Dorian Gray pays a hefty price for years of sin and vice in this completely unabridged edition of The Picture of Dorian Gray.

: Bioethics has focused on the areas of individual ethical choices--patient care--or public policy and law. There are, however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.

The rise of quantum information theory has lent new relevance to experimental tests for non-classicality, particularly in controversial cases such as adiabatic quantum computing superconducting circuits. The Leggett-Garg inequality is a “Bell inequality in time” designed to indicate whether a single quantum system behaves in a macrorealistic fashion. Unfortunately, a violation of the inequality can only show that the system is either (i) non-macrorealistic or (ii) macrorealistic but subjected to a measurement technique that happens to disturb the system. The “clumsiness” (...) loophole (ii) provides reliable refuge for the stubborn macrorealist, who can invoke it to brand recent experimental and theoretical work on the Leggett-Garg test inconclusive. Here, we present a revised Leggett-Garg protocol that permits one to conclude that a system is either (i) non-macrorealistic or (ii) macrorealistic but with the property that two seemingly non-invasive measurements can somehow collude and strongly disturb the system. By providing an explicit check of the invasiveness of the measurements, the protocol replaces the clumsiness loophole with a significantly smaller “collusion” loophole. (shrink)

This article seeks to explain how it was possible that, until the first century BC, the Roman dictatorship was never abused and turned against the constitution itself. The traditional explanation is that, contrary to its first century imitations, the dictatorship was subject to formal restrictions, such as the six months' tenure, which were strictly applied. By contrast, this article suggests that informal constraints on the dictator's powers, such as moral and religious norms, were as important as formal constraints. It shows, (...) more particularly, how the fides, or the requirement of trust, was essential for preventing an abuse of dictatorial powers. (shrink)

In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as need (...) assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are - within this context - guiding but not binding principles. -/- Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. -/- Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)

On 9 December 1930, Walter Benjamin sent a copy of his book The Origin of German Tragic Drama to Carl Schmitt, accompanied by a letter in which he expressed his indebtedness to Schmitt: "You will very quickly recognize how much my book is indebted to you for its presentation of the doctrine of sovereignty in the seventeenth century. Perhaps I may say, in addition, that I have also derived from your later works, especially Die Diktatur, a confirmation of my modes (...) of research in the philosophy of art from yours in the philosophy of the state. If the reading of my book allows this feeling to emerge in an intelligible fashion, then the purpose of my sending it to you will be achieved" (qtd. in Weber 1992, 5). As .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death: A Persistent Controversial StateKevin Wm. Wildes S.J. (bio)Along with the moral questions surrounding research and experimentation, the moral questions of death and dying have ranked among the most central and formative sets of issues for the field of bioethics. While the questions of death and dying have a long history (Wildes 1996), the attempt to address them as secular questions is an element of what established bioethics as (...) a field of inquiry.The controversies of death and dying are not only formative of bioethics, but also are among the most persistent bioethical controversies. Today, almost 30 years after the Harvard Ad Hoc Committee’s definition of death and 20 years after the Quinlan decision, the questions of death and dying are still with us. Recently, the question of physician-assisted suicide once again gained national [End Page 378] attention with the trials of Dr. Kevorkian and the decisions of the Ninth and Second Circuit Courts on the constitutionality of the Washington and New York state laws prohibiting physician-assisted suicide. At the same time, questions and controversies about the appropriate extent of treatment and the determination of death in relationship to treatment continue to be problematic in health care.As I reviewed the literature in the area of death and dying, one central question emerged: Why, after so much reflection, energy, and discussion, do the problems around death and dying continue to persist? There is a recurring character to these questions that is indeed a wonder. In reviewing these moral controversies, one might ask what these controversies and their persistent character tell us about bioethics that can help us to understand the issues and the field.Some might blame the development of medical technology for the persistence of these issues of death and dying. The development and use of technological resources certainly is an important element of these continuing controversies. The use of medical technologies at the end of life allows us the possibility to sustain lives that would have been lost just a few decades ago. However, while medical technology certainly opens new horizons and possibilities, the development and deployment of technology does not sufficiently explain why these issues are so difficult and persistent. The question underlying the use of medical technology at the end of life is the question about which criteria are to be used to make judgments about the appropriate use of such technology. If the use of medical technology depends on the moral views one holds about death, suffering, and the appropriate use of resources, then such issues will be morally controversial in a society that is morally pluralistic.To address these questions, it is important to remember what is all too obvious and yet often forgotten. Death is not only a medical event. In this century, particularly in the last 40 years, we have reduced death to a medical event, yet, the medical meanings do not exhaust the event (see Engelhardt 1996, pp. 189–238). Death is also a social, cultural, and often religious event and the medical realities of death must be interpreted within these different contexts. As such, death will be the locus of different meanings and interpretations. By keeping these different structures of interpretation in mind, we are better able to understand why controversies around death and dying persist. Just as the meaning of death will vary from culture to culture, so too will the criteria of death vary. Different moral communities have different criteria for death—e.g., pulmonary or cognitive function. Put another way, different communities and cultures will have different views of what constitutes a good life, and those views influence the way death is understood. How one understands the obligations to support life also varies according to one’s moral commitments and values.One’s view of what counts as death, or what counts as a good death, is influenced [End Page 379] by the moral commitments that one holds. The persistent controversies over death and dying are a symptom of deep, widespread moral and cultural pluralism. These views are controversial because, in many ways, our deaths are no longer private. That is, the way we die often is tied to a health... (shrink)

