Few historical subjects have generated such intense and sustained interest in recent decades as Britain's imperial past. What accounts for this preoccupation? Why has it gained such purchase on the historical imagination? How has it endured even as its subject slips further into the past?In seeking to answer these questions, the proposed volume brings together some of the leading figures in the field, historians of different generations, different nationalities, different methodological and theoretical perspectives and different ideological persuasions. Each addresses the (...) relationship between their personal development as historians of empire and the larger forces and events that helped to shape their careers. The result is a book that investigates the connections between the past and the present, the private and the public, the professional practices of historians and the political environments within which they take shape. This intellectual genealogy of the recent historiography of empire will be of great value to anyone studying or researching in the field of imperial history. (shrink)

We propose that in pictures both the extended limbs of actors and the ground are involved in gestalts for movement. Limbs extend to suggest more motion literally when a dancer is in air and refer to a canonical pose when on the ground. A running pony’s curled limbs off the ground depict fast action literally. A horse’s flying-gallop off the ground suggests speedy motion metaphorically. Cast shadows indicate the actor’s location with respect to the ground. We consider extended and curled (...) limbs, on-ground and off, in literal and metaphoric pictures. (shrink)

Usain Bolt’s Lightning Bolt pose, one arm highly extended to one side, suggests action. Likewise, static pictures of animals, legs extended, show animation. We tested a new cue for motion perception—extension—and in particular extension of dancer’s legs. An experiment with pictures of a dancer finds larger angles between the legs suggest greater movement, especially with in-air poses and in lateral views. Leg positions graded from simply standing to very difficult front and side splits. Liking ratings were more related to Difficulty (...) ratings than Movement ratings. (shrink)

Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for reading (...) representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)

Mark Johnson argues in favour of embodied experience as the basis for knowledge. An important implication of his analysis is that these experiences instigate pervasive metaphorical systems. Johnson 's argument involves reductionist problems, chicken-and-egg problems and, at times, unclear criteria for what counts as a basic experience and a metaphor.

In a case-history, Ben, a university-graduate blind adult, is shown to draw a cube as if it were folded out, but with slim rectangles for the sides around a central square. This form is drawn by sighted 8-year-olds. It might involve foreshortening and parallel projection, despite the presence of more sides than would be present in parallel projection in a single direction. Also, Ben drew a glass’s brim as both a straight line and as an ellipse, a form common in (...) drawings by sighted 8-year-olds that may include the circular brim foreshortened to an ellipse in a ¾ view. In several drawings made later in the testing session Ben only showed aspects of the depicted object facing one direction. In elevation and plan drawings, he showed aspects facing to the side of the object or above the object. Also, Ben’s use of foreshortening advanced in sophistication in the testing session. We hypothesize that the blind and the sighted are on the same drawing developmental trajectory. (shrink)

Clozapine is a very effective drug with both significant benefits and significant risks in treatment-resistant schizophrenia. Informed consent is generally accepted as both desirable and necessary in order to ensure that the patient’s human rights and dignity are respected. Disclosure is a key element of informed consent. It is unclear if the adequate documentation of disclosure is standard practice before initiation of clozapine. The aim of this study was to assess the adequacy of the documentation of disclosure in consent to (...) clozapine treatment in an adult mental health service and to develop guidelines on disclosure. The method was a retrospective analysis of charts of patients given clozapine who received the drug through the pharmacy of a single North Dublin psychiatric hospital. Results show that current practice has evident gaps. The professional, ethical and legal issues are discussed. (shrink)

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of (...) Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bob Dylan’s “Highway Shoes” The Hobo-Hero’s Road through ModernityTodd Kennedy (bio)In the final verse of Bob Dylan’s “Don’t Think Twice, It’s Alright” (1963), the speaker proclaims, “I’m walkin’ down that long, lonesome road, babe / where I’m bound, I can’t tell.” With no destination in sight, he seems content to remain on a perpetual, isolated journey on what he terms “the dark side of the road.” Such an (...) ethos of movement, which permeates Dylan’s corpus, mirrors a dissident strain of American culture that seeks to find a Jeffersonian, individualistic freedom via movement through space outside of mainstream society. As early as Bringing It All Back Home (1965), peaking with Blood on the Tracks (1975), and persisting into his most recent work, Dylan has consistently merged aspects of blues, country, and literary traditions, to invoke images of mobility that examine individual freedom in a world where technology, fragmentation, and homogeneity seem to result in a destructive dehumanizing of individuals. In so doing, Dylan uses an intensely innovative aesthetic as he ambivalently romanticizes uprooted wandering in a manner that both mirrors and expands upon what I term an ontology of the hobo-hero that permeates American letters from Walt Whitman to John Dos Passos (and beyond) as it glorifies those who remain in constant motion in order to maintain a sense of integrated self in the face of crushing modernity.Gilles Deleuze and Félix Guattari similarly identify such an ontology within American culture when they, in A Thousand Plateaus, declare America a “special case” defined by its ceaseless search for a “rhizome,” or a “space in which two things that have nothing to do with one another form a parallel constructed by the mind. It is not imitation or resemblance, but becoming” (10). For Deleuze, Guattari, and, as I argue, Bob Dylan, the rhizome occupies a singular place within American letters. In other words, Deleuze and Guattari admit that America “is not immune from [...] the search for roots” in its “quest for a national identity or even for a European ancestry or genealogy (Kerouac going off in search for his ancestors),” yet they adamantly assert,every thing important that has happened or is happening takes the route of the American rhizome [...]. American books are different from European books, even when Americans set off in search of trees. The conception of the book is different. Leaves of Grass. And directions in America are different: the search for arborescence and the return to the Old World occur in the East. But there is the rhizomatic West, with its Indians without ancestry, its ever-receding limit, its shifting and displaced frontiers.(19) [End Page 37]Such an assertion should come as no surprise, I would argue, since, beginning with the earliest attempts to define “America,” Americans have seen their identity linked to mobility. In fact, the lone commonality that Americans share is descent from immigrants who came to the United States from a “home” or “homeland” where cultural identity was not far removed from national identity. It would stand to reason, therefore, that a group of uprooted individuals thrust into a self-declared melting pot would begin to define themselves by their dislocation. For instance, eighteenth-century French immigrant J. Hector St. John de Crèvecœur claimed that, within the American continent, “individuals of all nations are melted into a new race of men” (44) as America represents, for Crèvecœur, an “asylum” in which “the poor of Europe have by some means met together” (42). Crèvecœur proceeded to privilege those people, such as farmers, who planted “roots” as they helped to build and improve their society, but Crèvecœur’s assertion that we are united by our mutual uprootedness proves indicative of what critic Robert James Butler has observed as a recurrent American “quest for pure motion” (80, emphasis in original). Or, one encounters what the novelist John Steinbeck claimed he perceived in “nearly every American”: a “burning desire to go, to move, to get under way, anyplace, away from any Here” (10). It is such an attempt for perennial rebirth through movement, a rhizomatic selfhood, that... (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, (...) Georgetown University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

