This chapter contains sections titled: History Specific Features of Medical Ethics Recent Developments References and Further Reading.

A physician and medical reformer enthused by the scientific and cultural progress of the Enlightenment as it took hold in Britain, Thomas Percival wrote on many topics, including public health and demography. His volume on medical ethics is considered the first modern formulation, and it and several of his other works are reissued in this series. This short book of improving tales, first published in 1777, and revised and enlarged in 1779, was originally (...) written for his own children, and, as he says, the articles 'are placed in the order in which they were written … as leisure allowed, or as the subjects of them were suggested'. The little stories contain lessons on obedience to parents, family affection, and kindness to animals, among many other examples of moral instruction. Percival refers to the book as 'Part the First', but a further collection seems never to have been published. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine by Laurence B. McCullough, John Gregory’s Writings on Medical Ethics and Philosophy of Medicine ed. by Laurence B. McCullough, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush by Lisbeth HaakonssenHeiner F. KlemmeLaurence B. McCullough. John Gregory and the Invention of Professional Medical (...) Ethics and the Profession of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xv + 347. Cloth, $140.00.Laurence B. McCullough, editor. John Gregory’s Writings on Medical Ethics and Philosophy of Medicine. Dordrecht, Boston, London: Kluwer Academic Publishers, 1998. Pp. xi + 254. Cloth, $105.00.Lisbeth Haakonssen. Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush. Amsterdam, Atlanta: Rodopi, 1997. Pp. x + 247. Paper, $20.50.The Scottish Enlightenment is widely appreciated for its contributions to philosophy, economics, sociology, law, chemistry, and medicine. The ideas and theories advanced by Hume, Smith, Millar, and Ferguson are still widely debated. John Gregory (1724–1773), important in his own time, is not as well known as some of his friends and colleagues. He was professor of medicine at the University of Edinburgh from 1766 to 1773, where he taught introductory lectures on the theory and practice of medicine. A set of extensive student notes from these lectures, entitled Observations on the Duties and Offices of a Physician, appeared anonymously in 1770. Two years later, Gregory himself published a revised version of his lectures under the title Lectures on the Duties and Qualifications of a Physician. These two books are said to mark the beginnings of professional medical ethics in the English-speaking world. They are also sometimes characterized as having anticipated bioethics.McCullough’s comprehensive John Gregory and the Invention of Professional Medical Ethics and the Profession of Medicine is the first modern intellectual biography of Gregory. Based on extensive research into eighteenth-century institutional context and the study of hitherto unknown manuscripts, he gives a full account of Gregory’s education at Edinburgh and Leiden, and his practice and teaching of medicine at Aberdeen, London, and Edinburgh. He stresses the importance of Gregory’s membership in the Aberdeen Philosophical Society and his close contact with Mrs. Montagu and her Circle for the understanding of his medical ethics. McCullough also shows that Bacon’s experimental method had a decisive influence on Gregory. Gregory took over Bacon’s three offices or ends of medicine: preservation of health, prolonging of life, and curing of diseases. In 1772, perhaps anticipating his premature death from hereditary gout, he added a fourth office, namely easing the pain of dying. Gregory referred mainly to Bacon (and Reid) in his Lectures to make clear how we can enlarge our medical knowledge by the method of experience and observation, pointing out that the progress of medicine had been seriously retarded by the way in which it was taught since Hippocrates. He also thought it was handicapped by the view that only professionals [End Page 535] should practice it, and claimed that even quacks have their advantages because their interest and reputation seldom suffer from the failure of the experiments necessary for the improvement of the medical profession.Gregory also argued that we should regard medicine not as a trade but as an art. In this context the principle of sympathy (or humanity) became important for him. Sympathy was the basis of the central duties in his Lectures. In a time of extreme instability of manners, when medicine was regarded more as a trade than an art, there was no physician-patient relationship based on the epistemological and moral authority of the physician. According to McCullough, it was Gregory who created “the physician-patient relationship as fiduciary. The virtues of the physician as fiduciary—openness to conviction, tenderness, and steadiness—provided for him the moral causes that would gather physicians together into a group worthy of the name, ‘profession,’ in its intellectual and moral senses” (265). The physician should no longer view his patients as moral strangers.McCullough claims that Gregory’s medical ethics is not just of historical interest, providing bioethics with its own history. It is also of... (shrink)

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to (...) the history of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care SettingPart II: Sample SyllabusMary Carrington Coutts (bio)The National Reference Center for Bioethics Literature at the Kennedy Institute of Ethics receives many inquiries from instructors at institutions that are just beginning to teach medical ethics. In an effort to assist those individuals, we have devised a syllabus that could be adapted for many uses. This is intended to be an (...) introductory level syllabus, perhaps one that would be appropriate for continuing staff education in a hospital or for an undergraduate college course. Of course, every instructor has his or her own style and preference for course content. This is offered merely as a place to start.Recognizing that participants bring a variety of backgrounds to a course, four possible text books and two casebooks have been selected as texts for a course in health care ethics. There are a number of other books that also could have been chosen. Some of these are listed in Scope Note 15: Basic Resources in Bioethics (published in the Kennedy Institute of Ethics Journal 1 (1): 75-90, March 1991). Other video selections are listed in Scope Note 9: Bioethics Audiovisuals: 1982-Present (1988); (available directly from the National Reference Center for Bioethics Literature). Additional recommendations for works that provide cross-cultural or international views of medical ethics appear in the supplemental readings list at the end of this syllabus.TextbooksBiomedical Ethics. Edited by Thomas A. Mappes and Jane S. Zembaty. 3rd ed. New York: McGraw-Hill, 1990, 641 pp. Cited: (M&Z). This text is well-suited for undergraduate education, with selected readings by philosophers, lawyers, and physicians. Includes 45 brief case studies to [End Page 263] illustrate various units of readings.Contemporary Issues in Bioethics. Edited by Tom L. Beauchamp and LeRoy Walters. 3rd ed. Belmont, CA: Wadsworth Pub. Co., 1989, 655 pp. Cited: (B&W). Appropriate for upper-level undergraduate or graduate education, this text includes selected readings by important philosophers, lawyers, physicians, and organizations. Includes the abridged texts of many significant court cases and government or organizational documents. Does not include case studies.Ethical Issues in Modern Medicine. Compiled by John Arras and Nancy K. Rhoden. 3rd ed. Mountain View, CA: Mayfield, 1989, 585 pp. Cited: (A&R). This text is suitable for upper-level undergraduate or graduate studies. It includes selections from well-respected lawyers, philosophers, and a few physicians. Includes excerpts from important court cases and policy documents. Provides only a few hypothetical case studies but does relate some authentic cases that are relevant to the various sections.Taking Sides: Clashing Views on Controversial Bioethical Issues. Edited by Carol Levine. 3rd ed. Guilford, CT: Dushkin Pub. Group, 1989, 370 pp. Cited: (L). A compilation of contrasting readings from the popular Hastings Center Report, this book is appropriate for undergraduate or continuing health care education. It does not include an introduction to basic biomedical ethical theory. Perhaps less systematic in its approach to bioethics than the previous textbooks, this book covers twenty topics relating to reproduction, death and dying, human and animal experimentation, and selected public policy issues. Provides pro and con arguments for each issue.CasebooksCases in Bioethics: Selections from the Hastings Center Report. Edited by Carol Levine. Rev. and updated ed. New York: St. Martin's Press, 1989, 291 pp. Cited: (HCR). This text includes cases studies taken from the well-known Hastings Center Report. Two or three commentaries usually accompany each case.Pence, Gregory E. Classic Cases in Medical Ethics: Accounts of the Cases That Have Shaped Medical Ethics, With Philosophical, Legal, and Historical Backgrounds. New York: Mc-Graw-Hill, 1990, 398 pp. Cited: (CC). This book describes a collection of famous (and infamous) cases from the history of biomedical ethics. The accounts of the cases here are more detailed than in other texts, and the style is more casual. [End Page 264]Course OutlineBelow are possible topics for discussion, listed with the relevant portions for each book. It is anticipated that only one textbook and one casebook would be chosen for a course. Whenever possible, price information for video purchase or rentals has been included, however this information is subject to change.Session 1... (shrink)

