A significant portion of the practice of medicine is dependent on individual acts of medical altruism. Many of these acts, such as the donation of blood, gametes, stem cells, and organs, entail varying degrees of bodily intrusion and, for the altruist, various combinations of discomfort, risk, and expense. Discussion of the ethics of altruism has typically been fragmented under various rubrics such as blood donation, organ and tissue transplantation, health information, and the assisted reproductive technologies. The ethics of these specific (...) examples of altruism are best explored in conjunction with a broader discussion of their relatively neglected mother discipline, altruism in medicine.David Steinberg, M.D., is a board certified internist, hematologist, and oncologist. He is Chief of the Section of Medical Ethics at the Lahey Clinic Medical Center in Burlington, Massachusetts, and Clinical Assistant Professor of Medicine at the Harvard Medical School.FootnotesThis work was made possible by a grant in memory of Harold Karp by the Karp Family Foundation. (shrink)

(2002). Clinical Research Should Not Be Permitted to Escape the Ethical Orbit of Clinical Care. The American Journal of Bioethics: Vol. 2, No. 2, pp. 27-28.

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the (...) psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An "opting in" paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An "opting in" program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of "organ takers" who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who "opt in" would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An "opting in" paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an "opting in" paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an "opting in" policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

I would have preferred that the Special Section on Children as Organ Donors had focused on the donation of a specific organ because morally relevant differences are obscured when the subject is discussed in general terms. The donation of a lobe of liver and peripheral blood or bone marrow stem cells does not result in the permanent loss of vital tissue because these organs regenerate; however, a kidney does not regenerate and its donor loses a vital organ permanently. Liver tissue (...) and peripheral blood or bone marrow stem cells are typically required to save a life, but, because most patients with end-stage renal disease can be kept alive on dialysis, the donation of a kidney is rarely life saving. Also, donor risk is organ specific; for example, it is more dangerous to donate a lobe of liver than it is to donate peripheral blood or bone marrow stem cells. (shrink)

Almost 60,000 people in the United States with end stage renal disease are waiting for a kidney transplant. Because of the scarcity of organs from deceased donors live kidney donors have become a critical source of organs; in 2001, for the first time in recent decades, the number of live kidney donors exceeded the number of deceased donors. The paradigm used to justify putting live kidney donors at risk includes the low risk to the donor, the favorable risk-benefit ratio, the (...) psychological benefits to the donor, altruism, and autonomy coupled with informed consent; because each of these arguments is flawed we need to lessen our dependence on live kidney donors and increase the number of organs retrieved from deceased donors. An “opting in” paradigm would reward people who agree to donate their kidneys after they die with allocation preference should they need a kidney while they are alive. An “opting in” program should increase the number of kidneys available for transplantation and eliminate the morally troubling problem of “organ takers” who would accept a kidney if they needed one but have made no provision to be an organ donor themselves. People who “opt in” would preferentially get an organ should they need one at the minimal cost of donating their kidneys when they have no use for them; it is a form of organ insurance a rational person should find extremely attractive. An “opting in” paradigm would simulate the reciprocal altruism observed in nature that sociobiologists believe enhances group survival. Although the allocation of organs based on factors other than need might be morally troubling, an “opting in” paradigm compares favorably with other methods of obtaining more organs and accepting the status quo of extreme organ scarcity. Although an “opting in” policy would be based on enlightened self-interest, by demonstrating the utilitarian value of mutual assistance, it would promote the attitude that self-interest sometimes requires the perception that we are all part of a common humanity. (shrink)

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines (...) are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other. (shrink)

An important motivation for believing in the modal realist’s ontology of other concrete possible worlds and their inhabitants is its theoretical utility, centrally the reduction of ordinary modal talk to counterpart theory as showcased by David Lewis’s 1968 translation scheme. In a recent paper Harold Noonan, following the lead of John Divers, argues that Lewis’s scheme is not strictly adequate by the modal realist’s own lights, and that nothing short of jettisoning de dicto contingency will help. In this paper, (...) I argue that this is a serious overreaction. First, I show that Noonan’s problem does not touch Lewis’s proposal, since his translation scheme is not even concerned with the relevant sentences. Thus, Noonan’s problem only points to a limit in scope. I then go on to propose a straightforward extension of the translation scheme that provides translations for the allegedly problematic sentences, but does so endangering neither adequacy nor de dicto contingency. (shrink)