We are printing, by kind permission of the Law Commission, two sections of the report of the Law Commission on injuries to unborn children. This report was the result of a request to the Law Commission by the Lord Chancellor at the time (Lord Hailsham of Saint Marylebone) to advise on `what the nature and extent of civil liability for antenatal injury should be'. The Law Commission followed its usual practice in such circumstances of consulting various bodies and obtaining expert (...) advice on the subject and then embodying the results in a working paper (Working Paper No. 47 - injuries to unborn children) published on 19 January 1973, which preceded their report (Cmnd 5709). Meanwhile a Royal Commission is considering much wider issues of civil liability for injury (including antenatal injury) but the terms of reference for the Law Commission were much narrower and confined to the position of children injured before birth. In the section relating to the present law the report makes it clear that it is probable that liability under the common law already exists. The Scottish Law Commission has also issued a report (Cmnd 5371). They were given different terms of reference and came to somewhat different conclusions. We are printing from this long report the paragraphs discussing the medical background and the summary of recommendations. As will be evident on reading the paragraphs on the medical background to injuries to the unborn child, events are moving very rapidly, particularly in the study of congenital defects and the effects of drugs but the problems of proof present great difficulty. Other causes of injury to the unborn child are better known to the general public: for example, those following the illness, infection and disease of the mother during pregnancy, injury caused in attempted termination of pregnancy and the risks resulting from the mother's condition. The summary of the recommendations sets out very clearly the legal position of the unborn child, as the Law Commission sees it, arising from injury before birth, the final conclusion being that `legislation is desirable'. These extracts from the report, apart from their intrinsic interest, lead on to the paper by Mr Kennedy and Dr Edwards in which they set out their criticisms of it, and provide quick references to the original document. (shrink)

Machine generated contents note: 1. Introduction Juliette Kennedy and Roman Kossak; 2. Historical remarks on Suslin's problem Akihiro Kanamori; 3. The continuum hypothesis, the generic-multiverse of sets, and the [OMEGA] conjecture W. Hugh Woodin; 4. [omega]-Models of finite set theory Ali Enayat, James H. Schmerl and Albert Visser; 5. Tennenbaum's theorem for models of arithmetic Richard Kaye; 6. Hierarchies of subsystems of weak arithmetic Shahram Mohsenipour; 7. Diophantine correct open induction Sidney Raffer; 8. Tennenbaum's theorem and recursive reducts James (...) H. Schmerl; 9. History of constructivism in the 20th century A. S. Troelstra; 10. A very short history of ultrafinitism Rose M. Cherubin and Mirco A. Mannucci; 11. Sue Toledo's notes of her conversations with Gödel in 1972-1975 Sue Toledo; 12. Stanley Tennenbaum's Socrates Curtis Franks; 13. Tennenbaum's proof of the irrationality of [the square root of] 2́. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:TOWARD A THOMISTIC PERSPECTIVE ON ABORTION AND THE LAW IN CONTE:MPORARY AMERICA M. CATHLEEN KAVENY Yale University New Haven, Oonnecticut Introduction W;HEN THE SUPREME COURT handed down its abortion decision Webster v. Reproductive Health Services 1 in the summer of 1989, it was widely prel 109 S. Ct. 3040 (1989). All further citations to Webster will be given parenthetically in the text. To summarize the most significant aspects. of (...) the decision: A. Chief Justice Rehnquist authored an opinion of the Oourt (of the highest precedential value) which was joined by Justices White, Kennedy, Scalia, and O'Connor. The majority found the lower courts to be in error in striking down as unconstitutional the preamble to a Missouri statute which asserted that "the life -0f each human being begins at conception." The opinion of the Court also found that Missouri could constitutionally prohibit the use of public employees and facilities in the performance of abortions not necessary to save the mother's life. B. The Court also upheld the Missouri statute's provision requiring a. doctor to perform viability tests before aborting a fetus the doctor believes is of 20 or more weeks gestational age. In the plurality opinion (of less precedential value than an opinion -0f the Court, since it is not joined by a majority of the justices), Chief Justice Rehnquist, Justice White, and Justice Kennedy argued that since most fetuses are not viable at twenty weeks, the provision would impose substantial restrictions unrelated to the health of the mother upon what are, in fact, simply sec-0nd trimester abortions. Because they believed such restrictions to be in tension with Roe's trimester system, the plurality decided to abandon that system, along with its stipulation that the state's interest in unborn life became compelling only at viability. The plurality contended, however, that Webster presented no occasion for reconsidering Roe's holding, which deemed unconstitutional a statute prohibiting all abortions except those necessary to save the life of the mother. In a concurring opinion, Justice Scalia went further, arguing that the Court should explicitly overrule Roe v. Wade. On the other hand, Justice O'Connor, 848 344 M. CAT'HLEEN KAVENY dieted that this would exaicerbate a dangerously bitter social·struggle. In its 1973 decision Roe v. Wade (410 U.S. 113), the court had e1abo:raJted.a woman's right to abortion, and, in rthe sixteen years that fo11owed it, it ga,V'e that right unwavering support. Webster 'seemed to mark a retl.'eat from that support. The new scope it offered for state regulation of rubortion promised rto ignite gra,ss-roots forvor and a stiate..:by-state battle between those seeking rto maintain the abortion rights est1ab1isihed by Roe and its sequalia and those st:dving to limit the s1oope of these rights in 1 significant ways. Much of the criticism of Webster has fooused narrowly upon how weM the,decision has aiocorided with various views on the morality of abortion. Yet important 1as this issue is, thorough ethicaJ ana:lysis of Webster must address severa1l additional fac~ tors. The ethiicatl aidequacy of positive law, induding judicial interpretations of faw siuch as Webster, must he ev1alruated in terms of whetheir it aidvanices or impedes the common good. The common good requires not only that we consider the moml substance of legal requirements but tha:t we ailso attend to the manner in which law is made, promulgated, ml!d interpreted. Such an analysis is,sorely needed; it should. specify the severa1l factors involved in determining whether any given legal also concurring in the plurality's judgment, maintained that this provision of the statute could be upheld without any reconsideration of Roe, since it co· hered with that decision's recognition of the compelling state interest in viable fetal life. C. Justice Blackmun authored an opinion dissenting from the majority on the issues discussed above, and he was joined by Justices Brennan and Mar· shall. The thrust of his opposition is directed against the plurality's treatment of the viability testing,provisions. Blackmun first suggested that i.f understood according to the canons of proper statutory interpretation, these provisions unconstitutionally restrict the attending physician... (shrink)

