Readings in Health Care Ethics provides a wide-ranging selection of important and engaging contributions to the field of health care ethics. The second edition adds a chapter on health care in Canada, and the introduction has been expanded to include discussion of a new direction in feminist naturalized ethics. The book presupposes no prior knowledge, only an interest in the bioethical issues that are shaping our world.

Recent discussions of genetic information have highlighted the need for ethical disclosure guidelines. For instance, the (Canadian) Royal Commission on New Reproductive Technologies points out the range of third-party interests in genetic information and the lack of clear ethical and professional guidelines governing its dissemination. Among the more worrying interests are those of insurance companies and prospective employers. However, also worrisome is the problem of negotiating the first-party interest in privacy (from which the professional obligation of confidentiality arises) and strong (...) third-party claims from family members. The survey by Knoppers and Laberge of consent forms currently used in DNA testing in Canada shows that fewer than half mention access by family members, and only three out of 20 alert subjects to the possibility of finding nonpaternity. Both the Royal Commission and the Knoppers research group recommend integrated, national consent standards, with the Knoppers group explicitly approving a standard of disclosure. While endorsing the call for integrated consent guidelines, in this paper I intend to raise some doubts about the adequacy of the reasonable person standard in light of gender differences in reproductive burden and risk perception. (shrink)

Much debate concerning ‘precedent autonomy’ – that is, the authority of former, competent selves to govern the welfare of later, non-competent selves – has assumed a radical discontinuity between selves, and has overlooked the ‘bridging’ role of intimate proxy decision-makers. I consider a recent proposal by Lynn et al. (1999) that presents a provocative alternative, foregrounding an imagined dialogue between the formerly competent patient and her/his trusted others. I consider what standards must be met for such dialogues to have moral (...) force, appealing to narrative and feminist ethics. I then critique the dualistic construction of selves implicit in much of the advance directive literature, noting the continuities of dependence, character, and body, as well as the social dimension of the construction of selves. (shrink)

