The purpose of this paper is to identify a kind of discrimination that has hitherto gone unrecognised. ‘Terminalism’ is discrimination against the dying, or treating the terminally ill worse than they would expect to be treated if they were not dying. I provide four examples from healthcare settings of this kind of discrimination: hospice eligibility requirements, allocation protocols for scarce medical resources, right to try laws and right to die laws. I conclude by offering some reflections on why discrimination against (...) the dying has been hard to identify, how it differs from ageism and ableism, and its significance for end-of-life care. (shrink)

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds. Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices. This paper (...) undertakes such a comparison. My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS. In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS. This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position. (shrink)

It is sometimes proposed that killing or harming abortion providers is the only logically consistent position available to opponents of abortion. Since lethal violence against morally responsible attackers is normally viewed as justified in order to defend innocent parties, pro-lifers should also think so in the case of the abortion doctor and so they should act to defend the unborn. In our paper, we defend the mainstream pro-life view against killing abortion doctors. We argue that the pro-life view can, in (...) various ways, reject the assumption that defensive violence to save innocent individuals is always permissible. Now even if that assumption is accepted, we contend that defensive violence against abortion doctors still is not justified. Drawing on Frances Kamm’s work, we contend that there are structural similarities between abortion and letting someone die who needs your help to stay alive; and we argue that it is impermissible to kill those who kill in order to avoid giving life-saving aid. (shrink)

The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are (...) no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal. (shrink)

How does Hume determine what qualities of the mind count as virtues and what qualities count as vices? By what standard, for example, does Hume dismiss the so-called “monkish virtues”? Hume’s commentators have proposed various possibilities for the standard of virtue, among them the general point of view and the usefulness/agreeableness of qualities. I consider the case for these standards and argue that Hume contends ultimately that consensus decides controversial questions about the status of virtues and vices. I try especially (...) to show that while the usefulness of any quality is not a means by which we can identify virtues or vices, it can be relevant to moral evaluations in so far as it influences what people tend to approve of. (shrink)

The volume documents, and makes an original contribution to, an astonishing period in twentieth-century philosophy—the progress of Arne Naess's ecophilosophy from its inception to the present. It includes Naess's most crucial polemics with leading thinkers, drawn from sources as diverse as scholarly articles, correspondence, TV interviews and unpublished exchanges. The book testifies to the skeptical and self-correcting aspects of Naess's vision, which has deepened and broadened to include third world and feminist perspectives. Philosophical Dialogues is an essential addition to the (...) literature on environmental philosophy. (shrink)

Seeing nature as ultimately separate from us rather than as apart of us is the source of a powerful environmental ethic. The work of Martin Buber, Rudolf Otto, and Peter Wessei Zapffe forms the conceptual framework for a view of nature as a Thou or a “Wholly Other,” a view which inspires awe for the nonhuman intrinsic value in nature. In contrast to the Self-realization approach of Naess and others, intrinsic value is here independent of the notion of a self. (...) This approach suggests an ethic of humility and respect for nonhuman nature-to the degree that the continued existence of humans should be considered an open question. (shrink)

There is a growing trend among some physicians, psychiatrists, bioethicists, and other mental health professionals not to treat physician-assisted suicide (PAS) as suicide. The grounds for doing so are that PAS fundamentally differs from other suicides. Perhaps most notably, in 2017 the American Association of Suicidology argued that PAS is distinct from the behavior that their organization seeks to prevent. This paper compares and contrasts suicide and PAS in order to see how much overlap there is. Contrary to the emerging (...) view that emphasizes their differences, I argue that there is significant overlap such that we ought not to separate PAS into its own category, making it diverge from how we think about and address suicide more generally. I start by examining several prominent theories of suicide and argue that PAS fits squarely within them. I then examine several apparent differences between PAS and other kinds of suicide and argue that these differences are merely apparent or they do not justify treating PAS as a fundamentally different kind of thing from suicide. (shrink)

In this article I argue that vanity, the desire for and delight in the favorable opinion of others, plays a fundamental role in Hume's account of moral motivation. Hume says that vanity and virtue are inseparable, though he does not explicitly say how or why this should be. I argue that Hume's account of sympathy can explain this alliance. In resting moral sentiment on sympathy, Hume gives a fundamental role to vanity as it becomes either a mediating motive to virtue (...) or else strengthens the otherwise weak motive of moral sentiment. (shrink)

Situationists contend that virtue ethics is empirically inadequate. However, it is my contention that there is much confusion over what “empirical adequacy” or “empirical inadequacy” actually means in this context. My aim in this paper is to clarify the meanings of empirical adequacy in order to see to what extent virtue ethics might fail to meet this standard. I argue that the situationists frequently misconstrue the empirical commitments of virtue ethics. More importantly, depending on what we mean by empirical adequacy, (...) either virtue ethics has no need to be empirically adequate or where it does have such a need, the psychological evidence fails to show that it is empirically inadequate. An additional contribution the paper intends to make is to provide a more detailed discussion of the explanatory nature of virtue ethics. (shrink)

