(2002). Clarifying the Ethics of Clinical Research: A Path toward Avoiding the Therapeutic Misconception. The American Journal of Bioethics: Vol. 2, No. 2, pp. 22-23.

Background: Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child’s growing autonomy are known ethical concerns that involve the whole professional team around the child’s care. Objectives: The purpose of this study was to explore healthcare professionals’ experiences of participating in ethics case reflection sessions in childhood cancer care. Research design: Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Participants and research (...) context: Healthcare professionals working at a publicly funded children’s hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. Ethical considerations: The children’s and their parents’ integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Findings: Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants’ articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. Discussion: The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Conclusion: Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child. A consolidated care approach would be valuable for both the child and the healthcare professionals because of the common care goals. (shrink)

The Clarifier of the Sweet Meaning. Buddha datta Thera. Translated by I. B. Horner. Sacred Books of the Buddhists Series No. 33, PTS, London 1978. lviii + 453 pp. £15.50.

Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in medical (...) debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

This paper clarifies and defends my account of the rights forfeiture theory of punishment in response to analyses by Michelle Madden Dempsey and Gerald Lang.

We respond to a Letter to the Editor regarding "Principlism and contemporary ethical considerations for providers of transgender health care." We address criticisms by Castle & Klein (2024) of blatant fatphobia related to the ethical elements concerning BMI restrictions for gender-affirming surgery. Our response corrects several mischaracterizations of the article and clarifies our position. My co-authors and I remain focused on advocating for patient-centered, ethically sound, evidence-based, and equitable healthcare policies.

A primary goal of clinical practice is to respect patient autonomy. To promote this goal for patients who have lost the ability to make their own decisions, commentators recommend that surrogates make their treatment decisions based on the substituted judgment standard. This standard is commonly interpreted as directing surrogates to make the decision the patient would have made in the circumstances, if the patient were competent. However, recent commentators have argued that this approach—attempting to make the decision the patient would (...) have made if competent—is theoretically problematic, practically infeasible, and ignores the interests of the patient9s family and loved ones. These commentators conclude that the substituted judgment standard should be revised significantly, or abandoned altogether. While this response would avoid the cited problems, it also would require substantial changes to clinical practice and would raise significant problems of its own. The present paper thus considers the possibility that the criticisms do not point to problems with the substituted judgment standard itself; instead, they point to problems with the way it is most commonly interpreted. This analysis suggests that the substituted judgment standard need not be dramatically revised or abandoned. Instead, it should be interpreted in a way that effectively promotes respect for the autonomy of incompetent patients. The ‘endorsed life’ interpretation described here helps clinicians and surrogates to achieve this important goal. To clarify this approach, we explain how it differs from three other recently proposed alternatives to the standard interpretation of the substituted judgment standard. (shrink)

Susan D. McCammon and Nicole M. Piemonte offer a thoughtful and thorough commentary on our manuscript entitled “Expanding the use of Continuous Sedation Until Death.” In this reply we attempt to clarify and further defend our position. We show how continuous sedation until death is not a “first resort” but rather a legitimate option among many that should available to terminally ill patients whose life expectancy is less than six months. We also attempt to show that we do not equivocate (...) the meaning of palliative care as the commentators suggested. We argue that the traditional notion of palliative care should move beyond relief of “experienced suffering” to relief of potential suffering for those whose life expectancy is less than six months. Lastly, we challenge the commentator’s position that the realm of ordinary medicine” should be the guide to care, by showing how the notion of ordinary medicine has been successfully challenged in both bioethical scholarship and the courts in a way that shows ordinary medicine to be an evolving concept rather than a static, universal guide. (shrink)

Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in medical (...) debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the 'special status of human beings'; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation-stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

As recognized by Gostin in Global Health Law, the principles of equality and dignity put human rights law in a unique position to promote progress towards global health equity. This seems particularly relevant for the right to health, which entitles everyone to ‘the highest standard of health attainable’. However, it is still unclear what such a standard entails, and in order for the right to health to be adequately enforced and, thus, to effectively channel progress towards global health equity, it (...) is fundamental that its scope of interests be clarified. Supranational human rights bodies have a key role in that regard. Not only can they clarify the legal content of the right to health for key actors through their monitoring procedures, they can also set common standards for states under their jurisdictions. Therefore, their contributions should be examined and optimized. (shrink)

