Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of (...) objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

No abstract available. First paragraph: In this issue’s target article, Stier and Schoene-Siefert purport to ‘depotentialize’ the argument from potentiality based on their claim that any human cell may be “converted” into a morally significant entity, and consequently, the argument from potentiality finally succumbs to a reductio ad absurdum. I aim to convey two reasons for skepticism about the innocuousness of the notion of cell convertibility, and hence, the cogency of their argument.

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help to (...) understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Virtue and Grace in the Theology of Thomas Aquinas by Justin M. AndersonThomas V. BergVirtue and Grace in the Theology of Thomas Aquinas by Justin M. Anderson (Cambridge: Cambridge University Press, 2020), xiii + 327 pp.To ignore Aquinas's theological backstory to his account of the virtues—namely, his account of grace in its relation to human action—is to distort his account of the virtues. This is the (...) very valid thesis explored by Justin Anderson in Virtue and Grace in the Theology of Thomas Aquinas. Anderson critiques the tendency among contemporary Anglophone virtue ethicists to quietly bracket his account of grace even as they admire his account the virtues. More pointedly, Anderson holds that Aquinas's account of virtue is inseparable from his account of sin, grace, "and God's presence in human life and action." He endeavors to evidence Aquinas's authentic account of virtue and its "inner reliance on the theological categories of grace, sin, and divine providence" (1).Anderson thus proposes a reading of Aquinas that is diachronic, analytical and systematic, and text-based, and which follows the logic inherent in Aquinas's own reasoning.And he delivers.After a brief overview of Aquinas's understanding of virtue in chapter 1, in chapter 2, Anderson explores the Thomistic distinction that will largely serve as a heuristic for most of the study: the distinction between virtue secundum quid (pagan virtue) and virtue simpliciter, virtue infused in us by God—virtue in the truest sense of the term.In chapter 3, Anderson traces the historical evolution in Aquinas's understanding of grace as this impacts his understanding of the conditions under which a person can possess or embody virtue. He bases this exploration in part on the work of both Henri Bouillard and Bernard Lonergan. First Anderson explores how that evolution came about in the context of the emergence of two powerful categories of thought: the Aristotelian concept of nature in the twelfth century and the category of the supernatural in the thirteenth. According to Bouillard, Aquinas's understanding of grace would [End Page 1421] have been further shaped by two sets of discoveries during his sojourn in Italy in the early 1260s, the first being two anti-Pelagian tracts of St. Augustine, and the second being the Liber de bona fortuna, a Latin compilation, possibly translated by William of Moerbeke, consisting of two chapters on good fortune, one taken from Aristotle's Magna Moralia, and the other from the Eudemian Ethics.Aquinas discovers in Augustine's anti-Pelagian works the contention that the beginning of faith is from God and not from the individual. As with the grace of final perseverance, both initiation and perdurance in faith are gratuitous gifts of God. In his encounter with the Liber (and particularly his consideration therein of the "problem of the first deliberation"), like other medievals, Aquinas "[was] presented Aristotelian investigations regarding the possibility of a divine movement, even unacknowledged by the agent, at the very roots of human action" (98). And, in Thomas's evolved understanding, this divine influence would constitute an inner movement within the human agent apart from those external circumstances ordained by providence.Anderson embraces the thesis that, in this context, and under these influences, Aquinas's understanding of grace underwent a "revolution," that a mature Aquinas—and this is the thesis of Lonergan—moves beyond a consideration of grace merely as habitus (gratia gratum faciens) to a notion of operative grace, of grace as a movement, utilizing "the unique idea of a 'moving grace', a movement of God in, and in some cases with, the human soul" (105).And—Anderson is emphatic—this revolution in thought quickly steers Aquinas clear of what centuries later will be termed semi-Pelagianism, and toward a firmly anti-Pelagian conception of the human capacity for virtue.Chapters 4–9 comprise the second and third parts of the book. It is here that Anderson masterfully and exhaustively engages in the heavy lifting of evincing just how, in fact, Aquinas's account of virtue is inseparable from his theology of grace. On the supposition that Aquinas's mature theology of grace understands the latter to... (shrink)

This paper explores how current United States policies for funding nonreproductive cloning are justified and argues against that justification. I show that a common conceptual framework underlies the national prohibition on the use of public funds for cloning research, which I call the simple argument. This argument rests on two premises: that research harming human embryos is unethical and that embryos produced via fertilization are identical to those produced via cloning. In response to the simple argument, I challenge the latter (...) premise. I demonstrate there are important ontological differences between human embryos (produced via fertilization) and clone embryos (produced via cloning). After considering the implications my argument has for the morality of publicly funding cloning for potential therapeutic purposes and potential responses to my position, I conclude that such funding is not only ethically permissible, but also humane national policy. (shrink)

This book is a philosophical examination of the logical problems associated with the claim that Jesus of Nazareth was one and the same person as God the Son, the Second Person of the divine Trinity.

