darwin stood alone as a real, empirical scientist and provided the first genuinely scientific hypothesis for the process by which evolution might have occurred. The theories of the other main evolutionists—Erasmus Darwin, Lamarck, Chambers, Spencer, and Wallace—were more or less besmirched by ideological, anthropomorphic, or other ‘non-scientific’ factors or by the uses to which they were put by their authors. Charles Darwin is thus made to stand out as a figure of comparatively unalloyed scientific status and is treated in relative isolation from the social and intellectual context in which he worked and into which his theory was received. (shrink)

No one really believes that literally all functions of the entire brain must be lost for an individual to be dead. A better definition of death involves a higher brain orientation.