It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and not do under (...) such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word to suffer ) is a person who seeks the healing (meaning to make whole ) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life. (shrink)

The report of the President's Council on Bioethics, Human Cloning and Human Dignity, addresses the central ethical, political, and policy issue in human embryonic stem cell research: the moral status of extracorporeal human embryos. The Council members were in sharp disagreement on this issue and essentially failed to adequately engage and respectfully acknowledge each others' deepest moral concerns, despite their stated commitment to do so. This essay provides a detailed critique of the two extreme views on the Council (i.e., embryos (...) have full moral status or they have none at all) and then gives theoretical grounding for our judgment about the intermediate moral status of embryos. It also supplies an account of how to address profound moral disagreements in the public arena, especially by way of constructing a middle ground that deliberately pays sincere respect to the views of those with whom it has deep disagreements. (shrink)

I propose, develop and defend the view that theories of meaning — for instance, a theory specifying the logical form or truth conditions of natural language sentences — should be naturalized to scientific psychological inquiry. This involves both psychologism — the claim that semantics characterizes psychological states — and scientific naturalism — the claim that semantics will depend on the data and theories of scientific psychology. I argue that scientific psychologism is more plausible than the traditional alternative, the view that (...) a theory of meaning is a priori. After defending scientific psychologism against several objections, I offer a speculative proposal that shows how a theory of meaning can be integrated into scientific psychology. (shrink)

Howard Brody expresses concern that citing the “two cases that put futility on the map,” namely Helga Wanglie and Baby K, may be providing ammunition to the opponents of the concept of medical futility. He in fact joins well-known opponents of the concept of medical futility in arguing that it is one thing for the physician to say whether a particular intervention will promote an identified goal, quite another to say whether a goal is worth pursuing. In the latter instance, (...) physicians are laying themselves open “to the criticism of taking on basic value judgments that are more appropriately left to patients and their surrogates.” Brody states that in both the Wanglie and Baby K cases, the “basic value judgments” had to do with the worthiness of maintaining unconscious life via medical technology. He classifies this as “a question of professional integrity—but not a question of futility,” adding that “more than semantics hinges on this distinction.” The “more than semantics” factor is a pragmatic, even political one. Failure to make this distinction renders physicians “that much more suspect and less trustworthy in the public debate.”. (shrink)

Vedānta Deśika produced his monumental poetic biography of Kṛṣṇa in a time when Kṛṣṇa-centered devotionalism was expanding to become perhaps the dominant mode of bhakti across South Asia. Central to this phenomenon is the growing popularity of the Bhāgavatapurāṇa, and especially of its exploration of Kṛṣṇa’s erotic play with the gopīs in his youth. Troubled by the unrestrained and seemingly adharmic sexuality of Kṛṣṇa, Deśika used the literary techniques and narrative paradigms of the mahākāvya to assimilate but also domesticate this (...) increasingly important Bhāgavata episode: Kṛṣṇa’s eroticism remains central but confined within more conventional marital norms and is thus made dharmically and theologically acceptable. Once he has resolved these dharmic problems, however, Deśika is happy to explore the soteriological, devotional, and paradoxical dimensions of erotic love with Kṛṣṇa. (shrink)

The pharmacological literature on negative dream experiences is reviewed with respect to Revonsuo's threat rehearsal theory of dreaming. Moderate support for the theory is found, although much more work is needed. Significant questions that remain include the precise role of acetylcholine in the generation of negative dream experiences and dissociations between the pharmacology of waking fear and anxiety and threatening dreams. [Revonsuo].

The principle of double effect has a long history, from scholastic disputations about self-defense and scandal to current debates about terrorism, torture, euthanasia, and abortion. Despite being widely debated, the principle remains poorly understood. In Intention, Character, and Double Effect, Lawrence Masek combines theoretical and applied questions into a systematic defense of the principle that does not depend on appeals to authority or intuitions about cases. Masek argues that actions can be wrong because they corrupt the agent's character and (...) that one must consider the agent's perspective to determine which effects the agent intends. This defense of the principle clears up common confusions and overcomes critics' objections, including confusions about trolley and transplant cases and objections from neuroscience and moral psychology. This book will interest scholars and students in different fields of study, including moral philosophy, action theory, moral theology, and moral psychology. Its discussion of contemporary ethical issues and sparse use of technical jargon make it suitable for undergraduate and graduate courses in applied ethics. The appendix summarizes the main cases that have been used to illustrate or to criticize the principle of double effect. (shrink)

