This book systematically reviews a variety of methods for addressing ethical problems in medicine, accounting for both their weaknesses and strengths. Illustrated throughout with specific cases or controversies, the book aims to develop an informed eclecticism that knows how to pick the right tool for the right job.

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.

The modern debate on whether—and why—physicians and hospitals can refuse patient or family demands for treatment on grounds of “futility” will be reaching its 20th anniversary this year (Blackhall, 1987). The early debate focused on the use of CPR, for good historical and clinical reasons, and CPR probably remains the primary target of hospital policy. But the reach of the arguments over futility extends well beyond this context, most vividly illustrated by the case of Helga Wanglie and the many commentaries (...) it spawned (Brody, 1998; Schneiderman, 1998; Trotter, 1999). There seems no obvious reason in principle that questions about futility cannot be raised about virtually any form of treatment that patients or families might demand, including such things as chemotherapy for cancer (Tomlinson, 2001). Still, we might fairly ask what new dimensions and complexities the futility question acquires when it moves onto decisions about treatments other than CPR. This is what I would like to do in this essay. I will use dialysis as the case in point, although I hope to extract lessons from the dialysis example that will be pertinent to other forms of life-sustaining treatment, like ventilators. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (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)

Merging recent evolutionary thought, theories of information and signs, and new findings in animal studies, Gary Tomlinson's The Machines of Evolution and the Scope of Meaning offers a groundbreaking account of meaning in our world.

Professor Cole is correct in his conclusion that the University of Pittsburgh Medical Center (UPMC) protocol does not violate requirements of "irreversibility" in criteria of death, but wrong about the reasons. "Irreversible" in this context is best understood not as an ontological or epistemic term, but as an ethical one. Understood that way, the patient declared dead under the protocol is "irreversibly" so, even though resuscitation by medical means is still possible. Nonetheless, the protocol revives difficult questions about our concept (...) of death. (shrink)

The research importance of biobanked biological materials and their derived data is growing, especially as these are increasingly linked with individual and population‐level medical and health information. The number, diversity, and size of biobanks are growing in tandem. So, too, is the number of individuals whose donations are being used in biobank‐supported research, with or without their knowledge. Pretty soon, we all will be “participants” in a variety of research projects we know nothing about. Until recently, our leftover tissue or (...) deidentified medical information could be used for research without our consent or even our knowledge. Even if we've been asked–as the current regulations require when research uses are anticipated‐we were most likely asked to give a blanket consent to any future use, with no prospect of learning about or controlling how our material is later used. This is an ethically problematic state of affairs, but there are options for improving it. (shrink)

The conflicting positions of the two early eleventh century Yogācāra scholars, Ratnākaraśānti and his critic Jñānaśrīmitra, concerning whether or not consciousness can exist without content are inseparable from their respective understandings of enlightenment. Ratnākaraśānti argues that consciousness can be contentless —and that, for a buddha, it must be. Mental content can be defeated by reasoning and made to disappear by meditative cultivation, and so it is fundamentally distinct from the nature of consciousness, which is never defeated and never ceases. That (...) mental content is thus separable from the nature of consciousness is unimaginable to Jñānaśrīmitra, who argues that all mental content cannot be so defeated, nor can it disappear completely, and who concludes that Ratnākaraśānti’s commitment to this idea can be based on nothing but faith. Contra Jñānaśrīmitra, I will suggest that Ratnākaraśānti’s view is based not only on faith, but is also driven by a certain theory of buddhahood, the implications of which he is committed to working out. Because Ratnākaraśānti’s theory of buddhahood is developed in part in his tantric work, our understanding of his position benefits from our reading it in this context, wherein buddhahood and the most effective techniques for attaining it are explored. (shrink)

Philosophy and Phenomenological Research, EarlyView.

Book reviewed in this article: Life and Death: Philosophical Essays in Biomedical Ethics. By Dan W. Brock.

Abstract:Ratnākaraśānti (ca. 970–1040) holds three conflicting positions: luminosity (prakāśa) is the ultimately real nature of consciousness; luminosity and appearances (ākāras) are identical; and appearances are false (alīka) because they are targeted by the neither-one-nor-many argument. But why is luminosity not false, too, given its identity with appearances? In response to this worry, Ratnākaraśānti develops a notion of identity (tādātmya) that lets him claim that, although luminosity and appearance are composed of the same stuff, they are not identical in every respect. (...) On the basis of this, he limits the scope of the neither-one-nor-many argument such that it targets appearances but not luminosity. Other philosophers (and possibly Ratnākaraśānti himself) then further limit the argument's scope, showing that it also does not target experiences of pleasure (sukha) and, crucially for their buddhology, the innate bliss (sahajānanda) that characterizes the experience of buddhahood. (shrink)