Those who would enquire into therelationship between health conceptions and health care consequences are faced with a formidable task. In order to make this challenge manageable it is necessary to define the scope of the task as precisely as possible. Are we, for instance, faced with a purely theoretical challenge; a task for applied philosophy, or must we employ multi-disciplinary methods?This paper argues that while philosophy has a central clarifying role, inquiry into the relationship between health conceptions and health (...) care organisation can be done properly only through the combined efforts of several disciplines. Unless we are to be concerned only with abstract models it is essential to take account of the reality of health care situations. Given this it is suggested that the study of health conceptions is only a part of a greater task (unless all conceptions are to count as health conceptions). What is needed is understanding of the possible and actual purposes of health care, and detailed study of their practical implications. (shrink)

There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...) these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clarifying the Relationship Between Vice and Mental Disorder: Vice as Manifestation of a Psychological DysfunctionMichael B. First (bio)KeywordsDSM-IV, psychiatric diagnosis, impulse control disorders, sexually violent predator commitmentIndividuals generally present for psychiatric evaluation for one of two reasons: either because they themselves are suffering from a psychiatric symptom that causes distress (e.g., severe panic) or impairs their ability to function effectively (e.g., memory loss), or else they are brought (...) to clinical attention because their behavior or attitudes are considered by others to be problematic. There are a wide range of behaviors that fall into this second category. In some cases, the individual is pressured to seek treatment because of the negative impact that a behavior has on a relationship partner (e.g., sexual dysfunction, anger outbursts) or an employer (e.g., excessive alcohol use). Often, however, the external trigger for a clinical evaluation falls under Sadler’s definition of vice, that is, criminal (illegal) behaviors or attitudes that could be considered “wrongful” or “immoral” in the social arena because the behavior violates the law or an important social more.Given that one of the most important goals of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is to facilitate clinical practice (First et al. 2004) and in doing so provide a diagnostic code to cover any patient that might present himself or herself to a mental health professional, the DSM has evolved over its various editions to become a veritable laundry list of psychological and behavioral ills, some of which may constitute a violation of the rights of others or society. The DSM-III (and its successors) have adopted a descriptive approach wherein disorders are defined in terms of their presenting surface symptomatology, which was necessitated by the field’s lack of knowledge about the underlying etiology of mental disorders. Given this reliance on presenting symptoms, it is therefore inevitable that some disorders are defined in terms of behaviors that can be considered vices. For example, impaired impulse [End Page 35] control often leads to acting out behavior that, at its mildest is inappropriate, and at its most severe is destructive to self and others. Many of the disorders cited by Sadler as being vice-laden fall into this category, namely, pyromania (failure to resist impulses to set fires), kleptomania (failure to resist impulses to steal), intermittent explosive disorder (failure to resist aggressive impulses), certain forms of substance abuse (i.e., those involving possession and use of illegal substances) and paraphilias (i.e., those involving nonconsenting victims).It is important to clarify from the outset that the criteria for determining whether a behavior is a “vice” (i.e., whether it is illegal or immoral) is not equivalent to the criteria for determining whether a behavior is indicative of a mental disorder. According to the DSM-IV-TR definition, a mental disorder is conceptualized as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychiatric Association [APA] 2000, xxxi). The definition warns against considering “deviant behavior[s] (e.g., political, religious, or sexual)” and “conflicts that are primarily between the individual and society” to be evidence of mental disorder except in those cases in which the “deviance or conflict is a symptom of a dysfunction in the individual.” Thus, when considering whether a particular “vice” behavior is a component of a mental disorder, it is crucial to determine whether the behavior is a manifestation of an underlying psychological dysfunction, such as a dysfunction in impulse control. If so, it may potentially be appropriate for that individual to be treated as “medically ill” in addition to, or instead of, being treated simply as a criminal.Let us examine some illustrative examples of cases that demonstrate the relationship between vice and mental disorders and the different ways in which the legal and mental health systems might deal with such cases. Consider the case of an individual who breaks... (shrink)