How is it that sounds from the mouth or marks on a page—which by themselves are nothing like things or events in the world—can be world-disclosive in an automatic manner? In this fascinating and important book, Lawrence J. Hatab presents a new vocabulary for Heidegger’s early phenomenology of being-in-the-world and applies it to the question of language. He takes language to be a mode of dwelling, in which there is an immediate, direct disclosure of meanings, and sketches an extensive (...) picture of proto-phenomenology, how it revises the posture of philosophy, and how this posture applies to the nature of language. Representational theories are not rejected but subordinated to a presentational account of immediate disclosure in concrete embodied life. The book critically addresses standard theories of language, such that typical questions in the philosophy of language are revised in a manner that avoids binary separations of language and world, speech and cognition, theory and practise, realism and idealism, internalism and externalism. (shrink)

This book explores what anyone interested in ethics can draw from Heidegger's thinking. Heidegger argues for the radical finitude of being. But finitude is not only an ontological matter; it is also located in ethical life. Moral matters are responses to finite limit-conditions, and ethics itself is finite in its modes of disclosure, appropriation, and performance. With Heidegger's help, Lawrence Hatab argues that ethics should be understood as the contingent engagement of basic practical questions, such as how should human (...) beings live? (shrink)

The placement of hydrogen in the periodic table has unique implications for fundamental questions of chemical behavior. Recent arguments in favor of placing hydrogen either separately at the top of the table or as a member of the carbon family are shown to have serious defects. A Coulombic model, in which all compounds of hydrogen are treated as hydrides, places hydrogen exclusively as the first member of the halogen family and forms the basis for reconsideration of fundamental concepts in bonding (...) and structures. The model provides excellent descriptive and predictive ability for structures and reactivities of a wide range of substances. (shrink)

Nietzsche's On the Genealogy of Morality is a forceful, perplexing, important book, radical in its own time and profoundly influential ever since. This introductory textbook offers a comprehensive, close reading of the entire work, with a section-by-section analysis that also aims to show how the Genealogy holds together as an integrated whole. The Genealogy is helpfully situated within Nietzsche's wider philosophy, and occasional interludes examine supplementary topics that further enhance the reader's understanding of the text. Two chapters examine how the (...) Genealogy relates to standard questions in moral and political philosophy. Written in a clear, accessible style, this book will appeal to students at every level coming to read the Genealogy for the first time, and a wider range of readers will also benefit from nuanced interpretations of controversial elements in Nietzsche's work. (shrink)

This book is a comprehensive exposition of the Transcendental Deduction of the Categories in both editions of Kant’s Critique of Pure Reason.

Two recent policy statements by providers of critical care representing the United States and Europe have rejected the concept and language of “medical futility,” on the ground that there is no universal consensus on a definition. They recommend using “potentially inappropriate” or “inappropriate” instead. As Bosslet and colleagues state: The term “potentially inappropriate” should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing (...) ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan... (shrink)

Abstract:Social contracting has a long and important place in the history of political philosophy (Hardin, 1991; Waldron, 1989) and as a theory of justice (Baynes, 1989; Rawls, 1971). More recently, it has been developed into an individual rights-based theory of organizations (Keeley, 1980, 1988), and as a way to integrate ethics and moral legitimacy into corporate strategy and action (Donaldson, 1982; Freeman&Gilbert, 1988). Currently, it is being proposed as an integrative theory of economic ethics (Donaldson&Dunfee, forthcoming). This paper will extend (...) the Donaldson and Dunfee approach by arguing thatsocial contracting can best be understood and applied in organizational settings if it is perceived and treated as a network governance process. This insight can benefit management scholars and practitioners alike, since it calls attention to the processes by which trust is created and sustained in on-going contractual relationships. It also strongly suggests that a new approach to applying managerial discretion, asmoral agency, is needed to realize the full competitive and ethical potential of emerging network forms. (shrink)

A few years ago a battered infant was admitted to a California hospital. After a period of observation and testing, the physicians concluded that the infant had been beaten so badly that his brain was almost completely destroyed, leaving him permanently unconscious. The hospital had just adopted a policy specifying that life-sustaining treatment for permanent unconsciousness was futile and, therefore, not indicated. According to this policy, after suitable subspecialty consultations and deliberations, including efforts to gain parental agreement and documentation of (...) unanimous ethics committee support, the patient's physician had the authority to discontinue life-sustaining treatment. The infant's physician wished to do this. The mother, however, who was the prime battery suspect, insisted that the baby be kept alive. (shrink)

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled (...) to at least a decent minimum level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of rudimentary decent minimum granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants. (shrink)

Examines the role of indeterminacy in 19th-century British art. Chronicles the irreconcilable tension between the visual and the verbal, beginning in 1806 with Wordsworth's questioning of the essential ground and companionableness of things, and concluding with Hardy's dramatization of the treacherous relationship between the word and the image. Writers revealed here, including Tennyson and Browning, rely in varying degrees on the pictorial to forge analogs as evidence of the kindredness of things. Annotation copyrighted by Book News, Inc., Portland, OR.