This paper considers Jñānaśrīmitra’s defense of manifestation as the criterion of ultimate existence. In the first section, "Asatkhyāti and Adhyavasāya: making sense of manifestation as the criterion of the real", I show the way that, in response to Ratnākaraśānti’s Nirākāravāda, Jñānaśrīmitra argues for a sharp distinction between manifestation and determination in an effort to establish that the manifestation of something unreal is incoherent. The unreal, he thinks, is only ever determined; it is never manifest to consciousness, properly speaking. In the (...) second section, “To be manifest is to be locked away in a single awareness-event”, I turn to one of the consequences of this view that Jñānaśrīmitra embraces: what manifests is only what appears in a single moment of conscious awareness. In the third section, “The scope of neither-one-nor-many: Jñānaśrīmitra’s Interpretation of PV 3.220–221”, I consider one of the problems this raises: how is it that an appearance with mutually opposed parts manifests in one and the same unitary moment of awareness? Jñānaśrīmitra solves this problem by appealing to the nature of manifestation and its distinction from determination: what is manifest, even if it is variegated, is nondual and indivisible; distinctions arise only on the basis of determination. I trace the details of this solution in the context of his discussion of an important pair of verses from Dharmakīrti. Finally, in the last section, “The marvelous nonduality of variegated awareness-events”, I turn to the surprising buddhological consequences of this solution. (shrink)

What is needed for something new to appear? According to Gilles Deleuze, one of the most brilliant contemporary philosophers, this question of "novelty" is the major problem posed by Bergson's work. In this companion book to Bergson's Matter and Memory, Deleuze demonstrates both the development and the range of three fundamental Bergsonian concepts: duration, memory, and the élan vital. Bergsonism is also important to an understanding of Deleuze's own work, influenced as it is by Bergson.Gilles Deleuze is Professor of Philosophy (...) at the University of Paris VIII, Vincennes/Saint Denis. Among his most recent books in translation are Nietzsche and Philosophy, Cinema: Image Movement and, with Felix Guattari, Anti-Oedipus, Kafka, and One Thousand Plateaus.Hugh Tomlinson is the translator of Deleuze's Nietzsche and Philosophy and Kant's Critical Philosophy. Barbara Habberjam is a translator living in England. (shrink)

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.

The composer of vocal music writes as poet and scholiast. His message is autonomous but not wholly his own. He sets to work with a preexistent artwork before him—a poem or passage of prose, often written without thought of musical setting—and fashions his song under its constraints. He welcomes to his work a second, distinct language, one which corresponds to his own at most only partially in syntax and significance.The composer's unique act of accommodation, structuring his setting after certain requisites (...) of his text, may have far-reaching implications for his musical style—implications too often ignored in today's musical analysis and criticism. Which particular textual characteristics the composer chooses to emphasize will depend on much beyond the text itself: on his view of the nature and capabilities of musical discourse, shaped internally by musical procedures developed from the canon of his predecessors, externally by general expectations and aspirations of his culture; and on his equally rich conception of the tradition behind his text. The text-music interface is therefore a provocative area of exploration for critic and historian alike. It points to the expressive aims of a composer in a given work, and it elucidates broader cultural assumptions concerning the nature of musical and poetic discourse.Gary Tomlinson, assistant professor of music history at the University of Pennsylvania, is the author of articles on Monteverdi, early opera, and Verdi. He is currently writing a book on Monteverdi and late-Renaissance culture. (shrink)

Hospital futility policies are ethically defensible, but they require the proper understanding of futility and should be embedded in a larger process for making decisions about limiting treatment.

Volume 20, Issue 9, September 2020, Page 29-31.

"--Lydia Goehr, Columbia University "This extraordinary book offers us an 'alternative story' of the history of opera. . . . [It] will have an important . . . effect on the way we think about opera."--Roger Parker, Oxford University.

This chapter picks up on what Heidegger in his 1949 ‘Letter on ‘Humanism’’ calls ‘the historical in being’, that dimension of being within which, for Heidegger, a ‘productive dialogue’ between phenomenology and existentialism, on the one hand, and Marxism, on the other, ‘first becomes possible.’ It introduces the possibility of this dialogue through a particular, and particularly revealing, problem with The German Ideology: namely, Marx and Engels offer no analysis of the relationship between time, temporality and their materialist concept of (...) history. (shrink)

This paper explores the philosophical stakes of eighth–twelfth-century Sanskrit debates about tantric initiation ( abhiṣeka ). I propose that three models of tantric initiation emerged in this period, in part in response to the Dharmakīrtian model of the gradual development of yogic perception. According to one, the true glimpse view, initiation gives a glimpse of precisely the experience of buddhahood, which is then made firm in post-initiatory practice. According to another, the exemplary glimpse view, the initiatory glimpse is only exemplary (...) of what buddhahood is like. Post-initiatory practice is necessary to transform the practitioner's attitude toward that glimpse, which eventually results in an experience of buddhahood itself. Finally, others advanced a no glimpse view: only the experience of reality itself in post-initiatory practice can result in an experience of buddhahood. I explore these three views through a close engagement with some representative texts from the period. (shrink)

