SummaryDavid Hartley's Observations provides an example from the history of medicine of the bearing of theories of the relationship between body and mind on the problem of morality and free will. Further, Hartley's solution requires a distinction between two understandings of what it means for morality to be rationally grounded. The kind of ethics which can be established for moral agents on the basis of medical knowledge alone (and for which Hartley's “Rule of Life” presents but one historical example) has (...) been termed ‘therapeutic’ It leads to a viewpoint in which it is difficult, if not impossible, to distinguish between the kinds of reasons for supporting morals and the kinds of reasons for supporting good teeth. The kind of ethics which requires additional grounds entering into the motivation of the agent himself has been termed “rational.” This distinction between therapeutic and rational ethics rests on the more basic distinction between general and particular grounds on which to establish a rational system of ethics. As a result, the initial problem of how any account of the body-mind relation might allow for the possibility of ethics leads to the more interesting problem of how a therapeutic interpretation of ethics, which is possible on the grounds of medical knowledge, might be reconciled with a fully rational interpretation of ethics which we require on philosophical grounds. “Medical ethics” has traditionally been viewed as the application of concepts from philosophical ethics to the specific problems presented in medical practice. In consequence of the second problem exposed here, it would be useful to extend the domain of medical ethics from the level of concepts and cases to the level of interpreting the rational grounds for those concepts. Otherwise one may fail to distinguish a medical view of ethics from an ethical view of medicine. (shrink)

Reconciliation and the Technics of Healing Content Type Journal Article Pages 235-237 DOI 10.1007/s11673-011-9318-y Authors Paul A. Komesaroff, Monash Centre for Ethics in Medicine and Society, Monash University, Melbourne, Vic., Australia Elizabeth Kath, Global Cities Institute, RMIT University, Melbourne, Vic., Australia Paul James, Global Cities Institute, RMIT University, Melbourne, Vic., Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 3.

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if (...) any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation—that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures—is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope. (shrink)

Medication reconciliation for pediatric oncology patientparticipants enrolled in clinical trials often reveals the use of chemical complementary medicine alongside protocol therapeutic agents. Considering the blurry delineation between clinical ethics and research ethics, this paper demonstrates how complementary medicine-related protocol violations introduce ethical questions of who should be included and excluded from clinical trials and offers recommendations on how to manage physician-patient-family interactions around these challenging issues.

Experiments in Love and Death is about the depth and complexity of the ethical issues that arise in illness and medicine. In his concept of 'microethics' Paul Komesaroff provides an alternative to the abstract debates about principles and consequences that have long dominated ethical thought. He shows how ethical decisions are everywhere: in small decisions, in facial expressions, in almost inconspicuous acts of recognition and trust. Through powerful descriptions of case studies and clear and concise explanations of contemporary philosophical theory (...) the book brings discussions about ethics in medicine back to where they belong-to the level of the everyday experience where people actually live, suffer and hope. A fresh and evocative look at the changing world of ethics as it applies to health and illness, this is an important book for all those touched by illness or suffering. About the author Paul Komesaroff is a physician and philosopher at Monash University in Melbourne, Australia. His books include Objectivity, Science and Society, Troubled Bodies, Sexuality and Medicine (ed. with Philipa Rothfield and John Wiltshire) and Pathways to Reconciliation (ed. with Philipa Rothfield and Cleo Fleming). (shrink)

There is currently an unrecognised conflict between the utilitarian nature of the overall NHS and the basic deontology of the doctor-patient interaction. This conflict leads to mistrust and misunderstanding between managers and clinicians. This misunderstanding is bad for both doctors and managers, and also leads to waste of time and resources, and poorer services to patients. The utilitarian thinkers tend to value finite, short term, evidence based technical interventions, delivered according to specifications and contracts. They appear happy to break care (...) up into smaller pieces, which can then be commissioned from multiple providers. The deontological thinkers tend to think about care delivered through a long term continuous relationship, and regard that relationship as therapeutic and salutogenic in itself. To them breaking care up into smaller fragments is a denial of what caring is really about. Very rarely are either or both sides of this debate fully aware of where their powerfully felt and often well argued positions start from. In this paper we offer an appraisal of the strengths and weaknesses of both moral viewpoints as applied in the UK NHS context and we suggest a way in which they can be reconciled, provided neither is pushed too far or too hard against the other. We believe this reconciliation would be good for patients, doctors, managers and improve the service as a whole. (shrink)

This article reflects on the assumption underlying the argument of Little et al. that "contested understandings" in the clinic are susceptible to reconciliation within a liberal framework described as "pragmatic pluralism". It is argued that no such reconciliation is possible or desirable because it is of the nature of the clinic that it provides a forum for multiple voices, ethical and cultural perspectives, and conceptual frameworks, and this is the source of its fecundity and creativity. Medicine itself cannot (...) be represented by a single discourse, precisely because it is itself an unruly collection of practices that, despite their heterogeneity, are able to engage in productive dialogues with each other. The heteroglossia of the clinic, therefore, is not a problem to be overcome. Rather, it is a rich resource to be mobilized in accordance with its multiple inherent purposes. (shrink)

There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...) are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine with the constraints inherent in a time-bound utilitarian medical system. Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice. There are no data in this manuscript. (shrink)