Opponents of physician-assisted suicide (PAS) maintain that physician withdrawal-of-life-sustaining-treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing-to-die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction (...) as in the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing-to-die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end-of-life care need not give up on it in response to these arguments. (shrink)

Acknowledgements -- 1. Interpreting Eighteenth-Century Medical Ethics -- Etiquette and Monopoly -- Sympathy and Contract -- A New Interpretation -- 2. John Gregory: Medical Ethics and Common Sense -- Personality and Profession -- The Art and Science of Medicine -- Duties of a Polite Profession -- 3. Thomas Percival: The Duty of Public Office -- Character and Context -- Medical Ethics and Medical Practice -- 4. Benjamin Rush: Medical Ethics (...) for a New Republic -- Character and Connections -- Medical Science -- Medicalized Ethics -- Epilogue -- Index. (shrink)

Available from UMI in association with The British Library. ;This thesis traces endeavours in the twentieth century to provide the 'intellectual' foundations for general medical practice as an independent, autonomous clinical discipline. The empirical focus of the study is upon the application of psychological and 'person-centred' approaches to general practice; above all, in the work of Michael Balint, and the Royal College of General Practitioners in the post-war period. The thesis is guided by two predominant theoretical concerns. First, (...) to highlight the complex strategies and the wide range of means and resources that have been required to give substance to the claim that general practice is 'by nature' a person-centred endeavour. Second, to consider--and to question--certain influential approaches to medical power in general, and to the social consequences of 'emancipatory'--person-centred--forms of medicine in particular. Specifically, the 'power/knowledge' approach to medical sociology is contested both with regard to its empirical findings and in relation to its basis in the work of Michel Foucault . ;The study which follows is intended neither as a narrative history of general practice nor as a history of ideas about general practice. Its empirical concern is more specific than either of these. Focusing upon the twentieth century and above all the post-war period, it seeks to analyse some of the ways in which general practitioners have sought to autonomise their discipline by giving it an 'intellectual' basis. If the 'general practitioner' has long existed as a professional label then nevertheless notions of what unifies the general practitioner's activities have undergone a degree of mutation. It is these 'models' of general practice--physiological, epidemiological, psychological--which will be investigated here. As such, the purpose behind the study is partly of a 'methodological' order. The study seeks to show that what counts in evolving a coherent model of general practice is not just the provision of a 'representation' of the general practitioner's activities but a construction on several levels. (shrink)

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these infants (...) too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. WhatwastobethecostindollarsandinanguishtosavethePatrickKennedysoftheworld?Triumphsledtograveconcerns asweapproachedtheedge.However,noadvancementinneonatologyhaseverchangedtheultimatequestions. (shrink)

Ethics boards have become obligatory passage points in today's medical science, and we forget how novel they really are. The use of humans in experiments is an age-old practice that records show goes back to at least the third century BC and, since the early modern period, as a practice it has become increasingly popular. Yet, in most countries around the world, hardly any formal checks and balances existed to govern the communal oversight of experiments involving (...) human subjects until at least the 1960s. Ethics by Committee traces the rise of ethics boards for human experimentation in the second half of the twentieth century. Using the Netherlands as a case-study, Noortje Jacobs shows how the authority of physicians to make decisions about clinical research gave way in most developed nations to formal mechanisms of communal decision-making that served to regiment the behavior of individual researchers. This historically unprecedented change in scientific governance came out of a growing international wariness of medical research in the decades after World War II. Research ethics committees were originally intended not only to make human experimentation more ethical but also to raise its epistemic quality. By examining complex negotiations over the appropriate governance of human subjects research, Ethics by Committee advances our understanding not only of the history of research ethics and the randomized controlled trial but also, more broadly, of how liberal democracies in the late twentieth century have sought to resolve public concerns over charged issues in medicine and science. (shrink)

Thomas Hurka presents the first full historical study of an important strand in the development of modern moral philosophy. His subject is a series of British ethical theorists from the late nineteenth century to the mid-twentieth century, who shared key assumptions that made them a unified and distinctive school. The best-known of them are Henry Sidgwick, G. E. Moore, and W. D. Ross; others include Hastings Rashdall, H. A. Prichard, C. D. Broad, and A. C. Ewing. They (...) disagreed on some important topics, especially in normative ethics. Thus some were consequentialists and others deontologists: Sidgwick thought only pleasure is good while others emphasized perfectionist goods such as knowledge, aesthetic appreciation, and virtue. But all were non-naturalists and intuitionists in metaethics, holding that moral judgements can be objectively true, have a distinctive subject-matter, and are known by direct insight. They also had similar views about how ethical theory should proceed and what are relevant arguments in it; their disagreements therefore took place on common ground. -/- Hurka recovers the history of this under-appreciated group by showing what its members thought, how they influenced each other, and how their ideas changed through time. He also identifies the shared assumptions that made their school unified and distinctive, and assesses their contributions critically, both when they debated each other and when they agreed. One of his themes is that that their general approach to ethics was more fruitful philosophically than many better-known ones of both earlier and later times. (shrink)

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical (...) grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics. (shrink)

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles (...) that govern physician behavior—beneficence, nonmaleficence, autonomy, and social justice—are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur. (shrink)

This paper aims to demonstrate how public disclosure can be used to balance physicians9 conscientious objections with their professional obligations to patients – specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. (...) The argument for publicly disclosing physicians9 conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians9 conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians9 conscientious objections are briefly addressed – potential harassment of physicians, workplace discrimination, and mischaracterising physicians9 professional aptitude – concluding that each of these concerns requires further deliberation in the realm of business ethics. (shrink)