In 1970 Van Rensselaer Potter was the first to use the term "bioethics" in a publication to advocate the development of a new discipline to address the basic problems of human flourishing. This article analyzes Potter's notion of bioethics in order to understand its origins, sources, and substance. In early publications, Potter conceptualized bioethics as a bridge: between present and future, nature and culture, science and values, and finally between humankind and nature. In later publications, disappointed by a predominant focus (...) on individual and medical issues, and with a wish to underscore the need for a broader perspective, Potter introduced the new term "global bioethics," meant to transcend ethics specialties and integrate them into a new interdisciplinary endeavor to address global problems. A growing interest in global bioethics today means that Potter's original insights are more timely than ever. (shrink)

: It has recently become known that, in Liverpool and elsewhere, parts of children's bodies were taken postmortem and used for research without the parents being told. But should parental consent be sought before using children's corpses for medical purposes? This paper presents the view that parental consent is overrated. Arguments are rejected for consent from dead children's interests, property rights, family autonomy, and religious freedom. The only direct reason to get parental consent is to avoid distressing the parents, which (...) carries implications for the consent process, secret harvesting of body parts, and the weight to be given to parental feelings. (shrink)

Feldman and Turner defend the making of so-called ‘NIMBY’ claims as ethically justifiable. They do so while confronting a case—Robert F. Kennedy Jr.'s opposition to the Cape Wind Project in Nantuck...

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.3 (2003) 189-192 [Access article in PDF] Is There a Common Morality? Robert M. VeatchSenior EditorOne of the most exciting and important developments in recent ethical theory—especially bioethical theory—is the emergence of the concept of "common morality." Some of the most influential theories in bioethics have endorsed the notion using it as the starting point of their systems. This issue of the Journal (...) is devoted to these developments.The core idea of a common morality is that all humans—at least all morally serious humans—have a pretheoretical awareness of certain moral norms. The claim is that normal humans intuit or in some other way know that there is something wrong with things like lying or breaking promises or killing people. These purportedly universally shared insights can provide the raw data from which ethical theories are constructed. As such, they are perhaps analogous to the raw sense data that are relied on in the natural sciences to launch the construction of scientific theories and accounts of the nature of reality. Some common morality theorists suggest an analogy between the natural and the moral sciences.In the natural sciences there is a widely shared belief that some raw sensory data are perceived by all normal humans and provide the basis for the construction of various scientific theories. For example, it is widely believed that all normal humans looking at the top light on a traffic signal perceive something that in English is called "red." Of course, different cultures will use different language to describe this experience. They may parse the boundaries differently (varying on the exact borderline between red and orange), provide widely differing accounts of why the experience of "red" occurs, and eventually generate significantly different theoretical formulations to explain the experience of redness. Moreover, some individuals may look at that top light of the traffic signal and not see color at all. One generally, however, does not account for this by denying there is any objective, generally shared basis for the experience that produces a sensation of redness in normal people. One simply explains the experience of the one who fails to see color by positing a defect in perception, called "color-blindness."Some moral theorists suggest that something analogous happens when humans look at the moral scene. The claim is that all normal humans in all places and cultures "see" certain moral requiredness. They see that some behaviors are, in some sense, generally wrong; that other behaviors are generally right; that [End Page 189] some character traits are generally praiseworthy, others blameworthy. No sophisticated common morality theorist denies that, as with color-blindness, there may be occasional outliers who for one reason or another fail to intuit or perceive these simple, abstract moral norms. Certainly, people in different cultures will define the terms differently, will recognize different limits on the norms, and will construct different theories to account for their experience. The primitive idea that there is something generally wrong with killing other humans will be articulated very differently in different cultures—some referring to the "sacredness of life;" others to a duty not to kill, a right to life, or a prohibition on killing the innocent. Some may extend the insight to a duty to prolong living, others limit it merely to a prohibition of direct, active killing. Some may endorse more exceptions—for killing of unjust aggressors, for killing in just war, for killing in self-defense; others, such as pacifists, will be much more stingy in doling out exceptions. Certainly, people at different times and places will articulate the norms in different language and embed them in different theories. The basic claim of common morality theorists, however, is that there is some primitive, pretheoretical insight that is shared by all normal, morally serious persons.Recently, the notion of a common morality has served as a starting point for bioethical theories as diverse as Bernard Gert, Charles Culver, and Danner Clouser's Bioethics: A Return to Fundamentals (1997) and the latest edition of Tom Beauchamp and James Childress's Principles of Biomedical Ethics... (shrink)