The book reconstructs the history of Western ethics. The approach chosen focuses the endless dialectic of moral codes, or different kinds of ethos, moral doctrines that are preached in order to bring about a reform of existing ethos, and ethical theories that have taken shape in the context of controversies about the ethos and moral doctrines as means of justifying or reforming moral doctrines. Such dialectic is what is meant here by the phrase ‘moral traditions’, taken as a name for (...) threads of moral discourse, made in turn of other interwoven threads, including transmission of shared codes, appeals to reform of prevailing custom, rational argument about the justification of some precept on the basis of some shared general teaching or principle, and rational argument about the ultimate basis for principles and justification of authoritative teaching. That is, the approach adopted to the reading of ethical texts depends on a firm belief in the fact that philosophers hardly created any ethical doctrine out of nothing. The main point this book tries to highlight is how different philosophical theories emerged and followed each other as a result of attempts at accounting for what was going on in the world of moral traditions. Changes were propelled by controversies between different schools, and highly abstract arguments were the unintended effects of moves made by controversialists forced to transform (and occasionally to turn upside down) their own doctrines in order to face the challenge posed by other arguments. This is the reason why the book examines not only texts that already enjoy pride of place in the history of philosophy (Aristotle, Kant, Hegel), but also other texts usually treated in the histories of religions (the Bible, the Talmud, the Quran), and others considered to be much less philosophical (Plutarchus, Pufendorf). -/- 1. Plato and a response to ethical scepticism. Two different traditions of morality in VI-V century Greece are described. The birth of philosophical questioning of traditional morality and temporal and spatial variation of custom is described within the context of the v century crisis, the demise of traditional aristocratic and tyrannical rule and the birth of democracy. Two conflicting answers to the challenge are reconstructed, namely conventionalist or immoralist theories formulated by the Sophists and the eudemonist and intellectualist Socratic theory. Plato’s own reformulation of Socrates answer to the Sophists is reconstructed. His psychological views, his classification of the four cardinal virtues and his political theory are described as parts of a unitary system, culminating in an extremely realist moral ontology identifying the idea of the good with the essence of the (moral and extra-moral) world itself. -/- 2. Aristotle and the invention of practical philosophy. Aristotle’s invention of practical philosophy as a field separated from first philosophy is shown to be an implication of his break with Plato moral ultra-realism. Aristotle’s agenda in his moral works is arguably dependent on a polemical intention, namely dismantling Socratic intellectualism. The semi-inductive or virtuously circular method of practical philosophy is illustrated, starting with the received opinions of the better and wiser individuals and trying dialectically to sift what is left of mistake and inconsistence in such opinions, finally trying to correct mistakes and make the overall practical science more consistent. The chapter illustrates then the relationship of individual ethics, or ‘monastics’, with the art and the science of the pater familias, or ‘economics’, and the science of the ruler and citizen, or politics. The nature of virtues, or better, excellences of character, is discussed, highlighting the basic role of hexis, or ‘disposition’. Prudence, or better practical wisdom, is the focus of the chapter. Its relationship with bouleusis or deliberation is examined, and its autonomous status vis-à-vis theoretical knowledge is stressed. -/- 3. Diogenes and philosophy as a way of life. The chapter provides an overview of Hellenistic ethics, which almost amounts to Hellenistic schools of philosophy, in so far as ‘philosophy’ became in these centuries primarily the name for a way of life. The typical character of the Cynical movement is highlighted, that of a school of life, not a school aimed at providing any kind of intellectual training was to be provided. -/- 4. Epicurus and ethics as self-care. The peculiar character of the Epicurean school is described, a combination of a science of well-being aiming, more than at pleasure as in the popular view, at reduction of useless suffering, of unnecessary needs, and at a balanced selection of pleasures of the best and most durable kind. -/- 5. Epictetus and ethics as therapy of the passions. The various phases of Stoicism are described, and the shifting place given to ethics in the Stoic system of idea, culminating in the paradoxical view of ethics, its impossibility in principle notwithstanding, as the only truly significant and necessary part of philosophy. Cicero is treated, showing how his own synthesis of various Hellenistic trends is as a truly philosophical enterprise, deserving serious consideration after one or two centuries when he was confined to the role of literate. Epictetus is chosen as the best example of what the Stoic tradition could yield, an art of living based on sophisticated introspection, in turn aimed at making a kind of cognitive therapy possible, dismantling obnoxious passions at their root by systematically correcting false representations. -/- 6. Philo and the reconciliation of Torah and Platonism. A reconstruction of basic ideas from a few books of the Hebrew Bible is provided, starting with the Prophetic tradition and the focus on God’s mercy as the source of motivation and standard for human behaviour. Then a comparative analysis is undertaken of a parallel tradition, namely the three codifications of the Torā (Law or, better, Instruction), highlighting how a core of moral ideas may be recognized as a basis and preamble of codification of civil law, cultural practice, and regulation of ritual purity. The importance of Leviticus is stressed as the turning point when emphasis mercy, typical of the Prophetic tradition, is combined with the legal tradition, yielding the change in sensibility of the Second Temple time. Philo of Alexandria is described as one of the three leading figures – together with Rabbi Hillel and Rabbi Yeshua – at the apex the emergence of the mentioned new sensibility, gradually including mercy as an essential part of justice and establishing the starting point of both the Rabbinic and the Christian tradition. This consists precisely in the precept of one’s neighbour’s love or of the golden rule, two eventually identical precepts whose meaning is arguably more sober and sensible than the long-lasting Christian tradition deriving from John and Augustine has made us believe and no novelty vis-à-vis so-called Ancient-Testament teachings. -/- 7. Augustine and Christianity as Neo-Platonism. The first section examines the moral doctrines of so-called 'ethical Treaties' from the Talmud, a group of treaties, among which the best known is Pirqé Avot, that were left out of the six "orders" of the canon as they did not fit in any of the six groups of issues ritual or legal on which the division was based. According to Maimonides, their peculiar theme is provided by the Deòt, 'opinions', i.e., mental dispositions, that is, the translation of the Greek term hexeis and Arab akhlak (in turn providing in this language the name for ethics as such). The three topics I reconstruct are: i) the notion of Torah: The Torah is understood as the world order itself, or as the ‘Wisdom’ that existed even before creation and was ‘the tool by which the world was built’; however, the Torah is an earthly and human entity, as it was "received" by humans, and from that very moment belongs to them; ii) the relationship between love of God and love of neighbour; the treaties require us to study and practice the Torah ‘for its own sake’, that is, require us to act out of love, not out of fear or hope of reward; iii) the idea of sanctification of daily life: having disappeared with the destruction of the Temple the possibility of any conflict between liturgical service and everyday life, the latter is assumed to be in itself divine service: to give food to the poor has the same value as sacrifices in the Temple, and as an implication, the insistence become recurrent on the goodness of created things in themselves along with a polemic against ascetic currents. The conclusions drawn are: i) the moral teachings of the Talmud and those of Yeshua are, rather than similar, virtually identical; one may safely say that the precept of love and the golden rule are central ones for all Talmudic rabbis, that mercy plays an indispensable role alongside with justice, and the latter is not a different thing from one’s neighbour’s love; ii) a peculiarity of Talmud rabbis facing Yeshua is the idea of study as worship, and knowledge as a source of justice; but this is an idea of Judaism after the Temple's destruction that cannot be attributed to the Pharisees of Yeshua’s time; iii) the relation of study and practice in the Talmud parallels that between faith and deeds in Paul's epistles, that is, respectively faith or learning are a necessary and sufficient condition to be recognized as righteous , but deeds are the inevitable effect of either faith or learning. The sayings ascribed to Yeshua are examined first, yielding the conclusion that a close equivalent may be found for every saying in Talmudic literature and yet the whole is ascribed to one rabbi, with rather consistent stress on God’s mercy and unconditional forgiving as the mark of true imitation of God. Thus, Yeshua’s teaching is pure Judaism. The third section describes briefly the galaxy of Gnostic currents and Manichaeism, trying to sketch the profile of moral teachings resulting from an encounter of Asian spiritual traditions, Hellenistic lore and sparks of teachings from apocalyptic Jewish currents. The last section summarizes the turbulent history of several encounters between Christian currents and Hellenistic philosophical schools. The first one was with late Cynicism. Recent, rather controversial, literature discovered the jargon and a few topics from the Stoic-Cynical popular philosophy in a few books from the New Testament itself. This, far from proving that Rabbi Yeshua had been influenced by cynic preachers, is a proof of the necessity felt by Christian preachers to translate the original ‘Christian’ teaching into a Greek lexicon deeply impregnated with cynic terminology. The second was with Platonism, yielding the mild and temperate moral teaching of Clemens of Alexandria, teaching the sanctity of nature and the human body, the joy of moderate fruition of ‘natural’ kinds of pleasures, and the beauty of the marital life – in short, the opposite of the standard picture of Medieval Christianity. Ambrose of Milan brings about a different kind of synthesis, namely with Middle Platonism, where Stoic themes prevail. The most shocking case is Augustine, where an early Manichean education is overcome in a former phase by a synthesis of Plotinian Neo-Platonism and Christian preaching, yielding a sustained polemic with the Manicheans and rather optimistic views on life and Creation, the body and sexuality, and Hebrew-Judaic tradition not far from Clemens of Alexandria. In a later phase, occasioned by controversy on the opposite front, with such Christian currents as the Pelagians and Donatists, Augustine comes back to heavily anti-Judaic and world-denying ascetic attitudes where is earlier Manichean upbringing seems to emerge again. The tragedy of medieval Christianity will be the later Augustine’s overwhelming influence. A final section is dedicated to the monastic tradition where a curious mixture of world-denying asceticism with an astonishingly penetrating ‘science’ of introspection emerges. -/- 8. Al Farabi and the reconciliation of Islam and Platonism. The Qurān and the qadit, that is, collections of sayings ascribed to the prophet Muhammad contain a wealth of precepts and catalogues of virtues mirroring moral contents from the Jewish and the Christian traditions, among them the basic notion of imitation of the Deity, where mercy is assumed to be its basic trait. An important tradition within Islam, namely Sufism, stressed to the utmost degree the role of mercy, turning Islam into a mystic doctrine centred on retreat from the world, abandonment to God’s will, and a peaceful and fraternal attitude to our fellow-beings. A secular literary tradition originating in the Sassanid Empire, the literature of advice to the Prince had for a time a widespread influence in the newly constituted Arabic-Islamic commonwealth. In a later phase, the legacy of Hellenic philosophy made its way into the intellectual elite of the Islamic world. The first important legacy was Platonic, and the Republic became the main text for Islamic Platonism. Al-Farabi wrote an enjoyable remake of the Platonic Republic, arguing that the citizen’s virtues were the basis on which the political building needs to rest. The secular lawgiver is enlightened by the light of reason in his everyday practice of governance, but room is made for the Prophet as the voice of revealed truth that confirms and completes the rational truth that philosophy may afford. In a second phase also Aristotelian and Stoic influence were assimilated. Miskawayh’s treatise was the masterwork at the time Arabic philosophy reached its Zenith. It is a treatment of the soul’s diseases and their remedies, combining the Aristotelian doctrine of the golden mean with the Stoic doctrine of the passions and elements of Galenic medicine. Towards the eleventh-twelve centuries a war raged among theologians and philosophers, finally won by the former with disappearance of philosophy as such. The newly established mainstream, yet, was no kind of intolerant fanaticism. It drew from the work of mystic theologian Al-Ghazālī, the best heir of Sufism, teaching a tolerant and peaceful attitude to our fellow-beings and a passive attitude to destiny as an expression of the Divine will. -/- 9. Moshe ben Maimon and the reconciliation of Torah and Aristotelian ethics. The encounter between the Talmudic tradition and Hellenic philosophy had taken place a first time in Alexandria at the time of Philo but the two traditions had parted way again. In fact, the kind of Platonic Judaism founded by Philo survived only within Christianity, in the fourth Gospel and then in writings by Clemens of Alexandria. The Talmudic literature had absorbed just less striking traits from the Hellenic Philosophy, namely an idea of ethics as care of the self and a role for the education of character as propaedeutic to theoretical knowledge. In the Arabic-Islamic world, a second round started when Jewish authors writing in Arabic undertook the task to prove the full compatibility of the tradition deriving from Torah and Platonic philosophy. The culmination of this attempt is provided by Moshe ben Maimon who tried to use Aristotelian ethics as a language into which the teaching from the Pirké Avot could be translated. -/- 10. Thomas Aquinas and the reconciliation of Christian morality and Aristotelian ethics. In the first section the fresh start is described of philosophical ethics in Latin Europe at the turn of the Millennium. In a first phase, Anselm and Peter Abelard built on a Platonic and Augustinian legacy. In this phase. remarkable innovations are introduced, including Abelard’s claim of the obliging character of erring consciousness. In a second phase, the rediscovery of Nicomachean Ethics thanks to Latin translation of Arabic versions gives birth to a new wave of ethical studies, recovering the very idea of Aristotelian practical philosophy, with the potential implication of full legitimization of natural morality, i.e. ethics without Revelation. Aquinas’s ethics is a theological ethics out of which it would be vain to try to extract a self-contained philosophical ethics. His treatment of topics in philosophical ethics, yet, does not boil down to repetition of Aristotelian arguments but is rather a creative reshaping of such arguments. For example, he introduces also in the practical philosophy a first principle parallel to the principle of non-contradiction; and he also carries out a synthesis of Aristotelianism, Stoicism, and neo-Platonism. Even though it is essentially moral theology, Aquinas’s doctrine - unlike Augustine – grants full citizenship to "natural" morality, firstly by rejecting the claim that the corruption of human nature due to the original sin is so radical as to leave "pure nature" incapable of moral goodness. The doctrine is presented in a more sophisticated formulation in a few of the Quaestiones, such as De Malo and De Veritate, in the Summa contra Gentes and in the commentaries to Aristotle than in the famous Summa Theologica, but the latter work includes the only or the largest exposition of some decisive part of the theory. Thus, the Summa Theologica should be read for what it is more than criticized for not being what it was not meant to be. It was not meant to be the brilliant synthesis of all that Reason he had been able to produce with what Revelation had added about which the Neo-Thomists used to dream, but rather a manual for the training of preachers and confessors, where theoretical claims are not too demanding and a few serious tensions are left. Besides a jump between the Prima Secundae and the Secunda Secundae, being the former an essay in virtue theory and the latter a handbook for confessors, the most serious tension is perhaps the one between the ethics of right reason presented in most of Ia-IIae and the eudemonistic ethics developed in quaestiones 1-5 of the same part; the alternative ethical theory which also may be found in Augustine, the Stoic view of a cosmic reason eventually coincident with the moral law, was believed by Anselm (followed by John Duns Scotus and William of Ockham) to be incompatible with eudemonism. It is questionable whether Thomas could reduce the tension proving that it is just an apparent tension, in so far as the right reason and bliss derived from knowledge of God tend to coincide, but this is just a conjecture. Thomas’s ethics is a virtue ethic, not a law-based one, and moral judgment focuses on the virtues, particularly charity, not on the commandments and even less on absolute prohibitions; Thomas, however, would not have considered a drastic alternative between law and the virtues such as the one which has been advanced in late twentieth-century philosophy to be justified. Nonetheless, when it discusses ‘special’ virtues, it ceases to be an ethics of virtue and becomes a disappointing and often contradictory discussion of legal and illegal acts. Such a discussion takes most of the time ‘reasonable’ middle positions on controversial issues but not the alternative approach that Aristotelianism would have made possible; even when some occasional Aristotelian claim shows up, such as money’s barrenness as a reason against usury, this seems to be made by an author who apparently ignores the Aristotelian Thomas of the Prima Secundae. It is an ethic of human autonomy which recognizes the binding character of the individual conscience and, potentially, even a duty to disobey unjust laws. It is true that what Thomas writes in his discussion of death penalty and persecution of heretics is simply disgusting, and yet we should blame Thomas the man, not Thomist ethical theory. Finally, Thomas’s ethics is not ethical ‘absolutism’, as both traditionalist Catholic theologians and secularist enemies of dogmatic morality tend to believe. It is instead an ethic of prudential judgment. Exceptions to this approach – or better results of logical fallacies – are such claims as the absolute character of negative precepts and of the existence of "intrinsically evil acts", claims that simply cease to make sense in the light of Thomas’s own distinction between human act and natural act, carrying consequences Thomas did not live long enough to draw or was not consistent enough to dare to draw. -/- 11. Francisco de Vitoria and casuistry. The first topic illustrated is the discussion about the notion of pura natura, namely the human condition after the original sin and before divine revelation. The core notion was already there in Aquinas but was later developed by Caietanus (Thomas de Vio) with a number of interesting implications: firstly a view of human nature as such much more positive than Augustine’s and his followers’ view, including both Calvinists and Jansenists; secondly, the implication that the philosopher’s morality, as opposed to the Christian’s morality, is a quite respectable kind of morality; thirdly, that