The historical continuity of spinal catastrophism, traced across multiform encounters between philosophy, psychology, biology, and geology. Drawing on cryptic intimations in the work of J. G. Ballard, Georges Bataille, William Burroughs, Andre Leroi-Gourhan, Elaine Morgan, and Friedrich Nietzsche, in the late twentieth century Daniel Barker formulated the axioms of spinal catastrophism: If human morphology, upright posture, and the possibility of language are the ramified accidents of natural history, then psychic ailments are ultimately afflictions of the spine, which itself (...) is a scale model of biogenetic trauma, a portable map of the catastrophic events that shaped that atrocity exhibition of evolutionary traumata, the sick orthograde talking mammal. Tracing its provenance through the biological notions of phylogeny and "organic memory" that fueled early psychoanalysis, back into idealism, nature philosophy, and romanticism, and across multiform encounters between philosophy, psychology, biology, and geology, Thomas Moynihan reveals the historical continuity of spinal catastrophism. From psychoanalysis and myth to geology and neuroanatomy, from bioanalysis to chronopathy, from spinal colonies of proto-minds to the retroparasitism of the CNS, from "railway spine" to Elizabeth Taylor's lost gill-slits, this extravagantly comprehensive philosophical adventure uses the spinal cord as a guiding thread to rediscover forgotten pathways in modern thought. Moynihan demonstrates that, far from being an fanciful notion rendered obsolete by advances in biology, spinal catastrophism dramatizes fundamental philosophical problematics of time, identity, continuity, and the transcendental that remain central to any attempt to reconcile human experience with natural history. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric, Reflection, and Emancipation: Farrell and Habermas on the Critical Studies of CommunicationG. Thomas GoodnightThere are moments in history that appear to be alive with emancipatory possibilities. Such were the years moving toward the end of the long twentieth century. In spring 1989, students protested the communist regime in China; the Tiananmen Square massacre initiated an episode of opposition and commenced China’s modern journey toward global (...) reengagement. Revolutions in Europe that autumn were more peaceful. On August 23 two million Estonian, Latvian, and Lithuanian citizens held hands and announced the Baltic Way as a departure from Soviet rule. Transitions rapidly followed in Hungary, Bulgaria, and East Germany, culminating in the Velvet Revolution where on November 17 student protests were beaten back by police in Prague only to be followed three days later by an assembly of 200,000 demanding the transfer of power from the Communist Party. On December 3, George Bush and Mikhail Gorbachev jointly announced an imminent end to the fifty-year-old Cold War. During this time of hopeful transition, two scholars were at work refiguring the philosophical mission of the Frankfurt school, transforming critique from its early totalizing posture into the critical study of communication.Thomas B. Farrell and Jürgen Habermas were trained in different traditions but adjacent disciplines, communication and sociology. Their works [End Page 421] share a commitment to philosophical inquiry directed toward critique and understanding the cultural, social, and linguistic constitution of communication. As a rhetorician and as a philosopher, these scholars share an evident passion for scholarly argument and for engagement with the controversies of public culture. In different ways, both were at work during the portentous years of transition from the Cold War to new democracies and incipient globalization. Each constructed a guarded program of hope in the possibilities of communicative reflection and reasoning. In the post-World War II era, such a broad, positive vision took long to develop. After the brutal realities of the Holocaust became publicly known in the late 1940s, “the generous faith in rationality and the possibilities of human progress which underlay much of earlier historical thought seems discredited today” (Katznelson 2003, 2). The Enlightenment possibilities for reason had been invested in the technical efficiency of modern institutions that produced the capacity to kill systematically without constraints. Ira Katznelson points to a generation of scholars—including individuals at Chicago, Columbia, the New School, and others—who began in the 1950s to engage in a project that would “shade the Enlightenment’s philosophical anthropology, thicken its defenses against evil, deepen its capacity to reason, and restore” an Enlightenment more critical and less susceptible to co-optation by the excesses of nationalism, ideology, and evil (2003, 2). The work of Farrell and Habermas belongs to the extended post-Holocaust moment, where the possibilities of reflective reason in ethical and moral deliberations were set carefully on a road to personal and collective emancipation.Max Horkheimer saw in the modern, postwar welfare state little reason for optimism. Writing in 1946 at the beginning of the Cold War, he concluded: “Language has been reduced to just another tool in the gigantic apparatus of production in modern society” (1974, 22). “Salestalk” by “the surrogates of culture” creates an “illusory triumph of democratic progress that consumes the intellectual substance on which democracy has lived” (Horkheimer 1974, 31). Scientifically engineered propaganda renders public opinion as “a substitute for reason.” With such tools, the forces of barbarism are always waiting in the wings to seize power. Early on, Habermas shared these views. His thesis, in The Structural Transformation of the Public Sphere (1989a), tracks the opening possibilities of communicative reasoning in the liminal spaces of eighteenth-century coffeehouses where frank talk replaced hierarchically driven politeness, the development of these talks into the practices of deliberative democracy, and the decline of deliberative democracy with the union of the state and mass media in producing spectacles in [End Page 422] support of rituals of legitimation. Habermas broke with Horkheimer over the dissertation, however. A thesis of decline, by itself, leaves open only the route of totalizing critique. While never far from critique of institutional practices, Habermas spent his career in opening a positive... (shrink)

After tracing the main features of the foundational ethical perspectives and their relationship to the rise of medical practice in early Islam, the paper focusses on the development of the moral concept of adab . This concept served as an important tool in defining and shaping an ethical tradition based on the integration of the Hippocratic tradition into Muslim medicine and its underlying moral values. The existence of plural therapeutic systems and their moral and theological sources are also noted (...) and an attempt is made to show how all of these diverse modes co-existed through most of the premodern history of medicine among Muslims. The paper ends by outlining the impact the European colonial and cultural encounter with the World of Islam had, in creating a duality in medical practice, education and institutions, thus limiting sustained and meaningful discourse between modern medical science and the ethical values of Islam. Keywords: Islam, adab , justice, colonialism CiteULike Connotea Del.icio.us What's this? (shrink)

Available from UMI in association with The British Library. ;Typically we maintain two incompatible standards towards right action and good character, and the tension between these polarities creates the paradox of moral luck. In practice we regard actions as right or wrong, and character as good or bad, partly according to what happens as a result of the agent's decision. Yet we also think that people should not be held responsible for matters beyond their control. ;This split underpins Kant's (...) assertion that only the good will is securely good, that its goodness is impervious to outcome ill-luck. Some commentators, such as Martha Nussbaum and to some extent Bernard Williams, think that this simply writes off the paradox. Williams asserts that the paradox is insoluble, and that its inescapability threatens the notion of agent responsibility. In contrast Thomas Nagel argues that agents' most cherished projects may be indeed be subject to luck, but that does not mean that their deepest motivations are moral. This, I suggest, is one of several means whereby we might limit the effect of the paradox without denying that the tension exists. But I also argue that it is wrong to accuse Kant of ignoring the paradox. ;Ethical consequentialists, on the other hand, appear to have no problem with moral luck, because the paradox depends on a dichotomy between the outside world and the locus of moral worth in the individual agent. But this turns out not to be true. The problem of moral luck is not some strange Kantian fixation, but a general dilemma: a variant on what Nagel terms "the problem of excess objectivity" which cuts across all of ethics and metaphysics. ;Retaining a broadly Kantian notion of agent-responsibility, but limiting what agents are responsible for, requires us to delineate the realm of ethics more narrowly than has been done by those who believe that the rational and/or prudential are coterminous with the ethical. This strategy for minimising the paradox's impact is explored in two areas from medical ethics, the allocation of scarce medical resources and informed consent, and two from public policy, secrecy and nuclear deterrence. Throughout, the analysis seeks to test Nagel's maxim that the best we can hope for is to act in such a manner that we would not have to revise our opinion of how we should have acted once the consequences of our actions become apparent. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such (...) as law and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Burns, C. R. Introduction.--Antiquity: Margalith, D. The ideal doctor as depicted in ancient Hebrew writings. Edelstein, L. The Hippocratic oath. Edelstein, L. The professional ethics of the Greek physician. Michler, M. Medical ethics in Hippocratic bone surgery. Maas, P. L., Oliver, J. H. An ancient poem on the duties of a physician.--The medieval era: Levey, M. Medical deontology in ninth century Islam. Bar-Sela, A., Hoff, H. E. Isaac Israeli's fifty admonitions of the physicians. Rosner, (...) F. The physician's prayer attributed to Moses Maimonides. MacKinney, L. C. Medical ethics and etiquette in the early middle ages, the persistence of Hippocratic ideals. Welborn, M. C. The long tradition, a study in fourteenth-century medical deontology.--The modern period: Larkey, S. V. The Hippocratic oath in Elizabethan England. Pleadwell, F. L. Samuel Sorbiere and his Advice to a young physician. Clark, G. Bernard Mandeville, M.D., and eighteenth-century ethics. Burns, C. R. Thomas Percival, medical ethics or medical jurisprudence? Burns, C. R. Reciprocity in the development of Anglo-American medical ethics, 1765-1865. Williams, T. F. Cabot, Peabody, and the care of the patient. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 62.4 (2001) 651-664 [Access article in PDF] Walter Charleton and Early Modern Eclecticism Eric Lewis The publication of Michael Albrecht's Eklektik (1994) revived a small amount of scholarly interest in an early modern "movement" with a lineage that can be traced back to Clement of Alexandria, who described a method of constructing a philosophical system by selecting (...) among different philosophical sects. 1 Not surprisingly, the reception of Albrecht's work demonstrated the complexities associated with identifying the "movement" and categorizing those who labeled themselves "eclectic" philosophers; that is, those who seemed to expound a system of philosophy assimilated from ancient and modern sources. The difficulties involved with defining "eclecticism" and applying the term to early modern natural science is further complicated by the tendency for "eclectics" to categorize their contemporaries in ways that are counterintuitive to our modern sensibilities. 2 Nevertheless, the proponents of this patchwork style of natural science are interesting precisely because they give us a glimpse into their interpretation of the state of philosophy and its relation to history during a time when the authority of The Philosopher was falling under ever increasing scrutiny.The recent literature on philosophic eclecticism largely ignored the English context where rising sentiment against sectarianism influenced the formation of the Royal Society. 3 The perceived chaos of a nation divided and redivided by the multiplication of religious associations produced a plethora of proposals for the restoration and maintenance of intellectual and social order. In particular the problems of religious and political order motivated certain members of the [End Page 651] "Newcastle Circle" (largely Royalists) to construct philosophical methodologies at least congruent with their ideological commitments to social stability. Thomas Hobbes, Margaret Cavendish, and her close friend the physician Walter Charleton each offered his and her own style of natural science. 4 Both Hobbes and the Duchess of Newcastle were excluded from participating in the community of natural philosophers formed in 1660; yet Charleton became a founding member of the Royal Society that year. Despite relative neglect, Charleton's importance to understanding the development of modern natural science in England should not be overlooked; and particularly his prescribed method of doing natural philosophy needs more attention. 5 Like the radically different methods developed by Margaret Cavendish and Thomas Hobbes, Charleton's eclecticism should be viewed as an exhaustive effort to prescribe a remedy to the perceived threat of rampant sectarianism. 6 Unlike Hobbes and Cavendish, however, Charleton saw authoritarianism and dogmatism as the greatest challenge to order, and found the solution to that challenge in mitigated skepticism and a style of philosophy that did not make an epistemic differentiation between the novel philosophies of his day and those of the ancients.Despite being a prolific writer, having a considerable reputation as a physician and placing himself in the center of the English community of natural scientists, Walter Charleton has been mostly ignored by modern scholars. In part this lack of attention can be attributed to the common view that he never developed a comprehensive philosophy nor maintained consistent metaphysical commitments. References to him claim that he was an "intellectual barometer of the age," 7 and his work has been described as "important as a case study in the reception of a mechanical philosophy." 8 His name is virtually absent from discussions concerning scientific methodology, though he is often described as a Renaissance [End Page 652] alchemical philosopher who fell under the influence of mechanistic atomism and the experimental agenda of a fledgling society of natural philosophers. Most accounts simply portray Charleton as a converted follower of the novel philosophy rather than as a novel thinker.The failure to see Charleton as more than a converted empiricist and mechanist likely results from the opinion that eclecticism does not constitute a philosophical method as much as it constitutes the last refuge for scholars during periods of intellectual crisis. The article on eclecticism in Encyclopedia Britannica (fourteenth edition) states: Eclecticism always tends to spring up after a period of vigorous constructive speculation, especially in the later stages of a controversy between... (shrink)

