Much of contemporary philosophy, political theory, and social thought has been shaped directly or indirectly by Georg Wilhelm Friedrich Hegel, though there is considerable disagreement about how his work should be understood. He has been described both as a metaphysician and characterized as an ironic narrator who anticipated the character of philosophy after metaphysics. His position is equally ambiguous with regard to his political thought. He has been construed both as an enemy of the liberal state and as a friend (...) of freedom. This volume's revisionist reassessment, building on the scholarship of Klaus Hartmann, explores these ambiguities in favor of a non-metaphysical reading of Hegel's arguments. It also shows how the foundations of his political thought support a liberal democratic state. This reappraisal of Hegel's arguments resituates him as a philosopher who anticipates the difficulties of post-modernity and offers a basis for reassessing ontology, aesthetics, and revolution. Philosophers and those doing work in political theory will find this volume of great interest. (shrink)

Edmund D. Pellegrino has played a central role in shaping the fields of bioethics and the philosophy of medicine. His writings encompass original explorations of the healing relationship, the need to place humanism in the medical curriculum, the nature of the patient’s good, and the importance of a virtue-based normative ethics for health care. In this anthology, H. Tristram Engelhardt, Jr., and Fabrice Jotterand have created a rich presentation of Pellegrino’s thought and its development. Pellegrino’s work has been (...) dedicated to showing that bioethics must be understood in the context of medical humanities, and that medical humanities, in turn, must be understood in the context of the philosophy of medicine. Arguing that bioethics should not be restricted to topics such as abortion, third-party-assisted reproduction, physician-assisted suicide, or cloning, Pellegrino has instead stressed that such issues are shaped by foundational views regarding the nature of the physician-patient relationship and the goals of medicine, which are the proper focus of the philosophy of medicine. This volume includes a preface by Dr. Pellegrino and a comprehensive Introduction by the editors. Of interest to medical ethicists as well as students, scholars, and physicians, _The Philosophy of Medicine Reborn_ offers fascinating insights into the emergence of a field and the work of one of its pioneers. “After a long period of dormancy, philosophy of medicine has blossomed with new life. The single most important physician-philosopher in that rebirth has been Edmund Pellegrino. His contributions to virtue theory, the concept of beneficence, the dispute over the internal and external sources of a morality for medicine, and the role of the Hippocratic tradition are all critical. The essays collected in this volume have changed the history of the philosophy of medicine. He shows that philosophy of medicine can be done with both passion and compassion.” —_Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University_ “Edmund Pellegrino's words have helped medical students, faculty, scholars and patients address the challenges they encounter in medicine and medical practice. His personal support has also been critical for many of us in developing programs in medical ethics and philosophy of medicine in our universities. Dr. Pellegrino combines the wisdom of a great physician with those of a great philosopher to produce a body of writing that will continue to inspire us all. This volume contains some of his best and most influential work.” —_Loretta Kopelman, The Brody School of Medicine, East Carolina University_ _ _ “Edmund Pellegrino has been a leading light in the philosophy of medicine for a generation. He was instrumental in the birth of bioethics, founded one of the leading journals, and provided able leadership in organizing early activities of the profession. He has served as department chairman, dean, and university president. Most recently, he chairs the President’s Council on Bioethics. In all this, first and foremost, he has been a physician. Those who are ill and suffering make a claim upon him. To respond to this claim, Pellegrino creatively brings together the worlds of science and of the humanities. For him, that is what medicine is about, making it the most scientific of the humanities and the most humane of the sciences. Fortunately for us, Pellegrino brings these worlds together in thought, as well as in practice. In this selection from his writings, Engelhardt and Jotterand have captured the heart of Pellegrino’s project, both in depth and breadth, so we can also hear that claim of the ill and so we can see what worlds must come together if we are to respond in the appropriate way.” —_George Khushf, University of South Carolina_ “Pellegrino’s work is both a treasure and important for understanding bioethics. His work in philosophy of medicine addresses the crucial questions that are so important to understanding the practice of medicine and the ethics of health care.” —_Kevin Wildes, President, Loyola University_ _ _. (shrink)

H. Tristram Engelhardt, Jr.; Generic Chaplaincy: Providing Spiritual Care in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

H. Tristram Engelhardt, Jr.; Controversies, Conflicts, and Consensus: A Concluding, Untheological Postscript, Christian bioethics: Non-Ecumenical Studies in Med.

Book reviewed in this article: Bioethics and Secular Humanism: The Search for a Common Morality. By H. Tristram Engelhardt, Jr.

