This paper discusses the logical space of alternative conceptual engineering projects, with a specific focus on (1) the processes, (2) the targets and goals, and (3) the methods of such projects. We present an overview of how these three aspects interact in the contemporary literature and discuss those alternative projects that have yet to be explored based on our suggested typology. We show how choices about each element in a conceptual engineering project constrain the possibilities for the others, thereby giving (...) rise to distinct groupings of possible projects under the banner of conceptual engineering. We conclude with a critical reflection on the potential ethical issues that arise as a result of effectively putting conceptual engineering into practice. (shrink)

The world of disability theory is currently divided between those who insist it reflects a physical fact affecting life quality and those who believe disability is defined by social prejudice. Despite a dialogue spanning bioethical, medical and social scientific literatures the differences between opposing views remains persistent. The result is similar to a figure-ground paradox in which one can see only part of a picture at any moment. This paper attempts to find areas of commonality between the opposing camps, and (...) thus to rearrange the figures of the paradox at a fundamental level. The purpose is first to identify areas in which common ground can be achieved, and secondarily, to clarify the areas in which disagreement continues. While a general and unified theory of physical difference/disability is beyond the scope of this paper the result may advance that general goal. (shrink)

This essay identifies two different methodological strategies used by the proponents of anarchism. In what is termed the "ontological" approach, the rationale for anarchism depends on a particular representation of human nature. That characterization of "being" determines the relation between the individual and the structures of social life. In the alternative approach, the epistemological status of "representation" is challenged, leaving human subjects without stable identities. Without the possibility of stable human representations, the foundations underlying the exercise of institutional power can (...) be challenged. This epistemological discussion is traced from Max Stirner to the twentieth-century movement known as poststructuralism. (shrink)

This essay reviews a range of issues arising from the complex case of Terri Schiavo and the lessons the case raises for bioethicists. It argues that embedded in the case is a broader controversy than is immediately evident, one involving the definitions by which bioethics judge cases of extreme physical and psychological limits, in its principled form of address. Further, it argues that bioethicists who assume the issues involved in the case are settled miss the point of the emotional responses (...) it has brought forth. (shrink)

Résumé Les affinités paradoxales que la recherche a pu pointer entre la « secte » philosophique épicurienne et la secte chrétienne dans les premiers siècles de notre ère sont rappelées puis examinées dans le détail du premier document attestant une rencontre précise entre les deux sectes, le récit des Actes des Apôtres qui montre Paul discutant avec les Épicuriens et les Stoïciens d’Athènes, puis nous restitue le discours de Paul devant l’Aréopage d’Athènes. Il apparaît que Paul se pose en philosophe (...) pour exposer sa doctrine en des termes jusqu’à un certain point compatibles avec une doctrine matérialiste voire polythéiste. (shrink)

In so far as the Tao Te Ching and the Chuang Tzu are life-philosophies, they are philosophies of solitude. My aim in the following pages is to explain and defend this claim, clarifying the distinctive kind of solitude that is taught by Lao Tzu and Chuang Tzu.

A question between John Harris and I is the degree to which lessons may be learned, and insights gained, from a life distinguished by physical differences. He argues it as the “aborting Beethoven fallacy”, I insist on the evidence that what we learn from physical differences may be critical and life enhancing.

There has been no informed or honest debate in North America over the issue of liberalized euthanasia. Despite thousands of newspaper stories, scores of learned academic articles, a handful of closely analyzed legal decisions, and hours of broadcast news and talk show imagery, a full discussion is yet to begin.

Offers possible solutions to such medical dilemmas as who should receive organ transplants.