The publication of 'Animal Rights and Souls in the 18th Century' will be welcomed by everyone interested in the development of the modern animal liberation movement, as well as by those who simply want to savour the work of enlightenment thinkers pushing back the boundaries of both science and ethics. At last these long out-of-print texts are again available to be read and enjoyed - and what texts they are! Gems like Bougeant's witty reductio of the (...) Christian view of animals are included together with path-breaking works of ethics such as Primatt's A Dissertation on the Duty of Mercy and Sin of Cruelty to Brute Animals . There are works I have never seen before, including the remarkable Cry of Nature by the Scottish revolutionary Jacobin, John Oswald. In this set, everyone will find something novel, delightful and truly enlightening. - Peter Singer The discussion of animal rights and the moral status of animals, so prevalent in the late twentieth century, has its roots in the mid to late eighteenth century. Some of the themes we consider of recent invention - the legal standing of animals, the ethical status of vegetarians, cruelty towards animals, ultimately resulting in cruelty to humans - are of long standing. But in the eighteenth-century literature they are interconnected with theological issues surrounding animal souls, the birth of the life sciences, the great chain of being and other peculiarly eighteenth-century problems. This collection explores the exciting early discussions of moral theories concerning animals, placing them within their historical and social context. It reveals that issues such as vivisection, animal souls and vegetarianism were very much live philosophical subjects 200 years ago. The six volumes reprinted here includes complete works and edited extracts from such key eighteenth-century thinkers as Oswald, Primatt, Smellie, Monboddo and Jenyns. Many of the materials are extremely rare and never previously reprinted. The collection, edited with a new introduction and bio-bibliography by Aaron V. Garrett provides valuable original source material to supplement contemporary discussions of animal rights. --18th-century material on the theme of animal rights and practical ethics --an important supplement to contemporary animal rights discussions --provides a broader account of early discussions of the 'science of human nature' through animals --widens our understanding of 18th-century ethics through an important area of practical ethics --includes many scarce texts, most of which have never been reprinted before. (shrink)

Codified moral medicine is an antidote to many problems, a bulwark against wallowing in the morass of moral idolatry, and a rampart that should be strengthened continually, rather than dismantled. The notion of medical professional self regulation, by means of codification and collaboration, was actually conceived in Britain, by Dr Thomas Percival, but born in America. The American Medical Ethics Revolution, through the medium of a tetrad of editors and a stellar collection of luminaries, displays (...) the pedigree of codified American medical ethical thought back to its earliest progenitor: the primordial 1847 American Medical Association (AMA) code of ethics. The clash of deftly handled academic sabres vivifies the medical ethical dimension of the practice of medicine in …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:706 BOOK REVIEWS struments of redemption for others. Mary is the primary exemplar of receiving her Son's redeeming love in freedom and of wholeheartedly mediating his graces to all he has redeemed. The final essay, "Mary and Modernity," is most timely for American Christians and ecumenists. It is a very worthwhile attempt to compare and contrast the secular triad of virtues, liberty, equality, and fraternity with the Christian triad (...) of theological virtues, faith, hope, and love, especially as they are exemplified in Mary. Although this approach perceives Mary more as a " sign of contradiction " to our secularistic culture, she will help us to avoid the extremes of confusing true freedom with licence, genuine equality with egalitarianism, and authentic fraternity with collectivism by helping inspire in us the really liberating values of her Son's Gospel. Everyone can benefit immensely from the intelligent reading of this book. Mt. St. Mary's Seminary Emmitsburg, Maryland FREDERICK M. JELLY, O.P. Dieu et l'etre d'apres Thomas d'Aquin et Hegel. By EMILIO BRITO. Paris: Presses Universitaires de France, 1991. Pp. 422. 245 francs. Sprung from premature fears of post-modernity or from an ignorant nostalgia for a monoform Catholicism which never existed, universal dismissals of " modernity " still appear occasionally in Catholic j ournals. They recall,the neo-scholastic te:xitbooks prior to Vatican II in whose pages the " moderni " (among whom were numbered not only "Kantiani" but "Hegeliani ") were dismissed by authors who, having read a few pages, were incapable of grasping the basic directions of philosophy from Herder to Heidegger. Emilio Brito, S.J., however, follows in the line of the French and German Jesuits: through this century they have sustained a varied dialogue, in philosophy and theology, between Thomas Aquinas and the important figures of modern philosophy. His two works on Hegel's Christology, and a third large study of God and creation in Schelling are now followed by this comparative work. The theology of Aquinas and the philosophy of Hegel are like two galaxies. Do they move past each other at a distance, or do they move through each other guarding a proper identity with similar forces and shared motifs? Brito has chosen one theme within these two vast realms of thought: his topic (and the book's title can mislead) is God; 'being' BOOK REVIEWS 707 is present as a stimulus to our reflection about God. After an introduction on recent interpretations of Hegel, particularly by Catholics, pages which should be read by all interested in contemporary theology, there are three sections: " the knowledge and naming of God," " the divine substance and the cycle of its attributes," and " the operations of absolute spirit." The chapters in each of the three areas present Aquinas's and then Hegel's thought, and sometimes a section of further comparison. At the end of the work Brito offers a conclusion ("God's Goodness") and a postlude ("God's Beauty"). Finally there is a "Resume." According to Brito, Aquinas's thought is clear (his Aristotelian logic is readily understandable), and his emphasis lies with the divine transcendence. Despite the process-format of the Summa theologiae and the traces of history in the headship of Christ, the diversity of sacraments, and the theologies of faith and natural law, his modest description of movement in God and in God's world of beings stands in contrast to the unleashed and unresolved development penetrating Hegel's Geist. The concluding " Resume " of nine pages is particularly valuable as it brings together the author's synthetic insights into Aquinas and Hegel (one might hope that at least it would appear in translation). The following excerpt displays its balance and clarity. The God of the Summa tends to stay back from mediation, letting itself exist in a certain exteriority, while the Hegelian absolute " raises out" the determinations it posits only by also absorbing them negatively. In the same vein, the Hegelian parousia of the negative abolishes absolutely the distance maintained by the inexpressible in language. In an opposite direction, the originating positivity of the God of Thomas grounds the irreducible presence of a reality represented in discourse. If he is a stranger to this approach and more... (shrink)