If You're an Egalitarian, How Come You're So Rich? is a persuasive extension of Cohen's critique of Rawls's egalitarianism, embedded in reflections on the inadequacies of Marxist theory, on the rationality of "nurtured" beliefs, on Cohen's own personal and intellectual journey, and, finally, on the issue named in the title, the responsibility of the wealthy just in an unjust society. It is an uneven, but highly readable, book. Based on Cohen's 1996 Gifford Lectures, the book is divided into a Prospectus (...) and ten Lectures, one of which was apparently a multimedia sing-along on the "lighter side of the problem of evil" and could not be reproduced! (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 103-113 [Access article in PDF] Scope Note Update Searching Across Boundaries: National Information Resource on Ethics and Human Genetics* While indeed an historical moment, the announcement of the mapping of the human genome has been treated in the literature as a beginning—a new way to think about biology and the ways in which biological concepts are applied to medicine. Issues of both (...) Science and Nature magazines celebrated the event by establishing interdisciplinary websites where readers can access essays on aspects of genome mapping and directly link to databases to search for more information on the topics (IV. Genome Gateway 2001; The Human Genome 2001). Since 1994, the National Information Resource on Ethics and Human Genetics (NIREHG), a special project of the National Reference Center for Bioethics Literature (NRC), has been providing such an integrated information service on ethics and genetics. Designed to enable a wide range of users to go from annotated bibliographies (Scope Notes) and brief essays (called "enotes") to database searching, NIREHG fosters an interdisciplinary approach to research on ethics and genetics. Links are provided between and among Scope Notes and enotes to information maintained on the NIREHG site as well as to sources found throughout the Internet. In providing the following annotations added to NIREHG materials since 1997, the Kennedy Institute of Ethics Journal (in its online presence through Project Muse) becomes an additional forum for NIREHG links. "It is a rare and wonderful moment when success teaches us humility, and this, I argue, is precisely the moment at which we find ourselves at the end of the twentieth century" (IV. Keller 2000, p. 7). It is with both joy and humility that we celebrate the mapping of the human genome. [End Page 103] I. Genetic Testing Andrews, Lori B. Future Perfect: Confronting Decisions About Genetics. New York: Columbia University Press, 2001. 264 p.Noting the wide impact of genetic testing, Andrews discusses patient self concept, reproduction decisions, confidentiality, discriminations in health insurance and employment, the need for competent counseling, and the legal, ethical, and social regulations she deems important to help solve dilemmas arising from the tests and their ensuing ramifications. She describes three models, pointing out both advantages and problems: a medical model with physician gatekeepers, a public health model that could provide education as well some testing for those unable to afford tests, and a fundamental rights model that could give greater weight to individuals decisions about the use of health care services. The book has 85 pages of footnotes.American Society of Human Genetics. Social Issues Subcommittee on Familial Disclosure. Professional Disclosure of Familial Genetic Information. American Journal of Human Genetics 62 (2): 474-83, February 1998.The ASHG statement outlines points to consider: the general rule of confidentiality, exceptional circumstances that permit disclosure, and the ethical duty to inform patients about familial implications. Background discussion includes: ethical frameworks for disclosure of otherwise confidential information, the duty to warn under law, and international trends and positions.Boetzkes, Elisabeth. Genetic Knowledge and Third-Party Interests. Cambridge Quarterly of Healthcare Ethics 8 (4): 386-92, Summer 1999.Protection from the interests of insurers or prospective employers are discussed from the point of view of the ethical basis of the professional obligation to confidentiality as well as the right to privacy of those tested. However, the author supports family members, saying that "first-party resistance to disclosure may be overcome by weighty third-party claims."Chadwick, Ruth; Shickle, Darren; ten Have, Henk; and Wiesing, Urban, eds. The Ethics of Genetic Screening. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1999. 255 p.Twenty-one chapters and 23 authors provide views of genetic testing/screening in different European countries and offer brief discussions of sociological perspectives, moral and philosophical issues, privacy, reconciling liberty and the common good, and questions raised in genetic testing of children.Clayton, Ellen Wright. Genetic Testing in Children. Journal of Medicine and Philosophy 22 (3): 233-51, June 1997.Clayton argues that there is room for... (shrink)

Universities around the world are undergoing a marketisation process in order to respond to consumer-oriented demands. Despite priority shifts, universities have remained traditionally hierarchical and elitist. Moreover, a new and growing generation of academic researchers has found it increasingly difficult to integrate in academia. Systems and patterns of behaviour breeding cultural narcissism, intended as a value and cultural system characterised by an investment in false self-projections backed by Machiavellian attainment, exist and appear to thrive in academic institutions. This organizational adaptation (...) for survival is now embedded in higher education and interlinked with mobbing, workplace bullying and academic misconduct. The problematics we are witnessing today in many academic settings (high rates of mental health issues, widespread research misconduct scandals and loss of credibility of academic research) are a by-product of an organizational narcissistic culture. Amidst economic shifts, it might seem reasonable to adopt measures aimed at increasing assets, invest in highly entrepreneurial academics who attract financial resources to universities and use any means to salvage the reputations of educational institutions. Yet these strategies might be promoting and perpetuating value systems that are undermining academic integrity, and therefore contributing to the scientific credibility crisis and failure of these institutions. (shrink)