theocracy and prosecution of the unfaithful lacked justification, with more far-fetching consequences than Aquinas himself had dared to draw. The second topic is casuistry, a new name for a comparatively older way of thinking, which was already there in late Stoicism and Cicero as well as in the Talmudic literature. This is an approach aimed at yielding probable enough solutions for doubtful cases even in absence of completely safe staring points. The genre developed from medieval reference books for confessors and became by the sixteenth-century a sophisticated tool-box for dealing with various fields of applied ethics. Francisco Vitoria, the main authority of Baroque Scholasticism, was a controversial figure, among the proponents of the new discipline of casuistry and a consistent proponent of more separation between the religious and the civil authority, stricter limits to the legitimacy of war, innate rights of non-Christian nations in the New World based on the notion of pura natura, providing a standard of ‘natural’ goodness, previous to revelation, on which the Indian nations were judged to live in a naturally good condition, provided with the institutions of family, justice, and religion had accordingly a right to full respect by Christian sovereigns. Bartolomé de Las Casas, arguing along similar lines, was the leader of a historical battle in defence of the rights of the Indios. -/- 12. Michel de Montaigne and the art of living. A short description of one of the Renaissance Phyrronism, one of the classical philosophies revived in the fifteenth and sixteenth century. Montaigne combines the sceptical epistemology with an understanding of ethics – indeed of philosophy as a whole – in terms of an art of living inspired by two basic ideas, sagesse, that is, practical wisdom as the only kind of rationality available after theology, science, and tradition have declared bankrupt, and an aesthetic ideal of self-transformation through the art of writing and introspection. -/- 13. Pierre Nicole and neo-Augustinianism. The chapter illustrates first the vicissitudes of Augustinianism newly born after the late medieval triumph of Thomist Aristotelianism in the alternative Protestant and Catholic versions processed by the Calvinists and the Jansenists. Then it illustrates the doctrines of Pierre Nicole, Blaise Pascal’s best disciple, on the impossibility of introspection, on the ubiquity of self-deception, on the incurably evil character of the passion of love, and on the two moralities, the one of the man of the world, the morality of honesty which is indispensable for granting peace and order but devoid of any true value for eternal salvation, since the same external behaviour may be prompted by opposite motivations, and the morality of charity, the only true one but also useless to society. The third topic is Pierre Malebranche’s view of self-deception as a ubiquitous phenomenon accounting for human action and responsibility and his reformulated theory of self-love, no less ubiquitous than for Nicole and yet not as incurably evil, given the distinction between morally indifferent and even necessary amour de soi and vicious amour proper, a distinction on which the whole of Rousseau’s moral and political theory rests. -/- 14. Samuel von Pufendorf and the new science of morality. The chapter is dedicated to the discovery of the idea of a ‘new moral science’. Hugo Grotius is discussed first highlighting the real character of his project, much closer to the Thomist idea of a natural law accessible to non-corrupted human reason when human beings are living in a state of pura natura. Then Hobbes’s combination of scepticism, voluntarism, and conventionalism is described and both the continuity with Grotius’s new science, in the search for non-revealed rational morality, and the break with him, in the adoption of voluntarism and refusal of an intellectualist view of natural law, are illustrated. Pufendorf’s work is illustrated as a synthesis of the two previous attempts and the – up to Schneewind underestimated – paradigmatic example of the new science of morality. -/- 15. Richard Cumberland and consequentialist voluntarism. The chapter gives an overview of eighteenth-century Anglican ethics, noticing how the Cambridge tradition gave special weight to natural theology as opposed to positive or revealed theology – and how two Cambridge fellows, John Gay and Thomas Brown, elaborated on Cumberland’s (and Malebranche’s, as well as Leibniz’s) strategy for finding a third way between intellectualist view and voluntarist view of the laws of nature. The result of their elaboration was a kind of a rational-choice account of the origins of natural laws, where a law-giver God chooses among a number possible sets of laws on a maximizing criterion, and God’s maximandum is happiness for his creatures. The chapter notices also how such a solution aimed at solving at once the problem of evil and that of the foundation of moral obligation by proving how God’s choice was justified as far as it was the one minimising the amount of suffering in the world. 16. Richard Price and intuitionism. The chapter describes first the doctrines of the Cambridge Platonists, an example of hyper-rationalist reaction to Calvinism. Secondly it describes the sophisticated and universally ignored – from Sidgwick to Anscombe –version of what was later labelled ‘ethical intuitionism’ – showing how it escapes familiar objections and misrepresentations of intuitionism – from Mill to Rawls – in grounding its argument on transcendental arguments while carefully avoiding recourse to introspection and psychological evidence, which has been taken as a too easy target by critics of intuitionism. Thirdly, the chapter discusses Whewell’s ‘philosophy of morality’, as opposed to ‘systematic morality’, not unlike Kant’s distinction between a pure and an empirical moral philosophy. Whewell worked out a systematization of traditional normative ethics as a first step before its rational justification; he believed that the point in the philosophy of morality is justifying a few rational truths about the structure of morality such as to rule hedonism, eudemonism, and consequentialism; yet a system of positive morality cannot be derived solely from such rational truths but requires consideration of the ongoing dialectics between idea and fact in historically given moralities. Whewell’s intuitionism turns out closer to Kantian ethics than commentators have made us believe until now, and quite different from what Sidgwick meant by intuitionism. -/- 17. Adam Smith and the morality of role-switch. The chapter describes first, Hutcheson’s attempt at basing the ‘new science’ of natural law on different bedrock than Pufendorf and the English Platonists, namely a moral sense, a faculty whose existence is assumed to be proved on an empirical basis. The second step is a reconstruction of Hume’s rejoinder in terms of a new science of man including morality on an ‘experimental’ basis, that is, a ‘Newtonian’ hypothetical-deductive approach, distinguished from Hutcheson’s allegedly uncritical descriptive approach to human nature. The third step is a reconstruction of Adam Smith theory of morality understood as emerging from a spontaneous interplay of exchanges of situations (the most basic meaning of the word ‘sympathy’ as construed by this author). -/- 18. Jeremy Bentham and utilitarianism. The bulk of the chapter is dedicated to the doctrines of Jeremy Bentham. The Enlightenment spirit that suggested the idea of a new morality, free from religion, is illustrated. The notion of utility is illustrated as well as the subsequent formulations of the principle of utility. The idea of felicific calculus is discussed, showing how its inner difficulties prompted several reformulations of the principle of utility in order to avoid undesirable implications of proposed formulations. The role of the thesis of spontaneous convergence between interest and duty is discussed, showing how it left numberless questions open, and the distinction between the virtues of prudence, justice and beneficence is described as a way out of the deadlocks of classical utilitarianism. After Bentham, Mill’s reformed utilitarianism is reconstructed, showing how it is a kind of mixed system – as closer to common sense as it gives up Bentham’s claims to consistency and simplicity – resulting as unintended consequences from the controversies in which Mill was too keen to engage. The hidden agenda of the controversy between Utilitarianism and Intuitionism, going beyond the image of the battle between Prejudice and Reason, is described, showing how both competing philosophical outlooks turn out to be more research programs than self-contained doctrinal bodies, and such programs appear to be implemented, and indeed radically transformed while in progress thanks to their enemies no less than to their supporters. -/- 19. Immanuel Kant, practical reason and judgment. The chapter argues that Kant took from Moses Mendelssohn the idea of a distinction between geometry of morals and a practical ethic. He was drastically misunderstood by his followers precisely on this point. He had learned from the sceptics and the Jansenists the lesson that men are prompted to act by deceptive ends, and he was aware that human actions are also empirical phenomena, where laws like the laws of Nature may be detected. His practical ethics made room for judgment as a holistic procedure for assessing the saliency of relevant moral qualities in one given situation; this procedure yields the same results as the geometry of morals does for abstract cases but does so immediately and without balancing conflicting duties with each other, since what makes for the salient quality of a situation is perceived from the very beginning. Kant's practical philosophy is richer than the received image, making room for an ‘empirical moral philosophy’ or moral anthropology including treatment of commerce, needs, value and price, happiness and well-being; the overall social theory and philosophy of history is less different from Adam Smith's than the received image makes believe; the paradox of happiness is central to Kant's philosophy; a distinction between happiness and well-being is clearly drawn; the distinction plays a basic role in establishing a link between the economic and the moral life. -/- 20. Georg Wilhelm Friedrich Hegel and the critique of abstract universalism. The chapter describes first the Romantic movement and the implications some of its concerns, rescuing passions, community, tradition, the individual as the bearer of a unique destiny, and the longing for organic unity between the individual, mankind and nature. Hegel’s contribution is discussed then, highlighting how, on the one hand, he shared a number of these concerns and on the other he had more rationalist leanings. The notion of morality is the pivotal point of the reconstruction, highlighting how Hegel construes this notion as a key to his own diagnosis of the malaise of modernity – the separation of individual and Gemeinschaft – and how his attack on Kant turns around this very idea. -/- 21. Friedrich Nietzsche against Christianity and the Enlightenment. The chapter illustrates first the idea of deconstruction of the back-world of values. Nietzsche claims to be legitimate heir of the French moralists, Leibniz, Kant and Hegel, in so far as he allegedly carries out to its deepest implications their discovery of what lies behind traditional naïve belief in the existence of an objective realm of values just waiting for description by the philosopher. The two exemplars form which genealogy draws inspiration are the classical philologist’s historical reconstructions of lost meanings and the chemist’s decomposition of elements. Then the genealogy of the notions of good and evil carried out in the first dissertation of Genealogy of morals is illustrated with its paradoxical conclusion that will to power is in fact the only ‘genuine’ kind of goodness. The third point illustrated is the dialectic of ascetism and self-realization with its ambiguous outcome. The suggested interpretation of such outcome is that Nietzsche’s normative ethics is a kind of virtue ethics taking an aesthetic ideal as a normative standard -/- 22. George Edward Moore and ideal utilitarianism. The chapter discusses the ideas of common sense and common-sense morality in Sidgwick. I argue that, far from aiming at overcoming common-sense morality, Sidgwick aimed purposely at grounding a consist code of morality by methods allegedly taken from the natural sciences to reach, also in ethics, the same kind of “mature” knowledge as in the natural sciences. His whole polemics with intuitionism was vitiated by the a priori assumption that the widespread ethos of the educated part of humankind, not the theories of the intuitionist philosophers, was what was worth considering as the expression of intuitionist ethics. In spite of a naïve positivist starting-point, Sidgwick was encouraged by his own approach in exploring the fruitfulness of coherentist methods for normative ethics. Thus, Sidgwick left an ambivalent legacy to twentieth-century ethics: the dogmatic idea of a “new” morality of a consequentialist kind, and the fruitful idea that we can argue rationally in normative ethics albeit without shared foundations. Then it reconstructs the background of ideas, concerns and intentions out of which Moore’s early essays, the preliminary version, and then the final version of Principia Ethica originated. I stress the role of religious concerns, as well as that of the Idealist legacy. I argue that PE is more a patchwork of rather diverging contributions than a unitary work, not to say the paradigm of a new school in Ethics. I add a comparison with Rashdall’s almost contemporary ethical work, suggesting that the latter defends the same general claims in a different way, one that manages to pave decisive objections in a more plausible way. I end by suggesting that the emergence of Analytic Ethics was a more ambiguous phenomenon than the received view would make us believe, and that the wheat (or some other gluten-free grain) of this tradition, that is, what logic can do for philosophy, should be separated from the chaff, that is, the confused and mutually incompatible legacies of Utilitarianism and Idealism. -/- 23. Edmund Husserl and the a-priori of action. The chapter illustrates first the idea of phenomenology and the Husserl’s project of a phenomenological ethic as illustrated in his 1908-1914 lectures. The key idea is dismissing psychology and trying to ground a new science of the a priori of action, within which a more restricted field of inquiry will be the science of right actions. Then the chapter illustrates the criticism of modern moral philosophy carried out in the 1920 lectures, where the main target is naturalism, understood in the Kantian meaning of primacy of common sense. The third point illustrate is Adolph Reinach’s theory of social acts as a key the grounding of norms, a view that basically sketches the very ideas ‘discovered’ later by Clarence I. Lewis, John Searle, Karl-Otto Apel and Jürgen Habermas. A final section is dedicated to Nicolai Hartman, who always refused to define himself a phenomenologist and yet developed a more articulated and detailed theory of ‘values’ – with surprising affinities with George E. Moore - than philosophers such as Max Scheler who claimed to Husserl’s legitimate heirs. -/- 24. Bertrand Russell and non-cognitivism. The chapter reconstructs first the discussion after Moore. The naturalistic-fallacy argument was widely accepted but twisted to prove instead that the intuitive character of the definition of ‘good’, its non-cognitive meaning, in a first phase identified with ‘emotive’ meaning. Alfred Julius Ayer is indicated as a typical proponent of such non-cognitivist meta-ethics. More detailed discussion is dedicated to Bertrand Russell’s ethics, a more nuanced and sophisticated doctrine, arguing that non-cognitivism does not condemn morality to arbitrariness and that the project of a rational normative ethics is still possible, heading finally to the justification of a kind of non-hedonist utilitarianism. Stevenson’s theory, another moderate version of emotivism is discussed at some length, showing how the author comes close to the discovery of the role of a pragmatic dimension of language as a basis for ethical argument. Last of all, the discussion from the Forties about Hume’s law is described, mentioning Karl Popper’s argument and Richard Hare’s early non-cognitivist but non-emotivist doctrine named prescriptivism. -/- 25. Elizabeth Anscombe and the revival of virtue ethics. The chapter discusses the three theses defended by Anscombe in 'Modern Moral Philosophy'. I argue that: a) her answer to the question "why should I be moral?" requires a solution of the problem of theodicy, and ignores any attempts to save the moral point of view without recourse to divine retribution; b) her notion of divine law is an odd one more neo-Augustinian than Biblical or Scholastic; c) her image of Kantian ethics and intuitionism is the impoverished image manufactured by consequentialist opponents for polemical purposes and that she seems strangely accept it; d) the difficulty of identifying the "relevant descriptions" of acts is not an argument in favour of an ethics of virtue and against consequentialism or Kantian ethics, and indeed the role of judgment in the latter is a response to the difficulties raised by the case of judgment concerning future action. A short look at further developments in the neo-naturalist current is given trough a reconstruction of Philippa Foot’s and Peter Geach’s critiques to the naturalist-fallacy argument and Alasdair MacIntyre’s grand reconstruction of the origins and allegedly unavoidable failure of the Enlightenment project of an autonomous ethic. -/- 26. Richard Hare and neo-Utilitarianism. The chapter addresses the issue of the complex process of self-transformation Utilitarianism underwent after Sidgwick’s and Moore’s fatal criticism and the unexpected Phoenix-like process of rebirth of a doctrine definitely refuted. A glimpse at this uproarious process is given through two examples. The first is Roy Harrod Wittgensteinian transformation of Utilitarianism in pure normative ethics depurated from hedonism as well as from whatsoever theory of the good. This results in preference utilitarianism combined with a ‘Kantian’ version of rule utilitarianism. The second is Richard Hare’s two-level preference utilitarianism where act utilitarianism plays the function of eventual rational justification of moral judgments and rule-utilitarianism that of action-guiding practical device. -/- 27. Hans-Georg Gadamer and rehabilitation of practical philosophy. The post-war rediscovery of ethics by many German thinkers and its culmination in the Sixties in the movement named ‘Rehabilitation of practical philosophy’ is described. Among the actors of such rehabilitation there were a few of Heidegger’s most brilliant disciples, and Hans-Georg Gadamer is chosen as a paradigmatic example. His reading of Aristotle’s lesson I reconstructed, starting with Heidegger’s lesson but then subtly subverting its outcome thanks to the recovery of the central role of the notion of phronesis. -/- 28. Karl-Otto Apel and the revival of Kantian ethics. Parallel to the neo-Aristotelian trend, there was in the Rehabilitation of practical philosophy a Kantian current. This started, instead than the rehabilitation of prudence, with the discovery of the pragmatic dimension of language carried out by Charles Peirce and the Oxford linguistic philosophy. On this basis, Karl-Otto Apel singled out as the decisive proponent of the linguistic and Kantian turn in German-speaking ethics, worked out the performative-contradiction argument while claiming that this was able to provide a new rational and universal basis for normative ethics. An examination of his argument is some detail is offered, followed by a more cursory reconstruction of Jürgen Habermas’s elaboration on Apel’s theory. -/- 29. John Rawls and public ethics as applied ethics. Rawls’s distinction between a “political” and a “metaphysical” approach to one central part of ethical theory, namely the theory of justice, is interpreted as a formulation of the same basic idea at the root of both the principles approach and neo-casuistry, both discussed in the following chapter, namely that it is possible to reach an agreement concerning positive moral judgments even though the discussion is still open – and in Rawls’ view never will be close – on the basic criteria for judgment. -/- 30. Beauchamp and Childress and bioethics as applied ethics. The chapter presents the revolution of applied ethics while stressing its methodological novelty, exemplified primarily by Beauchamp and Childress principles approach and then by Jonsen and Toulmin’s new casuistry. -/- . (shrink)