In the writings of Martin Heidegger being has again been singled out as the primary factor from which both world and meaning are ultimately derived. Owing to the focusing on what we call the world by recent phenomenological investigations, to which Heidegger himself has made important contributions, his philosophy shows many novel and original features. But as he sees it, being is again the primary factor which manifests itself, through man, in the meaningful clearing of the life-world. So in this (...) respect we must think of his style of thought as a new development of the classical tradition. (shrink)

Fokus eines Kriegseinsatzes und Fluchtpunkt des Preußischen Staatsrats Schmitt und seiner Lebens-, Zeit-, Rechts- und Ideengeschichte. Korrumpiert und verstoßen, widerstrebend und vereinnahmt ging das "Chamäleon" Carl Schmitt im Dritten Reich seinen eigenen Weg. Die europäische Zeit- und Rechtsgeschichte spiegelt sich exemplarisch im Werden und Wirken des "Kronjuristen des Dritten Reiches", und heute sind die Ideen dieses Staatsrechtsvordenkers und Großraumvisionärs wieder brennend aktuell.

This article seeks to explain how it was possible that, until the first century BC, the Roman dictatorship was never abused and turned against the constitution itself. The traditional explanation is that, contrary to its first century imitations, the dictatorship was subject to formal restrictions, such as the six months' tenure, which were strictly applied. By contrast, this article suggests that informal constraints on the dictator's powers, such as moral and religious norms, were as important as formal constraints. It shows, (...) more particularly, how the fides, or the requirement of trust, was essential for preventing an abuse of dictatorial powers. (shrink)

A particular tradition in medicine claims that a variety of evidence is helpful in determining whether an observed correlation is causal. In line with this tradition, it has been claimed that establishing a causal claim in medicine requires both probabilistic and mechanistic evidence. This claim has been put forward by Federica Russo and Jon Williamson. As a result, it is sometimes called the Russo–Williamson thesis. In support of this thesis, Russo and Williamson appeal to the practice of the International Agency (...) for Research on Cancer. However, this practice presents some problematic cases for the Russo–Williamson thesis. One response to such cases is to argue in favour of reforming these practices. In this paper, we propose an alternative response according to which such cases are in fact consistent with the Russo–Williamson thesis. This response requires maintaining that there is a role for mechanism-based extrapolation in the practice of the IARC. However, the response works only if this mechanism-based extrapolation is reliable, and some have argued against the reliability of mechanism-based extrapolation. Against this, we provide some reasons for believing that reliable mechanism-based extrapolation is going on in the practice of the IARC. The reasons are provided by appealing to the role of robustness analysis. (shrink)