By strict definition, television journalism, like every form of journalism, has always been ?unreal?; some form of constructed mediated reality.1 But now, television journalism is coming to a crossroads?one where ethics and technology will meet squarely at right angles if not head?on. And it is reality, even the constructed mediated kind, that will be at risk. In a few years, television journalism at the network and local levels will have the capability, through television's emerging conversion from analog to digital technology, (...) to easily manipulate video and audio in utterly fundamental ways. It will be simple to completely re?shape, even to create, reality. The question won't be: ?Is it live or is it Memorex?"2 rather, it will be something like: ?Is it real or is it digitex?"3This article explores this new technology and the concomitant merger of form and substance in television journalism; it presents several hypothetical examples of this kind of unethical behavior and the motivations behind them; and, finally, it wonders what impact unethical digitexing might have on the First Amendment. (shrink)

The whole brain-death criterion of death now enjoys a wide acceptance both within the medical profession and among the general public. That acceptance is in large part the product of the contention that brain death is the proper criterion for even a conservative definition of death – the irreversible loss of the integrated functioning of the organism as a whole. This claim – most recently made in the report of the Presidential Commission and in a comprehensive article by James Bernat (...) and others – is based upon a series of fallacious arguments. Chief among these is the argument that whole brain-death is the proper criterion for the conservative definition because the brain is the organ that integrates the rest of the organism. A central part of the paper shows that this argument rests upon a confusion between a function and the mechanism that performs it, and replies to the defenses that the Presidential Commission makes on this point. The concluding portion of the paper argues that this issue is not merely of academic interest, but has the potential for undermining the present consensus that supports the use of whole brain-death criteria. * Keywords: brain-death, definition of death, determination of death * I would like to thank Howard Brody and Bruce Miller for helpful suggestions and criticisms. CiteULike Connotea Del.icio.us What's this? (shrink)

Feminists may overlook the way that our practices of reading and writing serve as discursive technologies of power, particularly if we fail to acknowledge the dominance of the invisible subject position of the (middle-class, heterosexual) white woman. Under such circumstances, specific seemingly neutral rhetorical strategies can serve as potent tools of dominance, infusing the reading situation with strategies of subordination that go unremarked because they are authorised by tradition and convention. I examine here the use of a specific rhetorical device (...) in a specific context, the evocation of a comment by Judith Butler that I call The Case of the Et Cetera, as it appears in six critiques of intersectionality by European scholars and one by a North American scholar relying on the European narrative. I argue that Butler’s comment is used to deploy a pattern of rhetoric that I call managing intersectionality. This move depoliticises intersectionality by making it the property of a white managerial subject position that is treated as racially unmarked. My target is the metadiscursive regime that authorises this uninterrogated reinscription of racialised hierarchy in feminist academic argument. (shrink)

This paper proceeds from the premise that time and temporality constitute a distinct philosophical problem for Marx and Engels’s materialist concept of history in 'The German Ideology'. It is thus necessary to 'temporalize' this concept of history: to situate it in relation to the active production of a dynamic difference between the past, the present, and the future. After revisiting the philosophical dimensions of Marx’s concepts of materialism, the human, and need, this article uncovers a temporality within the materialist concept (...) of history that is irreducible to a historicist framework of linear, progressive time. (shrink)

The emergence several years ago of SARS, with its high rate of infection and death among healthcare workers, resurrected a recurring ethical question: do health professionals have a duty to provide care to patients with deadly infectious diseases, even at some substantial risk to themselves and their families? The conventional answer, repeated on the heels of the SARS epidemic, is that they do. In this paper, I argue that the arguments in support of such a duty are wanting in significant (...) respects, and that the language of duty is simply not adequate to an understanding of all the moral dimensions of professional responses to the care of risky patients. Instead, we should speak the language of virtues and ideals if we want to do justice to the complexity of such harrowing circumstances. (shrink)

Classified advertising occupies a prominent place in the history and current economics of the print media in America, including magazines. There are dozens of classifications, most of which are as innocuous as the language that constitutes the individual advertisements. The personals classification, however, is not always so innocuous. Gun-for-hire classified advertisements in one magazine were so blatant that several serious crimes, including murder, were committed as a result of the advertisements. Generally, courts find no liability for disseminators of advertising that (...) causes harm. But the application of the ethical theory of basic mixed rule deontology would mandate that publications should not publish such classified advertising notwithstanding that it is likely legal to do so. (shrink)

Three recently published books, by Stavros Tombazos, Jonathan Martineau, and Harry Harootunian, join a now established body of literature that highlights the temporal aspects of Marx’s work. Their differences notwithstanding, these books are united by the conviction that, at its core, capitalism is an immense and complex organisation of time, and thus that the importance of Marx’s work is realised by its singular contribution to our understanding of this. Each book is centrally concerned with the historically specific character of capital’s (...) temporal order, such that each presents a new reading of the relationship between capitalism and historical time. (shrink)

The present book is true to its title. A collection of articles that stems from a symposium of the same name at the University of Hamburg in 2017, the authors here bring different perspectives to bear on the philosophical and historical relations between Buddhism and scepticism. Though this is relatively well-trodden ground, the insightful studies here shed new light on the matter. We find historical studies of the possible links between Pyrrhonism and Buddhism ; a defense of Nāgārjuna's philosophical scepticism (...) as of the Pyrrhonian variety ; considerations of the role of sceptical doubt in less expected places, such as in Dharmakīrti's and Vasubandhu's... (shrink)