Legal precedent, professional‐society statements, and even many medical ethicists agree that some situations may call for a clinician to engage in an act of lying or nonlying deception of a patient or patient's family member. Still, the moral terrain of clinical deception is largely uncharted, and when it comes to practical guidance for clinicians, many might think that ethicists offer nothing more than the rule never to deceive. This guidance is insufficient to meet the real‐world demands of clinical practice, and (...) this article endeavors to articulate a framework to help clinicians better navigate the ethics of clinical deceit. The framework articulates four morally relevant dimensions of a potential deceptive act that should be examined to better determine the moral justification that might be required: the target of the act, the nature of the information, the nature of the act, and the context of the act. (shrink)

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. (...) While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad. (shrink)

In the debate over clinicians’ conscience, there is a greater ethical, legal, and scholarly focus on negative, rather than positive, claims of conscience. This asymmetry produces a seemingly unjustified double standard with respect to clinicians’ conscience under the law. For example, a Roman Catholic physician working at a secular institution may refuse to provide physician-aid-in-dying on the basis of conscience, but a secular physician working at a Roman Catholic institution may not insist on providing physician-aid-in-dying on the basis of conscience. (...) This article outlines arguments against this asymmetry and critiques them for failing to distinguish between positive claims of conscience as positive or negative rights. I suggest the asymmetry debate should be focused on whether positive claims of conscience as positive rights ought to enjoy the same protections as negative claims of conscience. Clarifying the debate in this way helps elucidate some of the best reasons for the asymmetry, which these arguments have not addressed. This article does not take a definitive position on whether the asymmetry is justified, but attempts to bring some focus to the debate by directing arguments against the asymmetry to address the significant differences between positive claims of conscience as positive rights and negative claims of conscience. (shrink)

Analyses of factual causation face perennial problems, including preemption, overdetermination, and omissions. Arguably, the thorniest, are cases of omissive overdetermination, involving two independent omissions, each sufficient for the harm, and neither, independently, making a difference. A famous example is Saunders, where pedestrian was hit by a driver of a rental car who never pressed on the (unbeknownst to the driver) defective (and, negligently, never inspected) brakes. Causal intuitions in such cases are messy, reflected in disagreement about which omission mattered. What (...) these analyses mistakenly take for granted, is that at issue is the 'efficacy' of each omission. I argue, on the contrary, the puzzle of omissive overdetermination favors taking the act/omission distinction seriously. Factual causation, properly understood precludes omissions (i.e. omissions are not causal). Of course, the law also attaches liability to omissions, but this works differently from liability for real causes (e.g. omissions have a duty requirement, they also respond differentially to difference-making considerations). The manner in which liability attaches for omissions differs from that of straightforward causal liability, and is entirely dependent on the underlying causal structure. Attention to that structure (e.g. that the driver's hitting the pedestrian with his car is what actually caused the injury) sheds light on which omissions matter (e.g. driver's failure to press on the brakes) and why (because that failure removes a defense the driver would have to liability for the accident he caused). Other cases, where the parties' connection is entirely omissive (e.g. two physicians fail to detect independently lethal conditions), come out differently (tracking moralized elements). The analysis offered makes better sense of both why omissive determination cases are puzzling and how to resolve them. (shrink)

Cover; Table of Contents; Introduction; References; List of Illustrations; Acknowledgments; 1. Essays; Intimacy Unveiled (Suzanne Anker); From Apocalypse to Analogy; Transforming Life; References; List of Illustrations; Through the Looking Glass: Encounters with Suzanne Anker's Wonderlands (Sabine Flach); I. Making is Thinking -- Art as Knowledge; II. "We can know more than we can tell"; III. Ars Quaerendi -- The Art of Asking Questions; IV. Synechein -- The Art of Interweaving; References; List of Illustrations; 2. Dialogues; Dialogue I: The (...) Glass Veil. (shrink)

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making, which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming (...) contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)

