This paper offers an exposition of what the question of method in ethics consultation involves under two conditions: when ethics consultation is regarded as a practice and when the question of method is treated systematically. It discusses the concept of the practice and the importance of rules in constituting the actions, cognition, and perceptions of practitioners. The main body of the paper focuses on three elements of the question of method: canon, discipline, and history, which are treated heuristically to outline (...) what the question of method in ethics consultation fully involves. (shrink)

The law has therefore had two conflicting impacts on medical ethics: the positive effect of eroding paternalism and replacing it with a patient-centered ethic; and the negative effect of encouraging physicians to be more concerned with avoiding litigation than doing the "right" thing.

How closely involved with hospital ethics committees should patients and their families become? Should they routinely have access to committees, or be empowered to initiate consultations? To what extent should they be informed of the content or outcome of committee deliberations? Seeing ethics committees as the locus of competing responsibilities allows us to respond to the questions posed by a patient rights model and to acknowledge more fully the complex moral dynamics of clinical medicine.

In lieu of an abstract, here is a brief excerpt of the content:George J. Leonard EMERSON, WHITMAN, AND CONCEPTUAL ART The widespread abandoning of the art object at the end of the 1960s was taken as something radically, even frighteningly, new, by critics and artists alike. Objects, concept artist Joseph Kosuth was asserting by 1969, are "irrelevant" to art. Though an artist might choose, as in the past, to "employ" objects, "all art is finally conceptual." In fact it was (...) now time that the object, nothing more than the "physical residue" of the artist's mental activity, was dispensed with.1 "We / open our eyes and ears seeing life / each day excellent as it is," John Cage chanted: "This / realization no longer needs art...."2 Aestheticians as disparate as Murray Krieger and Harold Rosenberg reacted to this "transfiguration of the commonplace," as Arthur Danto has called it. Danto has gained a wide scholarly audience for his ideas about the 1960s as "the end of art," or at least as the beginning of "post-historical art."3 We know from such works as Renato Poggioli's TL· T^ry oftL· Avant-Garde that, in this century, particular movements have routinely declared themselves to be art's climax.4 Critics like Jacques Barzun and artists like Amedee Ozenfant had been saying for years that art was exhausted. Yet conceptualism's attack on the object struck most critics as something both alarming and new: Irving Sandler wrote in a special edition of the College Art Association's Art Journal devoted to the problem that it demolished "every notion of what art should be,"5 and Murray Krieger feared that this "leap beyond Pop Art" would "complete the obliteration of the realm of art, its objects, its museums...."6 But the conceptualist attacks on the art object were, in fact, not new. One can find attacks as scathing in Emerson and Whitman; so scathing, that criticism has rarely taken them seriously. The attacks the concep297 298Philosophy and Literature tualists mounted in the 1960s were only the culmination ofan intellectual tendency which appeared throughout the West one hundred and sixty years before. It has long been a scholarly commonplace that after 1800 an "intellectual tendency"—as M. H. Abrams finallytermed it—extolling the possibilities of this world emerged in all parts of Western culture. When itappears in literature we nowusually call it, withAbrams, Natural Supernaturalism; or, with Harold Bloom, the "visionary company." Man, Wordsworth decreed, can and must learn to find "Paradise" in "the common day."7 Surprisingly litde work has been done on what happened when this intellectual tendency, Natural Supernaturalism, confronted the art object. Emerson and Whitman can stand for many who were necessarily ill at ease with the idea of art objects as elite objects superior to the common things it was their mission to extol. Wordsworth works before these two; Ruskin develops similar ideas into greater complexity; but since Emerson writes clear expository prose and avoids fanciful terminology, he makes a good place to enter this dark wood. Let us begin with some straightfor-ward, overdue interdisciplinary history, reading Emerson on the art object, noticing similar passages in Whitman, and noting where Emerson has reworked Hegel for his own ends. For Emerson objects are but thought's "inert effect," as for the concept artist Kosuth they would be but the "physical residue" of the artist's activity. Emerson and Kosuth, opposite Shakespeare, do not applaud the art process as the giving to an airy nothing a local habitation and a name; rather they disdain the stuff as petrifactions, as dead mud footprints left by living thoughts diat have raced away.8 In his essay "Circles," Emerson derides our admiration for a work of architecture, directing us to the "litde waving hand" that built it, for "that which builds is better than that which is built." By the same logic, the invisible thoughts which truly wrought the object were even better than the hand and "nimbler."9 When such passages are discussed at all, they are usually considered Platonic,10 but, in his essay "Art," Emerson envisions a use for art objects Plato would have blinked at. For the time being, art objects have a particular "office" to fill. That office, Emerson wrote in... (shrink)

The realities of long‐term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

Taking the phenomena of “workplace spirituality” as its case, Shape-Shifting Capital argues that “spirituality” is constitutive of contemporary capitalism and outlines a methodology for tracking broad sociological shifts in the nature of Western religion and economy at the level of lived experience.