"Wisdom in the Open Air" traces the Norwegian roots of the strain of thinking called "deep ecology" - the search for the solutions to environmental problems by examining the fundamental tenets of our culture. Although Arne Naess coined the term in the 1970s, the insights of deep ecology actually reflect a whole tradition of thought that can be seen in the history of Norwegian culture, from ancient mountain myths to the radical ecoactivism of today. Beginning with an introduction to Norway's (...) emphasis on nature and the wild, Reed and Rothenberg explore the birth of the environmental movement in the 1960s and 1970s. What follows is a collection of writings by prominent Norwegian thinkers on humanity and nature, most never before published in English. From Peter Wessel Zapffe, a twentieth-century Kierkegaardian figure, the list goes on to include Arne Naess, activist/critic/artist Sigmund Kvaloy, wilderness educator Nils Faarlund, novelist Finn Alnaes, sociologist Johan Galtung, and social reformer Erik Dammann. Their points of view offer thoughts on the significance of modern life and what it means to be human in the face of deteriorating environmental global trends of the 20th century. "Wisdom in the Open Air" asks and answers a fundamental question concerning the ecomovement: what is the role of deep, often abstract, thinking in the attempt to avert a very real ecological crisis? (shrink)

The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of the doctor–patient relationship. (...) I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide. (shrink)

The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary “double” effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing (...) view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

Essential to the doctrine of double effect is the idea that agents are prohibited from intending evil as a means to a good end. I argue in this paper that some recent accounts of intention from proponents of double effect cannot sustain this prohibition on harmful means. I outline two ways to gerrymander intention that mark these accounts. First, intention is construed in such a way that an agent intends only those states of affairs that she cares about or finds (...) motivating for their own sake. Second, intention is construed in such a way that what counts as intended is determined sufficiently by the agent’s beliefs. (shrink)

This article aims to deconstruct the concept of dignity in a way that is meaningful, in particular to nurses and other health workers who seek to promote the dignity of children in their care. Despite the emphasis in a variety of codes and policies to promote dignity, there is a lack of a clear definition of dignity in the literature. In particular there is little reference to dignity, theoretically or empirically, as it relates to children. Without clarity it is not (...) possible to act in an ethical way on behalf of children whose dignity could otherwise be compromised. The theoretical position taken has evolved from the medico-nursing and philosophical discourse concerning the nature of human dignity and more recent sociological texts that discuss the social construction of the child and childhood. The article is further influenced by additional insights derived from an ethnographic pilot study at a large district general hospital. This study was undertaken in an attempt to appreciate the subjective experience of dignity by children, and to begin to address the empirical gap in the literature and promote discussion. The concept of a macro and a micro dignity is discussed, together with the role of the nurse in articulating the relationship between the two. The importance of control and witnesses in the experience of dignity is discussed and, finally, also the ethical implications when seeking to promote the dignity of children. (shrink)

I appreciate all of the commentaries for their careful and thoughtful engagement with my article. Because of limited space, I can only focus on some criticisms and cannot develop my responses as fully as I would like. This is probably best for the reader anyway. John Keown worries about the ‘dualism’ of the third objection against expressivism. By this I think he means that critics of the expressivist argument at the beginning of life view a certain class of human beings (...) as ‘non-persons’ and therefore not worthy of protection (‘dualism’ thus refers to two classes of human beings). Obviously, a pro-life stance will take issue with classifying the unborn as non-persons, as defenders of selective abortion and other biotechnologies do, but I did not think it relevant to get into the weeds on this issue. Keown claims that the worrisome dualism views those with intellectual disabilities, whether ‘newborns or adults’, as non-persons who lack a right not to be killed. However, I do not think defenders of either selective abortion or assisted suicide are committed to this. Many would insist (whether they are justified in doing this is another matter) that once you are born, you are a person and therefore cannot …. (shrink)

Recent work at the intersection of moral philosophy and the philosophy of psychology has dealt mostly with Aristotelian virtue ethics. The dearth of scholarship that engages with Hume’s moral philosophy, however, is both noticeable and peculiar. Hume's Moral Philosophy and Contemporary Psychology demonstrates how Hume’s moral philosophy comports with recent work from the empirical sciences and moral psychology. It shows how contemporary work in virtue ethics has much stronger similarities to the metaphysically thin conception of human nature that Hume developed, (...) rather than the metaphysically thick conception of human nature that Aristotle espoused. It also reveals how contemporary work in moral motivation and moral epistemology has strong affinities with themes in Hume’s sympathetic sentimentalism. (shrink)