The Food and Drug Administration and the European Medicines Agency have launched a recent initiative to enhance collaboration in research, with the intent to “ensure that clinical trials submitted in drug marketing applications in the United States and European Union are conducted uniformly, appropriately, and ethically.” This initiative recalls efforts from two decades ago when the United States, the European Union and Japan formed the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use as (...) a mechanism for harmonizing clinical research regulations. The intent of harmonization was to improve patients’ “access to new drugs, to prevent unnecessary global development delays and to avoid animal and human study duplications” through policy reconciliation.FDA/EMA efforts at collaboration call for a reassessment of past harmonization efforts: to what extent are ICH member policies already synchronized and to what extent can they be harmonized in the future? This paper will focus on these questions through the lens of pediatric investigation. (shrink)

One of Ludwik Fleck’s ideas about the development of scientific knowledge is that—once a system of interpretation is in place—the process that follows can be characterised as one of inertia: any new evidence comes under a strong pressure to be incorporated into the established frame. This can result in what Fleck called a harmony of illusions when contradictory evidence becomes almost invisible or is incorporated into the established frame only by huge efforts.The paper analyses early explanations of the tuberculin reaction (...) as a case study of Fleck’s argument. For Robert Koch, who had presented tuberculin in 1890, the compound was supposed to be a diagnostic tool and a cure for tuberculosis. His conception of its effect was rather peculiar, but strictly in line with ideas on the pathogenesis of infectious diseases he had developed much earlier. After tuberculin was released in late 1890, whether Koch’s conception was convincing depended on the place that a given observer had in the medical world in late-nineteenth-century Germany. Inside Koch’s group, the status of the tuberculin reaction remained stable and tuberculin retained its value as a diagnostic and curative tool. On the other hand, observers from outside that thought collective, and in particular from clinical medicine, soon pointed to flaws in its conception. These critics developed a rather different picture of tuberculin as a mysterious and dangerous drug. No reconciliation followed and what we find instead in German medicine around the year 1900 is the presence of rather contradictory concepts and practices surrounding Koch’s wonder cure. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

The central question of this conference is whether the media can contribute to high quality social dialogue. The prospects for resolving that question positively in the “sound and fury” depend on recovering the idea of truth. At present the news media are lurching along from one crisis to another with an empty centre. We need to articulate a believable concept of truth as communication's master principle. As the norm of healing is to medicine, justice to politics, critical thinking to education, (...) craftsmanship to engineering, and stewardship to business, so truth-telling is the news profession's occupational norm. Truth-telling is the ethical framework that fundamentally reorders the media's professional culture and enables them to enrich social dialogue rather than undermine it.Historically the mainstream press has defined itself in terms of an objectivist worldview. Centred on human rationality and armed with the scientific method, the facts in news have been said to mirror reality. The aim has been true and incontrovertible accounts of a domain separate from human consciousness. In Bertrand Russell's formula, “truth consists in some form of correspondence between belief and fact” . In the received view, truth is defined in elementary epistemological terms as accurate representation. News corresponds to context-free neutral algorithms, and ethics is equated with impartiality.The attacks on this misguided view of human knowledge had already originated in Giambattista Vico's fantasia and Wilhelm Dilthey's verstehen in the counter-Enlightenment of the 18th century. They have continued with hermeneutics, critical theory in the Frankfurt School, American pragmatism, Wittgenstein's linguistic philosophy, Gramsci, and in their own way, Lyotard's denial of master narratives and Derrida's sliding signifiers; until the anti-foundationalism of our own day indicates a crisis in correspondence views of truth. Institutional structures remain Enlightenment-driven, but in principle the tide has turned currently toward restricting objectivism to the territory of mathematics, physics, and the natural sciences. In reporting, objectivity has become increasingly controversial as the working press' professional standard, though it will remain entrenched in our ordinary practices of news production and dissemination until an alternative mission for the press is convincingly formulated.The demise of correspondence views of truth has created a predicament for the notion of truth altogether. However, instead of appealing to coherence versions or abandoning the concept, truth needs to be relocated in the moral sphere. Truth is a problem of axiology rather than epistemology. With the dominant scheme no longer tenable, truth should become the province of ethicists who can reconstruct it as the news media's contribution to social dialogue.When truth is articulated in terms of a moral framework, we can mold its richly textured meaning around the Hebrew emeth , the Greek aletheia . In Serbo-Croatian the true is justified as with plumbline in carpentry. In the powerful wheel imagery of the Buddhist tradition, truth is the immovable axle. The Truth and Reconciliation Commission in South Africa presumes that sufferings from apartheid can be healed through truthful testimony. In Ghandhi's “satyagrapha,” the power of truth through the human spirit eventually wins over force . Dietrich Bonhoeffer's Ethics contends correctly that a truthful account lays hold of the context, motives, and presuppositions involved .Telling the truth depends on the quality of discernment so that penultimates do not gain ultimacy. Truth means, in other words, to strike gold, to get at “the core, the essence, the nub, the heart of the matter” . For Henry David Thoreau – though addressing a different issue – when we are truthful, we attempt to “drive life into a corner and¼if it proves to be mean, why then to get the genuine meanness out of it and publish its meanness to the world; or if it were sublime, to know it by personal experience and be able to give a true account of the encounter” . For the former secretary general of the United Nations, Dag Hammarskjold, “the most dangerous of all moral dilemmas is when we are obliged to conceal truth in order to help the truth be victorious” . In the Talmud, the liar's punishment is that no one believes him.Augustine , professor of rhetoric at Milan and later Bishop of Hippo, illustrates a non-correspondence view of truth. His rhetorical theory is a major contribution to the philosophy of communication, contradicting the highly secular and linear view of the ancient Greeks. As with Aristotle, rhetoric entails reasoned judgement for Augustine; however, he “break[s] away from Graeco-Roman rhetoric, moving instead toward ¼rhetoric as aletheiac act” . Rhetoric for him is not knowledge-producing or opinion-producing but truth-producing . The Epistolae Doctrina Christiana scourges the value-neutral, technical language of “word merchants” without wisdom.Truth is not fundamentally a prescriptive statement. The aletheiac act in Augustine “tends to be more relational than propositional, a dialogically interpersonal, sacramentally charitable act rather than a statement¼taking into account and being motivated by [the cardinal virtues] faith, hope, and charity” . The truth for him does not merely make things clear, but motivates us to belief and action. In truthful communication for Augustine, “it is not enough to seek to move men's minds, merely for the sake of power; instead, the power to move is to be used to lead men to truth”. (shrink)