This paper explores how current United States policies for funding nonreproductive cloning are justified and argues against that justification. I show that a common conceptual framework underlies the national prohibition on the use of public funds for cloning research, which I call the simple argument. This argument rests on two premises: that research harming human embryos is unethical and that embryos produced via fertilization are identical to those produced via cloning. In response to the simple argument, I challenge the latter (...) premise. I demonstrate there are important ontological differences between human embryos (produced via fertilization) and clone embryos (produced via cloning). After considering the implications my argument has for the morality of publicly funding cloning for potential therapeutic purposes and potential responses to my position, I conclude that such funding is not only ethically permissible, but also humane national policy. (shrink)

Thomas V. Morris introduces philosophical theology, examining God's goodness, power and knowledge; God's relationship to creation and time; and God's Incarnation and Trinity. A Contours of Christian Philosophy book. 180 pages, paper.

This mischievously artful essay plays out on several levels; think of them as storeys of an imaginary castle much like the real, solid, central Italian one it explores and expounds. On its own ground floor, the essay recounts a gruesome murder, a noble husband’s midnight revenge upon his wife and upon her bastard lover, his own half-brother, in her castle chamber, in bed. In sex. Of course. The murder itself is pure Renaissance, quintessential Boccaccio or Bandello, but the aftermath, in (...) fort and village, is more singular, more ethnographically delightful, as castle and village trace a ceremonious passage from frozen limbo to fluid grief and storytelling, finally set in motion by the arrival of the dead wife’s brother. Meanwhile, one flight up, the essay retells my own investigation of the real castle’s geometry, as I clambered through rooms, peered out windows, prowled the roof, and scanned blueprints seeking the places of the plotters’ plots. In an expository attic, I lodge reflections on my teaching stratagems, as I led a first-year seminar into detection’s crafts and exposition’s ploys. All the while, on its rooftop, this essay dances among fantastical chimneys and turrets of high theory and literary practice, musing on the patent irony of artful artifice, which evokes both the irony and the pathos of scholars’ cool histories about hot deeds and feelings. Art suggests we authors had best hide ourselves, unlike normal essayists, so as not to spoil the show. But, I posit, our self-effacement is so conspicuous that it proclaims our presence, as in fact it should, and, by so doing, trumpets the necessary tensions of our artifice and craft. Thus artfulness itself nicely both proclaims and celebrates the bittersweet frustrations of historians’ and readers’ quest for knowledge and, especially, for experience of a lost past. (shrink)

This paper proposes a Rawlsian conception of moral justification as a social activity. Through a close reading, Rawls’ view of ethical justification is shown to be significantly more dialogical and deliberative than is commonly appreciated. The result is a view that emphasizes the social nature of ethical justification and identifies information sharing between persons as the crux of justification in metaethics, in contrast to normative ethics. I call it Rawlsian reflective equilibrium to distinguish it from other varieties.

One of the most difficult and perplexing tenets of classical theism is the doctrine of divine simplicity. Broadly put, this is generally understood to be the thesis that God is altogether without any proper parts, composition, or metaphysical complexity whatsoever. For a good deal more than a millennium, veritable armies of philosophical theologians – Jewish, Christian and Islamic – proclaimed the truth and importance of divine simplicity. Yet in our own time, the doctrine has enjoyed no such support. Among many (...) otherwise orthodox theists, those who do not just disregard it completely explicitly deny it. However, in a couple of recent articles, William E. Mann has attempted to expound the idea of divine simplicity anew and to defend it against a number of criticisms. He even has gone so far as to hint at reaffirming its importance, suggesting that the doctrine may have a significant amount of explanatory power and other theoretical virtue as part of an overall account of the nature of God, by either entailing or in other ways providing for much else that traditional theists have wanted to say about God. In this paper, I want to take a close look at Mann's formulation of the doctrine and at a general supporting theory he adumbrates in his attempt to render more plausible, or at least more defensible, various of its elements and implications. As Mann has made what is arguably the best attempt to defend the doctrine in recent years, I think that such an examination is important and will repay our efforts. (shrink)