Classifying research proposals by risk of harm is fundamental to the approval process and the most pivotal risk category in most regulations is that of “minimal risk.” If studies have no more than a minimal risk, for example, a nearly worldwide consensus exists that review boards may sometimes: (1) expedite review, (2) waive or modify some or all elements of informed consent, or (3) enroll vulnerable subjects including healthy children, incapacitated persons and prisoners even if studies do not hold out (...) direct benefits to them. The moral and social purposes behind this threshold are discussed along with relevant views from the National Commission, NBAC, NHRPAC, Grimes v. Kennedy Krieger Institute, The Nuremberg Code, and The WMA's Declaration of Helsinki. Representative policies from Australia, Canada, South Africa, the U.S., and CIOMS are reviewed revealing different understandings of this sorting threshold. Six of nine frequently cited interpretations of “minimal risk” are untenable. The “absolute” interpretation of the “routine examination” standard is defended as best. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:News from the President’s Council on BioethicsF. Daniel Davis (bio) and Diane M. Gianelli (bio)As most readers of this column already know, the President's Council on Bioethics went through a major transition during the past year when Leon Kass—in October 2005—handed the chairman's gavel over to Georgetown University's Edmund Pellegrino. Dr. Kass has remained on the Council as a member.1When the gavel change took place, the Council's phone started (...) ringing. Everyone wanted to know the same thing: What topics would the Council take up this term? Dr. Pellegrino's answer was always the same: The Council's agenda would be established through a consultative process with the members themselves and with an eye to those problems and controversies in bioethics to which we, as a body, can make a contribution.Taking its cue from the list of potential topics suggested by members, the Council—over the course of the next several meetings—listened to experts on such topics as children and bioethics (with a focus on children in clinical research), organ transplantation, and that oft-cited-but-hard-to-define concept, "human dignity."The latter topic entered the arena of discussion because it is a concept that is cited frequently in the bioethics literature, and it is also one that has figured prominently in Council discussions and documents. Although the concept is widely invoked, there is no universal understanding of what it means, and it is not easy to encapsulate into a one-size-fits-all definition. Indeed, some critics maintain that appeals to human dignity are fig leaves used to camouflage unconvincing arguments. So between December 2005 and April 2006, the Council devoted several sessions to various perspectives on "human dignity: its meaning, its foundations, and its relevance to bioethics." After hearing from James Childress, Patricia Churchland, Daniel Sulmasy, and Paul Weithman2 on the topic, the Council decided to issue a volume of approximately 20 essays, some by Council members and others by scholars from a variety of relevant disciplines.3 The volume is expected to encompass a broad array of opinion on the topic of human dignity and is scheduled to be published next spring."Children" were also the focus of several sessions during the past year. The Council's last report addressed care giving for the elderly.4 After it was issued, several members suggested it was time to focus on the youngest members of [End Page 375] society. The challenge, of course, was to find a topic that was both timely and relevant—and one about which the Council was uniquely qualified to make a contribution. A number of experts in a variety of related fields testified before the Council about possible issues it could explore: newborn screening for genetic disorders; decision-making standards for those who lack capacity; ethical issues in neonatal and pediatric intensive care; pharmacology and psychiatric disorders in children; and children and clinical research. In addition, a number of groups and individuals involved in related topics met with staff to discuss their interests and concerns.This exploratory engagement with facets of the broad topic of children and bioethics led the Council to focus, more narrowly, on a cluster of issues concerning newborn screening for genetic disorders—a topic on which it is likely that the Council will issue a white paper, possibly by next summer. The stimulus for this particular focus has been the American College of Medical Genetics's recommendation that all newborns in the U.S. be screened for a panel of 29 disorders.5 Currently, each state decides for its residents which conditions are subject to mandated screening, so it is possible to get early diagnoses of treatable disorders in one geographical area but not in another. Proponents of screening find the federal approach to mandated screening more equitable. Potential ethical problems, however, exist with the proposal. Some want to ensure that newborns are screened only for treatable conditions on grounds that it would be too burdensome to discover one is carrying the gene for a late-onset disease that cannot be prevented. Others want to make sure that insurance coverage for individuals and their families is... (shrink)