Background: Food is an important part of nursing care and recognized as a basic need and a human right. Nutritional care for older adults in institutions represents a particularly important area to address in nursing education and practice, as the right to food can be at risk and health personnel experience ethical challenges related to food and nutrition. Objective: The present study investigates the development of coursework on nutritional care with a human rights perspective in a nursing programme for first-year (...) nursing students and draws upon reflections and lessons learned. Research design: The study utilized educational design research. The coursework, developed through two rounds, combined on-campus learning and clinical placement in nursing homes. Nursing studentsʼ perspectives and experiences gathered through focus groups and a written assignment informed the development and evaluation of the coursework. Participants and research context: In the first round, multistage focus group interviews were conducted with 18 nursing students before, during and after placement. In the second round, four focus group interviews with 26 nursing students were conducted shortly after placement. Ethical consideration: The study was approved by the Norwegian Centre for Research Data. Findings: Three main ʽlessons learnedʼ emerged regarding introducing a human rights perspective in nursing education: 1) the contribution of the human rights perspective in changing the narrative of ʽvulnerable and malnourished patientsʼ, 2) the importance of relationships and experiences for learning about human rights and 3) the benefit of combining development of ethical competence with a human rights perspective. Conclusion: A human rights perspective enabled the students to give meaning to nutritional care beyond understanding of food as a basic physical need. Incorporating human rights in nursing education can support nursing students and nurses in recognizing and addressing ethical and structural challenges and being able to fulfil the right to food for patients. (shrink)

I argue that we can reconcile two seemingly incompatible traditions for thinking about concepts. On the one hand, many cognitive scientists assume that the systematic redeployment of representational abilities suffices for having concepts. On the other hand, a long philosophical tradition maintains that language is necessary for genuinely conceptual thought. I argue that on a theoretically useful and empirically plausible concept of 'concept', it is necessary and sufficient for conceptual thought that a thinker be able to entertain many of the (...) potential thoughts produced by recombining her representational abilities apart from a direct confrontation with the states of affairs being represented. Such representational abilities support a cognitive engagement with the world that is flexible, abstract, and active. (shrink)

Although there is discussion among ethicists about the permissibility of actions on the antenatal placenta, these discussions rarely take seriously the metaphysics involved. Rather, authors resort to opinion on how the placenta comes to be and for whose good it exists. This paper takes these metaphysical questions seriously. Through discussion of the biology of the placenta, I conclude that it is a shared organ of the mother and the fetus. In an analogy to the ethics of conjoined twinning, I conclude (...) that actions on the placenta must take the good of both the mother and the fetus into account. (shrink)

Education is important in shaping professional identity, including how one approaches norms and normalisation. In the analysis presented in this study, nursing students' own constructions of norms and normality from the outlook of their education are highlighted and problematised. To deepen the understanding of these matters, the aim of this study was to explore constructions of norms and normality among students in nursing education. Students studying in a nursing department at a Swedish university college were approached and asked to consider (...) open survey questions targeting their views on norms and normality; 154 of them replied. After a discourse analytic approach to the data, we could see how the students constructed norms and normality as (a) instrumental instructions, consisting of easy‐to‐digest statements grounded in the profession's obvious moral and ethical values, (b) limiting and frustrating obstacles for personal freedom that were important to challenge, (c) rules to be obeyed for the stability of society and (d) a matter of reflection, with each individual being responsible for understanding differences in norms, perspectives and opinions. We conclude that nursing education would benefit from norm‐critical perspectives, problematising students' own positions to norms, power and privilege. (shrink)

As a founding father of Existentialism, Karl Jaspers has been seen as a twentieth-century successor to Nietzsche and Kierkegaard; as an exponent of reason, he has been seen as an heir of Kant. But studies tracing influences upon his thought or placing him in the context of Existentialism have not dealt with Jaspers's concern with the political realm and how we think in it and about it. In this study Elisabeth Young-Bruehl explicates Jaspers's practical philosophizing, his search for ways (...) in which we can orient ourselves toward our world and its political questions. (shrink)

ArgumentNineteenth-century Prussia was deeply entrenched in philhellenism, which affected the ideological framework of its public institutions. At Berlin’s Friedrich Wilhelm University, philhellenism provided the rationale for a persistent elevation of the humanities over the burgeoning experimental life sciences. Despite this outspoken hierarchy, professor of physiology Emil du Bois-Reymond eventually managed to increase the prestige of his discipline considerably. We argue that du Bois-Reymond’s use of philhellenic repertoires in his expositions on physiology for the educated German public contributed to the rise (...) of physiology as a renowned scientific discipline. Du Bois-Reymond’s rhetorical strategies helped to disassociate experimental physiology from clinical medicine, legitimize experimental practices, and associate the emerging discipline with the more esteemed humanities and theoretical sciences. His appropriation of philhellenic rhetoric thus spurred the late nineteenth-century change in disciplinary hierarchies and helped to pave the way for the current hegemonic position of the life sciences. (shrink)