Abstract:Anticipating sixteenth-century trends in vernacular Aristotelianism, Machiavelli concealed his theoretical engagement with Aristotle behind a veil of examples. Scholars have established that in The Prince, Machiavelli employed topical dialectic to update ancient maxims for the modern era. I show how he used dialectic to occupy and transform Aristotelian commonplaces that justified Renaissance philosophers’ appeal to the ideal in political reasoning. These occupations reveal Machiavelli’s preference for particulars over generalities as a considered judgment about the suitability of philosophy for popular readers. (...) Machiavelli’s covert reading of Aristotle is, I submit, a signal episode in the history of humanism. (shrink)

Evolutionary discussions regarding the relationship between social status and fertility in the contemporary U.S. typically claim that the relationship is either negative or absent entirely. The published data on recent generations of Americans upon which such statements rest, however, are solid with respect to women but sparse and equivocal for men. In the current study, we investigate education and income in relation to age at first child, childlessness, and number of children for men and women in two samples—one of the (...) general American population and one of graduates of an elite American university. We find that increased education is strongly associated with delayed childbearing in both sexes and is also moderately associated with decreased completed or near-completed fertility. Women in the general population with higher adult income have fewer children, but this relationship does not hold within all educational groups, including our sample with elite educations. Higher-income men, however, do not have fewer children in the general population and in fact have lower childlessness rates. Further, higher income in men is positively associated with fertility among our sample with elite educations as well as within the general population among those with college educations. Such findings undermine simple statements on the relationship between status and fertility. (shrink)

Moral pluralism poses a foundational problem for secular clinical ethics: How can ethical dilemmas be resolved in a context where there is disagreement not only on particular cases, but further, on...

This book examines some of the changes that are taking place in Tok Pisin, an English-based pidgin, as it becomes the native language of the younger generation of rural and urban speakers.

What is the proper role of a clinical ethics consultant’s religious beliefs in forming recommendations for clinical ethics consultation? Where Janet Malek has argued that religious belief should have no influence on the formation of a CEC’s recommendations, Clint Parker has argued a CEC should freely appeal to all their background beliefs, including religious beliefs, in formulating their recommendations. In this paper, I critique both their views by arguing the position envisioned by Malek puts the CEC too far from religion (...) and the position envisioned by Parker puts the CEC too close. For a CEC to give recommendations about what is morally prohibited, permissible, or obligatory in the clinic, I propose a view of the CEC that is neither religious nor non-religious but quasi-religious. I argue that a quasi-religious approach avoids the problems of both religious and non-religious views while preserving their benefits. Additionally, a quasi-religious view resists the marginalization of “religious” traditions that occurs when secular ethicists come to think of their approach as somehow distinctly non-religious. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

9 Eastern Christianity and Jesuit Scholarship on Arabic and Islam: Modern History and Contemporary Theological Reflections -- 10 Autonomy, Dignity, Human Rights: Correcting a Popular Error -- 11 Liberal and Authoritarian Approaches to Raising Good Citizens -- 12 Stewardship as Welcome and Respect for the Dignity of the Vulnerable: An Essay in Bioethics -- 13 Dialogue in a Pluralist Context: Theological Ethics and the New Interest in Happiness -- Index.

In this article, the importance of ritual as a collective response to death is discussed. A case example, taken from a larger ethnographic study, is used to explore the responses and reactions of a group of Italian nurses to death as it occurs within an intensive care unit in Rome, Italy. The material presented is used to analyse the significance that cultural, religious and social beliefs and quasi‐beliefs can have in nursing practice. The issues highlighted in this examination of the (...) place of ritual in death are located and discussed within their highly specific cultural context and suggest that, where emphasis remains on nurses as a collective rather than on the individual nurse, ritual acts to ensure that social and moral order prevails. (shrink)