The effects of environmental degradation and climate change are propelling a discourse shift towards regenerative agriculture, yet understanding motivations for implementing regenerative practices on private agricultural lands is still a challenge. We study that challenge within the realm of regenerative ranching, a subcategory of regenerative agriculture. By examining the frequency of values articulated by respondents, a valuation typology stemming from 24 semi-structured interviews with ranchers in Montana, North Dakota, and South Dakota is revealed. Instrumental valuations dominated in the studied region (...) in connection to regenerative ranching practices, although some respondents articulated relational and intrinsic valuations tied to their practices. While this study focuses on regenerative ranching, we posit that a better understanding of the interplay between diverse valuations as they relate to private land management practices is vital to promoting more resilient and thoughtful ecosystem governance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reply to My CommentatorsDavid CarrierI am immensely thankful to Rika Burnham and Elliott Kai-Kee, Enrique Martínez Celaya, Klaus Ottmann, and Sean Ulmer for their comments on my book. And to Daniel A. Siedell for organizing this mini-symposium, which really is an author's dream. By gently pressing me to think about important issues, these sympathetic commentators have advanced dialogue.When writing Museum Skepticism I became very aware that there are two (...) kinds of literature that discuss museums. There are memoirs of curators or other museum employees, and there are the commentaries by academics, which usually look at museums from the outside. My ambition was to look at this institution in a way that would both be sympathetic to the practical concerns and embody a theoretical point of view. One otherwise sympathetic reviewer complained that I was only looking at the museum from the outside.1 That certainly is correct, but for obvious reasons people who work in museums are unusually unwilling to describe their inner workings. To have a good theory of the museum, you need to be practical. Often, for example, critics complain about the proliferation of shops and restaurants, urge that admission be free, or say that blockbuster shows are destructive and overcrowded. However one judges such moralizing, the museum director who needs to balance the budget can hardly be guided by such reasoning. One can be critical, as I am, about the power of the super-rich in museum life. But in what other way could funding be found? The history of debates about the National Endowment for the Arts (NEA) points to obvious ways in which, in America at least, reliance on public funding poses problems. My goal, then, was to develop a realistic analysis.Sean Ulmer correctly notes that to understand the art in museums, we must consider its prior history. Chinese paintings, Islamic decorations, Maori sculpture, and premodern European art were not made to be displayed in public galleries. And so there are legitimate questions about how to set it alongside modernist art, whose natural home is the art museum. Allowing this much, I am not sure why he thinks it impossible to describe museums in a single book. We need to understand how artifacts with such varied origins can be coherently displayed in one building. Here, then, we get to Ulmer's second concern—museum displays. Recently museums have experimented with thematic displays. The Museum of Modern Art in New York did that before its recent reconstruction; the Tate Modern has such a system; and during summer 2006 the Whitney tried such a plan. I understand the need of museums to experiment, to find new ways to attract visitors to the permanent collection. Still, a straight chronological display has the obvious advantage of presenting that history of art in which, for example, Impressionism leads to Cubism, and then on to Abstract Expressionism. The obvious danger of thematic displays is that they bewilder the larger public. [End Page 22]When I said that museums are top-down institutions, I was thinking of the grander public museums where the function of the trustees is to raise money, either by giving themselves or by networking. These people who provide funding no doubt have their own agendas, but they, in turn, respond to larger economic and political concerns. I would be astonished if the Metropolitan Museum of Art asked Arthur Danto or Leo Steinberg to be a trustee; or, to look closer at hand, if the Carnegie Museum of Art or the Cleveland Museum of Art asked me to play that role. Since we are mere professors, what practical help could we provide? I expect that at smaller museums the situation is different. But here, again, it is important to be realistic. Cleveland's art historians have not had any influence on the rebuilding plan for the Cleveland Museum of Art. Of course I would be flattered if the new director asked for my opinion, but to be honest, I am not sure that I could tell him anything useful. When Ulmer discusses the comparative role of permanent collections and temporary exhibitions, he touches on a very important point. Like him, I... (shrink)