Thomas V. Morris discusses life, death, religion, the nature of faith and more. This captivating book is ideal both for thoughtful unbelievers who consider Christianity unreasonable, and Christians wanting to know how to share their faith with sceptics. Writing in an engaging, conversational style, Morris takes an intriguing new look at the big questions that keep coming up -- questions about life, death, God, religion, the nature of faith, the formation of an adequate worldview, and the meaning of life. (...) Morris explores these kinds of questions in an earnest yet thoroughly entertaining and easily readable way, relating numerous personal anecdotes, incorporating intriguing material from the films of Woody Allen and the journals of Tolstoy, and using the writings of the seventeenth-century genius Blaise Pascal as a central guide. (shrink)

Philosophers of science deploy mathematical models to describe epistemic communities, or groups of people creating and sharing knowledge for individual and collective purposes. These models capture...

In recent years, there has been a striking resurgence of interest in the traditional Judeo-Christian concept of God. This anthology contains a representative sample of some of the best contemporary philosophical work on this central religious idea, covering such topics as the existence of God, the physical nature of God, and the "divine attributes"--goodness, omnipotence, omniscience, eternity, immutability, and simplicity.

One of the most difficult and perplexing tenets of classical theism is the doctrine of divine simplicity. Broadly put, this is generally understood to be the thesis that God is altogether without any proper parts, composition, or metaphysical complexity whatsoever. For a good deal more than a millennium, veritable armies of philosophical theologians – Jewish, Christian and Islamic – proclaimed the truth and importance of divine simplicity. Yet in our own time, the doctrine has enjoyed no such support. Among many (...) otherwise orthodox theists, those who do not just disregard it completely explicitly deny it. However, in a couple of recent articles, William E. Mann has attempted to expound the idea of divine simplicity anew and to defend it against a number of criticisms. He even has gone so far as to hint at reaffirming its importance, suggesting that the doctrine may have a significant amount of explanatory power and other theoretical virtue as part of an overall account of the nature of God, by either entailing or in other ways providing for much else that traditional theists have wanted to say about God. In this paper, I want to take a close look at Mann's formulation of the doctrine and at a general supporting theory he adumbrates in his attempt to render more plausible, or at least more defensible, various of its elements and implications. As Mann has made what is arguably the best attempt to defend the doctrine in recent years, I think that such an examination is important and will repay our efforts. (shrink)

In an article which appeared a few years ago, entitled ‘God's Death’ , A.D. Smith launched one of the most interesting of recent attacks on the traditional doctrine of the Incarnation. Focusing on the death of Christ, he claimed to demonstrate the logical impossibility of Jesus having been both human and divine. Each of the premises of his argument was said to be a commitment of orthodox theology. He thus presented his reasoning as displaying an internal incoherence in that way (...) of thinking about divinity, humanity, and the person of Christ. The argument was basically quite simple: According to Christian theology and in concurrence with general thought on the matter, we must hold that human death involves the possibility of annihilation. As a man, Jesus of Nazareth faced and underwent a human death. He thus faced the possibility of annihilation. But orthodox theologians hold God to be of such an ontological status that no divine being could even possibly be annihilated. So no divine person could die a human death. From this follows the impossibility of the traditional claim that the Second Person of the divine Trinity became a man, lived a human life, and died a human death for us and our salvation. The qualitative difference between God and man is such as to render incarnational christology an incoherent theological stance. (shrink)

Ellen Fox and collaborators have produced the most detailed description of healthcare ethics practices in the United States available. Some findings are shocking for anyone committed to promoting q...

‘Either God is or he is not.’ But to which view shall we be inclined? Reason cannot decide this question. Infinite chaos separates us. At the far end of this infinite distance, a coin is being spun which will come down heads or tails. How will you wager? Reason cannot make you choose either, reason cannot prove either wrong.In this vivid and memorable passage, Blaise Pascal began to develop the famous argument which has come to be known as ‘Pascal's Wager.’ (...) The Wager is widely regarded as an argument for the rationality of belief in God which completely circumvents all considerations of proof or evidence that there is a God. (shrink)