We give a reduction of the function field Mordell–Lang conjecture to the function field Manin–Mumford conjecture, for abelian varieties, in all characteristics, via model theory, but avoiding recourse to the dichotomy theorems for (generalized) Zariski geometries. Additional ingredients include the “Theorem of the Kernel”, and a result of Wagner on commutative groups of finite Morley rank without proper infinite definable subgroups. In positive characteristic, where the main interest lies, there is one more crucial ingredient: “quantifier-elimination” for the corresponding [Formula: see (...) text] where [Formula: see text] is a saturated separably closed field. (shrink)

Socially responsible investment (SRI) has become a major intervention in global investment practices that responds to the power of institutional investors to affect corporate practice. While SRI grew out of the decisions made by churches to curtail investment in so-called “sin stocks” (companies which profited from alcohol, tobacco and gambling), little work has been done to explain why such a dramatic difference in investment strategy would occur or how it ought to impact the investment decisions of individual Christians and their (...) faith communities. This paper explores how social institutions with a religious character determine how to balance the risk of inflicting harm on those institutions with responsibility for transforming the economic order through making investment decisions. Using data collected from shareholder proposals in corporate proxy filings and interviews with investment managers, we develop a typology of theologically grounded approaches to risk and responsibility. (shrink)

There is a spectrum of identities: from the mathematical, through cases where specific criteria matter, to the complex or intuitive cases where we can recognize identity but don't know what the criteria should be. In a series of essays by senior figures in the sciences and humanities, this book examines what identity means across a number of academic disciplines. Topics range from mathematics, through the rules of recognition in biology and the law, to comprehending the individual in the visual, performing (...) and literary arts, and ultimately to notions of the philosophy of existence. Using the theme of identity to make new interdisciplinary connections, the contributors offer interested readers a glimpse into their specialist subjects and suggest new ways for students and scholars to think about identity in relation to their own work. (shrink)

Mind and the Body Politic is a collection of Elisabeth Young-Bruehl's essays and lectures on political theory, psychoanalysis, feminism, and the theory of biography.

Background: Caring for a partner with primary malignant brain tumour can be a dramatic life-changing event. Primary malignant brain tumour is known to give poor life expectancy and severe neurological and cognitive symptoms, such as changed behaviour and personality, which demand greater caring responsibilities from spouses. Aim: The aim of the study is to explore ethical dilemmas spouses experience in the everyday care of a partner in treatment for primary malignant brain tumour. Research design, participants and research context: A phenomenological (...) and hermeneutic qualitative descriptive design was adopted as a method for collecting and analysing data. Ten spouses were interviewed twice using an in-depth, semi-structured interview guide. The interviews took place at the spouses’ homes or at the hospital. Ethical consideration: Ethical matters were considered throughout the research process. Permission from The National Committee on Health Research Ethics and the Danish Data Protection Agency was obtained. Findings: The analysis showed that the spouses perceived daily ethical dilemmas in caring for a partner with primary malignant brain tumour. Their life as well as their partner’s life had changed considerably. The main theme that emerged therefore was ‘oscillating in a changing relationship’. This theme was further elaborated in three subthemes that in more detail demonstrated the dilemmas: ‘doing the right thing in unpredictable daily situations’; ‘torn between patience and guilt’; and ‘living in a time of uncertainty, hope and despair’. Conclusion: Caring for a partner with changed behaviour and personality due to primary malignant brain tumour may involve exhausting ethical caring dilemmas. Spouses’ married life may change to a semi-professional asymmetrical relationship, which is challenged by the oscillation between acting responsibly for their partners’ well-being and caring dilemmas with no answer for what the right thing to do is. Mixed feelings of right and wrong, patience and guilt, hope and despair seem to be spousal companions through their partners’ progressing illness. (shrink)

Wonder, miracle, occult science, poetry, and the epistemological implications in Renaissance authors: Marsilio Ficino, Giovanni Pico, Pietro Pomponazzi, Agrippa of Nettesheim, Giordano Bruno, Francesco Patrizi, Tommaso Campanella, Francisco Suárez.