The challenge in maintaining patient autonomy regarding medical decision-making and confidentiality lies not only in control over information transferred to and regarding patients, but in the ambiguity of autonomy itself. post-modernity is characterized by the recognition of not just numerous accounts of autonomy, but by the inability in a principled fashion to select one as canonical. Autonomy is understood as a good, a right-making condition, and an element of human flourishing. In each case, it can have a different content, depending (...) in part on whether it is given a nomological or a volitional construal. Different accounts of autonomy can lead to strikingly different understandings of appropriate behavior, including the argument that one ought on behalf of autonomy to liberate individuals from the sense of autonomy they themselves affirm. In the face of competing accounts of moral probity, autonomy in a secular morality and bioethics must by default be understood in terms of the permission of patients, which makes space for numerous moral accounts and different communal construals of free choice, which in turn will legitimate different practices of informing patients and maintaining confidentiality. (shrink)

H. Tristram Engelhardt, Jr.; The DeChristianization of Christian Health Care Institutions, or, How the Pursuit of Social Justice and Excellence can Obscure the.

Once God is no longer recognized as the ground and the enforcer of morality, the character and force of morality undergoes a significant change, a point made by G.E.M. Anscombe in her observation that without God the significance of morality is changed, as the word criminal would be changed if there were no criminal law and criminal courts. There is no longer in principle a God's-eye perspective from which one can envisage setting moral pluralism aside. In addition, it becomes impossible (...) to show that morality should always trump concerns of prudence, concerns for one's own non-moral interests and the interests of those to whom one is close. Immanuel Kant's attempt to maintain the unity of morality and the force of moral obligation by invoking the idea of God and the postulates of pure practical reason are explored and assessed. Hegel's reconstruction of the status of moral obligation is also examined, given his attempt to eschew Kant's thing-in-itself, as well as Kant's at least possible transcendent God. Severed from any metaphysical anchor, morality gains a contingent content from socio-historical context and its enforcement from the state. Hegel's disengagement from a transcendent God marks a watershed in the place of God in philosophical reflections regarding the status of moral obligations on the European continent. Anscombe is vindicated. Absent the presence of God, there is an important change in the force of moral obligation. (shrink)

H. Tristram Engelhardt, Jr.; Roman Catholic Social Teaching and Religious Hospital Identity in a Post-Christian Age, Christian bioethics: Non-Ecumenical Studies.

Contemporary Christians are separated by foundationally disparate understandings of Christianity itself. Christians do not share one theology, much less a common understanding of the significance of sin, suffering, disease, and death. These foundational disagreements not only stand as impediments to an intellectually defensible ecumenism, but they also form the underpinnings of major disputes in the culture wars, particularly as these are expressed in healthcare. There is not one Christian bioethics of sin, suffering, sickness, and death. In this article, the character (...) of the moral-theological visions separating the various Christianities and thus their bioethics is examined. Particular emphasis is placed on the differences that set contemporary Western theology at odds with the theology of the Christianity of the first millennium. As is shown, the ground for this gulf lies in the divide between traditional and post-traditional views of the appropriate role of philosophy in theology, a difference rooted in disparate understandings of the meaning of church and of the meaning of the logos, the Son of God. (shrink)

Given intractable secular moral pluralism, the force and significance of the four principles (autonomy, beneficence, non-maleficence, and justice) of Tom Beauchamp and James Childress must be critically re-considered. This essay examines the history of the articulation of these four principles of bioethics, showing why initially there was an illusion of a common morality that led many to hold that the principles could give guidance across cultures. But there is no one sense of the content or the theoretical justification of these (...) principles. In addition, a wide range of secular moral and bioethical choices has been demoralized into lifestyle choices; the force of the secular moral point of view has also been deflated, thus compounding moral pluralism. It is the political generation of the principles that provides a common morality in the sense of an established morality. The principles are best understood as embedded not in a common morality, sensu stricto, but in that morality that is established at law and public policy in a particular polity. Although moral pluralism is substantive and intractable at the level of moral content, in a particular polity a particular morality and a particular bioethics can be established, regarding which health care ethics consultants can be experts. Public morality and bioethics are at their roots a political reality. (shrink)