This chapter provides an outline of consent in the history of medical ethics. In doing so, it ranges over attitudes towards consent in medicine in ancient Greece, medieval Europe and the Middle East, as well as the history of Western law and medical ethics from the early modern period onwards. It considers the relationship between consent and both the disclosure of information to patients and the need to indemnify physicians, while attempting to avoid (...) an anachronistic projection of concern with patient autonomy too far back into the historical record. The chapter also includes a survey of the development of the social and intellectual infrastructure that underpins modern medical consent. It concludes with a brief discussion of possible future directions for ethical approaches to medical consent and competence that would depart from the models that arose in the twentieth-century. (shrink)

Medical ethics changed dramatically in the past 30 years because physicians and humanists actively engaged each other in discussions that sometimes led to confrontation and controversy, but usually have improved the quality of medical decision-making. Before then medical ethics had been isolated for almost two centuries from the larger philosophical, social, and religious controversies of the time. There was, however, an earlier period where leaders in medicine and in the humanities worked closely together and both (...) fields were richer for it. This volume begins with the 18th century Scottish Enlightenment when professors of medicine such as John Gregory, Edward Percival, and the American, Benjamin Rush, were close friends of philosophers like David Hume, Adam Smith, and Thomas Reid. They continually exchanged views on matters of ethics with each other in print, at meetings of elite intellectual groups, and at the dinner table. Then something happened, physicians and humanists quit talking with each other. In searching for the causes of the collapse, this book identifies shifts in the social class of physicians, developments in medical science, and changes in the patterns of medical education. Only in the past three decades has the dialogue resumed as physicians turned to humanists for help just when humanists wanted their work to be relevant to real-life social problems. Again, the book asks why, finding answers in the shift from acute to chronic disease as the dominant pattern of illness, the social rights revolution of the 1960's, and the increasing dissonance between physician ethics and ethics outside medicine. The book tells the critical story of how the breakdown in communication between physicians and humanists occurred and how it was repaired when new developments in medicine together with a social revolution forced the leaders of these two fields to resume their dialogue. (shrink)

This article commemorates the fiftieth anniversary of The Sociological Imagination by recalling, renewing and updating C. Wright Mills’ pledge to expand a politically aware, self-reflective and publicly accessible intellectual culture between aestheticism and scientism. We begin by sketching how Mills’ ‘bifocal’ vision of the translation between the close-up perspective on personal milieus and the longer view of social structures contrasts with recent calls for a public sociology which would sustain its professional legitimacy while reviving its critical conscience. To illustrate this (...) point, we argue that his project can be reframed in a way that ‘provincializes’ the universalizing claims and scientific aspirations of much of North American sociology by exposing its imperial unconscious in pre- and post-war movements toward the professionalization and scientization of knowledge. Here our focus turns to the prospects for a ‘sociology of empire’ to trace imperial forms which are symptomatically manifested both in the discipline’s assumptions about historical progress and in Mills’ critique of these assumptions. Finally, with an example from the history of British colonialism in Egypt, we show how, despite its blindspots, Mills’ vision of the sociological imagination implicitly projects an alternative ‘sociological map’ with distinct vantage points that can account for the changing cultural tasks of our time, especially concerning how collectives of human and non-human agents are unequally mediated within networks of power. We conclude by revisiting Mills’ distinctive approach to ‘the craft of sociology’, considered more as a prayer than a profession, and undertaken more as a personal and political calling than as career. (shrink)

In his six 1983 lectures published under the title, Fearless Speech (2001), Michel Foucault developed the theme of free speech and its relation to frankness, truth-telling, criticism, and duty. Derived from the ancient Greek word parrhesia, Foucault's analysis of free speech is relevant to the mentoring of medical students. This is especially true given the educational and social need to transform future physicians into able citizens who practice a fearless freedom of expression on behalf of their patients, the public, (...) the medical profession, and themselves in the public and political arena. In this paper, we argue that Foucault's understanding of free speech, or parrhesia, should be read as an ethical response to the American Medical Association's recent educational effort, Initiative to Transform Medical Education (ITME): Recommendations for change in the system of medical education (2007). In this document, the American Medical Association identifies gaps in medical education, emphasizing the need to enhance health system safety and quality, to improve education in training institutions, and to address the inadequacy of physician preparedness in new content areas. These gaps, and their relationship to the ITME goal of promoting excellence in patient care by implementing reform in the US system of medical education, call for a serious consideration and use of Foucault's parrhesia in the way that medical students are trained and mentored. (shrink)

Character strengths profiles in the specific setting of medical professionals are widely unchartered territory. This paper focused on an overview of character strengths profiles of medical professionals (medical students and physicians) based on literature research and available empirical data illustrating their impact on well-being and work engagement. A literature research was conducted and the majority of peer-reviewed considered articles dealt with theoretical or conceptually driven ‘virtues’ associated with medical specialties or questions of ethics in patient (...) care (e.g., professionalism, or what makes a good physician). The virtues of compassion, courage, altruism, and benevolence were described most often. Only a limited number of papers addressed character strengths of medical students or physicians according to the VIA-classification. Those articles showed that the VIA-character strengthsfairness, honesty,kindness, andteamworkwere considered most often by respondents to be particularly important for the medical profession. Available cross-sectional (time span: six years) and longitudinal (time span: three years) data regarding VIA-character strengths profiles of medical professionals were analyzed (N= 584 medical students, 274 physicians). These profiles were quite homogenous among both groups. The character strengthsfairness,honesty,judgment,kindness, andlovehad the highest means in both samples. Noteworthy differences appeared when comparing medical specialties, in particular concerning general surgeons and psychiatrists, with the former reporting clearly higher levels of e.g.,honesty(d= 1.02) orprudence(d= 1.19). Long-term results revealed significant positive effects of character strengths on well-being and work engagement (e.g.,perseveranceon physicians’ work engagement) but also significant negative effects (e.g.,appreciation of beauty and excellenceon students’ well-being). Further,hopewas significantly associated both positively with physicians’ well-being and negatively with students’ work engagement, possibly indicating specific issues concerning medical education or hospital working conditions. According to the modern-day physician’s pledge, medical professionals should pay attention to their own well-being and health. Therefore, promoting self-awareness and character building among medical professionals could be a beneficial strategy. (shrink)

During the Nazi era, physicians provided expertise and a veneer of legitimacy enabling crimes against humanity. In a creative educational initiative to address current ethical dilemmas in clinical medicine, we conduct ethics learning missions bringing senior physicians to relevant Nazi era sites in either Germany or Poland. The tours share a core curriculum contextualising history and medical ethics, with variations in emphasis. Tours to Germany provide an understanding of the theoretical origins of the ethical violations and (...) crimes of Nazi physicians. Tours to Poland address the magnitude of the Nazi physician’s atrocities as well as displays of heroism by Jewish and righteous among the nations' physicians. Exemplary as well as shameful physician behaviour is analysed from an ethical perspective. A combination of unique educational methodologies maximises learning and personal growth, enabling participants to examine ethically complex clinical situations with extrapolation to modern-day medical practice. Learning is designed with relevance to contemporary medical ethics dilemmas such as beginning and end-of-life issues, providing tenets from which participants can develop as more ethical and informed physicians. Participant feedback confirms efficacy and worth of these growth-promoting ethics learning tours which should be expanded to other international groups and settings. (shrink)

The professional regulatory system known as medical ethics has been one of the most visionary and socially valuable creations of the medical profession. Its beneficial influence has extended beyond physician/patient relations, to the shaping of many key humanistic and egalitarian features of the world’s legal and political institutions. The continued existence of medical ethics as a professionally influential normative system, however, is being challenged by international human rights. The UNESCO Universal Declaration on Bioethics and (...) Human Rights, is likely to be an important point of intersection in this process. (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental (...) illness as the sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.6769504. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