"Most of the papers in this volume (all except for those by Steinberg, Haase, and Street) were presented at a conference...at Ryerson University in October of 2010."--p. xvii.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 350-353 [Access article in PDF] Book Review The Ways of Naysaying: No, Not, Nothing, and Nonbeing, The Ways of Naysaying: No, Not, Nothing, and Nonbeing, by Eva T. H. Brann; xviii & 249 pp. Lanham, Md.: Rowman & Littlefield Publishers, 2001, $35.00. This, the third of Eva Brann's trilogy on imagination, time, and naysaying respectively, is described by one of her colleagues as her (...) "cradle-to-grave book" (p. xvi). The word "naysaying" plays felicitously on the sound of the English word "nay" and the cognate Indo-European root "ne," which gives Brann a convenient starting-point for discerning what various forms of naysaying have in common. Note that this is saying rather than thinking, being, or doing, although the relations among these acts are a recurring concern in her discussion. Unlike some "postmoderns," Brann does not regard language as a self-contained arena with no reference outside of itself. Rather, for her, language is a convenient medium for thinking about what is extralinguistic, whether in the mind or elsewhere.Nor does she think that a word must necessarily have some underlying unity beneath its various meanings. In fact, heeding Wittgenstein's warning, she admits that "it is a pathologically bad craving to want a word to have one ultimate meaning, worse to look for one meaning over many words, and worst to assume that such a meaning may apply to a something beyond the realm of language." Nevertheless, she suggests, "this craving to look for one truth behind many appearances may be simply irradicable, being nothing less than the philosophical impulse" (p. xiv).Where does her "philosophical impulse" focus, on texts or on things? She explicitly tells us that texts are indispensable (at least for her) to get very far with the things themselves (p. 2). And so, in the course of her investigation, she attends to Parmenides, Plato, Aristotle, Anselm, Kant, Fichte, Hegel, Bergson, Frege, Meinong, Russell, Whitehead, Dewey, Heidegger, and Wittgenstein, among others. Nonetheless, she begins by noticing a sort of willful denial that is pre-linguistic and "speechless" (the contrariness of an infant), and she ends with the nothingness that is void of all language and everything else. These two topics, expressed by the words "No" (Chapter One) and "Nothing" (Chapter Six) respectively, "frame" her inquiry (p. 42). Along the way she always has an eye to what lies behind or beyond language, in the world or in the mind, with a chapter each for "Not," "Nonexistence," "Nonbeing," and "Negativity." She [End Page 350] says that Chapter Four, concerning "Nonbeing," is the center and philosophic focus of her study. Brann's chapters thus represent the six big divisions for organizing her observations. Indeed, for Brann, the plurality of naysayings "seems to fall naturally" into her sixfold division (p. xiv).Thoughtfully pondering this structure takes the reader a long way toward understanding the work (in both senses of "work": the thought itself and the text which records that thought). The chapter divisions progress from the willful, through the logical, the imaginative, the philosophic, and the dialectical, to end, as we noted, in the absolute Nothing, the "antagonist of Being." For instance, the distinction between the first two--the willful and the logical--is the distinction between the personal (denial) and the impersonal (negation). In considering willful denial, Brann understands the will to be a "willingness, inclination, readiness"--usually "determinate," "focused and active" (p. 7). Likewise, negation also has a personal origin: "Negation arises from the human desire and ability to make distinctions; it is (most likely) grounded in the opposition and polarities that belong to beings (of which the first... is surely that of thinking itself to its object, be it ideal or real)" (p. 29f.). Thus, although logical negation seems to originate in the personal subject there is something quite detachable and impersonal about logical formulations, so that Heraclitus "bids people hear his truth 'not listening to me but to the