The mind-body relation or, more particularly, the mind-brain relation 1 has been a perennial puzzle for philosophers—how can things so different be intimately related? Husserl dealt with the mind-brain relation in Section 63 of Ideen II, “Psychophysischer Parallelismus and Wechselwirkung,” 2 where he gave a critique of psychophysical parallelism. For Husserl, the mind-brain relation is to be understood not as a material or metaphysical relation, but as a relation between the presented sense or significance of two varieties of appearances. Husserl’s (...) account in this section will be examined and the following points will be discussed: (1) Husserl’s argument that the significance of brain states is basic to the full sense of a mind operating in an objective world; (2) Husserl’s view that a strict parallelism between the psyche and brain is an eidetic impossibility; (3) Husserl’s treatment of these questions, in so far as he raises but does not adequately resolve the issue, whether states of consciousness precede or follow brain states; (4) Husserl’s somewhat Cartesian failure to distinguish the phenomenological priority of consciousness from the metaphysical question of the possibility of an existent mind apart from a body. (shrink)

H. Tristram Engelhardt, Jr.; Can Philosophy Save Christianity? Are the Roots of the Foundations of Christian Bioethics Ecumenical? Reflections on the Nature of.

Physician-assisted suicide offers a moral and theological Rorschach test. Foundational commitments regarding morality and theology are disclosed by how the issue is perceived and by what moral problems it is seen to present. One of the cardinal differences disclosed is that between Western and Orthodox Christian approaches to theology in general, and the theology of dying and suicide in particular. Confrontation with the issue of suicide is likely to bring further doctrinal development in many of the Western Christian religions, so (...) as to be able to accept physician-assisted suicide and euthanasia. (shrink)

H. Tristram Engelhardt, Jr., Joseph Boyle, John Peppin, David Solomon; Christian Bioethics, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Vol.

Of all the moral concerns regarding privacy in its various meanings, this essay selects only one: the right to be left alone by others, in particular, by government. Because moral controversies in pluralist societies tend to be interminable, and surely controversies regarding privacy are no exception, I approach the right to privacy in terms of the centrality of persons. When there are foundational disputes about which content-full moral view should govern, it is not possible to resolve such controversies without begging (...) the question or conceding at the outset crucial moral premises. This observation is not to affirm a moral skepticism or relativism. At worst, it involves an epistemic skepticism, a skepticism about the possibility of resolving controversies by sound rational argument without begging the question or engaging in an infinite regress. (shrink)

H. Tristram Engelhardt, Jr.; Discerning the Signs of the Times: Recognizing the Dangers of Reckless Social Justice and Advocating With Responsibility, Christian.

The prospect of germ-line genetic engineering, the ability to engineer genetic changes that can be passed on to subsequent generations, raises a wide range of moral and public policy questions. One of the most provocative questions is, simply put: Are there moral reasons that can be articulated in general secular terms for accepting human nature as we find it? Or, at least in terms of general secular moral restraints, may we reshape human nature better to meet our own interests, as (...) we define them? This question in turn raises the further question of whether human nature as it now exists has a moral standing akin to sacredness that can be understood in nonreligious terms. This essay will take as a given that it is not possible to show in general secular moral terms that human nature has a sanctity or special moral standing that should guide secular health-care policy. In addition, as this essay shows, it is not possible through appeals to considerations of authorizing consent or beneficence toward others to remedy this failure to establish a sanctity or special moral standing for human nature. Absent a religious or culturally normative understanding of human nature and given the availability of germline genetic engineering, there is a plurality of possibilities for refashioning our nature. The unavailability of substantive secular moral constraints on germ-line genetic engineering discloses a secularly licit plurality of possibilities for human nature. The likelihood that we will be able to refashion our human nature reveals how few general secular moral constraints there are to guide us. Paradoxically, the more we are able to reengineer our human nature, the less guidance is available. The plurality of possible conceptions of human well-being that can be pursued through germ-line genetic engineering challenges our self-understanding as humans. Given human freedom, and in the absence of taken-for-granted religious or cultural moral constraints, the likelihood of germ-line genetic engineering opens the possibility of human nature in the plural. (shrink)

The American Society for Bioethics and the Humanities (ASBH) issued its Core Competencies for Health Care Ethics Consultation just as it is becoming ever clearer that secular ethics is intractably plural and without foundations in any reality that is not a social–historical construction (ASBH Core Competencies for Health Care Ethics Consultation , 2nd edn. American Society for Bioethics and Humanities, Glenview, IL, 2011 ). Core Competencies fails to recognize that the ethics of health care ethics consultants is not ethics in (...) the usual sense of a morally canonical ethics. Its ethics is the ethics established at law and in enforceable health care public policy in a particular jurisdiction. Its normativity is a legal normativity, so that the wrongness of violating this ethics is simply the legal penalties involved and the likelihood of their being imposed. That the ethics of ethics consultation is that ethics legally established accounts for the circumstance that the major role of hospital ethics consultants is as quasi-lawyers giving legal advice, aiding in risk management, and engaging in mediation. It also indicates why this collage of roles has succeeded so well. This article shows how moral philosophy as it was reborn in the 13th century West led to the ethics of modernity and then finally to the ethics of hospital ethics consultation. It provides a brief history of the emergence of an ethics that is after morality. Against this background, the significance of Core Competencies must be critically reconsidered. (shrink)