The Open Access Movement maintains that all scientific and scholarly literature should be available to all for free via the Internet. This concept is not new. Some scholars trace its roots as far back as 1963 when “hypertext” was first introduced. Although the Open Access Movement may have originated more than fifty years ago, it has been fueled by more recent events, including the unremitting escalation of journal subscription prices over the last two decades, resulting in massive cancellations of (...) journals by academic libraries; the ubiquitous nature of the Internet and the parallel explosion of electronic resources; and the desire of authors to find a new publishing model which continues to offer the benefits of peer review while providing for more rapid publication and wide-spread distribution than the current labor-intensive, time-consuming model.The Open Access Movement has resulted in a number of online repositories devoted to legal analysis and policy. This column explores the genesis of the movement, its value to researchers and policymakers, and provides an overview of the two principal open access products in the legal arena. (shrink)

The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring (EFM) for every pregnancy. The modern-day EFM advocates acknowledge EFM’s decades long failure but simultaneously recommend EFM use for lawsuit protection and because the profession has used EFM for every pregnancy for fifty years, therefore, it must be efficacious. These self-indulgent, illogical rationalizations ignore the half century of evidence-based scientific research proving that EFM (...) is a complete failure as well as ignoring the fact that continued EFM use violates the fundamental principles of modern bioethics. This blind advocacy perpetuates four pernicious EFM harms occurring to mothers, babies, and the medical profession itself. This article sets out these four EFM harms with the goal of abolishing the misguided, illogical, contradictory, arguments used by the twenty-first century EFM Lewis Carroll mimics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal Mind in its Early Years, 1876–1920:An IntroductionThomas W. StaleyAt its inception, and in the succeeding decades, the journal Mind was a publication of singular significance. Founded in 1876 by Alexander Bain, it was the first of its kind: the pioneering "philosophical journal" in the Anglophone world, to use Bain's own description.1 Close on the heels of Nature, the hugely successful periodical established seven years earlier to (...) address progress in the natural sciences, Mind would devote itself to another important domain of intellectual work in Britain and worldwide. At the time, science and philosophy were as yet poorly demarcated areas, and the primary ground on which this distinction was negotiated was the study of the human mind and its role in social phenomena.2 Especially under its first two editors, George Croom Robertson (serving from the foundation to 1891) and G. F. Stout (from 1892 until 1920), the journal bore witness to a wholesale transformation of scholarly activity regarding these subjects.The purview of Mind was advertised on its opening page by Croom Robertson.3 This introductory offering bears close scrutiny as an indication of how the journal would develop. Foremost, in his mission statement, Robertson elaborated his position in terms of a series of dichotomies that [End Page 259] Mind would bridge. As both an "organ for... original researches" and a "critical record," the journal would be an announcer for and a judge of new work on the phenomena of "subjective consciousness" as well as "objective" physiological operations. On the side of psychology, it would deal with such "natural" mental productions as language as well as the "abnormal mental phases" of insanity. It would treat the mental character of animals in addition to that of humans, employing a relative methodology encompassing "much of... Anthropology and all that is meant by Comparative Psychology." In its philosophical aspect, Mind would range from the theoretical ground of "ultimate questions" to applications in educational practice and "Logic, Aesthetics, and Ethics." It would deal with the historical background of philosophy and with "what is being done or left undone in the present day." While an obvious focus was expected on the intellectual community in Britain itself, attention would be granted to work "on the Continent and in America" and the reader was assured that "Mind will not be the organ of any philosophical school."Mind's masthead, formally unchanged until 1972, denominated it as a "Quarterly Review of Philosophy and Psychology" but Robertson's comments indicate that it would encompass far more than this phrase might immediately suggest. Explicitly at issue was a wide range of controversies then current in Britain. Late Victorian culture was characterized by a self-conscious examination of its own status and prospects. Especially vital concerns included the secularization of knowledge-making institutions4; shifts in the role of public social movements5; the reshaping of scholarship to accommodate new modes of inquiry, fostering in the process new relationships between literature and science6; and the morality of scientific practice7—all items of substantive interest for Mind and its founding editor. [End Page 260]As detailed in a pair of articles written for the journal's centennial in 1976, Mind under its first two editors gradually transformed into an exclusive forum for academic philosophy, shedding its aspirations to chronicle scientific psychology as well as its other broader goals for social reform.8 However, for a significant period, it continued to pursue the ambitious program of inquiry indicated on its very first page. In Robertson's introduction, Mind's territory was effectively defined to cover all of what was then known alternately as "moral philosophy" or "moral science." At the moment of the journal's foundation, this was a field undergoing wholesale transformation. An examination of the project of the new periodical provides a window into many important changes underway in intellectual activity at the time. That this project would be centered on problems of "mind" was hardly a surprise. The dominant orientation of British philosophy since the Enlightenment work of Locke and Hume had been directed toward issues of human society by way of an inquiry into individual mental operations. However, with... (shrink)

In recent years, there has been a surge of high-profile publications on applications of artificial intelligence (AI) systems for medical diagnosis and prognosis. While AI provides various opportunities for medical practice, there is an emerging consensus that the existing studies show considerable deficits and are unable to establish the clinical benefit of AI systems. Hence, the view that the clinical benefit of AI systems needs to be studied in clinical trials—particularly randomised controlled trials (RCTs)—is gaining ground. However, an (...) issue that has been overlooked so far in the debate is that, compared with drug RCTs, AI RCTs require methodological adjustments, which entail ethical challenges. This paper sets out to develop a systematic account of the ethics of AI RCTs by focusing on the moral principles of clinical equipoise, informed consent and fairness. This way, the objective is to animate further debate on the (research) ethics of medical AI. (shrink)

This textbook brings the humanities to students in order to evoke the humanity of students. It helps to form individuals who take charge of their own minds, who are free from narrow and unreflective forms of thought, and who act compassionately in their public and professional worlds. Using concepts and methods of the humanities, the book addresses undergraduate and premed students, medical students, and students in other health professions, as well as physicians and other healthcare practitioners. It encourages them (...) to consider the ethical and existential issues related to the experience of disease, care of the dying, health policy, religion and health, and medical technology. Case studies, images, questions for discussion, and role-playing exercises help readers to engage in the practical, interpretive, and analytical aspects of the material, developing skills for critical thinking as well as compassionate care. (shrink)

Information technology plays an increasingly important role in the medical working environment. Besides facilitating improvements in the quality of health care, it might also bear some unwished effects. Examining the ‘making’ of a diagnosis and the role it plays in modern medicine leads to the question how far this process of ‘diagnosing’ might be affected by the ‘technical surroundings’. A number of examples from clinical medicine in the hospital and the ambulatory sector illustrate the way IT is being (...) utilised in modern medicine. A twofold negative effect could result from this ‘computerisation’: Firstly, the technical requirements for the use of IT might force the process of diagnosing to be adapted with subsequent wrong or altered diagnoses. Secondly, constraints like cost control might be facilitated by IT and thus its application might cause the doctors trying to avoid such pressures by modifying the diagnosis and potentially worsening treatment and outcome. (shrink)

The paper argues in favor of bioethics as an alternative to traditional medical ethics. Relations between the patient and the doctor placed in the bioethical context are considered as a part of more general, global issues: relations between clients, customers, various (including non-medical) services and the professional medical community and society in general, world-renowned scientists and the international community. Medical ethics is seen in the wider expanse of diverse economic, political and cultural relations not (...) only in terms of responsibilities but also natural rights which all people have without exception and with regard to professional identity. In contrast to traditional medical ethics, bioethics not only encourages one to reconsider the content of human morality, which is built on interpersonal relations, but also shows that disease and health are not merely medical phenomena. In this situation, paramount importance is assigned to interests of the client and society rather than medical corporations. Such a transformation of medical theory and practice requires public discussion of professional ethics issues and external regulation control. There is a need to develop ethical criteria for medical activity not only at the national but also international, or even global, levels, as well as criteria for long-term effects of highly technological professional medical practice. Bioethics expands the boundaries of professional medical ethics and ethical reflection of its normative foundations as it carries out both internal (code of ethics) and external (ethics committees and commission) “regulation” of professional practice. The purpose of bioethics is the preservation and development of life represented not only by man but also other creatures, which has never been on the agenda of medical ethics. (shrink)