logos,' the cosmic collecting and distinguishing power" (p. 128). So the logos that begins for us as "reason manifested in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:CATHOLICISM, PUBLIC THEOLOGY, AND POSTMODERNITY: ON RICHARD JOHN NEUHAUS'S " CATHOLIC MOMENT" DAVID L. SCHINDLER University of Notre Dame HAT CATHOLICS should assume.their rightful place m the task of forming a culture, and indeed shaping a public philosophy in and for a pluralistic, dernocrwtic society, is ia suggestion which has not often been heard in the history of American culture, and certainly not from. nonCatholics. It is a (...) suggestion thrut Richard John Neuhaus, a Lutheran pastor, nonetheless makes with eloquence and wit in The Catholic Moment.1 The book makes for enjoyable and even exciting reading. It is difficult for a Catholic, even of a non-itriumphalistic sort, nort rto be moved by his suggestion: not to be stimulated into rserious ~efl.ection upon the meaning of Catholic identity, particularly now in the pT"esent cultural situation in America and indeed the West, which seems-note the subtitle of Neuhaus's book-aptly described in terms of a modernity giving way to posrtmodernity, a modernility searching for genuinely postmodern patterns of thought. Neuhaus is insistent-and the insistence is refresb.ing-,that this reflection be carried through with integri,ty (cf., e.g., p. 150) : the Catholicism. for which our-a postmodern-culture [.g ripe is and must be ·a Caitholicisrn which is fiaithful to the Gospel and to tits own tradition. This double intention of Neuhaus to speak on behalf of a Catholicism which is in and for a postmodern world sets.the context for.the questions I wish to pose in the present inquiry. The meaning of Neuhaus's Catholic moment is twofold: 1 The Catholic Moment: The Parado11J of the Church in the Postmodern World, by Richard John Neuhaus (San Francisco: Harper & Row, 1987). All references in the text are to this book. 107 108 DAVID L. SCHINDLER [It] is the moment in which the Roman Catholic Church in the world can and should be the lead church in proclaiming and exemplifying the Gospel. This can and should also be the moment in which the Roman Catholic Church in the United States assumes its rightful role in the culture-forming task of constructing a religiously informed public philosophy for the American experiment in ordered liberty (p. 282). In.the light of this ~statement, and indeed of the overarching context md[ca;ted by the suhbitle of his book, I wish to direct attention in whait follows to three issues: what Neuhaus takes to be an authentic Catholic Christianity ·and Catholic Christian rtheology (tha;t is, a Christianity which iis f.aithful in" proc1aiming and exemplifyiing the Gospel ") ; what he takes to be the proper sense (the sense required by Ca.tholic Christianity) of the itask of forming ·a culture and " constructing a religiously informed public philosophy" in and for a plumlistic, democrrutic society such as that of America; and finally what he takes to be the ·appropriate sense of this fask in a world which he distinguishes as postmodern. Now Neuhaus develops his response to these issues in terms of wha;t he calls a paradoxical relation between the Church and the world. My purpose in what follows, therefore, will be to e:x;amine the meaning he accords " Catholic, " public," ·and "postmodern," m terms of this central notion of " paradox." I. In his discussion of the relation betwen rthe Church and the world, Neuhaus provides a sketch of the five types proposed by H. Richard Niebuhr (pp. 16ff.). These are: the Church against the world, the Church of the world, the Church above the world, the Church and the world in paradox, and the Church as the transformer of the wor1cl. The first, "the Church against the world," iis what is often identified as a sectarian model, evident for ex;ample in monasticism and in such communities ·as the Hutterites and Mennonites. The second type, " The Church of the world," can be exemplified in nmeitrenth century l.iberial theology 00:d its promotion of a THE CATHOLIC MOMENT 109 " cultural Protesitantism," wherein " rel[gion W18iS to be placed at the service of the besrt in the evolution of society" (p. 19). The model which views: the- Chur'Ch ia;s a transformer of the world "smacks... (shrink)