In this paper, I argue that the doctrine of double effect is disposed toward abuse. I try to identify two distinct sources of abuse of double effect: the conditions associated with standard formulations of double effect and the difficulty of fully understanding one’s own intentions in action. Both of these sources of abuse are exacerbated in complex circumstances, where double effect is most often employed. I raise this concern about abuse not as a criticism of double effect but rather as (...) a problem that defenders should observe and try to prevent. I go on to suggest certain methods for avoiding the abuse of double effect such as hesitating to use it, applying it only with other agents, and selectively and carefully propagating it. (shrink)

This paper attempts to give a complete and coherent account of how Hume’s moral psychology can explain the cultivation of moral character. I argue that the outcome of a fully formed moral character is an agent who strengthens her calm moral sentiments into settled principles of action. I then take up the question of how the process of strengthening moral sentiments might occur, rejecting the possibilities of sympathy, “reflection,” and “resolution” because either they are too weak or else they make (...) the passion violent, preventing the essential calm nature of moral sentiments. I next argue that custom and the non-moral motives of pride and the love of fame play the critical roles in character formation. Custom can be considered as both the process of education, whereby certain impressions are habitually and formally inculcated into us by educators, and the process of experience in society and conversation, whereby we learn to associate pleasure with the virtues and pain with the vices. In both these processes, Hume implicitly appeals to certain non-moral motives, especially pride and the love of fame, in order to launch the effects of custom. (shrink)

Hume says that sympathy is the source of our moral feeling of approval for useful qualities. But does Hume give the same psychological explanation of our approval of immediately agreeable qualities as he does to our approval of useful qualities? Does he trace our moral approbation of immediately agreeable qualities to sympathy? Some commentators, including Rachel Cohon and Don Garrett, argue that he does not. Let us call this view the ‘narrow view’ of sympathy in contrast to the ‘wide view’ (...) of sympathy, which holds that sympathy is required for every moral sentiment. There is indeed some apparent textual evidence in Hume’s work that seems to support the narrow view. My aim in this paper is to examine that evidence and show how it is merely apparent, in particular by showing how a number of passages can be and are misread. I thus want to argue indirectly for the wide view. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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Next SectionIt is commonly proposed that artifacts cannot be understood without reference to human intentions. This fact, I contend, has relevance to the use of artifacts in intentional action. I argue that because artifacts have intentions embedded into them antecedently, when we use artifacts we are sometimes compelled to intend descriptions of our actions that we might, for various reasons, be inclined to believe that we do not intend. I focus this argument to a specific set of artifacts, namely, medical (...) devices, before considering an extended application to emergency contraceptive devices. Although there is some debate about whether emergency contraception has an abortifacient effect, I argue that if there is an abortifacient effect, then the effect cannot normally be a side effect of one’s action. (shrink)

This paper examines and evaluates from a Christian perspective the common Christian presumption against pleasing people, which is roughly the idea that Christians should not be motivated by or delight in the favorable opinion of others. I argue that several ways of saving the idea that Christians can blamelessly care what others think about them are misguided or insufficient. I contend that the most important way to save this idea is by drawing attention to concern for the opinions of others (...) in the context of a social role. (shrink)

Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

Many commentators propose that Hume thinks that we are not or should not be motivated to perform naturally virtuous actions from moral sentiments if we want our actions to be genuinely virtuous. It is this proposal with which I take issue in this article, arguing that Hume fully incorporates the moral sentiments into his understanding of how human beings act when it comes to the natural virtues and that he does not see the moral sentiments as a problematic kind of (...) motivation that threatens or weakens the virtuous status of the action. (shrink)

The current paper provides an overview of treatment noncompliance at various points in the treatment pathway, especially with respect to treatment for Pelvic-floor Dysfunction. The effects of noncompliance on healthcare are considered, and examples of supporting patients psychologically to increase compliance are discussed. An outline of a method to identify costs of non-compliance, and where such costs most intensely impact the healthcare system, is provided. It is suggested that psychological support is effective in terms of increased compliance and improved healthcare (...) economics. The model is presented for PFD, but the principles developed can be generalised to many aspects of healthcare. (shrink)

This paper looks at the relation between scientific knowledge and normative pragmatics from the point of view of cosmological milieus that map out a sense of purposefulness, as argued by Bentley Allan. Cosmological consequences are drawn out in light of the model of the Stack, as postulated by Benjamin Bratton, through the lens of Haraway’s “situated knowledge” through which new modes of governance and self-understanding emerge, demanding an adaptation of strictly human-centered political theory. The reciprocal dynamics of the interface are (...) explored as a distributed site, not only for the invention of narrative, non-homogenizing meaning from the “totality” of the Stack, but equally as a site of intervention to guide and weight otherwise the non-linear causal forces of our complex, interconnected condition. (shrink)