A unique relationship exists between physicians and philosophers — one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages — a sense of how medicine has adapted to the social (...) cultural and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary. (shrink)

In 1972, I created the new field of clinical medical ethics (CME) in the Department of Medicine at the University of Chicago. In my view, CME is an intrinsic part of medicine and is not a branch of bioethics or philosophical ethics or legal ethics. The relationship of patients with medically trained and licensed clinicians is at the very heart of CME. CME must be practiced and applied not by nonclinical bioethicists, but rather by licensed clinicians (...) in their routine, daily encounters with inpatients and outpatients. CME addresses many clinical issues such as truth-telling, informed consent, confidentiality, surrogate decision making, and end-of-life care, while also encouraging personal, humane, and compassionate interactions between experienced clinicians and patients.The goals of CME are to improve patient care and outcomes by helping physicians and other health professionals Clinical Medical Ethics: Its History and Contributions to American Medicine Mark Siegler, Guest Editor identify and respond to clinical-ethical challenges that arise in the ordinary care of patients. As Edmund Pellegrino, Peter A. Singer, and I wrote in the first issue of The Journal of Clinical Ethics, 30 years ago: “The central goal of CME is to improve the quality of patient care by identifying, analyzing, and contributing to the resolution of ethical problems that arise in the routine practice of clinical medicine.” Similar to cardiology and oncology consultations, ethics consultations are a small component of a much larger field, and the process of consultations is certainly not at the core of cardiology or oncology or CME.In this article, I intend to discuss the origins of the field of CME, its goals and methods, the relationship between the broad field of CME and the much narrower practice of ethics consultation, the contributions of the MacLean Center at the University of Chicago in developing the field of CME, and, finally, how CME has improved the practice of medicine in the United States. (shrink)

The Experiment Must Continue is a beautifully articulated ethnographic history of medical experimentation in East Africa from 1940 through 2014. In it, Melissa Graboyes combines her training in public health and in history to treat her subject with the dual sensitivities of a medical ethicist and a fine historian. She breathes life into the fascinating histories of research on human subjects, elucidating the hopes of the interventionists and the experiences of the putative beneficiaries. Historical case studies (...) highlight failed attempts to eliminate tropical diseases, while modern examples delve into ongoing malaria and HIV/AIDS research. Collectively, these show how East Africans have perceived research differently than researchers do and that the active participation of subjects led to the creation of a hybrid ethical form. By writing an ethnography of the past and a history of the present, Graboyes casts medical experimentation in a new light, and makes the resounding case that we must readjust our dominant ideas of consent, participation, and exploitation. With global implications, this lively book is as relevant for scholars as it is for anyone invested in the place of medicine in society. (shrink)

Medical ethics involve more than a prohibition against advertising or solicitation of patients, or a limit on the height of the letters on a doctor's office door. The true ethics of health care are the fundamental values that guide-or should guide-physicians in every aspect of their interaction with patients, their families, and society at large. Professional ethics is a complex and controversial issue, but one that must be dealt with in an era of increasing skepticism about (...) the practice of medicine. Medical Stewardship is a carefully reasoned historical and philosophical inquiry into the origins of our notions of medical ethics, and the ways in which a true sense of the doctor's proper role can be restored. Tracing the development of medical ethics from ancient times to the modern era, Dr. Kepler consides them in relation to the medical profession of today. He considers several areas seldom discussed in works on medical ethics: the exploitation of the patient, preventive versus disease treatment, ethical problems in medical education, drug abuse by physicians, the ethics of organized medicine, and some important but under-utilized roles of the physician. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:102 HISTORY OF PHILOSOPHY historical circumstances a suprahistorical, eternal significance, and that a historian or interpreter of a philosophy will do it justice only if he grasps this lasting truth and content, in addition to comparing it with the opinions of other earlier or later thinkers. One cannot see how a thinker who considered Plato as valid while treating him and others historically could have arrived at a (...) different conclusion. But it is a position admirably expressed that would deserve greater attention and a wider following among the present practitioners of the history of philosophy. Hoffmann's method and style in this, as in most of his other writings, deserve the highest praise, for he combines simplicity with density. His manner of expression reflects his commitment to truth (a commitment curiously omitted by many contemporary existentialists), and the integrity of his character: Hoffmann was one of the few German scholars who made no concessions to Nazism because he was a faithful representative of that German tradition which was incompatible with Nazism: classical humanism in its scholarly, literary and educational meaning, philosophical idealism, and liberal protestantism. Guided by Plato, Kant and Goethe, Hoffmann was untouched by the Romantic and nationalistic strands of German thought. His work transmits to us the precious heritage of a life completely devoted to philosophy and to scholarship, and of an important period in the history of German thought. He omits many things which we have learned in the last few years, or which we may still learn through future studies. Yet he can teach us many important things that are too easily forgotten in our present discussions: the role of Platonism in the history of philosophy and of the sciences, and the fundamental impact of ancient philosophy upon early Christian, medieval and modern thought. It is a heritage which we should try to enlarge, if we can, but also strive to preserve, and to keep alive. PAUL OSKARKRISTELLER Columbia University Studies in Epicurus and Aristotle. By Philip Merlan. (Wiesbaden: Harrassowitz [Klassisch-Philologische Studien, Heft 22], 1960. Pp. viii + 112. P1. 4. DM 12.--) Ever since the publication in 1936 of Bignone's L'Aristotele perduto e la formazione filosofica di Epicuro there have been attempts to define the exact nature of the debt which Epicurus owes to the Peripatos. In this collection of essays, the author of From Platonism to Neoplatonism turns his keen powers of analysis upon a number of specific problems deriving from Plato's Laws and carrying us via Aristotle's Metaphysics and Ethics to Epicurus's theology and beyond. In the first chapter, "Hedone in Epicurus and Aristotle," the author takes us on a generous stroll through hedonist materials, BOOK REVIEWS 103 including an ode by Schiller, to explore the precise meaning of the term hedone. More especially he is concerned to show how close the Epicurean understanding of the term is to that of Aristotle in at least some of his writings, notably Protrepticus and Nic. Eth. H and Met. A. The results of this investigation may be stated in the author's own words: Whether it occurs in Epicurus or in Aristotle, the term hedone can mean anything between gross sensual "pleasure" and entirely spiritual "joy." And on the whole it seems preferable to speak of the philosophy of Epicurus as a philosophy of joy rather than of pleasure. As far as Aristotle is concerned, it seems more appropriate to say that his Changeless Changer (or Changeless Changers) live a life that is filled with joy rather than pleasure, and that his hedonism is ultimately rooted in that of Eudoxus. Chapter 2, "How Many Kinds of Divinities Did Epicurus Recognize?," argues from the theory of the existence of indiscernible non-identicals (Cicero,4cademica 2.17.55; Philodemus De Pietate col. 80 = fr. 40 Us.) and from the theory of "isonomia," i.e., the balancing of one class of things by an equally large class of a different or opposite character (cf. C. Bailey, Greek Atomists, p. 461 ff.) that the Epicureans recognized two types of worshippables, as is indeed suggested by schol. Diog. Laert. 10.139: (I) the popular traditional divinities who are kar arithmon, i.e., severally unique, and... (shrink)

This book critically engages with the idea of transparency whose ubiquitous demand stands in stark contrast to its lack of conceptual clarity. The book carefully examines this notion in its own right, traces its emergence in Early Modernity and analyzes its omnipresence in contemporary rhetoric. Today, transparency has become a catchword outplaying other Enlightenment values like empowerment, sincerity and the notion of a public sphere. In a suspicious manner, transparency is entangled in the discourses on power, surveillance, and self-exposure. Bringing (...) together prominent scholars from the emerging field of Critical Transparency Studies, the book offers a map of the various sites at which transparency has become virulent and connects the dots between past and present. By studying its appearances in today’s hyper-mediated economies of information and by linking it back to its historical roots, the book analyzes transparency and its discontents, and scrutinizes the reasons why it has become the imperative of a supposedly post-ideological age. (shrink)