: New genetic technologies continue to emerge that allow us to control the genetic endowment of future children. Increasingly the claim is made that it is morally "irresponsible" for parents to fail to use such technologies when they know their possible children are at risk for a serious genetic disorder. We believe such charges are often unwarranted. Our goal in this article is to offer a careful conceptual analysis of the language of irresponsibility in an effort to encourage more care (...) in its use. Two of our more important sub-claims are: A fair judgment of genetic irresponsibility necessarily requires a thick background description of the specific reproductive choice; and there is no necessary connection between an act's being morally wrong and its being irresponsible. These are distinct judgments requiring distinct justifications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Richard H. Popkin 1923-2005Harry M. Bracken and Richard A. WatsonRichard H. Popkin, founding editor of the journal of the History of Philosophy, died on April 14, 2005. He was 81 years old and had continued his research and writing to the last moment before he entered the hospital on march 21st with extreme respiratory difficulties.Popkin's The History of Scepticism from Erasmus to Descartes (1960) revolutionized the study and understanding (...) of early modern philosophy. Popkin entered the minds and world of thinkers from Erasmus to Descartes in a way few other scholars had done, and he showed how the development of philosophy and science was far from an easy series of steps from success to success. Instead, philosophers and scientists pursued a dozen lines from the scepticism of Sextus Empiricus through religious belief, atheism, numerology, astrology, alchemy, eschatology, magic, and millenarianism—a maelstrom of ideas out of which emerged the major figures and ideas of Modern philosophy and science. Dick once explained that actually he lived in the 17th century, and certainly he knew as many of those thinkers and their thoughts as did many people who actually lived at that time. Of course Popkin did not originate the notion of exploring the history of philosophy in the context of its times, but he made that approach central today. It led him not only through the Early Modern period, but also from medieval jewish philosophy to a critical analysis of the Kennedy assassination.Popkin received his PhD at Columbia University, and in his career he taught at the universities of Connecticut, Iowa, California (San Diego and Los Angeles), Washington University in St. Louis, and Harvey Mudd College. He served as the first editor of the Journal of the History of Philosophy, and as president of JHP, Inc. For many years, and was active in its operation for over four decades, having attended the annual meeting of the Board of Directors a little over a month before he died. After retirement, he lived in close association with the Clark Library in Los Angeles. He was well known to scholars and librarians throughout the world. Whatever library he visited, he was likely to find some obscure or hidden document that would either clear up some mystery, or give rise to a new problem. His memory was extraordinary. During his final years when he was virtually blind, he would sift through his mind, send assistants off to look for something that had to be in this or that library and write papers in his head for later dictation. Besides his memory, indispensable throughout his lifetime he had Julie, his co-worker and wife of 60 years, without whom, the Popkin we knew could not have existed.These few paragraphs are meant to be neither an obituary nor an adequate memorial. We were Dick's first two PhDs, and we were barely five years his junior. He treated us from the beginning as colleagues and he became a lifelong friend. He changed our lives, as he did the lives of many other aspiring scholars. We miss him.Copyright © 2005 Journal of the History of Philosophy, Inc.... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Is Bioethics Applied Ethics?Robert M. VeatchBioethics is often referred to as a kind of applied ethics. The term applied ethics can be controversial if it is taken to imply that ethical theory from philosophy or religious ethics has to be the starting point for ethical analysis of some practical field such as medicine or law or politics. The term can be understood as requiring some premises from an ethical (...) theory that are then "applied" to some problem area, as a "top down" way of doing the work of moral reflection in a way that axioms in geometry are applied to present proofs of mathematical claim.The publication of an important work in the history of medical ethics, A History of Medical Ethics, provides an opportunity to reflect more carefully on what applied ethics means. That massive multi-authored volume edited by Robert Baker and Laurence McCullough (2007) is scheduled for publication this fall. With the permission of the Press, we have asked Baker and McCullough to prepare an article-length version of one of the central essays in that work. Their paper challenges the idea that ethical theory should be "applied" to medicine or other fields, putting forth an alternative of the "appropriation" of an ethical theory by the formulation of concepts, principles, moral rules, or other specifications that may turn out to be unique or at least modified for the particular field in question.In this issue of the Kennedy Institute of Ethics Journal, we publish the Baker-McCullough article together with five critical commentaries. We include two medical historians who have a sustained commitment to studying the history of ethics in medicine, two systematic ethicists who have an unusual level of commitment to studying ethics historically, and a physician with unusual sensitivity to the history of medical ethics. Each comments on the Baker-McCullough thesis and offers an alternative view of the link between ethical theory and the field of biomedical ethics.Daniel Fox triggered some of the initial reflection on the history of medical ethics in the 1970s. His work is discussed by Baker and McCullough. Fox is sympathetic with the Baker-McCullough appropriation thesis, viewing their position as complementary to his own, although he [End Page 1] urges more attention to the political aspects of medicine, professional dominance, and professional control of medical resources.Ulf Schmidt, a specialist on the historical aspects of research during the Nazi era, focuses on Baker and McCullough's use of that historical example of the appropriation of medical ethics.The two ethicists who comment both have had many years experience with historical aspects of medical ethics, and both worked on the historically important Belmont Report of the National Commission for the Protection of Human Subjects. Both question whether Baker and McCullough overstate the problem of the relation between application and appropriation. Albert Jonsen, as a member of the National Commission, concentrates on the Belmont Report, showing how he sees the report appropriating philosophical ethics.Tom Beauchamp, who was the primary staff person responsible for the report, provides a somewhat different read on the report and particularly on the role of Kantian ethics in the report's discussion of autonomy. Beauchamp accuses Baker and McCullough of having too narrow an understanding of the meaning of the term "applied," claiming that no people doing medical ethics today would simply apply ethical theory in a deductivist manner.Finally, Jeremy Sugarman, the physician ethicist, is, in a somewhat surprising turn, the cautious defender of the application that Baker and McCullough challenge. Although he ends up sympathetic with the appropriation that implies going beyond straight-forward top-down application, he outlines the value of ethical theory for the practical analysis of ethical problems in fields such as medicine.ReferenceBaker, Robert, and McCullough, Laurence, eds. 2007. A History of Medical Ethics. New York: Cambridge University Press, in press. [End Page 2]Google ScholarCopyright © 2007 Johns Hopkins University Press... (shrink)

Biodefense and emerging infectious disease animal research aims to avoid or ameliorate human disease, suffering, and death arising, or potentially arising, from natural outbreaks or intentional deployment of some of the world’s most dreaded pathogens. Top priority research goals include finding vaccines to prevent, diagnostic tools to detect, and medicines for smallpox, plague, ebola, anthrax, tularemia, and viral hemorrhagic fevers, among many other pathogens (National Institute of Allergy and Infectious Diseases [NIAID] priority pathogens). To this end, increased funding for conducting (...) research, developing research facilities, and purchasing (stockpiling) developed vaccines, diagnostic tools, and therapeutics .. (shrink)