Readers of this journal know that Hume regarded an Enquiry concerning the Principles of Morals as his finest work. It was, Hume said, "incomparably the best." Yet, most of the scholarly work on Hume's moral philosophy in recent decades focuses on the Treatise, which Hume wrote some three decades prior to the Enquiry.There are good reasons to focus on the older work. It is much longer, so there is more to sink our scholarly teeth into. Many discussions and discursions appear (...) in the Treatise that are absent, entirely or nearly so, from the Enquiry, such as the distinction between artificial and natural virtues and the claim that reason is and ought only to be the slave of the passions. Nevertheless, Hume's own... (shrink)

This piece, included in the drift special issue of continent. , was created as one step in a thread of inquiry. While each of the contributions to drift stand on their own, the project was an attempt to follow a line of theoretical inquiry as it passed through time and the postal service(s) from October 2012 until May 2013. This issue hosts two threads: between space & place and between intention & attention . The editors recommend that to experience the (...) drifiting thought that attention be paid to the contributions as they entered into conversation one after another. This particular piece is from the BETWEEN INTENTION & ATTENTION thread: Jeremy Fernando, Sitting in the Dock of the bay, watching... * R.H. Jackson, Reading Eyes * Gina Rae Foster, Nyctoleptic Nomadism: The Drift/Swerve of Knowing * Bronwyn Lay, Driftwood * Patricia Reed, Sentences on Drifitng * David Prater, drift: a way * * * * * 1. To drift is to be propelled by currents. 2. Sentences are textual currents. 3. To drift is to be com pelled with currents. 4. To be compelled is to be overcome by some force. 5. To be overcome by some force requires the instantiation of a weightless body (virtual or actual), upon which and through which a force can operate. 6. Forces can be physical, cognitive, unconscious and sensory. 7. Forces of drift have no particular telos; they incline bodies without knowable destination. 8. Drifting is nomadic, where nomadism includes movements between places, times (also time-zones), genres, thought and cognitive states. 9. Forces are attractors; attractivity is a force. 10. Attractivity is a relation between force and body. 11. Attractivity is relation of exteriority; it is of the domain of the foreign. 12. To drift is to become the prey of attraction, the prey of the foreign. 13. In the movement of becoming prey, one can either be eaten or feed into a re-composition of things. 14. Drifting is liminal; it can be equally productive and destructive. 15. The deviated course implied by drifting may yield novelty, yet may equally yield a perpetual deferral of any positionality. 16. The state of drifting is necessary to the creation of novelty. 17. The state of drifting can inhibit the creation of novelty. 18. The modern drift was celebrated as a form of emancipation, through the liberation of urban structures traced on foot, to the negation of banal tasks in riding on the open highway. In the attention economy, drifting has become a paradigm of labour, precarious and otherwise. 19. To drift in a novel fashion requires a necessary threshold between distraction and re-attraction. 20. Re-attraction is a form of going off-track, yet implies the fidelity to an alter force. Re-attraction is eccentric in inclination, that is, decentred, casting alter orbits of orientation. 21. Eccentricity is a form of drift defined as a body inflected by the force of heterogeneous inclination. Eccentricity is the fidelity to the becoming-foreign of the body as prey to attractivity. 22. Drift as eccentricity is equal to the creation of novel modes of inclination alter to the limits of normative orbits of determinate trajectories. 23. The effects of eccentric drifting can only be known post-movement. 24. All modes of drifting (natural and cognitive) are relative to some former position, although distances and their capacity for measurement are inconsistent. 25. Eccentric drifting does not result in relativism. Drifting is transitional, and, like a Moiré pattern, produces interferences between things. 26. Where there is drifting there are both side-effects and side-affects, which feed-back into the inclination of drift itself. 27. Side-effects and side-affects may produce conditions and sensibilities of failure. 28. The ethics of drifting play out in the responsiveness to side-effects/side-affects. 29. Eccentric drifting is not algorithmic, informational, strategic nor opportunistic; it is tactically lived experience. 30. Eccentric drifting is a dance with contingency, of repositioning a body (a body includes thought) through the affirmation of re-attraction. 31. Eccentric drifting is a form of love, a love of existence that proceeds strategic coupling with ideas, people, situations, places and so forth. 32. As a form of love, eccentric drifting can generate changes of state (and even changes of State). 33. Currents that propel/compel a state of eccentric drifting may be imaginary; a possible current includes the attractive force to that which is not (yet) present. 34. Eccentric drifting is not only a state of transitional movement, but most importantly includes the fabrication of imaginary forces that could propel/compel a given body and its spheres of interaction. 35. These sentences comment on drift, but are not exemplary of drifting. (shrink)