One dominant aspect of British Idealism of the late nineteenth century was its critical reaction to the central traditions of British philosophy from Hobbes to Mill; much of T. H. Green’s thought was cast against his criticism of the Lockean “way of ideas”; F. H. Bradley challenged key doctrines in Mill’s logic and the theory of the association of ideas as developed by Hume, Mill, and Hartley; Bernard Bosanquet’s political philosophy raised objections to the forms of liberal individualism found in (...) Bentham, Mill, and Spencer; and all three were critical of utilitarianism. In advancing their criticisms, they brought to bear the insights of other traditions they had encountered in their studies at Oxford: the ancient philosophies of Plato and Aristotle and the German idealism which had been gradually arriving from the continent. The extent to which they forged new positions from these sources varied. While Bradley’s thought was more eclectic and independent, Green’s thinking was always dominated by Kant and Bosanquet’s by Hegel. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:AQUINAS ON THE IMMATERIALITY OF THE INTELLECT DAVID RUEL FOSTER Seton Hall University South Orange, New Jersey I. A Controversial Question? HE QUESTION of the immateriailiity of the intelloot s,an important part of the wider question about the nau11e of the soul. The axgiumen'ts for the immaiteriality of rthe intellect a11e particularly important to Thomas's thought because they undergil1d his argument for the incorruptibility of the soul; the (...) incorruptibiility of the soul, in turn, leads towards the dootrine of the immortaility of the soruJ, a tenet of faith which Thoma.s wants to explain and deifend.1 This article will present Thomas's two most prominent arguments for the immateriality of the intieliteot and critique the first iin light of rthe seoond.2 Whether,the principle of int~Uectual ilife must, by the very 1.Arguments for the immateriality of the intellect do not necessarily appear in articles on the incorruptibility of the soul but are always presupposed by them in Thomas. For example, in Summa theologiae I, q. 75, a. 6, "Whether the human soul is incorruptible?" (" Utrum anima humana sit corruptibilis "), Thomas supports the crucial premise in his argument by referring to the,arguments for the immateriality of the intellect in articles 2 and 5 (" Utrum anima humana sit aliquid subsistens? "; "Utrum anima sit composita ex materia et forma?" Summa theologiae I, q. 75, aa. 2 and 5). 2 Five important instances of the arguments are as follows: In Sententias II, d. 19, q. 1, a. l; Summa contra gentiles II, chapters 49-50; Summa theologiae I, q. 75, aa. 2 and 5; Quaestiones Dis-putatae De anima a. 14; Oompendium theologiae, De fide, chapters 79 and 84. This chronological ordering is based on Weisheipl's catalogue in Friar Thomas D'A.quino, pp. 355-406; and Eschmann's, A Catalogue of St. Thomas's Work, in Gilson's, The Christian Philosophy of St. Thomas Aquinas, pp. 381-439. The dating of the Compendium theologiae is the most problematic. 415 416 DAVID RUEL FOSTER natUJ.1e of its.act, be immaterial is a particularly controrverted question today. Many corutempo~ary thinkers helie¥e that human understanding can be ex:pfained in strictly physical terms. ':Chis was not the case in Thomas's day, and it is important to takie notre of this. Thomas W1as noit foroed by any opponent to sharpen his arguments for the imma.teriality of the inteHect. The major Islamic philosophers, ailithough they disagreed among themselves about aspects of the inbe1iJiect's nature (e.g., the plaice and ro[e of the agent intellect)' md agree thait the intellectual soul was immaterial. Plato and Aristotle, according.to Thomas, agreed on this f.undamental point. In fact, although there were post-Socratic materialists,3 Thoma;s usuru1Jy goes ha;ek to the Pre-Socratics in order rto give an example of someone who taJUght that the inte!IJiectual :act. depends entirely on physicrul principles. Perhaps it is better to s1ay that, because the doctrine of runiversal hylomorphism was so widely accepted in his time, Thomas was not challenged regarding the incorporeality of the intellect. Many of Thoma:s's contemporaries, foililowing the tewching of Awoobroin, held that the intellectuaJ. souil was composed of spiritua.l matter.and the appropriate form,4 hut this was not in opposition to Thomas's arguments for the immateriality of the intellect. II. The Two Most Prominent Arguments A. Type I The first argument (hereaf·ter caUed Type 1) proceeds from the intellect's potential to know all corporeal things. It is justifiably described as Thomas's preferred argument,5 for s For example, the Epicureans. 4 J. Weisheipl, "Albertus Magnus and Universal Hylomorphism: Avicebron," in Albert the priam rationem formalem, which is :to grasp the essence of the obj,oot. Then Thom!lis draws his conclusion " therefore,... the inte!llecrbuaJ soul itse[f is an absolute form." The conclusion that the irntellect's mode of being is immaterial, a " form without matter," follows from the premises: majorr premise, the objeclt is,in the knower in an ahso1uite way, i.e., without matter; minor premise, the object is received in the knower.ruooording to rthe mode of he... (shrink)

Advance directives are useful ways to express one's wishes about end of life care, but even now most people have not completed one of the documents. David Doukas and William Reichel strongly encourage planning for end of life care. Although Planning for Uncertainty is at times fairly abstract for the general reader, it does provide useful background and practical steps.