H. Tristram Engelhardt, Jr.; Medicine, Philosophy, and Theology: Christian Bioethics Reconsidered, Christian bioethics: Non-Ecumenical Studies in Medical Morali.

Bioethics is not merely a theoretical discipline but a practice as well. Indeed, bioethics is a sort of moral trade. Bioethicists serve on ethics committees, give expert testimony to courts, provide guidance for healthcare policy, and receive payment for these services. The difficulty is that their role as experts able to guide clinical choice and public policy formation is brought into question by the diversity of moral understandings regarding central moral issues at the heart of the culture wars in healthcare. (...) The disconfirmation of the expert role of bioethicists by their apparent actual role as partisans of particular moral schools and perspectives could be set aside, were there an avenue to moral consensus, a door to a common moral vision to guide this new profession of moral experts. This brief article addresses the hunger for consensus in bioethics, its impossibility with respect to the controversial issues that mark the field, and the inclination nevertheless to deny this manifest diversity by appeals to a consensus that could allow bioethicists to function as ethics experts able substantively to guide clinical choices and public policy. (shrink)

The legal basis of informed consent in Texas may on first examination suggest an unqualified affirmation of persons as the source of authority over themselves. This view of individuals in the practice of informed consent tends to present persons outside of any social context in general and outside of their families in particular. The actual functioning of law and medical practice in Texas, however, is far more complex. This study begins with a brief overview of the roots of Texas law (...) and public policy regarding informed consent. This surface account is then contrasted with examples drawn from the actual functioning of Texas law: Texas legislation regarding out-of-hospital do-not-resuscitate (DNR) orders. As a default approach to medical decision-making when patients lose decisional capacity and have failed to appoint a formal proxy or establish their wishes, this law establishes a defeasible presumption in favor of what the law characterizes as “qualified relatives” who can function as decision-makers for those terminal family members who lose decisional capacity. The study shows how, in the face of a general affirmation of the autonomy of individuals as if they were morally and socially isolated agents, space is nevertheless made for families to choose on behalf of their own members. The result is a multi-tier public morality, one affirming individuals as morally authoritative and the other recognizing the decisional standing of families. (shrink)

This essay is meant as a form of philosophical exorcism. The goal is to dispel the view that there are general secular grounds for holding human germline genetic engineering to be intrinsically wrong, a malum in se, or a morally culpable violation of human nature. The essay endorses the view that major obligations of prudence and care attend the development of this technology. However, these justifiable moral concerns can be seen more clearly when one has dispelled what must, from a (...) secular perspective, be regarded as pseudo-issues. (shrink)

The contemporary societies of the West are characterized by a collision of radically incommensurable cultures, that of traditional Christianity and that of the robustly laicist cultures that took shape in the nineteenth and twentieth centuries, drawing not only on the French Revolution and the Western European Enlightenment but also on deep roots in the synthesis of faith and reason that framed the thirteenth-century Western Christian Middle ages. This article explores the foundational contrast and conflict between traditional Christian bioethics and the (...) now-dominant secular culture through a portrayal of the historical and conceptual geography of the collapse of the Christendom established by St. Constantine the Great, Equal-to-the-Apostles, and on account of the emergence of secular fundamentalist states. The question is addressed anew as to what Athens can have to do with Jerusalem, as well as to what the Academy can have to do with the Church. The differences between a traditional Christian bioethics and a secular bioethics are illustrated in terms of questions bearing on the use of life-prolonging and death-postponing treatment. (shrink)

A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in (...) tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls’s original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy. (shrink)

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God’s existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense of specifically Christian bioethical (...) norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics. (shrink)

An authentic Christian bioethical account of abortion must take into consideration the conflicting epistemologies that separate Christian moral theology from secular moral philosophy. Moral epistemologies directed to the issue of abortion that fail to appreciate the orientation of morality to God will also fail adequately to appreciate the moral issues at stake. Christian accounts of the bioethics of abortion that reduce moral-theological considerations to moral-philosophical considerations will not only fail to appreciate fully the offense of abortion, but morally mislead. This (...) article locates the bioethics of abortion within the theology of the Church of the first millennium, emphasizing that abortion was prohibited, whether or not one considered the embryo or fetus to be ensouled. (shrink)