: When reflecting on arguments in the debate about genetic technologies, decision makers must try to be empathetic to those who are worse off. Disparities in health and health care in the U.S. pale when global facts are considered. Although U.S. citizens ought to be concerned about the worse off in the U.S., such concern ultimately must be balanced against the urgent imperative to address the plight of those in poor countries. It is a matter of fairness that care and (...) concern be directed to those who are truly worse off in global terms. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Research Ethics after World War II: The Insular Culture of BiomedicineAllan M. Brandt (bio) and Lara Freidenfelds (bio)Human subjects research in the United States has only recently emerged as an important area of historical investigation. Over the last quarter century, scholars have begun the process of grounding within an historical context both the complex relationship between researchers and subjects and the processes by which biomedical knowledge is produced. Their (...) studies examine topics ranging from the impact of the anti-vivisectionist movement on human experimentation in the early twentieth century (Lederer 1995) to the development of the discipline of bioethics in the 1960s and 1970s (Rothman 1991) and the emergence of the legal concept of informed consent for human research (Katz, Glass, and Capron 1972). Many of the discussions focus on isolated incidents of scandal, such as the Tuskegee Syphilis Study (Jones 1993; Brandt 1978) and the Willowbrook School hepatitis study (Rothman and Rothman 1984). In doing so, they attempt to explain how such clearly unethical research could have been initiated and what consequences have resulted from public knowledge of such research.Nonetheless, the broader historical contexts and implications of human subjects research have yet to be fully delineated. This project will be of crucial importance, not only for historians, but also for those concerned with research policy and medical ethics. The historical examination of human subjects research will provide further insight into the details of research methods, the construction of protocols, and the historically specific interest in certain diseases. In addition, scholars will better understand the relationships of power and authority between researcher and subject, as well as the social and scientific mechanisms for the production of new biomedical knowledge. The process of enlisting research subjects illuminates the significance of class, gender, ethnicity, and race in science, in biomedicine, and in society. The fact that, historically, much research has employed research subjects from vulnerable populations, who participated in coercive contexts, has exposed powerful social assumptions embedded in the research enterprise. [End Page 239]The revelation of new documents indicating past abuses has sparked much of the investigation into human subjects research and the recent investigation of human radiation experiments during the Cold War era. One of the most important achievements of the Advisory Committee on Human Radiation Experiments was the uncovering of thousands of documents, a remarkable mine of archival data, that had been previously inaccessible to researchers. Jonathan Moreno and Susan Lederer’s article on the history of Cold War research ethics in this issue of the Kennedy Institute ofEthics Journal represents the first attempt since the publication of the Committee’s Final Report to analyze the Committee’s findings in a serious historical context.Historical accounts of the emergence of bioethics traditionally have left a great void in their discussions of human experimentation, generally ignoring the period between the writing of the Nuremberg Code in 1947 and the publication of Henry Beecher’s 1966 New England Journal ofMedicine article condemning systematic, unethical practices in human experimentation (Rothman 1991). The period from 1946 to 1966, however, was a time of vigorous research characterized by a fragmented community of medical researchers who applied inconsistent ethical standards and employed highly variable research practices. Both military and civilian medical researchers were intensely interested in radiation and thus conducted human subjects research along those lines, including examinations of the effects of plutonium injections and of total body irradiation, the use of trace radioisotopes to study various body processes, and observations of the effects of radiation intentionally released into the environment. The U.S. Government sponsored several thousand such studies (ACHRE 1995 [GPO, pp. 227–31; Oxford, pp. 135–38]), some of which were conducted on hospital patients, institutionalized children, military personnel, and prisoners. The Cold War scientific culture that produced this research must be examined from an historical ethical perspective.A central aspect of the culture of biomedical science after World War II was its insularity. Increasingly high standards of admission and challenging training had come to ensure that only a select group of individuals was admitted to the professions of medicine and research science. In this culture of experts, trustworthiness and ethical judgment were considered to be dependent upon expertise... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.3 (2001) 219-220 [Access article in PDF] Introduction In the last couple of decades,commodification has become almost a buzz-word in bioethics. As we become technically more adept at detaching elements of human bodies and making use of them for others, it seems as if more and more things-from motherhood to gametes to kidneys to our very DNA-can be borrowed, rented, bought, and sold. (...) Other technology allows us unprecedented influence over the characteristics of our offspring (unprecedented, that is, if we ignore the many cultures in which children were and are routinely discarded because they are the wrong sex, disabled, or the product of multiple births). It is common, for example, for writers to worry that the availability of pre-implantation genetic diagnosis will seduce parents into thinking of their children as commodities, to be ordered in much the same way as automobiles, with the inevitable concomitant that they will want to "return" children who do not measure up to their specifications.Unfortunately, a great deal of the talk about "commodification" has been clumsy and sloppy. The term has been used as a magic bullet, as if saying "But that's commodification!" is the same as having made an argument. In fact, commodification of human persons, human bodies, human labor, human relationships, is a complex matter. In many human dealings, commodified and noncommodified understandings of the same thing, or the same transaction, exist more or less comfortably together. Most Westerners condemn commercial sex, for example, while at the same time knowing that in most times and places in the world, marriage was and is thought of as primarily an economic relationship. The common use of "cheap" in post-World War II American slang to describe a teenage woman who is more sexually available than her peers perfectly captures the market rhetoric inherent in respectable American sexual mores.Given this complexity, it is not surprising that many writers in bioethics have gravitated to the work of Margaret Jane Radin. In her two books, Contested Commodities (Harvard University Press, 1996) and Reinterpreting Property (University of Chicago Press, 1993), and many articles, [End Page 219] Radin has taken on the problem of commodification without falling into either sentimentality or cynicism. She is a careful thinker and a careful (and demanding!) writer. We have long valued her work as we have sought to grapple with the many ways in which the problem of commodification arises in bioethics. In this issue of the Kennedy Institute of Ethics Journal, entitled "Who's Afraid of Commodification?," we have asked three colleagues to join us in reflecting on aspects of the problem of commodification in bioethics. We are especially delighted that Radin agreed to respond to our efforts in this direction.Lisa Sowle Cahill takes the discussion of commodification to a new level, as she focuses on global ethics, especially genetic research and the marketing and accessibility of pharmaceuticals. Dena S. Davis explores the debates over refusal of treatment and rational suicide and concludes that to put a value on particular pieces of one's lifespan does not necessarily lead to negative aspects of commodification. Ronald M. Green analyzes Radin's use of Kant. Suzanne Holland addresses commodification of body parts, from gametes to cadaveric tissue, and concludes with some specific recommendations. Thomas A. Shannon takes a fresh look at the problem of whether we should allow the sale of organs; he shares with Holland a special concern for the rhetoric of commodification. Finally, Margaret Jane Radin responds to the preceding essays, asking four "stubbornly difficult" questions, questions that show that the debate about commodification is only just begun. Dena S. Davis and Suzanne Holland... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to its (...) patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

