In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)

Modernism in the philosophy of science demands a unified story about what makes an inquiry scientific (or a successful science). Fine's "natural ontological attitude" (NOA) is "postmodern" in joining trust in local scientific practice with suspicion toward any global interpretation of science to legitimate or undercut that trust. I consider four readings of this combination of trust and suspicion and their consequences for the autonomy and cultural credibility of the sciences. Three readings take respectively Fine's trusting attitude, his emphasis upon (...) local practice, and his antiessentialism about science as most fundamental to NOA. A fourth, more adequate reading, prompted by recent feminist interpretations of science, offers less restrictive readings of both Fine's trust and his suspicion toward approaching science with "ready-made philosophical engines" (Fine 1986b, 177). (shrink)

Volume 20, Issue 3, March 2020, Page 44-46.

Joseph Margolis, known for his considerable contributions to the philosophy of art and aesthetics, pragmatism, and American philosophy, has focused primarily on the troublesome concepts of culture, history, language, agency, art, interpretation, and the human person or self. For Margolis, the signal problem has always been the same: how can we distinguish between physical nature and human culture? How do these realms relate? _The Cultural Space of the Arts and the Infelicities of Reductionism_ identifies a conceptual tendency that can (...) be drawn from the work of the twentieth century's best-known analytic philosophers of art: Arthur Danto, Richard Wollheim, Kendall Walton, Nelson Goodman, Monroe Beardsley, Noël Carroll, and Jerrold Levinson, among others. This trend threatens to impoverish our grasp and appreciation of the arts by failing to do justice to the culturally informed nature of the arts themselves. Through his analysis, Margolis sets out to retrieve an adequate picture of the essential differences between physical nature and human culture—particularly through language, history, meaning, significance, the emergence of the human self or person, and the essential features of human life—all to explain how such difference bears on our perception of paintings and literature. Clearly argued and provocatively engaging, Margolis's work reestablishes what is essential to a productive encounter with art. (shrink)

If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars’ engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. The tension between the (...) analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference—one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups’ differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (shrink)

Few issues in business ethics are as polarizing as the practice of risk classification and underwrit­ ing in the insurance industry. Theorists who approach the issue from a background in economics often start from the assumption that policy-holders should be charged a rate that reflects the ex­ pected loss that they bring to the insurance scheme. Yet theorists who approach the question from a background in philosophy or civil rights law often begin with a presumption against socalled “actuarially fair” premiums (...) and in favor of “community rating,” in which everyone is charged the same price. This paper begins by examining and rejecting the three primary argu­ ments that have been given to show that actuarially fair premiums are unjust. It then considers the two primary arguments that have been offered by those who wish to defend the practice of risk classification. These arguments overshoot their target, by requiring a “freedom to under­ write” that is much greater than the level of freedom enjoyed in most other commercial transac­ tions. The paper concludes by presenting a defense of a more limited right to underwrite, one that grants the legitimacy of the central principle of risk classification, but permits specific deviations from that ideal when other important social goods are at stake. (shrink)

Medical ethics has become an important and recognized component of physician training. There is one area, however, in which medical students receive little guidance. There is practically no discussion of the financial aspects of medical practice. My objective in this paper is to initiate a discussion about the moral dimension of physician billing practices. I argue that physicians should expand their conception of professional responsibility in order to recognize that their moral obligations toward patients include a commitment to honest and (...) forthright billing practices. I argue that physicians should aspire to a standard of clinical accuracy—not legal adequacy—in describing their activities. More generally, physicians should strive to promote an integrity-based professional culture, first and foremost by stigmatizing rather than celebrating creative billing practices, as well as condemning the misguided sense of solidarity that currently makes it taboo for physicians to criticize each other on this score. (shrink)

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...) an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post‐trial access as a means to achieve social reintegration through this neurotechnological accommodation. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)