Just as the physics of Newton and Einstein are separated by foundationally different paradigms, so that key terms such as time, space, mass, and energy have different meanings in the different physics, this is also the case with respect to the various Christianities. Given different theological frameworks, the ‘same term’ can have different extensions and intensions. This essay explores the implications of the differences in the theological paradigm shaping Orthodox Christianity in contrast to Western Christianity, in particular Roman Catholicism, with (...) a special focus on the differences in the communities’ appreciation of the wrongness of abortion. Using the example of abortion, the contrast between Orthodox Christianity’s noetically grounded approach to moral-theological issues and that which developed in the West and gave centrality to a philosophically shaped moral theology is explored. (shrink)

H. Tristram Engelhardt, Jr.; Medicine and the Biomedical Sciences After God: Do Right-Worshipping Christians Know More Than Others About the Content of Morality.

Engelhardt invites readers to understand what it means to live in a world after God, where questions of sin and virtue have been replaced with life-and-death-style choices. After God provides a dark prophetic vision. But there is still hope. As Engelhardt argues, In this culture, children now grow up apart from and defended against a recognition of the God Who lives. They are nurtured in a social fabric that is structured so as to avoid a recognition of, much (...) less an encounter with, God. Nevertheless... a traditional Christianity has endured, even though its morality and bioethics have become ever more strongly counter-cultural. The source of this traditional Christian otherness over against the surrounding post-theistic culture lies in the origins of Christianity itself, in the Christianity of the Apostles and the Fathers, namely, in Orthodox Christianity. Against the tenor of the times, disregarding the animus to set traditional Christianity aside, and despite heretics prominent within its fold, Orthodox Christianity remains a light in a world after God. --! From back cover. (shrink)

Orthodox Christian theology gives philosophy the same role it played in the Church of the first half-millennium. This article distinguishes among nine senses of philosophy and four senses of theology in order to highlight the characteristic features of Orthodox Christian theology’s use of philosophy and philosophical reasoning. It shows why, given the metaphysics and epistemology of Orthodox Christian theology (e.g., God is recognized as fully transcendent, such thatthere is no analogia entis between created and Uncreated Being, with the result that (...) the experience of the encounter with God can only be recounted apophatically) and its sociology of knowledge (e.g., theology in the strict sense occurs primarily in monasteries, not in the academy), philosophy is regarded as not able to contribute to the development of old doctrines or the fashioning of new doctrines, but only to the clarification of doctrinal statements. As a consequence, Orthodox Christian theology has been committed to severely confining philosophy’s role in theology. (shrink)

H. Tristram Engelhardt, Jr.; Conflicting Moralities and Theologies: The Culture Wars in Bioethics Reexamined, Christian bioethics: Non-Ecumenical Studies in Med.

The philosophy of medicine cum bioethics has become the socially recognized source for moral and epistemic direction in health-care decision-making. Over the last three decades, this field has been accepted politically as an authorized source of guidance for policy and law. The field's political actors have included the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the Department of Health, Education, and Welfare, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical (...) and Behavioral Research , the National Bioethics Advisory Commission, and the new Council on Bioethics; these groups and agencies have set forth rules on issues ranging from the role of humans in biomedical research to the production of human embryos for research, the definition of death, and the permissibility of human cloning. The members of the field are not just scholars and teachers in an academic realm directed to both theoretical and applied issues. They are, in addition, practitioners of a conceptual and moral trade that possesses a legal and political standing. This essay critically addresses the sudden emergence of bioethics as a societally recognized source of moral guidance, a source replete with authorized moral experts. Attention is directed to moral and conceptual assumptions that have led the philosophy of medicine, and especially bioethics, to acquire a quasi-juridical/political role in guiding clinical choices, framing health-care policy, and directing court holdings. (shrink)

H. Tristram Engelhardt, Jr.; Bioethics after the Enlightenment, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 8, Issue 3, 1 January 20.

The author argues that to think theologically about genetic enhancement is to think prayerfully about how to locate all one’s uses of medicine, recognizing that they must all be lodged in the Christian struggle to holiness. He is critical of the essays in this issue because they often appear to take on a scholastic life of their own outside of the all-consuming struggle to salvation of Christians across the millennia.