For all its apparent debate bioethical discourse is in fact very narrow. The discussion that occurs is typically within limited parameters, rarely fundamental. Nor does it accommodate divergent perspectives with ease. The reason lies in its ideology and the political and economic perspectives that ideology promotes. Here the ideology of bioethics' fundamental axioms is critiqued as arbitrary and exclusive rather than necessary and inclusive. The result unpacks the ideological and political underpinnings of bioethical thinking and suggests new avenues for a (...) broader debate over fundamentals, and a different approach to bioethical debate. (shrink)

From fertilization to approximately the sixteenth day of development, human embryonic cells are said to have the capacities of totipotency and monozygotic twinning, both of which are problematic to a theory of ensoulment at fertilization. In this article I will address the problems which these capacities pose to such a theory and present an interpretation of the biological data which renders ensoulment at fertilization more plausible. I will then argue that not only is an ensoulment theory consistent with current biological (...) data on the human embryo, but it may offer an explanation for the phenomencon of monozygotic twinning. (shrink)

The acceptance of military directives violating medical ethics and international covenants encouraged by the demonisation of the enemy by the US president in 2002 has effectively removed the right of medical personnel to refuse participation in internationally proscribed actionsMedicine and its traditional ethic of care is today a victim of the current conflict in Iraq and Afghanistan, its uniquely humanising mission rejected by US President George W Bush and his advisors. In denying the applicability of international agreements guaranteeing medicine’s ecumenical (...) role in this conflict they have transformed medicine into just another weapon of tactical significance. The result, predictable in retrospect, has been to make military physicians and nurses complicit—actively or passively—in what Litton calls an “atrocity-producing situation”, resulting in detainee or prisoner abuse.1From the first revelations of detainee torture in US detention camps to recent allegations of continued abuse , the focus of international attention has shifted from the US prosecution of low ranking, non-commissioned military personnel to the context in which the atrocities they committed occurred. “No one up the chain of command has ever been held accountable for what is in these horrifying images,” Center for Constitutional Rights Director Bill Goodman said of recently published photographs of 2004 prisoner torture and abuse.2 “The situation in several areas violates international law and conventions on human rights and torture,” said the UN Special Rapporteur on Torture following a 2006 investigation.3The denial of international law and convention involved the overt disavowal of covenants and conventions that for almost 150 years required medical personnel in the US military to act within the guidelines of a Hippocratic vision of medicine. To understand how fundamental this change has been requires a brief review of the history of medicine’s previously protected status and then a description of …. (shrink)

Healthcare Providers advising patient surrogates on the appropriateness of continued care for comatose patients have often been sharply criticized for coercive behavior toward patient surrogates; with failing to provide them with adequate information; and for a general failure to adequately cinsider the cimplex needs and hopes of patients, their surrogates, and caregivers. Because decisions on the continuation or withdrawal of care often need the legal approval of surrogates the failure of both medical personnel and patient families to understand each other's (...) priorities may lead to ethical and interpersonal conflict. (shrink)

A personable teenager with Down's syndrome became a Canadian cause célèbre a few months ago when University Hospital in Edmonton, Alberta, denied him a position on the organ transplantation waiting list. Terry Urquart lacked “reasonable” intelligence, hospital officials said, a criterion for all transplant candidates at that hospital. Protests by the boy's family, and by groups active in the cause of those with developmental disabilities, became well-photographed stories on the nightly television news and in the nation's newspapers. It did not (...) hurt the Urquart cause one bit that the 17-year-old teenager had won a gold medal in skiing at the International Special Olympics. (shrink)

Two rival paradigms permeate bioethics. One generally favors eugenics, euthanasia, assisted suicide and other methods for those with severely restricting physical and cognitive attributes. The other typically opposes these and favors instead ample support for "persons of difference" and their caring families or loved ones. In an attempt to understand the relation between these two paradigms, this article analyzes a publicly reported debate between proponents of both paradigms, bioethicist Peter Singer and lawyer Harriet McBryde Johnson. At issue, the article concludes, (...) are two distinct axiomatic sets of values resulting in not simply different styles of rhetoric but different vocabularies, in effect two different languages of ethics. (shrink)