In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

ABSTRACT The purpose of this research is to examine ethical climate as a mediator iin the relationship between ethical leadership and workplace bullying. An online questionnaire was answered by 223 Portuguese employees, who had worked for at least 6 consecutive months at the same organization. Results support the mediating role of ethical climate on the relationship between ethical leadership and bullying at work, suggesting that ethical leaders can contribute to the minimization of bullying through their impact on ethical climate and (...) employees’ behavior. Drawing on the social learning theory and the social information processing theory, this study clarifies the mediating role of ethical climate. (shrink)

Somogy Varga's criticisms and questions provide me with a welcome opportunity to clarify some key elements of my proposal. First, I briefly summarize my motivation and original proposal for a phenomenological–dimensional research program. Second, I address Varga's two challenges. Each challenge highlights an element of my proposal that was underdeveloped in the original article. I therefore provide a brief clarification of my proposal before responding directly to Varga's two challenges.My proposal is to shift phenomenological psychopathology toward a broadly dimensional, rather (...) than categorial, research program. This approach will allow phenomenologists to operate outside the constraints of... (shrink)

Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un- Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent (...) that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article, we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic. (shrink)

We discuss what we take to be three possible misconceptions in the foundations of general relativity, relating to: the interpretation of the weak equivalence principle and the relationship between gravity and inertia; the connection between gravitational redshift results and spacetime curvature; and the Einstein equivalence principle and the ability to ``transform away" gravity in local inertial coordinate systems.

The focus of this paper is on the practice of clarifying illocutionary force, the social activity of asking for and providing descriptions that make explicit what kind of act what done in speaking. Two forms of this practice are distinguished, one that takes place as part of the speech encounter that is the target of the practice, and one that takes place subsequent to that speech encounter. It is argued that the function of the practice differs between these forms, (...) and that this yields two very different ways of responding to a clarificatory query. The paper concludes by considering some implications of this difference in function for understanding of the character of illocutionary force itself, with a focus on its repercussions for understanding the possible role of the stance of participant, as opposed to theorist, in determining what was done in speaking. (shrink)

An intriguing though little noticed trend within moral theology over the last half century or so is the move towards re-conceptualising moral norms previously considered mandatory into ideals. The ideal-normative turn has been taken by official Catholic and Anglican ecclesial documents, in both cases as regards the closely related matters of marital permanence and extra/post-marital unions. Yet the turn has occurred with little or no scrutiny of the distinction at its heart, that between ideal and mandatory norms. This article applies (...) the distinction to an analysis of New Testament moral normativity, with particular focus on teachings on marriage. Through this examination core elements of New Testament normativity are clarified and the credibility of the ideal-normative turn as it pertains to marital permanence is thereby challenged. (shrink)

Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...

I respond to Vaidman’s recent criticisms of my paper “A New Problem for Quantum Mechanics”.

The critical examination of current hypotheses is one of the key ways in which scientific fields develop and grow. Therefore, any critique, including Haidle and Schlaudt’s article, “Where Does Cumulative Culture Begin? A Plea for a Sociologically Informed Perspective,” represents a welcome addition to the literature. However, critiques must also be evaluated. In their article, Haidle and Schlaudt review some approaches to culture and cumulative culture in both human and nonhuman primates. H&S discuss the “zone of latent solutions” hypothesis as (...) applied to nonhuman primates and stone-toolmaking premodern hominins. Here, we will evaluate whether H&S’s critique addresses its target. (shrink)

Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...) even more will be involved. However, despite the pressing need for reflection on research ethics, it is important to carefully identify the concerns we have about research. Otherwise we run the risk that the moral language we use, and which we hear other people use, may do our moral thinking for us. We argue that many recent claims about the occurrence of coercion in medical research are misguided and misuse the word "coercion." We try to identify the real problems, and urge people to attend carefully to the implications of their descriptions of moral problems in research. (shrink)