The writers in this symposium are drawn together under the topic of medicine — not to discuss any new discovery in the prevention or treatment of disease. Quite the contrary. We are drawn here to consider a phenomenon. We are here to consider whether a collective romantic fantasy called alternative medicine that has seized our society really deserves the acclaim it is receiving. This, for the most part, is what people like us do when we gather in symposia or meetings (...) to discuss alternative medicine. We argue about beliefs and claims, not results. Are the beliefs and claims of this collective romantic fantasy justified by empirical data? Or rather, will the beliefs and claims of this collective romantic fantasy be justified by empirical data because the fantasy is already securely in place in our political and fiscal, medical and educational, structures? (shrink)

The American Journal of Bioethics, Volume 11, Issue 10, Page W1-W3, October 2011.

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)

For two and a half millennia readers of Aristotle have been struggling to understand just what sort of causation is being attributed to the Prime Unmoved Mover or PM, whether final or efficient, assuming that this supreme being could not be a material cause or even a formal cause of the entire cosmos. Fred Miller entered into this still ongoing debate with a fresh proposal, drawing on an almost incidental remark in GC 1.6.323a25-33 that was later picked up by Philoponus (...) in his commentary on Aristotle’s text. The fundamental question is whether the PM’s causal role is to be restricted to a case of final causation or is there evidence for efficient causation as well? Just how ancient this question of interpretation is can be clearly shown by the following remarks made by Simplicius in the first half of the sixth century in his Neo-Platonist commentary on Phys VIII.6.267b17-26:Simplicius goes on to argue in some detail for this dual picture, primarily because of his harmonizing approach to Plato and Aristotle, but also by referencing some very specific passages in other works—notably Cael, GC, DM—but also Met, albeit only from its first book (1361.11-1363.24). He starts out here by claiming that “[n]o one disputes that Aristotle calls god or the primary mover a final cause” but realizes that showing that the PM is an efficient cause as well needs some textual support, which he dutifully attempts to provide. We will be going over some of the same ground cited here in trying to articulate Aristotle’s conception of divine causation and in particular to decide if Fred Miller’s thoughts about the “untouched toucher” will help us in the overall endeavor to explore Λ.6-10. Since he points out (at p. 278) that the PM could hardly be a material cause or even a formal cause, his framing the issue as to whether the mode of causation here is exclusively efficient or exclusively final, or, on the other hand, both at once, seems very close to how Simplicius set up the problem. Indeed, he cites the same section of Simplicius’s commentary quoted above and finds this ancient perplexity a good jumping off point for his own attempt to shed light on a fundamental issue of interpretation, noting that if we balk at the Neo-Platonic suggestion that Aristotle’s PM “is on a par with Plato’s demiurge,” the question becomes: “in what way is the prime mover supposed to be an efficient cause?” (p. 279). Miller’s novel suggestion is that one way of dealing with this question is the thought that the PM is an “untouched toucher.” It is crucial to his picture that this suggestion is strongly tied to the prospect of finding “a way in which the unmoved mover of the cosmos could be a genuine efficient cause” (p. 287) and not I believe, as W.D. Ross may have held, an efficient cause only by being a final cause. This will become important when we explore what untouched touching would be quite generally, given the emphasis on the psychological dynamics of this sort of affective action as suggested by the everyday examples provided by both Aristotle and Philoponus. (shrink)

Through his innovative study of language, noted Heidegger scholar Lawrence Hatab offers a proto-phenomenological account of the lived world, the “first” world of factical life, where pre-reflective, immediate disclosiveness precedes and makes possible representational models of language. Common distinctions between mind and world, fact and value, cognition and affect miss the meaning-laden dimension of embodied, practical existence, where language and life are a matter of “dwelling in speech.” In this second volume, Hatab supplements and fortifies his initial analysis by (...) offering a detailed treatment of child development and language acquisition, which exhibit a proto-phenomenological world in the making. He then takes up an in-depth study of the differences between oral and written language (particularly in the ancient Greek world) and how the history of alphabetic literacy shows why Western philosophy came to emphasize objective, representational models of cognition and language, which conceal and pass over the presentational domain of dwelling in speech. Such a study offers significant new angles on the nature of philosophy and language. (shrink)

D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation. The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost in (...) the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous. (shrink)