During the first 16 days after fertilization, the developing embryo has the capacity to separate into two genetically identical embryos, or monozygotic twins (triplets, etc.). Because of this capacity, philosophers typically argue that the pre-16 day embryo is not a human being. On a Biological Account of Personal Identity (BAPI), which considers us human beings as essentially organisms, the development of the embryo into an organism at 16 (or 21) days marks our origins. The development of an embryo into an (...) organism is also said to mark the point at which the embryo loses its potential to give rise to monozygotic twins. This is considered a strength of the Biological account of our origins. I will argue here that it is the BAPI's own criteria that will have to allow cases of monozygotic twinning occurring even after 16 days, and that in virtue of this a Biological Account faces twinning puzzles usually reserved for earlier accounts of our origins. (shrink)

Morain and colleagues (2019) advocate rethinking the rather dogmatic guidance from both regulatory authorities and professional associations cautioning physician-investigators against obtaining inf...

Is Tom Shakespeare disabled, or simply distinct in stature? And if the latter, what makes that distinction important?For more than a decade, the British sociologist has been a critical voice in the sociology of difference. The son of a physician with achondroplasia “widely admired as a doctor and as a disabled role model” ,1 Shakespeare fils also has achondroplasia, is the father of children with the condition and, like his father, is professionally successful. As his book’s back cover announces, Shakespeare (...) has “taught and researched sociology at the Universities of Cambridge, Sunderland, Leeds, and Newcastle. He has written and broadcast extensively about disability and genetics, and his co-authored books include The Sexual Politics of Disability, Exploring Disability, and Genetic Politics.”This volume brings together a decade of papers that, Shakespeare says, “draws on my experience of being a disabled person, and the son, father, husband and friend of disabled people”1 to argue the following thesis: “Disability results from the interplay of individual and contextual factors. In other words, people are disabled by society and by their bodies.”1 That argument, he suggests, has resulted in the “breakdown of my relationship with the mainstream of the UK disabled people’s movement”, whose members advance a model of disability based wholly on social construction. Shakespeare sees that as simplistic and no longer viable despite of the extraordinary gains made by those seeking parity through advancement of the social construction thesis.1According to Shakespeare, his former confrères in the British disability movement see as a betrayal his rejection of their argument, one he formerly endorsed, and thus perhaps a repudiation of a generation of admittedly successful activism. To them, in other words, Shakespeare is no longer disabled but disabling, and that judgment must …. (shrink)

The online symposium concerning the Olivieri case provides a wealth of information, and lessons for the future.1 The articles, especially the one by Francois Baylis,2 and the e-letters concerning the articles, expand the teaching value of this case.After reading both articles and ….

No single principle is more critical to our ethical stance than the one asserting the sanctity of human life. In debates ranging from the care of anencephalic infants to the maintenance of fragile seniors, the question is, Where are the boundaries of sanctified human life? The generally accepted assumption is that a once firm set of principles and definitions is now eroding in the face of There is no doubt,that the miracles of medical technology have brought up ethical issues not (...) contemplated by us until the very recent past.”. (shrink)

One supposition underlying the Anderson & Lebiere target article is that the maximally broad “encompassing of its subject matter – the behavior of man” is regarded as an unquestioned quality criterion for guiding cognitive research. One might argue for an explicit specification of the limitations of a given paradigm, rather than extending it to apply to as many domains as possible.

Since its inception, bioethics’ principled stance has been to argue against paternalism and elitism, and for an inclusive ethical perspective. But at least in North America, the growth of bioethics as a special area of applied ethics has created conflicts within the field itself. Those who, a generation earlier, argued against paternalism and for both professional and public accountability in medical decision making are now part of the decision making process. Too often, it is argued in this paper, their allegiance (...) is to the employer, or to a view of medicine that is institutionally based. As a result, it is suggested by this review, medical ethicists have adopted the perspective that, in the early 1970s, they most criticised. The answer, it is argued here, is to revisit a lexicographical ordering of responsibility in bioethics, one that recognises professionals as individuals with responsibilities, as citizens with a public posture, and finally, as professionals involved in the process of medical decision making. (shrink)