In Shaping Our Selves, Erik Parens offers both a personal history of bioethics and a cleverly clarifying lens to train on disputes in bioethics about emerging technologies. The question for readers is whether this lens, as useful as it is, leaves too much outside our field of vision. Parens, born in 1957, comes from the first wave of bioethics scholars—those of us who still mostly happened into bioethics as a field, before it was sufficiently well-established to be identified as a (...) career pathway. Bioethics enjoys a fascinating diversity of origin stories, and Parens’s is no exception. He began his studies at the University of Chicago’s pan-disciplinary Committee on Social Thought, one of a handful.. (shrink)

The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. (...) We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 16.4 (2006) 379-396MuseSearchJournalsThis JournalContents[Access article in PDF]Pharmacists and Conscientious Objection *In March 2005, a Wisconsin pharmacist's act of conscience garnered headlines across the United States. After a married woman with four children submitted a prescription for the morning-after pill, the pharmacist, Neil Noesen, not only refused to fill it, but also refused to transfer the prescription to another pharmacist or to return the (...) prescription to the customer. As more such incidents occurred, many states "... decided to consider and enact laws setting the bounds of pharmacists' and other health care workers' professional obligations" (III, Grady 2006, p. 327). Discussions of objector legislation, also referred to as "conscience clauses," "refusal clauses," and "abandonment laws" (III, Appel 2005, p. 279), are not limited to professional ethics, but also draw from philosophical, theological, and legal perspectives. The purpose of this Scope Note is to present a wide variety of viewpoints on the health provider's right to conscience.More than 40 years ago the development of "The Pill" as the first reliable method of birth control not only ushered in a feminist revolution, but also provided a new focus for concerns of conscience for those who were part of the anti-abortion movement based on religious belief in the sanctity of life. Similarly, in the past ten years, worldwide, and seven years (1999) since the emergency contraception "morning after" pill first became available as a prescription item, there has been an upsurge in the number of medical personnel who refuse to prescribe or dispense it on grounds of personal conscience, whether for religious reasons or not. Their actions bring into play issues of power and control for health care personnel and for patients—in this case women, which also raises women's rights issues. Ironically, studies in France, Sweden, and the United Kingdom have shown that emergency contraception does not reduce the abortion rate—it is too infrequently used (II, Glasier 2006).It is important to underline the difference between the "morning-after" pill or "Plan B," which is made up of two progestin pills containing levonorgestrel (a synthetic derivative of the female hormone progesterone), and RU-486 (Mifiprex [End Page 379] or mifipristone with misoprostol). Plan B, if taken within 72 hours post-coitus prevents implantation, and therefore pregnancy, by suppressing the output of luteinizing hormone, the hormone that triggers the ovulation process. Scientists have been unable to determine whether this action could destroy already fertilized eggs, but even if it does, it uses the same mechanism as occurs with the birth-control pill, that was developed some 45 years ago. By contrast, RU-486 acts up to 49 days after implantation by blocking the action of progesterone in order to terminate the pregnancy and as such is an abortifacient (II, US FDA 1).On 24 August 2006, the U.S. Food and Drug Administration announced approval of the Plan B pill for over-the-counter (OTC ) sales (II, US FDA 2). Although this action makes the drug more widely available, it remains to be seen whether pharmacists who are conscientious objectors and who refuse to dispense it also will refuse to provide it OTC.A survey article by Rebecca Dresser (II, 2005, p. 9) succinctly sums up the problem for conscientious objectors: "Because emergency contraception can act to block implantation of a fertilized egg, people who believe in protection of human life after conception find it morally objectionable."When conscientious objections are raised over abortion or birth control services performed, prescribed, or dispensed, they affect not only the health professionals—physicians, pharmacists, nurses, and health technicians—who may object, as well as their colleagues and/or managers, but also the consumers: the female patients who are then forced to reconsider or to seek an alternative supplier, as well as their spouses or partners. Alta Charo (II, 2005, p. 2473) makes the point that the patient needs to have access to a system of counseling and referral "so... (shrink)