Lorazepam has been repeatedly shown to induce memory impairments. The effects of this benzodiazepine on the processes involved in the strategic regulation of memory accuracy have not as yet been explored. An experimental procedure that delineates the role of monitoring and control processes was used. Fifteen lorazepam and 15 placebo subjects were examined using a semantic memory task that combined both a forced- and a free-report option and a no-incentive and an incentive condition. Memory accuracy was lower in the lorazepam (...) than in the placebo group. Lorazepam impaired control sensitivity . While the absolute aspect of monitoring was impaired , both the discriminative aspect and the response criterion setting were spared. The pharmacological dissociation between monitoring effectiveness and control sensitivity indicates that these two components involve distinct processes. (shrink)

A crítica da cultura como reflexo do mundo que realmente existe é o ponto de partida para a apreensão do caráter social dos sentidos estéticos, manifestamente sobre a criação artística, o conhecimento estético e a produção material sob o capitalismo. Partindo de tal pressuposto, o presente artigo se debruçará sobre a problemática geral da estética e do seu papel formador na cultura.

The topic of Hannah Arendt's Jewish identity can be approached from many directions. This chapter considers Arendt in the context of the vision of world history articulated by her teacher and mentor Karl Jaspers, in which her people, the Jews of Palestine, were considered as one of the “Axial Age” peoples. It argues that it is Arendt's Jewish identity—not just the identity she asserted in defending herself as a Jew when attacked as one, but more deeply her connection to the (...) Axial Age prophetic tradition—that made her the cosmopolitan she was, while Jaspers's cosmopolitanism was more learned than inherited and reinforced by group experience. (shrink)

Approaching language change within a Darwinian framework constitutes a long-standing tradition within the literature of diachronic linguistics. However, many publications remain vague, omitting conceptual details or missing necessary terminology. For example, phylogenetic trees of language families are regularly compared to biological speciation, but definitions on mechanisms of inheritance, i.e. how linguistic information is transferred between individuals and cohorts, or on the linguistic correlates to genotype and phenotype are often missing or lacking. In light of this, Haider’s attempts to develop this (...) approach into a theoretically more precise position, closely mirroring principles of Darwinian natural selection in the dimension of diachronic grammatical change, but contrasting this with non-Darwinian lexical change. He draws a comparison to viral replication, essentially positing that grammar variants act as mental viruses, competing for replication in new hosts, i.e. children during critical periods of language acquisition. Haider proposes that in light of this competition for replication, the unconscious fixation of an individual’s grammar leads to diachronic grammatical change largely mirroring Darwinian natural selection. Despite the intuitive appeal this mode of reasoning may feature, the following response paper identifies and discusses a suit of shortcomings to this conceptualization. Some problems arise from underspecified theoretical notions, others due to the incomplete or inaccurate adoption of biological principles, and yet more through a partial incompatibility with empirical data. These criticisms do not amount to a dismissal of the Darwinian framework Haider is following, but to a rejection of Haider’s current position. Albeit it remains unclear if a truly Darwinian approach to language change can be reached, suggestions on how Haider’s theoretical notions could be further developed are made and pertinent efforts may ultimately lead to a productive theory. (shrink)

We are not convinced by Gangestad & Simpson that differential mating strategies within each sex would be greater than such strategies between sexes. The target article does not provide actual evidence of human males who do not desire mating with multiple females, or evidence that the benefits for females of short-term matings with multiple males have ever outweighed the associated costs.