Historical analysis confirms the home-grown character of Nigeria’s conflicts and the complexity of their peaceful resolution. Religious leaders have traditionally contested political space with other actors and continue to do so. But the religiosity of popular culture is such that Nigerian religious leaders can make a substantive contribution to peace building and countering religious extremism if given the time, space and tools to do so. Elections have been critical moments in the evolution of religious tensions and conflicts owing to the (...) country’s geographical demographic and history, and the popular hope of correcting injustice that they evoke. There is a need to distinguish between genuine religious conflicts and conflicts that are essentially socio-economic or about competition for political power which become “religionised.” The evolution of the terrorist organisation, Boko Haram, can be traced back to intra-Muslim conflicts and anti-Sufi movements. But it reflects no less the underdevelopment and poverty of the Northeast and the impact of corruption on the perception of state and national government. The crude and violent narrative of Abubakar Shekau, its leader, shows a deterioration beyond that of its founder Malam Yusuf, who was able to offer financial and economic inducements over and above a rejection of most aspects of modernity and Western education. Increasingly, efforts are being made by religious leaders at both national, and local levels through formal, and grassroots networks to build better understanding and awareness between faiths to change and challenge narratives. With the appropriate support, these networks have great potential for improving communal relations and overcoming Boko Haram’s narratives of hate. (shrink)

There is much to learn from Durán and Jongsma’s paper.1 One particularly important insight concerns the relationship between epistemology and ethics in medical artificial intelligence. In clinical environments, the task of AI systems is to provide risk estimates or diagnostic decisions, which then need to be weighed by physicians. Hence, while the implementation of AI systems might give rise to ethical issues—for example, overtreatment, defensive medicine or paternalism2—the issue that lies at the heart is an epistemic problem: how (...) can physicians know whether to trust decisions made by AI systems? In this manner, various studies examining the interaction of AI systems and physicians have shown that without being able to evaluate their trustworthiness, especially novice physicians become over-reliant on algorithmic support—and ultimately are led astray by incorrect decisions.3–5 This leads to a second insight from the paper, namely that even if some AI system happens to be opaque, it is still not built on the moon. To assess its trustworthiness, AI developers or physicians have different sorts of higher order evidence at hand. Most importantly, …. (shrink)

Modern scholars and bioethicists continue to learn from the Holocaust. Scholarship and history show that the authoritarian Nazi state limited and steered the development and power of professions and professional ethics during the Holocaust. Eliminationist anti-Semitism drove German professions and many professionals to join in policies and programs of mass deportation and ultimately genocidal mass murder, while also excluding many professionals from paid work. For many physicians and other medical professionals, humane and truly ethical practices were (...) limited by constrained professional autonomy and coercive state laws. Education and research in natural sciences were distorted by applications of racist eugenic policies and practices. In law schools and legal professions, professionals were rewarded as judgmental enforcers of state policies, often working with limited independent agency and in the public sphere. Mass harm and mass crimes were therefore perpetrated in accordance with Nazi laws and policies, incorporating professions and professionals into destructive practices, along with other occupational groups. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Got Ethics? Envisioning and Evaluating the Future of Our Guild and DisciplineStacey M. Floyd-Thomas (bio)IN LIGHT OF THE SOCIETY OF CHRISTIAN ETHICS’ TWENTY-First Century and 2020 Initiatives, several ad hoc committees and working groups have examined the fate and future of both the Society and the field of Christian ethics. The stated purposes of these initiatives and their correlative task forces were to think about (...) a new era that is ostensibly different from the state of the discipline of Christian ethics and the demographics of the Society in the past. In effect, each initiative was charged with addressing the evolving needs of our field, particularly giving attention to our mission, membership, meeting, media, management, and mass appeal. There has also been considerable attention paid to our relevance in an academy and society where underrepresented groups of color are no longer minorities in the demographic composition of the United States. Further, numerous discussions have focused on the shifting dynamics of a global and postsecular age. Each initiative therefore chose to focus its attention on the practices of the Society in order to expand our ethical conversations with ethicists in other cultures, traditions, and institutional settings. Finally, each initiative executed its own inventory, and recommendations to the board and membership emerged.The 2016 preconference workshop titled “Got Ethics?” was a roundtable discussion that was an effort to make good on the hard work of those initiatives and the good intentions of the SCE board. Herein four ethicists—namely, Gloria Albrecht, Agnes Chiu, Gary Dorrien, and Miguel De La Torre, joined me in the quest to revisit the implications that a diverse demographic and discipline as well as the developing global context may pose for the future of our scholarship and society. Each panelist stated hard truths for these troubling times that poignantly mark both the crises of theological education and the church, and even more urgently for the future of our discipline and our Society as Christian ethicists. [End Page 195]Gary Dorrien offered a rigorous overview of the history of Christian social ethics that coalesced around the ever-growing gap that threatens its viability:Today, as in previous generations, some ethicists work hard at straddling the divide between social justice activism and disciplinary scholarship. For many of us, our purview consists entirely of ethicists fitting this description. All of us up here work hard at doing both things and we struggle with the trade-offs of doing so. I have completed my assignment and my time is up, but I have a cautionary conclusion. Unlike previous generations of social ethicists, we cannot assume that our field has a future. The existence of our field is in jeopardy except in Catholic institutions. On the road I have talked with many academic administrators who are skeptical that their schools need to teach anything called Christian ethics or comparative religious ethics or social ethics. We cannot settle for merely asserting that our work is relevant and that our field has an established standing. The weight of presumption is shifting against us. The field is shrinking, and we must prove that our work is substantial and relevant.1As Dorrien traces the history of social ethics as a discipline, beginning with the rise of the Social Gospel and its modern social consciousness, he also causes us to reflect on our postmodern consciousness as well. Social ethics began with black and white Social Gospel ministers who preached radical social change; however, Reinhold Niebuhr’s Christian realism tempered this radical vision, moving the discipline in a more moderate direction. Today social ethics remains in a crisis of identity and relevance, caught between the need to establish itself as a discipline in its own right and the ethical exigency of speaking directly to social injustices.As an emerging moral theologian, Agnes Chiu echoes Dorrien’s perspective by asserting thatChristian ethics is a discipline that intersects and calls for Christian engagement with the world. It enables Christianity to be relevant because it deals with issues with which the world wrestles such as justice, conflicts, and human dignity. Theologians have long warned against the danger of irrelevancy and indifference by both our discipline and the... (shrink)

Common morality has been the touchstone of medical ethics since the publication of Beauchamp and Childress's Principles of Biomedical Ethics in 1979. Rosamond Rhodes challenges this dominant view by presenting an original and novel account of the ethics of medicine, one deeply rooted in the actual experience of medical professionals. She argues that common morality accounts of medical ethics are unsuitable for the profession, and inadequate for responding to the particular issues that (...) arise in medical practice. Instead, Rhodes argues that medicine's distinctive ethics should be explained in terms of the trust that society allows to the profession. Trust is the core and starting point of Rhodes' moral framework, which states that the most basic duty of doctors0is to "seek trust and be trustworthy." 0Building from this foundation, Rhodes explicates the sixteen specific duties that doctors take on when they join the profession, and demonstrates how her view of these duties is largely consistent with the codes of medical ethics of medical societies around the world. She then explains why it is critical for physicians to develop the attitudes or "doctorly" virtues that comprise the character of trustworthy doctors and buttress physicians' efforts to fulfil their professional obligations. Her book's presentation of physicians' duties and the elements that comprise a doctorly character, together add up to a cohesive and comprehensive description of what medical professionalism really entails. Rhodes's analysis provides a clear understanding of medical professionalism as well as a guide for doctors navigating the ethically challenging situations that arise in clinical practice. (shrink)