Citizens have two mutually exclusive options: they can exile, or even execute, a god among men, or they can submit to superhuman monarchy. Aristotle thinks any state would choose the former, but finds the latter option superior and argues the citizenry should submit to the superhuman monarch because that is precisely what ideal citizens would do if such a being appeared in their society. This problem appears in great cinema and nowhere more powerfully than in J. J. Abrams's Star (...) Trek and Star Trek Into Darkness with the character of James T. Kirk. In his Nicomachean Ethics, Aristotle describes a man he calls the megalopsychos, the great‐souled man or proud man. Aristotle defines the two solutions to the problem of greatness, exile or monarchic rule, as mutually exclusive, but Kirk is able to progress from exile on Delta Vega to the captain's chair, the former seeming necessary for the latter. (shrink)

Increasingly complex and autonomous systems require machine ethics to maximize the benefits and minimize the risks to society arising from the new technology. It is challenging to decide which type of ethical theory to employ and how to implement it effectively. This survey provides a threefold contribution. First, it introduces a trimorphic taxonomy to analyze machine ethics implementations with respect to their object (ethical theories), as well as their nontechnical and technical aspects. Second, an exhaustive selection and description of relevant (...) works is presented. Third, applying the new taxonomy to the selected works, dominant research patterns, and lessons for the field are identified, and future directions for research are suggested. (shrink)

Winnicotts Konzept des »Holding« bezieht sich auf das komplexe psychische Tun und Wirken der Mutter für ihr neugeborenes Kind, also darauf, dass sie sowohl als »Umwelt-Mutter« als auch als »Objekt-Mutter« fungieren muss. Während das Holding mit der Umwelt-Mutter assoziiert ist, möchte ich das »Containing« hier der Objekt-Mutter zuordnen. Es soll gezeigt werden, dass Winnicott diese Konzepte in Anlehnung an Freuds frühe Beobachtungen der für die emotionale Entwicklung des Kindes entscheidenden Rolle der Mutter erarbeitete. Obwohl die Rolle des Vaters ebenso wichtig (...) sei, betonte Winnicott, es liege in der Hand der Mutter, der Psyche des Kindes die Bedeutung des Vaters nahezubringen – oder nicht. Anknüpfend an Winnicotts späte Formulierungen aus »Objektverwendung und Identifizierung« wird vorgeschlagen, dass das psychische Überleben des Objekts die entscheidende interpsychische Dynamik im Kern der Eltern-Kind-Beziehung ist. Das intrapsychisch entstehende subjektiv überlebende Objekt gewinnt im Kontext der analytischen Situation potenziell an Stärke, wenn der Analytiker imstande ist, sein Überleben zu unterstützen. Um diese Themen kreist Winnicotts Objektbeziehungstheorie. (shrink)

Background on probability and evolution -- Laying the foundation. Population-environment systems ; Causal probability and empirical practice ; Irrelevance of fitness as a causal property of token organisms ; Roles of environmental variation in selection -- Reconstructing evolution and chance. Populations in biological practice: Pragmatic yet real ; Real causation in pragmatic population-environment systems ; Fitness concepts in measurement and modeling ; Chance in population-environment systems ; The input measure problem for MM-CCS chance -- Conclusion.

La tension entre le non-dualisme et le dualisme domine toute l’histoire du Vedanta. En face de l’advaita de Śaṅkara, le système de Madhva, auquel cette étude est consacrée, représente l’extrême dualisme, dvaita. Cependant Madhva, après avoir posé la réalité irréductible de la différence entre Dieu et le monde, a comme compensé cette scission de l’être par l’affirmation que tout être autre que l’Être absolu est dépendant de celui-ci, seul Dieu ne dépendant que de lui-même. L’originalité du système de Madhva est (...) d’inventer une relation nouvelle entre l’Être et les êtres. Seul l’Être est capable de faire exister des êtres différents de lui et totalement dépendants de lui ; Dieu permet à toute réalité d’être, et d’être ce qu’elle est. (shrink)