The term “Anthropocene” is frequently used to refer to the present planetary epoch, characterized by a geological signature of human activities, which have led to global ecological crises. This paper probes at what it means to be human on earth now, using healing as a concept to orient humanity in relation to other species, and particularly medicinal plants. Donna Haraway’s concept of the “Chthulucene” is used as an alternate lens to the Anthropocene, which highlights the inextricable linkages between humans and (...) other-than-human species. Healing can be viewed as a type of embodied orientation or engagement with the world, which has the potential to reach across boundaries of the skin, blur distinctions between self and other, and allow for both transpersonal and trans-species reconciliation. I focus my attention on Indigenous Shipibo healing rituals, and Shipibo concepts of healing that integrate humans within the ecosystem, and traverse species boundaries through communication with and embodiment of plant spirits. These healing rituals offer ways of coming into being within an ecology of selves—both internal and external, human and non-human—through listening and lending voice. I explore the potential for healing and ritual to work as a form of porous resistance through the internal blurring of binaries and hierarchical structures. (shrink)

The Human Genome Project is nearing completion, and shortly we will have access to the complete genetic sequence of an average human being. Hopes are high that the sequence will contribute profoundly to medicine in particular, but also to our understanding of our evolutionary past. Of course, detractors have long insisted that because the HGP represents a victory for formalism in biology, determining the function of DNA sequences will remain an outstanding problem for at least the next several decades. Moreover, (...) it is not clear that having the complete sequence will be significantly useful to biologists seeking to understand gene function in the first place. What can we expect in the postgenomic era? ;I reject the very idea that a complete, encapsulated sequence of a human genome is foundational to biological understanding. I set my investigation within the framework of the ancient debate between preformationists and epigenecists. I survey and conceptually analyze arguments on both sides, especially as they relate to the separation of genetics and embryology in the early part of the twentieth century. I identify modern variants of both preformationism and epigenesis, and note their reconciliation in the form of a Modern Consensus on development established after the neo-Darwinian Synthesis in biology in the 1940s. ;Drawing on recent work in molecular and developmental biology, I challenge the seeming intuitiveness of the Modern Consensus and its subsumption of developmental concerns under the aegis of molecular genetics. I then propose and defend an alternative synthesis of preformationism and epigenesis, and of genetics and developmental biology, according to which development does not reduce to mere gene activation. I underscore the practical benefit of my perspective through a lengthy discussion of the psychiatric genetics approach to schizophrenia. (shrink)

La teología católica de la pena, que durante siglos se mantuvo prácticamente inalterada, ha experimentado en los últimos 20 años una profunda transformación, impulsada por la idea conciliar de la dignidad de la persona humana, una más cabal comprensión del concepto bíblico de justicia divina y una conciencia más aguda de las deficiencias e injusticias del sistema penal, en particular, de la pena carcelaria. El presente artículo, a través del estudio de diversos documentos magisteriales relevantes para este tema, ilustra la (...) nueva perspectiva de la justicia reconciliadora, que busca dar a la sanción retributiva un sentido auténticamente medicinal, convirtiéndola en un recorrido potencialmente dotado de sentido para el delincuente, conducente a su rehabilitación y su reinserción en la comunidad. The Catholic Theology of punishment, which for centuries had remained unaltered, has undergone during the last 20 years a deep transformation, due to the conciliar idea of the dignity of the human person, a better understanding of the biblical concept of divine justice, and a new awareness of the deficiencies of the criminal justice system, especially as regards prison. This article, through the analysis of different magisterial documents, illustrates the new perspective of reconciliative justice, which seeks to give retributive sanctions an authentic medicinal orientation, as a potentially meaningful process for their subjects, in order to enable their rehabilitation and reintegration in the community. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Moses Maimonides: The Man and His WorksAlfred L. IvryHerbert A. Davidson. Moses Maimonides: The Man and His Works. New York: Oxford University Press, 2005. Pp. x + 567. Cloth, $45.00Herbert Davidson is a scholar of exceptional brilliance whose previous studies of medieval Jewish and Islamic philosophy have been widely acclaimed. In the present work, he ventures beyond philosophical argument to encompass an analysis of every aspect of the (...) life and work of one of the most celebrated—and controversial—figures in Jewish history, Moses Maimonides (1138–1204). In so doing, Davidson discloses a formidable knowledge of Talmud and rabbinic literature, as well as of the history, science, astronomy, medicine and philosophy of Maimonides' day. Davidson offers elegant descriptions and often challenging evaluations of Maimonides' life, education, and work: the rabbinic oeuvre, philosophical and medical treatises, and miscellaneous epistles.Maimonides' accomplishments do not include a number of works commonly but mistakenly attributed to him, in Davidson's opinion. He offers persuasive reasons (though admittedly not always conclusive proof) for rejecting Maimonidean authorship of a "Treatise on Logic," and the Epistles "In Opposition to Astrology" and "On Religious Persecution." Davidson's rejection of the last named epistle abets his interpretation of the early period of Maimonides' life, according to which he was not compelled to convert or to dissimulate a faith in Islam, as many think. [End Page 484]It is a cardinal principle for Davidson, though he does not identify the term as such, that Maimonides never practiced dissimulation in any significant way, or as Davidson sees it, that he did not lie. Davidson's Maimonides, for all the personal failings he notes, is a figure of immense rectitude and religious sincerity, to be taken at his word.Davidson comes, then, to defend Maimonides against his past and present critics who see esoteric and heretical teachings lurking behind Maimonides' protestations of orthodox belief. Davidson is no simple apologist for Maimonides, however, and does not hesitate to identify places in Maimonides' writings where the Master nodded. Such places abound for Davidson in Maimonides' philosophical masterpiece (as it is commonly thought), the Guide for the Perplexed, raising the strong suspicion that Davidson hardly regards it as such (creation arguments apart). He is much more taken with Maimonides' rabbinic acumen and achievements than with his philosophical work, arguing that Maimonides did not, when writing the Guide, have the time and concentration he possessed when composing the Commentary on the Mishnah and the Mishneh Torah.Davidson is assured by the strong and traditional affirmations of faith expressed in Maimonides' rabbinic writings that he maintained the same beliefs in his philosophy. The reconciliation of faith and reason is a theme that runs through all of Maimonides' writings. For Davidson this issues in a religious philosophy both radical and conservative: radical in that the Jewish God assumes an Aristotelian mien; conservative in that a "measure of personality" (365) is expressed through the act of creation and the performance of other miracles, notably the revelation at Sinai, prophecy, and resurrection. Problematic as he acknowledges the latter notion is for Maimonides, Davidson yet believes he held it.This is typical of Davidson's iconoclastic posture towards much of contemporary Maimonidean scholarship. Davidson does not believe Maimonides knew all that much philosophy and was not as careful with his writing as he claimed; that he did not have a first-hand knowledge of Aristotle, using Avicenna mostly instead; that his vaunted secret "Accounts of Creation and of the Chariot" were thinly disguised common notions of medieval physics and metaphysics; and that his entire claim to secret or esoteric teachings has none of the significance scholars in the past or present have given it.Here Davidson's bête noir is Leo Strauss, whom he regards as projecting his own dissimulating tactics upon Maimonides, turning him into an atheist (400). Davidson sees Shlomo Pines, adopting Strauss' methodology, as foisting an agnostic posture upon Maimonides. Davidson does not consider a Deistic alternative, probably assuming it incompatible with a creator God. Yet Maimonides' God functions dispassionately in His governance of the world, not knowing individuals directly, and offering them only a collective immaterial immortality.Maimonides exempts Moses and... (shrink)