To those defining euthanasia as a battle for the principle of self-determination, persons seeking physician assisted death (PAD) are soldiers in the fight for patient autonomy. The reasons they seek it, or the potential of other, non-life-threatening interventions is less important than this principle: individuals have the right not only to choose death (suicide), but to be assisted in dying. They should not be second guessed or denied on the basis of another's distaste for that decision. This paper offers a (...) general review of deaths attributed to Dr. Jack Kevorkian's PAD practice in an attempt to answer two questions: Why do persons seek physician assisted death, and, to what extent does induced death seem, in retrospect, a reasonable and perhaps necessary medical response to specific patient complaints? (shrink)

The critical role of surrogates—commonly if erroneously called “Informal caregivers”—has been generally ignored by clinical and bioethical literatures. While assumed to provide no more than ancillary support, these patient representatives directly or indirectly affect patient care to the extent they inhibit or facilitate both home-based care and patient decisions regarding treatment alternatives. Members of this group include relatives and neighbors who may or may not act in consort as advisors, assistants, care providers, and surrogate decisionmakers acting on the patient's behalf (...) with members of the medical community. Not only do they often possess a critical voice strongly influencing both patient care decisions and, after discharge, home care and rehabilitation, this paper argues they do so from a perspective that is often radically different from one endorsed by medical professionals. (shrink)

Although space limitations do not permit including all the responses received after the passing of David Thomasma, some representative expressions are included below. As these remembrances attest, Edmund Pellegrino spoke for all of us when he said at David's memorial service, “It has been said that we die only when forgotten; if so, David will live a long time. He remains a presence for his family, friends, collaborators, and all who met him.”.

In a special issue of this journal, a range of authors addressed the critical problem of difference in bioethics. To what extent do class, culture, ethnicity, and race affect the ethical decisions that patients and professionals must make in a medical context? Those arguing for an understanding of cultural influences in bioethical decisionmakingtypically argue from the perspective of individual case studies to demonstrate the importance of these social constructs. Others, like Erika Blacksher, however, worry that this approach will obscure the (...) uniqueness of individual decisionmakng patterns, allowing all persons of a single group to be aggregated as if their class, cultural construct, or religious affiliation were the single motive element in their medicolegal decisionmaking. There is, she cautions, a risk of misuse if a professional care provider reflexively assumes individual patient or surrogate reactions on the basis of ethnicity or culture. (shrink)

A recent issue of CambridgeQuarterlyofHealthcareEthics provides a fascinating look into the uncertainties surrounding the subject of human cloning. As Nelkin and Lindee point out, for example, the popular assumption is that this technology will lead to individual immortality. life everlasting for the deserving.considers the use of cloning for the replication of human individuals to be ethically unacceptable.”.

Normative criteria adopted to assure just, equitable, and efficient allocation of donor organs to potential recipients has been widely praised as a model for the allocation of scarce medical resources. Because the organ transplantation program relies upon voluntary participation by potential donors, all such programs necessarily rely upon public confidence in allocation decision making protocols. Several well publicized cases have raised questions in North America about the efficacy of allocation procedures. An analysis of those cases, and the relevant technical literature, (...) suggest consistent structural deficits exist in the organ allocation process as it is applied by many individual transplantation centres. These irregularities are based upon both the failure of rank waiting as a method to guarantee just treatment and a general failure to recognize the extent to which prescriptive criteria — social values — are commonly used to screen potential organ transplant candidates. Resulting idiosyncratic determinations, and a devaluation of rank waiting as a criterion, raise fundamental questions regarding justice, fairness, and equability in the application procedure at large. To correct these structural problems in organ allocation procedures, a multicriterion model defining prescriptive criteria through the Analytic Hierarchy Process (AHP) is proposed. (shrink)