This exciting volume brings together leading figures across existential psychology in a clear-sighted guide to its current practice and therapeutic possibilities. Its accessible yet scholarly presentation dispels common myths about existential psychotherapy while demonstrating core methods and innovative techniques as compatible with the range of clinicians' theoretical orientations and practical approaches. Chapters review the evidence for its therapeutic value, and provide updates on education, training, and research efforts in the field, both in the US and abroad. Throughout, existential psychotherapy emerges (...) as a vital, flexible, and empirically sound modality in keeping with the current-and future-promotion of psychological well-being. Highlights of the coverage include: Emotion, relationship, and meaning as core existential practice: evidence-based foundations. · Meaning-centered psychotherapy: a Socratic clinical practice. Experience processing as an aspect of existential psychotherapy: life enhancement methodology. Structural Existential Analysis (SEA): a phenomenological method for therapeutic work. Experiencing change: an existential perspective. Creating the World Congress for existential therapy. Clarifying and Furthering Existential Psychotherapy will spark discussion and debate among students, therapists, researchers, and practitioners in existential psychology, existential psychotherapy, and allied fields as well as the interested public. It makes a suitable text for graduate courses in existential therapy, psychological theories, and related subjects. (shrink)

Having been used in various guises and debates for quite some time the notion of mediatization (and related concepts such as mediation or medialization) promises to expand the horizon of media and communication research. Casting the role of the media in and for current western societies as ever more central employing a range of theoretical approaches, mediatization could help to further advance our knowledge of the role of mediated communication for the creation of social realities today. Still, the recent interest (...) in the conceptual framework has also caused confusion as to which approaches are compatible, to which methodological scope the concept extends and what its theoretical and ideational roots are. This article tries to sort through the wealth of conceptual propositions in order to clarify a research approach that might help to reunite social, cultural and communication theory in the face of today's media culture. (shrink)

This paper discusses why integration is important in doing research for developing policy and practice of sustainable environmental management. The imperative of integration includes environmental, social, economic, and other disciplinary considerations, as well as stakeholder interests. However, what is meant by integration is not always clear. While the imperative is being increasingly enunciated, the challenges it presents are difficult and indicate a long term pursuit. This paper clarifies the different dimensions of integration, as an important preliminary step toward advancing mutual (...) understanding and the development of approaches. The paper identifies the driving forces for integration, discusses when integration is required, categorises forms of integration, and proposes principles to inform research programs and projects. (shrink)

Implicitly or explicitly, youth work practitioners, scholars and advocates typically invoke a set of egalitarian values to explain, justify and promote the ethical basis of their work. Despite such commitments, there exists conceptual ambiguity surrounding equality across much of the youth work literature which has significant consequences for how youth work is framed and defended. This article introduces the interdisciplinary field of Equality Studies and argues that an Equality Studies approach provides a means to (i) clarify equality-related normative goals within (...) the youth work field and (ii) enhance radically orientated youth work by strengthening the conception of equality at its core. It analyses three areas of conceptual ambiguity within the youth work literature with respect to the value of equality, in each case demonstrating how an Equality Studies approach can help remedy the problem. These areas are: (i) the assumption that equality means ‘sameness’; (ii) the limits of equality of opportunity and anti-discrimination; and (iii) the relationship between equality and other values. It then evaluates the concept of ‘equity’, arguing that it is a vague, inadequate and unnecessary vehicle for capturing egalitarian concerns. The article concludes with some comments on the feasibility of radically egalitarian youth work. (shrink)