continent. 1.4 (2011): 279—285. Concerning its Transitive Nature, the Conversion of Native Americans of Spanish Colonial California, Indoctrinated Catholicism, & the Creation There’s no direct archaeological evidence that Jesus ever existed. 1 I memorized the Act of Contrition. I don’t remember it now, except the beginning: Forgive me Father for I have sinned . . . This was in preparation for the Sacrament of Holy Reconciliation, where in a confessional I confessed my sins to Father Scott, who looked like (...) Jesus, at least in Western cultural representations of Jesus since the middle ages, and if Jesus put on a few pounds. Father Scott was long-haired, redheaded, bearded, chubby, and tall. When he left church with the procession of altar servers and Eucharistic ministers, yelling, “Sing a Good Song Unto the Lord,” he smiled, hands folded, and he gazed over his parishioners, and bounced along. For four months every year he lived among the Crow Nation in Montana, where towards the end of his tenure at Our Lady of Refuge, they adopted him as an honorary member of their tribe. * This is the prayer we chanted, holding hands, every night before dinner: Bless us oh Lord, for these our gifts, which we are about to receive, our bounty through Christ, our Lord, Amen. Then we all said, God bless the cook! When we were with my grandparents, Grandpa said, God bless Chicky, and Holly, and Harvey, and Boots—all the dead dogs. * My sister tells me that she sits next to a handsome man on a flight across the country. After chitchat, she withdraws her book. She’s reading Kevin Sampsell’s A Common Pornography . After a few moments, the handsome man also reads from his book—his leather-bound Bible. Sister thinks, Oh, Jesus—too bad. She falls asleep. Later, settled in Nashville, she opens her volume and out falls a Jesus-covered card that reads, You can still find God and Salvation! Because that handsome God-fearing young man saw that word— pornography . * I suppose Father Jim’s dark hair, beard, and glasses made me think doctoral-ly of him. He called while I was in the midst of a breakup, after I’d twice attempted suicide, and my mother was desperate for help. She somehow found and phoned him. And Jim, now years out of Our Lady of Refuge’s parish, twenty years since my baptism, years even since he’d left the priesthood and the Catholic faith, still made the effort to bring me back into the fold. He said, “Have you seen a priest?” I did not respond, as I was more shocked to hear his voice than anything, so I said, “How are you, Father Jim? Sorry, I guess I shouldn’t call you ‘Father.’” And I said, “Why did you leave the priesthood? Do you have a girlfriend?” He said that I should call him just “Jim.” He said, “Do you need someone to talk to?” I said, “Not really.” He said, “Call your mother; she’s worried about you.” That was the last time I talked to Father Jim. * Mother let me know just how disappointed Jesus was. I cried and cried, and said I was sorry. Into my hands she placed my missal, ordered forty Rosaries. She said next Saturday I would go to confession. I hated confession. Who wouldn’t? * I realize, of course, that this page is a kind of confessional. * The Kumeyaay, Ipai, Tipai, Chumash, Esselen, Rumsen—all Native Americans of Alta California—shared similarities in their religions. Southern Californian tribes made use of Datura, or jimpson weed, a hallucinogen, for religious rituals. In the creation, God made brother sky and sister earth. Brother and sister mated, and sister gave birth to all things on Earth, including people, but it was difficult to distinguish people from all other aspects of Earth because everything was alive: granite and obsidian, the Pacific and its waves, the San Diego and Los Angeles Rivers. Wiyot—a hero—was very powerful, born from lightning, the son of the Creator and a virgin. When Wiyot thought that human women’s legs were more beautiful than Frog’s, Frog became jealous and poisoned Wiyot. The dying Wiyot went to all the people’s villages, and he distributed his power among them. He said, “When I die, I should be cremated.” The people built the fire and funeral pyre. When the fire was ready, and the people about to place Wiyot’s body upon it, Coyote came and snatched away Wiyot’s heart. * My friend Nick told me once how he ate some jimpson weed and that he hallucinated for three days. His family took a road trip and, while driving over the Sierra Nevada mountains, he kept seeing dinosaurs roaming the open meadows and charging down snowy slopes. So it’s no wonder that Native Americans who ingested this plant would have developed religion. * Walking Castroville’s streets after school I got into fights but mostly watched other boys scrabbling on the asphalt. I went to Burger King for Whoppers. Me and my friends cussed. Antonio admonished me when I said, “damn,” while strutting a sidewalk alongside the church. He said, “Jaime”—pronounced Hi-May, which was what all the Mexicans called me—“you’re crazy, eh. Don’t cuss at the church.” He meant while at church, as in, within its vicinity. I said, “We’re not in church.” Once we’d crossed the street, Tony said, “Damn dude, you’re fuckin crazy!” * Blessed Father Fray Junípero Serra raised the Eucharistic goblet to his lips, and candlelight danced on the blood’s tiny waves. Incense clouded the church so completely that some of the Pame natives grew nauseous. So, too, felt Blessed Father Fray Junípero Serra later that night, as he bent over a ceramic bowl and vomited blood, not only the Lord’s, but his own, for poison had laced the sacred vessel into which he poured the sacrament. The physician tending to the sick prelate urged him to take the remedy he’d prepared. But Blessed Father Fray Junípero Serra refused, said that he would pray, for he had never taken any medicine in his life, and he never would. * The Chumash of El Valle de Los Osos called themselves the Stishni, separating themselves from Chumash of other regions, those varying tribes of the central California coast that spoke mutually unintelligible dialects of their Hokan language. This made learning their languages impossible for the Spanish friars, to say nothing of translating the Doctrina. Thus the priests baptized few natives, despite the help that the tribes offered the fledgling settlements in the form of meat and acorn meal, which the Spaniards found repugnant. Some from these cultures, feeling threatened by the newcomers, shot flaming arrows into the thatched roofs of the mission structures. And why wouldn’t they feel threatened when priests chastised them for performing, for example, their Coyote Dance, wherein a man donning a coyote-skin-and-skull costume dances while a singer sings his tale, which laments the human feces strewn imaginatively about the Earth? Coyote, meantime, tries to get an onlooker to lick his genitals, and finally engages in public sexual intercourse with a female tribe member or two, then ends the dance by defecating. Though the Franciscans called such forbidden acts devilry , the Chumash maintained their Datura cult religion, along with the enforced Christianity. For the Chumash, the Earth was made of two enormous snakes that caused earthquakes when they slithered past one another—a vast reptilian tectonics. In the 20th century, long after Blessed Father Fray Junípero Serra and his cohorts had died, when asked by an anthropologist about religious contradictions, conflating the Datura and Christian cults, a Chumash man replied, incredulous: “But these are two different religions.” * When Portolá ordered that if by March 19th, the feast day of St. Joseph, the San Antonio had not arrived in San Diego Bay to relieve them, the Sacred Expedition to Nueva California would be abandoned, Blessed Father Fray Junípero Serra prayed a novena for San José’s intercession. And lo, a lookout sighted the San Antonio ’s sails—what seemed to the priest a miracle—that very Saint’s feast day. Europeans would stay in California, and Blessed Father Fray Junípero Serra would continue to reap a great harvest of souls for the Lord. By the end of mission secularization in 1836—sixty-six years after the San Antonio rescued the Spaniards—Native American populations in California had declined by seventy-three percent. * When Peter the Aleut would not renounce his Eastern Orthodox faith the padre of San Francisco had a toe severed from each foot with each refusal, totaling ten. The native Ohlones employed in this gruesome task—their obsidian chiseled knives tearing through skin and grinding bone—continued as per their orders, and cut off also each of Peter’s fingers (equals a total of twenty refusals). They quartered the martyr, spilled his bowels, as if from bear attack, attack by a bear in the shape of a Catholic. * Blessed Father Fray Junípero Serra absolutely believed that the slow rate of conversion for the native people was due to the influence of the Devil, who had been outraged by the coming of the Catholics to California, this region that he had long held in his dominion. * In his reception speech for the Nobel Prize for Literature, John Steinbeck said, “Man himself has become our greatest hazard and our only hope. So that today, St. John the Apostle may well be paraphrased: In the end is the Word, and the Word is Man—and the Word is with Men.” * In 1602, when Sebastián Vizcaíno and his friars sang mass on Catalina Island, as many as a hundred Pimungans witnessed the rite, asking by signs what it was about. According to Vizcaíno’s records, the Californians marveled not a little at the idea of Heaven and at the image of Jesus crucified. * Vizcaíno was brought to a prairie on Santa Catalina Island where the Pimungans worshipped their sun god. Upon the prairie they had placed an icon, a headless figure with horns protruding from the body, a figure that Vizcaíno predictably described as a demon. The Pimungans urged Vizcaíno not to approach the image of their deity, but he ignored them. He placed his crucifix against the wooden figurine and prayed the Our Father. Vizcaíno told the natives that his prayer was from Heaven, and that their god was the Devil. Vizcaíno held out his crucifix, encouraging the Pimungans to touch it and receive Jesus. He pointed at the sky and indicated Heaven. The Pimungans worshipped a sun deity, so they were impressed with this white man and his description of his god, for their gods seemed to be one and the same. It’s no wonder then that Vizcaíno’s diary reports the natives being pleased with this exchange. “Surely,” the diary says, “they will be converted to our Holy Faith.” * The Miwok women wailed and scratched at their faces when their men consorted with Sir Francis Drake and the other Englishmen who had landed on California’s coast in the summer of 1579. “The blood streaming downe along their brests, besides despoiling the upper parts of their bodies of those single coverings . . .they would with furie cast themselves upon the ground . . . on hard stones, knobby hillocks, stocks of wood, and pricking bushes.” Drake and his men fell themselves to their knees in prayer, their eyes Heavenward, so that the natives might see they prayed to God and they too might worship God then their eyes that had been so blinded by the deceiver might be opened. * Father Fray Antonio de la Ascención—Carmelite friar in Vizcaíno’s party—writes that the Indians of California can “easily and with very little labor be taught our Holy Catholic faith, and that they would receive it well and lovingly.” He calls for two hundred older and honorable soldiers to ensure brotherhood during the conquest, so that peace and love—the best tools to pacify pagans—should reign. The religious, the friar says, should likewise be wise and loving to easily quell animosities between Spaniards and the heathen, and therefore avoid war. The Spaniards should bring with them trinkets—beads, mirrors, knives—to distribute amongst the gentiles, so that they might come to love the Christians, and see “that they are coming to their lands to give them that of which they bring, and not to take away the Indians’ possessions, and may understand that they are seeking the good of their souls.” No women are to accompany the conquest, says Father Fray Antonio, “to avoid offenses to God.” * In 1955 Wallace Stevens admitted himself to St. Francis Hospital in Hartford, Connecticut. There, it’s rumored he converted to Catholicism before dying of stomach cancer, exclaiming to his priest after the baptism, “Now I am in the fold.” Stevens’s late-career poems seem less cynical, more in awe of being and death (read “Metaphor as Degeneration” from The Auroras of Autumn ). He could have chosen from at least three secular hospitals in Hartford at the time. * I was reading Stevens’s Collected Poems when I joined eHarmony and listed that as my “currently reading” book among the “more than twelve” books a year that I would read. I fell in love with my wife when she said, “Are you sending your work out to literary journals?” Prior to this, the first girl I talked to on the phone, when I explained my doctoral exams, said, “So, you’re like, reading Stephen King and stuff?” When I said not exactly she responded defensively: “He must be doing something right, since he makes all that money.” * Mom walked me, my brother, and sister, through the Stations of the Cross. We did this on Ash Wednesdays, or whenever she thought we needed extra God after church. It might’ve happened before church, though that’s unlikely because we were always late. Anyway, it’s easiest to walk the Stations of the Cross when there’s no one else around. To walk the actual Stations means one goes to Jerusalem and walks the Via Dolorosa to the Church of the Holy Sepulchre. So the Stations elsewhere—usually paintings, or low-relief sculptures upon church walls—serve as a kind of virtual Dolorosa. Mom held our hands and started from the rear of Our Lady of Refuge: the First Station. Mom said we should say a prayer at each Station and to think of all the pain Jesus went through so that we could go to Heaven. It was hard to keep thinking about that one thing for so long. My mind went to that Saturday’s little league game, to the donut and chocolate milk (our after-church reward from Castroville Bakery), and as I grew older I thought about girls. When you’re thirteen you can’t not think about the girl’s butt in the pew in front of yours as she kneels and stands to pray throughout mass. * It grew increasingly juvenile to lie awake at night daring myself to utter a simple sentence. Even if I said I didn’t believe in God, wouldn’t He know the truth? He was omniscient, like a narrator. Even the idea of Him as a him ceased making sense. Not only did this come with a budding realization of my paternalistic culture, but due to the simple question of why? If God was everything, everywhere, all knowing, then why would he be a man? There’s that question: If God is a man then God must have a penis, and if so, what for? * The Catholic Church incorporates some modern scientific research into its dogma concerning the formation of the Universe, Solar System, and Earth, as well as evolution. According to Catholic doctrine, in approximately the fifth millennia BCE, humans began to worship the one true God. Those humans were Adam and Eve, though the Church says humans had been around for thousands of years prior to Adam and Eve. The Church claims to be infallible. Every time the Church changes its doctrine it remains infallible. * One Catholic writer, Tom Meagher, writes that “Modernism[—]the idea that we come to our beliefs individually through emotional or personal experiences[—]has crept into our Catholic schools.” * Catholics believe that evil spirits, given power through Original Sin, can imbue ordinary inanimate objects of everyday use. Thus, such objects should be blessed in order to induce in them the desire to serve the good. Such objects are not limited to, but include, “new ships and boats, railways and trains, bridges, fountains, wells, cornmills, limekilns, smelting furnaces, telegrams, steam engines, and machines for providing electricity.” * In The Sound of Music Julie Andrews and Christopher Plummer sing together: “Nothing comes from nothing, nothing ever could...” * To explain competing theories on the very early universe, and pre-verse would be another book. What was the inflaton? Did (mem)branes collide, initiating the Big Bang, as opposed to Lemaître’s primordial atom, a singularity? Without a unified theory there’s gravity hanging out there, fucking everything up. We cannot make sense of the mechanics of the Planck Epoch—0-10-34 seconds into the Universe’s creation—named for Max Planck, who stumbled into the discovery of quantum mechanics in the early twentieth century. * My students often ask if I believe in God, since I espouse evolution, the Big Bang, Science, reject a strictly biblical or creationist theory of the Universe. I tell them that yes, I believe in God, though not the God that they imagine one must believe in. * When questioned regarding the rumor that, before his death, founder of quantum mechanics Max Planck had converted to Catholicism, he replied that he did not believe “in a personal God, let alone a Christian God.” * Physicist and Catholic priest George Lemaître, who formulated the theory and wrote the 1946 book The Primeval Atom Hypothesis , was made a household name by then-detractor Fred Hoyle, who pejoratively referred to the idea as a “Big Bang.” * Suicide is a mortal sin. To end one’s own life one must have despair, which is to lose hope, which is to lose faith, and to disbelieve in God. * Archaeology has uncovered graffiti in all of California’s missions—Indian pictographs inscribed into the adobe, covered with layers of whitewash. Native deities and depictions of cultural practices show that tribespeople never fully gave up their native traditions even after baptism and coming to the missions. There was something inside Native Californians that would never die. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 35.3 (2002) 208-222 [Access article in PDF] Writing, Illness and Affirmation Jeremiah Dyehouse My formula for greatness in a human being is amor fati: that one wants nothing to be different, not forward, not backward, not in all eternity. Not merely to bear what is necessary, still less conceal it—all idealism is mendaciousness in the face of what is necessary—but love it. —Friedrich Nietzsche In her (...) widely circulated book On Death and Dying, Elisabeth Kübler-Ross, M.D., addresses herself to a changed historical context for work in medicine. In societies with increasingly effective medical care, she argues, doctors and nurses find themselves working with patients whose health problems range from imperceptible yet terminal sicknesses to psychosomatic ailments. Today, especially, it is easy to see the reality of her description of this situation: forms of terminal cancer can be detected earlier and earlier in a patient's life, rendering the disconcerting reality of a terminal illness with few or no symptoms. Equally strange for doctors and patients today are forms of environmental illness like chronic fatigue syndrome, a condition suffered by many but still disputed by doctors and researchers. To this situation of medical risk, personal suffering, and therapeutic care, Kübler-Ross prescribes a communicative engagement with the dying. This engagement, she argues, not only teaches doctors about death and dying, but it also provides respite for those who must experience these events.The problem of communicating with the dying, the main focus of Kübler-Ross's book, is nevertheless eclipsed by the other, more notable aspect of On Death and Dying. For out of this book emerged the now very popular understanding of the stages of death, the normal sequence of an individual's emotional reconciliation to dying: the processes of denial and isolation, anger, bargaining, depression—the whole series of intrapsychic processes leading up to a final acceptance of death and dying. Now we live amongst a whole panoply of staged progresses towards the acceptance of trauma: trauma associated not only with death and dying but also with substance abuse, catastrophe, and forms of violence. It is perhaps worth recalling, however, that the most famous of these stage models, the five stages [End Page 208] of death, emerged out of Kübler-Ross's attempt to learn what the dying can teach the living about communication.In what follows, I assume that writing about illness is another, more popular form of Kübler-Ross's descriptive and communicative project. To write pathography, as Anne Hunsaker Hawkins calls narratives of illness and dying in her survey of these texts, Reconstructing Illness: Studies in Pathography, is to engage with what sickness and dying teach about life and writing. As might be guessed, most pathographies orbit familiar centers of gravity: agency for the dying, reconciliation for the living, the whole leaden project of acceptance. Even so, pathography is not always and everywhere engaged in such projects. Pathography, as Hawkins demonstrates, is a highly variable project. Literary pathography is quite different from popular pathography, and texts within these categories differ with respect to the purpose of their writing. Pathography is conceived as a communicative engagement with sickness and dying, with the sick and the dying, but is hardly unified in its aims or its functions. It is a form of writing that not just potentially but actually admits a diversity of purposes and produces a variety of effects.It is my purpose here to propose a typology for pathographies. Although pathography as a genre of writing takes a bewildering variety of forms, these writings can be grouped according to their effects. I divide pathography into three types, according to the kind of response they offer to sickness and dying, to the sick and the dying. First, I treat pathography as a process of passive acceptance, the bearing of a burden proposed by the necessities of illness and death. Next, I characterize pathographies that approach the writing of illness or dying as a process of active acceptance. This type of pathography uses writing about illness and dying as a process for the... (shrink)