While there is no denying the relevance of ethical knowledge and analytical and cognitive skills in ethics consultation, such knowledge and skills can be overemphasized. They can be effectively put into practice only by an ethics consultant, who has a broad range of other skills, including interpretive and communicative capacities as well as the capacity effectively to address the psychosocial needs of patients, family members, and healthcare professionals in the context of an ethics consultation case. In this paper, I discuss (...) how emotion can play an important interpretive role in clinical ethics consultation and why attention to the role of defense mechanisms can be helpful. I concentrate on defense mechanisms, arguing first, that the presence of these mechanisms is understandable given the emotional stresses and communicative occlusions that occur between the families of patients and critical care professionals in the circumstances of critical care; second, that identifying these mechanisms is essential for interpreting and managing how these factors influence the way that the “facts” of the case are understood by family members; and, third, that effectively addressing these mechanisms is an important component for effectively doing ethics consultation. Recognizing defense mechanisms, understanding how and why they operate, and knowing how to deal with these defense mechanisms when they pose problems for communication or decision making are thus essential prerequisites for effective ethics consultation, especially in critical care. (shrink)

Since at least the advent of Jack Kevorkian’s “suicide machine” the major argument against adopting physician-assisted suicide laws has been that they will lead us down a slippery slope to state-sa...

How should one think about innovation in medicine and surgery? Increasingly, the answer to this question has involved reference to what might be called the regulatory ethics paradigm (REP). The regulatory ethics paradigm holds that deviations from standard care involve a degree or kind of experimentation that requires the application of a set of procedures designed to assure the protection of the rights and welfare of the subjects of research. In REP, innovative treatments are regarded as questionable until they are (...) framed in a research protocol with formal mechanisms of informed consent. The protocol must be reviewed and approved by an Institutional Review Board (IRB) or equivalent. The regulatory ethics paradigm in effect imposes the condition that clinical innovations be conducted according to scientific research methodologies. It creates the presumption that without review by an IRB, innovation cannot be conducted in an ethically defensible fashion. The regulatory ethics paradigm also requires the preparation of investigational protocols according to sound evidentiary and methodological standards. In so doing, it creates a presumption that innovations that are not rigorously validated are ethically dubious. These assumptions have deep roots. The Belmont Report, for example, articulated the orienting intuition that “radically new procedures... should... be made the object of formal research at an early stage [emphasis added] in order to determine whether they are safe and effective”.1 The Belmont Report takes the view that formal research to establish safety and efficacy of new interventions is usually feasible at an early stage in the development of a novel intervention. It thus establishes a bias that innovative treatments be conducted and evaluated under a research protocol that has passed muster at an IRB review. Given the …. (shrink)

In “Deception and the Clinical Ethicist,” Christopher Meyers defends that view that deception practiced by clinical ethicists is legitimate if it satisfies a series of justifying conditions (Meyers...

American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.

Georges J. D. Moyal - Deux notes sur l' «imparfaite science» du geometre athee - Journal of the History of Philosophy 43:3 Journal of the History of Philosophy 43.3 277-300 Deux notes sur l'« imparfaite science » du géomètre athée Georges J. D. Moyal Deux questions. La Ve Méditation de Descartes vise à démontrer que l'existence d'un Dieu vérace est la condition nécessaire de toute science. En effet, Descartes y écrit ceci : « . . . je remarque que la (...) certitude de toutes les autres choses en dépend si absolument [sc. de l'existence de Dieu], que sans cette connaissance il est impossible de pouvoir jamais rien savoir parfaitement. » Ce qui le mène, bien entendu, d'abord à reconnaître que « . . . si j'ignorais qu'il y eût un Dieu [ . . . ] je n'aurais jamais une vraie et certaine science d'aucune chose que ce soit, mais seulement de vagues et inconstantes opinions » et par là même, à refuser ensuite cette parfaite science au géomètre athée : « Or, qu'un athée puisse connaître clairement que les trois angles d'un triangle sont égaux à deux droits, je ne le nie pas ; mais je maintiens seulement qu'il ne le connaît pas par une vraie et certaine science, parce que toute connaissance qui peut être rendue douteuse ne doit pas être appelée science . . . » Il faut reconnaître qu'il y a à nos yeux, aujourd'hui, quelque chose de surprenant à ce que le géomètre athée se voie ainsi refuser cette parfaite science.. (shrink)