ON DECEMBER 10, 1991 Charles Shonubi, a Nigerian citizen but a resident of the USA, was arrested at John F. Kennedy International Airport for the importation of heroin into the United States.1 Shonubi's modus operandi was ``balloon swallowing.'' That is, heroin was mixed with another substance to form a paste and this paste was sealed in balloons which were then swallowed. The idea was that once the illegal substance was safely inside the USA, the smuggler would pass the balloons (...) and recover the heroin. On the date of his arrest, Shonubi was found to have swallowed 103 balloons containing a total of 427.4 grams of heroin. There was little doubt about Shonubi's guilt. In fact, there was considerable evidence that he had made at least seven prior heroin-smuggling trips to the USA (although he was not tried for these). In October 1992 Shonubi was convicted in a United States District Court for possessing and importing heroin. Although the conviction was only for crimes associated with Shonubi's arrest date of December 10, 1991, the sentencing judge, Jack B. Weinstein, also made a ®nding that Shonubi had indeed made seven prior drug-smuggling trips to the USA. The interesting part of this case was in the sentencing. According to the federal sentencing guidelines, the sentence in cases such as this should depend on the total quantity of heroin involved. This instruction was interpreted rather broadly.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Modern Vs. Contemporary Medicine: The Patient-Provider Relation in the Twenty-First CenturyRobert M. Veatch (bio)The revolution in medical ethics of the past quarter century has begun reshaping the patient-provider relation in such a way that it will never be the same. 1 Dramatic changes have occurred at the level of specific decisions such as consent, forgoing treatment, and birth technologies, but the most significant impact will be on the way (...) the relation is conceptualized and the kinds of authority each party in the relation will be assumed to possess. The change is so fundamental that it deserves to be called a change from modern to contemporary medicine.Contrasting Modern and Contemporary MedicineModern MedicineMedicine of the modern period can be said to have had its origins in the sixteenth century with the emergence of the scientific mentality in such figures as Francis Bacon, but it really took off in the enlightenment of the eighteenth century. While intellectuals in medicine up to that time tended to be in conversation with those of philosophy, theology, and the arts, the emergence of medicine as a science changed that communication.The effect of the scientizing of medicine was that physicians tended to lose contact with the humanists. It was as if a physician, if he mastered the medical science, could, without any intervening value judgments, know how to treat the patient. In fact, for some conditions, there was (and still is) so much consensus [End Page 366] on the values that it is as if they were not present at all. If a patient has pneumonia, the most important element in a clinical decision seems to be pharmacological knowledge of whether a drug can produce a cure. The clinician knowledgeable of penicillin seems all that is needed.Upon reflection a suppressed premise becomes obvious: if it is better to live with the penicillin than to die without it, then one ought to take the penicillin. Since almost no one doubts the wisdom of that value judgment, all that seems to be needed is pharmacological knowledge. This view of medicine implies that certain treatments are “medically indicated,” as if the knowledge of the science could demonstrate that certain treatments were appropriate, in fact, were “treatments of choice.”Of course, on rare occasions, someone would question the value presumption. We discovered that certain patients with metastatic cancer who developed pneumonia might not automatically agree that it is better to live with the penicillin. Also Christian Scientists might deny that use of the drug led to the best possible consequences. These were set aside as unusual cases, ethically exotic problems, to be addressed outside the normal bounds of medical science. We still believed that medical science together with competent diagnostic skills were the critical factors in deciding what the appropriate treatment was.Some clinicians spoke as if these decisions could be made with no value judgments at all (except in cases in which outside “religious” or “cultural” influences contravened). Many more sophisticated clinicians, however, understood all along that an implicit value system was built into the medical profession. Some have even claimed that the very concept of medicine contains within it a set of norms or goals or values that are “intrinsic to the practice” (Pellegrino and Thomasma 1988, p. 116). For many those values are encapsulated in the Hippocratic tradition, particularly the core Hippocratic principle that the physician should act always for the benefit of the patient according to his ability and judgment.When physicians began spending their time learning medical science, the richness of their conversation with the philosophical and religious traditions of the day was lost. Clinicians, without a rich knowledge of those traditions, hit upon the Hippocratic ethic, embracing it as the epitome of their goals without real understanding of its implications and potential conflicts with other ethical traditions (cf. Veatch and Mason 1987).Contemporary MedicineThe most critical contribution of the medical ethics of the current generation has been the calling into question of the Hippocratic ethic, especially the presumption that science by itself (or aided by a single, core ethic intrinsic to all practice of medicine) is sufficient to practice medicine. This generation’s medical ethics... (shrink)

Although this is a work of biography rather than of philosophy, in presenting the life of a philosopher like de Tracy a good deal of attention is necessarily paid to presenting his thought. The author provides extensive discussions of the five volumes of the Elements d’ideologie, including the Grammaire, the Logique, and the Traité de la volonté et de ses effets. In addition, he describes how de Tracy developed his science to apply to political economy, morals, and politics. In both (...) cases the author seeks to show how de Tracy’s thought takes its bearings from his experiences in revolutionary France and from his readings of Locke, Condillac, Helvetius, d’Holbach, Diderot, and Voltaire. While preserving the materialist presuppositions of these antecedents, de Tracy’s originality, according to Kennedy, lies in applying their materialism to a novel theory of movement. Further, in applying this theory of movement to human things, de Tracy prepares for the modern historical interpretation of ideology. Unfortunately, the author does not elaborate what precisely distinguishes de Tracy’s theory of movement from similar theories in the Epicurean tradition which he follows. Further, he does not explain how de Tracy’s application of this theory of movement to history, at the same time as Hegel, affects the historical interpretation of "ideology" in a way that differs from Hegel and that yet explains the evolution of the concept of "ideology." We may conjecture that de Tracy’s incipient philosophy of history adumbrates later materialist theories of historical development as encountered in Comte, whom he inspired, or in John Stuart Mill, who as a young man had been acquainted with de Tracy. But this does not distinguish "the ideologue" from Voltaire, who is often credited with originating the philosophy of history and who was a source of de Tracy’s thought in so many other respects. (shrink)

It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...) make simple generalizations about disability's relationship to well-being in other important senses. After defending this view, we discuss its practical implications for selective abortion for disability, nondisabled people's interactions with disabled people, and the use of QALYs in health policy. (shrink)