I outline a dilemma for Derek Parfit’s project to vindicate moral realism. In On What Matters, Parfit argues that the best versions of three of the main moral traditions agree on a set of moral principles, which should make us more confident about the prospects of truth in ethics. I show that the result of this Convergence Argument can be interpreted in two ways. Either there remain three separate and deontically equivalent theories or there remains just one theory, the Triple (...) Theory. Both interpretations fail to deliver what Parfit is looking for. The first interpretation leads to a situation of underdetermination of theory choice that gives rise to a skeptical challenge. The second interpretation jettisons Parfit’s Conciliatory Project, that is, the reconciliation of the three moral traditions. The dilemma, I contend, is the result of Parfit failing to resolve two antithetical lines of thought. His search for the Trinity of moral theorizing must thus fail. (shrink)

Psychologists can measure normalcy, define madness, develop therapeutic paradigms, and list the nuances of human behavior with utmost precision. We have biofeedback, psychometrics, psychoanalysis, cognitive therapy, positive psychology, behavior modification, and a host of deeply promising projects in the research and development pipeline. To be sure, our discipline has advanced accurate understanding of the soul's essential properties and has scientifically harnessed this knowledge to clinically mitigate the deep agony of the human mind. But, despite our advances and genuine effectiveness, our (...) discipline remains incomplete. Theoretically, scientifically, and therapeutically, we fall short of the fuller effectuality that awaits us. We need Christ. It is through the Christian revelation that psychology will find its maturity. For psychology there are blessings afoot. These blessings stem from our recognition that the Clinical Christ - the activity of the God of the Christian revelation throughout the realms of our discipline - desires to redeem, relate, heal, love, and empower us. The chapters of this book explore different aspects of the Clinical Christ, Christian Holism, and their implications. A central tenet of Christian Holism is that the Holy Spirit is fully present in the clinical situation, with and within the therapist and the client, and is actively engaged in the treatment process. Ten further tenets proceeding from the central tenet are described. Other chapters include treatment of the importance of forgiveness, reconciliation and dream work in the practice of Christian Holism. There is copious material in other chapters citing significant research data validating health benefits of Christian prayer and spirituality, the need for the Church to restore the healing ministry and energetic components of Christian prayer and spirituality. (shrink)

Biomedical research involving human subjects is an arena of conflicts of interests. One of the most important conflicts is between interests of participants and interests of future patients. Legal regulations and ethical guidelines are instruments designed to help find a fair balance between risks and burdens taken by research subjects and development of knowledge and new treatment. There is an universally accepted ethical principle, which states that it is not ethically allowed to sacrifice individual interests for the sake of society (...) and science. This is the principle of precedence of individual. But there is a problem with how to interpret the principle of precedence of individual in the context of research without prospect of future benefit involving children. There are proposals trying to reconcile non-beneficial research involving children with the concept of the best interests. We assert that this reconciliation is flawed and propose an interpretation of the principle of precedence of individual as follows: not all, but only the most important interests of participants, must be guaranteed; this principle should be interpreted as the secure participant standard. In consequence, the issue of permissible risk ceiling becomes ethically crucial in research with incompetent subjects. (shrink)

Inspired by Christian Platonism as developed in the late fifteenth-century Florentine milieu, the French physician Jean Fernel proposed a particular interpretation of Galen in a medico-philosophical work entitled On the Hidden Causes of Things. With this interpretation, he responded to the serious and urgent need for a reconciliation of the newly reconstituted Galen of Renaissance humanism with Christian faith. The present study examines Fernel's strategy and method in constructing this singular Galenic body of doctrine, special attention being given to (...) the roles attributed to the Creator, the formative force, and the soul. Subsequently, an analysis of the notions of spirit and of its innate heat as indispensable instruments of Fernel's physiology will uncover the very target of his criticism of materialism. (shrink)

Inspired by Christian Platonism as developed in the late fifteenth-century Florentine milieu, the French physician Jean Fernel proposed a particular interpretation of Galen in a medico-philosophical work entitled On the Hidden Causes of Things . With this interpretation, he responded to the serious and urgent need for a reconciliation of the newly reconstituted Galen of Renaissance humanism with Christian faith. The present study examines Fernel's strategy and method in constructing this singular Galenic body of doctrine, special attention being given (...) to the roles attributed to the Creator, the formative force, and the soul. Subsequently, an analysis of the notions of spirit and of its innate heat as indispensable instruments of Fernel's physiology will uncover the very target of his criticism of materialism. (shrink)