The English polymath Joseph Priestley wrote on a wide range of scientific, theological and pedagogical subjects. After the appearance of his influential Rudiments of English Grammar and A Course of Lectures on the Theory of Language and Universal Grammar, both of which are reissued in this series, Priestley produced in 1765 his Essay on a Course of Liberal Education, which is included and expanded on in this 1778 publication. Here he explains the reasons behind his decision to guide the (...) curriculum at Warrington Academy towards a greater focus on subjects with a more direct application to 'civil and active life'. He offers more general instruction on the cultivation of young men in various spheres, notably through foreign travel and developing 'knowledge of the world'. Priestley ends by outlining a suggested course of lectures on the history and laws of England. (shrink)

Locke has been accused of endorsing a theory of kinds that is inconsistent with his theory of individuation. This purported inconsistency comes to the fore in Locke’s treatment of cases involving organisms and the masses of matter that constitute them, for example, the case of a mass constituting an oak tree. In this essay, I argue that this purported problem, known as ‘The Kinds Problem’, can be solved. The Kinds Problem depends on the faulty assumption that nominal essences include only (...) features observable at a time t. Once this assumption is rejected, new candidates open up for the relevant difference in the world that is included in the nominal essence of e.g. mass but not oak tree. And I argue that there is at least one good candidate for the extrinsic feature observable only over time in which the mass differs from the oak it constitutes, namely its persistence conditions. The Kinds Problem can be solved. (shrink)

Judea Pearl (2000) was the first to propose a definition of actual causation using causal models. A number of authors have suggested that an adequate account of actual causation must appeal not only to causal structure but also to considerations of normality. In Halpern and Hitchcock (2011), we offer a definition of actual causation using extended causal models, which include information about both causal structure and normality. Extended causal models are potentially very complex. In this study, we show how it (...) is possible to achieve a compact representation of extended causal models. (shrink)

The Tanner Lectures on Human Values, which honor the American scholar, industrialist, and philanthropist Obert Clark Tanner, are presented annually at each of nine universities in the United States and Great Britain. They were established at the University of California, Berkeley, beginning in the 2000/1 academic year. The Berkeley Tanner Lectures Series has been established in the belief that these distinguished lectures, together with the lively debates stimulated by their presentation in Berkeley, deserve to be made available to a wider (...) audience. The Practice of Value is an exploration of a pervasive but puzzling aspect of our world: value. At the core of the book are the Tanner Lectures delivered at Berkeley in 2001 by Joseph Raz, who has been one of the leading figures in moral and legal philosophy since the 1970s. His aim is to make sense of the dependence of value on social practice, without falling back on cultural relativism. In response, three eminent philosophers, Christine Korsgaard, Robert Pippin, and Bernard Williams, offer interestingly different approaches to the subject. The book begins with an introduction by Jay Wallace, setting the scene for what follows, and ends with a response from Raz to his commentators. The result is a fascinating debate, accessible to readers throughout and beyond philosophy, about the relations between human values and human life. (shrink)

Reviving the ancient political wisdom of St. Augustine in combination with insights drawn from contemporary political theorist John Rawls, Joseph Rivera grapples with the polarizing nature of religion in the public square. Political theology, as a discipline, tends to argue that communitarianism remains the only viable political option for religious practitioners in a complex, pluralist society. Unsurprisingly, we are increasingly accustomed to think the religious voice is anti-secular and illiberal. On the contrary, Christian theology and political liberalism, Rivera argues, (...) are not incompatible. Political Theology and Pluralism challenges the longstanding antithesis between theology and political liberalism by asking his readers to focus not on difference, but on our common humanity. Outlining real strategies for public dialogue in a liberal state, Rivera offers the opportunity to discover what it means to practice civic friendship in pluralist context. (shrink)

If ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler. —Wilder Penfield, M.D. Neuroethics is a recently coined term that is shaping our cultu...

The Problem of Virtue The shortest and surest way of making men happy is not to adorn their cities, nor even to enrich them, but to make them good. ...

Aeschylus' constant metrical practice shows that either Ag. 404/5 in the strophe, or 421/2, correspondingly in the antistrophe, is corrupt in the manuscript tradition..

The Johns Hopkins‐Fogarty African Bioethics Training Program (FABTP) has offered a fully‐funded, one‐year, non‐degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub‐Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our data (...) show that since 2001, the 28 former FABTP trainees have authored or co‐authored 105 new bioethics‐related publications; were awarded 33 bioethics‐related grants; played key roles on 78 bioethics‐related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post‐training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)