Heidegger revisits German idealism after the “turn” in his thought in the mid-1930’s. There are a couple of reasons for this. One is philosophical, if not “theological” in his sense of that term. The other is personal. This later reason is emphasized by Otto Pöggeler, who suggests that after 1945 Heidegger sought to understand what had gone wrong in the tragic European debacle. Heidegger will lay the blame at the doorstep of what he terms onto-theology and the subjectivism he sees (...) as endemic to the German idealist tradition, above all as exemplified in Hegel’s “onto-theo-ego-logy.” The article explores Heidegger’s reading of this tradi­tion of German philosophy as it begins with Leibniz and culminates in Nietzsche. It is the Event itself that makes possible the overcoming of metaphysics and its onto-theology. As Heidegger says in Contributions to Philosophy (From the Event), the ens realissimum (das Seiendste) “is” no more. It is the Event (Ereignis) that is the “most real,” since it is the Event that shows up and manifests itself as the revelation of the truth of Beinge in Da-sein, the being that is there in the Event. (shrink)

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and (...) profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business. (shrink)

L'absence d'une analyse quelconque du concept de vérité a de quoi surprendre dans un discours qui se propose de dire à quelles conditions s'obtient cette vérité. C'est pourtant bien de cette carence que souffrent les Méditations. A l'exception d'une brève allusion, dans la Cinquième Méditation, attribuable d'ailleurs à Clerselier, et dans une traduction remaniée par lui mais non approuvée par Descartes, le mot « vérité » n'y est défini nulle part.

In a practice like ethics consultation, quality and accountability are intertwined. Critics of ethics consultation have complained that clinical ethics consultants exercise power or influence in patient care without sufficient external oversight. Without oversight or external accountability, ethics consultation is seen as more sophistical than philosophical. Although there has been more discussion of accountability, concern for quality in ethics consultation is arguably more important, because it represents a central challenge for the field, namely, how to structure a responsible practice of (...) ethics consultation. (shrink)

Contrairement à ce que peut suggérer l ’ expression de lumière naturelle lorsqu ’ il en est question, le cogito n ’ est pas une vérité de la raison. La raison est révoquée en doute au moment où il survient et ne saurait donc en assurer la vérité. Ce rôle est dévolu à la réflexivité de l ’ acte par lequel la pensée se constitue son propre objet lorsqu ’ elle affirme Je suis : immédiatement accessible à elle-même, c ’ (...) est une chose dans le monde, et par conséquent un existant, qu ’ elle saisit ainsi, non pas une représentation. Le cogito est ainsi inextricablement impliqué dans un acte certes, mais cet acte n ’ est pas le performatif qu ’ a voulu en faire Hintikka. La proposition qui l ’ exprime s ’ apparente en fait à une contingente : selon l ’ analyse ici proposée, il lui est en effet possible d ’ être fausse. (shrink)

The proliferation of ethics committees and ethics consultation services has engendered a discussion of the issue of the expertise of those who provide clinical ethics consultation services. In this paper, I discuss two aspects of this issue: the cognitive dimension or content knowledge that the clinical ethics consultant should possess and the practical dimension or set of dispositions, skills, and traits that are necessary for effective ethics consultation. I argue that the failure to differentiate and fully explicate these dimensions contributes (...) to the confusion over the issue of expertise and fuels, at least partly, the controversies about expertise (or authority) in ethics and the legitimacy of the use of ethical knowledge in clinical ethics consultation. (shrink)

HISTORIANS DESCRIBE AND EXPLAIN THE PAST. IT IS ARGUED THAT THIS ACTIVITY CAN BE EXTENDED TO ENCOMPASS FUTURE-REFERRING STATEMENTS WITHOUT BECOMING SOOTHSAYING. DESCRIPTIVE AND EXPLANATORY TECHNIQUES ARE EXAMINED, AND THE TEST OF THEIR ADEQUACY SEEN TO INVOLVE SPECULATIVE PREDICTION AND PROJECTION. PHILOSOPHERS OF HISTORY ALSO USE SUCH TECHNIQUES, IMAGINATIVELY COMPLETING INCOMPLETE DESCRIPTIVE PATTERNS BY REFERENCE TO THE FUTURE, IN ORDER TO SUGGEST AND EVALUATE EXPLANATIONS OF PAST EVENTS.