In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this paper, I will articulate my own view of why much of the apparently fundamental conflict between individual liberty and responsibility, on the one hand, and equality and equality's related concern for cost-efficiency, on the other hand, is less intractable than it is usually assumed to (...) be. The result will be to break the rigid and stereotypical association of liberty-emphasizing social philosophies with the pluralistic market paradigm for a health care system and egalitarian, equity-emphasizing social philosophies with the unitary public system paradigm. Understanding better the moral ingredients of liberty and equitable distribution as well as the complexity of how liberty and equality actually intersect in a health care system opens the door to seeing the possibility of significant reconciliation. I will conclude, among other things, that even semi-libertarian views of distributive justice should strongly embrace compulsory, universal coverage of health care for some significant level of care, and that egalitarian views ought not to regard different levels of coverage for people of different income levels as necessarily unjust. (shrink)

This chapter argues that adequately facing and responding to medical error requires making space for blame. In vindicating blame as a response to medical error, this essay does not advocate a return to a “bad apple” blame culture in which unlucky practitioners are unfairly scapegoated. It does, however, defend the targeted feeling and expression of angry, and even resentful, blaming attitudes toward health-care providers who make at least certain kinds of mistakes. The chapter makes the case that the angry and (...) resentful feelings associated with blame reflect a conception of oneself as a person worthy of consideration, and that expressing these feelings allows victims and families to fight for their dignity and self-respect. Along the way, it distinguishes between shaming and blaming, explaining that blaming, unlike shaming, characteristically aims to draw offenders into a moral dialogue. As a result, a good blaming practice can provide a logic within which providers who make costly errors may seek forgiveness, reconciliation, and healing. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

Military physicians are often perceived to be in a position of ‘dual loyalty’ because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics, each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional (...) values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different. (shrink)

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning (...) access to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

ABSTRACTThe quality of medicines is generally adequately assured by manufacturers and regulatory authorities for well-resourced settings, while the implementation of existing quality standards is challenged in many low- and middle-income countries. This situation of multiple pharmaceutical standards raises the question whether it could ever be ethically justified to compromise on the quality assurance of medicines depending on what individuals, communities, or societies can afford. In this paper, we contend that ethically, any unjustified exceptions to medicines’ quality assurance (...) represents a violation of the principles of beneficence and non-maleficence. Exceptions are only acceptable in exceptional and temporary circumstances, if based on a meaningful quality risk assessment, guided by a rigorous ethical framework built on the principles of independence, technical competence, transparency, and accountability. We also discuss how such exceptional and temporary circumstances should be defined/justified.... (shrink)

“I want my leadership to be judged by the impact of our work on the health of two populations: women and the people of Africa.” This is how Dr. Margaret Chan, the current Director-General of the World Health Organization , described her leadership mission. The reason behind this mission is evident. Women and girls constitute 70% of the world’s poor and 80% of the world’s refugees. Gender violence against women aged 15–44 is responsible for more deaths and disability than cancer, (...) malaria, traffic accidents, and war. An estimated 350,000 to 500,000 women still die in childbirth every year. The negative health implications of absolute poverty are worst in Sub-Saharan Africa and South Asia. Hence, Chan aims to have the biggest impact on the world’s poorest people. (shrink)

ABSTRACT Medicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases (such as HIV/aids and tuberculosis) these essential medicines are protected by patents that permit the patent‐holder to operate a monopoly on their manufacture (...) and supply, and to price these medicines well above marginal cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states’ sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. (shrink)

Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. The inadequate resources available for global health reflect not only natural constraints but also unwise social and political choices. However, pitting efforts to reduce inequality and better fund global health against efforts to put available resources (...) to their best use mistakes complementary objectives for conflicting ones. (shrink)

Based on anthropological fieldwork conducted in the Eastern Cape, the paper explores the interconnections between dreams (amathongo, amaphupha) and medicines (amayeza, imithi, amachiza) as aspects of the Xhosa diviner’s culture, knowledge and experience. Background information is provided in the introduction, inter alia, on the Xhosa patrilineal clan (isiduko), divination (imvumisa, evumiso) and religious and cultural change. The ability to dream, inter alia of the ancestors and medicines, is central to the diviner’s intuition and professional stock-in-trade, which are part (...) and parcel of a religious healing tradition. Examples of dreams involving the ancestors (iminyanya), diviners, clients and medicinal plants are presented and analysed in relation to relevant case material. The ritual significance of dreams is explored in some detail. The distinctions between diviner (igqirha lokuvumisa) and herbalist (ixhwele), and between medicines and charms (amakhubalo), receive attention in the section on medicines. The underlying purpose of traditional Xhosa religious ideology is discussed in the conclusion. (shrink)

Dr Devi Sridhar, Department of Politics and International relations, University of Oxford, All Souls College, High St, OX1 4AL UK, Email: devi.sridhar{at}politics.ox.ac.uk ' + u + '@' + d + ' '//--> Abstract This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These (...) include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration. CiteULike Connotea Del.icio.us What's this? (shrink)

Providing access to medicines and health care is one of the most challenging issues facing society today. In this paper the author highlights some of the complexities of the health value chain as well as the problems that the world’s poor have in terms of access to medical care and medicines. He then attempts to delineate the roles and responsibilities of all stakeholders in order to define the specific corporate responsibilities of pharmaceutical companies in the context of the (...) entire responsibility system—the strength of which is determined by its weakest link. Finally, he looks forward to a transformational change being wrought for pro-poor health development by forging new coalitions that cut across both the health and traditional development stakeholders. (shrink)

ABSTRACTMedicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases these essential medicines are protected by patents that permit the patent‐holder to operate a monopoly on their manufacture and supply, and to price these (...) class='Hi'>medicines well above marginal cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states’ sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. (shrink)

Instead of impeding access to essential medicines in developing countries, the essay explores why and how patents can serve as a source of funding for the much needed access to medicine. Instead of a weakening of patents, prolonged protection periods are suggested in circumstances where there is widespread lack of access. The revenues from extended patents are seen as a source of funding for drug donations to the least developed countries.

The global health crisis in non-communicable diseases (NCDs) reveals a deep global health inequity that lies at the heart of global justice concerns. Mirroring the HIV/AIDS epidemic, NCDs bring into stark relief once more the human consequences of trade policies that reinforce global inequities in treatment access. Recognising distributive justice issues in access to medicines for their populations, World Trade Organisation (WTO) members confirmed the primacy of access to medicines for all in trade and public health in the (...) landmark Doha Declaration on the TRIPS Agreement and Public Health of 2001. (shrink)

Medicines regulators have generally adopted a scientistic view of medicines evaluation, which they present as an exercise that should—and indeed can—be purely “objective,” based only on knowledge produced through validated research protocols. The growing body of social science literature analyzing the regulation of medicines has questioned this pretense of objectivity and underlined the socio-political construction of evidence on the risks and benefits of medicines. But while the European Medicines Agency has become the dominant regulatory body (...) in Europe and a key player at world level, very few studies have investigated its actual practices. Based on interviews with European regulators, but also on direct observations of several meetings of the European Medicines Agency’s main expert committee, this article aims to analyze how regulatory knowledge is defined and then transformed into regulatory decisions. First, it describes the main characteristics of European medicines regulation and the historical definition of what can count as “objective” evidence on the safety and efficacy of medicines. Second, it demonstrates that experts use many different types of knowledge in building their opinions: the results of studies, but also knowledge about firms’ past and present strategies, about patients’ needs and future behavior, about the state of research and clinical practices, and about legal and policy-making issues. Third, it explains why, in spite of the various forms of knowledge involved, experts manage to produce consensual opinions on medicines and why these opinions are considered genuine decisions in the sector. (shrink)

This article evaluates New Zealand’s Medicines Amendment Bill 2011. This Bill is currently before Parliament and will amend the Medicines Act 1981. On June 20, 2011, the Australian and New Zealand governments announced their decision to proceed with a joint scheme for the regulation of therapeutic products such as medicines, medical devices, and new medical interventions. Eventually, the joint arrangements will be administered by a single regulatory agency: the Australia New Zealand Therapeutic Products Agency. The medicines (...) regulations in Australia and New Zealand will be updated as part of this process. The Medicines Amendment Bill addresses some of the well-recognised deficiencies in the Medicines Act 1981. However, a comprehensive overhaul of the Act is not being undertaken. I argue that repealing and replacing the Medicines Act 1981 would be preferable and advisable, given the number of legal difficulties with the Act and, in particular, where it does not align with equivalent current international law. (shrink)

Since the adoption of the WTO-TRIPS Agreement in 1994, there has been significant controversy over the impact of pharmaceutical patent protection on the access to medicines in the developing world. In addition to the market exclusivity provided by patents, the pharmaceutical industry has also sought to further extend their monopolies by advocating the need for additional ‘regulatory’ protection for new medicines, known as data exclusivity. Data exclusivity limits the use of clinical trial data that need to be submitted (...) to the regulatory authorities before a new drug can enter the market. For a specified period, generic competitors cannot apply for regulatory approval for equivalent drugs relying on the originator's data. As a consequence, data exclusivity lengthens the monopoly for the original drug, impairing the availability of generic drugs. This article illustrates how the pharmaceutical industry has convinced the US and the EU to impose data exclusivity on their trade partners, many of them developing countries. The key arguments formulated by the pharmaceutical industry in favor of adopting data exclusivity and their underlying ethical assumptions are described in this article, analyzed, and found to be unconvincing. Contrary to industry's arguments, it is unlikely that data exclusivity will promote innovation, especially in developing countries. Moreover, the industry's appeal to a property rights claim over clinical test data and the idea that data exclusivity can prevent the generic competitors from ‘free-riding’ encounters some important problems: Neither legitimize excluding all others. (shrink)

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients (...) benefit? What is the impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? (shrink)

This paper deploys Laclau and Mouffe's discourse theory to examine the dispute over intellectual property protection and global HIV/aids medicines access. Over the 1980s and 1990s, major pharmaceutical companies and minority world governments successfully crafted a strong patent protection regime, institutionalized in the World Trade Organization's intellectual property rules. In the early 2000s, a transnational civil society campaign challenged this regime, positioning patents at the centre of a highly publicized dispute. This dispute has been retrospectively identified as a turning (...) point in medicines access discourse, with the 2001–2003 period dubbed the ‘golden window’ for expanded global HIV/aids medicines access. However, this ‘window’ has also been critiqued as an unsustainable aberration to a continuing hegemonic regime that prioritizes patent protection, to the detriment of equitable global medicines access. This paper draws on both political economy analyses and discourse theoretical concepts to examine the processes of rupture and suture in HIV/aids medicines access discourse. (shrink)

This article examines two spheres of global governance in which the World Health Organization (WHO) has sought to exercise international leadership — combating “counterfeit” medicines and illicit trade in tobacco products. Medicines and tobacco products lie at polar opposite ends of the health spectrum, and are regulated for vastly different reasons and through different tools and approaches. Nevertheless, attempts to govern counterfeit trade in each of these products raise a host of somewhat similar challenges, involving normative and operational (...) conflicts that cut across the crowded intersection of health protection and promotion, intellectual property protection, and activity to combat transnational organized crime. As negotiations of an illicit trade protocol to the WHO Framework Convention on Tobacco Control enter their final stages, lessons learned from counterfeit medicines governance need to be applied to ensure that the most appropriate governance arrangements are adopted. (shrink)