Background Several jurisdictions, including Singapore, Australia, New Zealand and most recently Ireland, have a public interest or public good criterion for granting waivers of consent in biomedical research using secondary health data or tissue. However, the concept of the public interest is not well defined in this context, which creates difficulties for institutions, institutional review boards and regulators trying to implement the criterion. Main text This paper clarifies how the public interest criterion can be defensibly deployed. We first explain the (...) ethical basis for requiring waivers to only be granted to studies meeting the public interest criterion, then explore how further criteria may be set to determine the extent to which a given study can legitimately claim to be in the public interest. We propose an approach that does not attempt to measure magnitude of benefit directly, but rather takes into account metrics that are more straightforward to apply. To ensure consistent and justifiable interpretation, research institutions and IRBs should also incorporate procedural features such as transparency and public engagement in determining which studies satisfy the public interest requirement. Conclusion The requirement of public interest for consent waivers in secondary biomedical research should be guided by well-defined criteria for systematic evaluation. Such a criteria and its application need to be periodically subject to intra-committee and intra-institution review, reflection, deliberation and amendment. (shrink)

Understanding a patient’s story is integral to providing ethically supportable and practical recommendations that can improve patient care. Important skills include how to elicit an individual’s story, how to weave different narrative threads together, and how to assist the care team, patients, and caregivers to resolve difficult decisions or moral dilemmas. Narrative approaches to ethics consultation deepen dialogue and stakeholders’ engagement to reveal important values, preferences, and beliefs that may prove critical in resolving care challenges. Recognizing barriers to narrative inquiry, (...) such as patients who are unable or refuse to share their story, is also important. In this article we offer specific steps and guidelines that ethicists can follow to systematically elicit and construct patients’ stories. We provide a case example to illustrate how a narrative approach to ethics consultation illuminates salient ethical issues that may otherwise go unnoticed. We argue that this approach should be part of every consultant’s tool kit. (shrink)

In a series of recently published lectures and essays two Roman Catholic Cardinals—Cardinals Ratzinger and Kasper—have offered significantly different positions of the issue of the relationship of the Universal to the Particular Churches. Cardinal Kasper locates the root of the disagreement in the philosophical foundations of the two views in privileging the Universal over the Particular (or vice versa) as the starting point for ecclesiology. I will explain why I find Josiah Royce’s late work (as informed by C. S. Peirce’s (...) thought) to be a valuable resource for the complexities of such a rich ecclesiological enquiry. I examine the interrelationship between Spirit, Community and the Interpretation of Signs in the mature thought of Royce, I assess his contribution to the preceding discussion, and I offer some insights into his potential value to any ongoing dialogue on the nature and purpose of the Church. (shrink)

In recent years, a number of authors – such as Kershnar and Kelly, Steinhoff, and Scanlon – have criticized the doctrine of double effect (DDE) as incoherent, lacking an underlying rationale, or leading to counterintuitive conclusions. These critiques, however, rest on a failure to understand the DDE’s broader theoretical context and presuppositions. This paper aims to clarify and advance the debate regarding the DDE by, first, outlining a contemporary version of the broader normative theory (i.e. the Aristotelian-Thomistic natural law tradition) (...) within which the DDE finds its proper context, and explaining the rationale for the DDE within this context; second, clarifying the DDE’s proportionality condition to avoid common misinterpretations; and, third, showing how the DDE, when properly formulated and understood within the appropriate theoretical context, can withstand the recent criticisms that have been raised against it. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 46-47, June 2011.

In this paper we investigate the logical consequences of the common understanding of amateurism in the context of big-time US college athletics, and in so doing, illustrate a method based on linguistic analysis and logic. The initial thrust of the paper centres on the term ?amateur? as presupposed by the late Professor Brand in his attempt to justify the ?business? of NCAA-sponsored Division I sports by decoupling the ?participants from the enterprise?. Next, we examine a more rigorous definition of the (...) term ?amateur? in order to show more clearly the difficulties posed by the current situation in college athletics. Additionally, our use of linguistic analysis exposes a flaw in the NCAA's recent move to amend by-law 12.02 in an attempt to avoid the charge of exploitation. Lastly, we put forth a new proposal for better dealing with the central issues swirling around the NCAA as it strives to formulate sound policy at this ?tectonic? juncture of players, fans, college programmes and academic integrity. (shrink)

Futility is easily defined as uselessness. The mistaken appearance that it cannot be defined is explained by difficulties applying it to particular cases. This latter problem is a major goal of clinical training and cannot be solved in a pithy statement.

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)