Proposed models of closed timelike curves have been shown to enable powerful information-processing protocols. We examine the simulation of models of CTCs both by other models of CTCs and by physical systems without access to CTCs. We prove that the recently proposed transition probability CTCs are physically equivalent to postselection CTCs, in the sense that one model can simulate the other with reasonable overhead. As a consequence, their information-processing capabilities are equivalent. We also describe a method for quantum computers to (...) simulate Deutschian CTCs. In cases for which the overhead is reasonable, it might be possible to perform the simulation in a table-top experiment. This approach has the benefit of resolving some ambiguities associated with the equivalent circuit model of Ralph et al. Furthermore, we provide an explicit form for the state of the CTC system such that it is a maximum-entropy state, as prescribed by Deutsch. (shrink)

ABSTRACT This article seeks to explain why the Roman dictatorship, which had served as a positive model of constitutional emergency government until the French Revolution, acquired a negative meaning during the Revolution itself. Both Montesquieu and Rousseau regarded the dictatorship as a legitimate institution, necessary to protect the republic in times of crisis. For the French revolutionaries, the word ‘dictatorship’ acquired negative connotations: it became a rhetorical tool for accusing their political opponents of authoritarian rule. This article argues that Carl (...) Schmitt’s distinction between commissarial and sovereign dictatorship is unhelpful for understanding why the dictatorship was rejected by the French revolutionaries. Instead, it shows that it was the early identification with Montesquieu’s aristocratic dictatorship, which caused the delegates of the National Assembly to reject it as a threat to popular sovereignty. The exception was Marat, who proposed to establish a popular dictatorship à la Rousseau to purge the state from counterrevolutionary forces. However, Marat’s proposal found little support with his fellow-Jacobins, as it allowed the Girondins to accuse them of a conspiracy against the Convention. This caused the Jacobins to reject the dictatorship altogether and to propose alternative models of emergency government. (shrink)

Equality is a concept that is often used in health care discussions about the allocation of resources and the design of health care systems. In secular discussions and debates the concept of equality is highly controverted and can take on many different specifications. One might think that Christians hold a common understanding of equality. A more careful study, though, makes it quite clear that equality is just as controversial among different Christian communities as it is in the secular world.

At its root meaning a “crisis” is a separation. In our everyday lives we use the term crisis to designate a period of decision. A crisis is a moment of separation when one must make a decision about a direction. To make a crisis decision, a person needs some criteria or set of norms to guide the decisions that are made. Sometimes, at a moment of crisis decisionmaking, there is chaos when one does not know which norm to use in (...) making a decision. Without some norm a crisis is a significant loss of direction because there are different criteria for deciding which way to turn or how to decide. It is in this most fundamental sense that one can say that contemporary medicine is in crisis. (shrink)

In his classic Mimesis: The Representation of Reality in Western Literature, Erich Auerbach famously cites the opening pages of Honoré de Balzac’s Père Goriot as emblematic of modern realism. With their minute description of the boardinghouse, where much of the novel’s action takes place, these pages emphasize physical setting, Auerbach argues, in a way new to Western literature. Yet Balzac’s descriptions are driven by something more than an ambition to represent “contemporary life” in scrupulous detail. In Auerbach’s view, the characteristic (...) element of Balzac’s realism is an obsession with the reciprocal action of characters and milieu, a scientific or philosophical principle according to which the quality... (shrink)

The author of this text argues that the methodological issues in bioethics mirrors the experience of moral pluralism in a secular society. The different methods that have been used in the field reflect the different moral views found in a pluralistic society.

: During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and (...) health care. (shrink)

Despite the attempts to promote the inclusion of pregnant women into clinical research, this group is still widely excluded. An analysis of the “vulnerability of pregnant women” that questions deeply internalized stereotypes is necessary for finding the right balance in the protection of pregnant women as research participants. Criticism of the traditional account of vulnerability will lead to an alternative that focuses on situations rather than groups and on the obligations of responsible parties. The paper adds to the current general (...) discussion of vulnerability and at the same time addresses the specific problem of drug treatment during pregnancy. (shrink)

A fundamental and bold claim of Portmann’s philosophy of biology is a thesis about the autonomy of self-representation of all living beings: “Self-presentation has to be understood as a basic fact of life, on a par with self-maintenance and the preservation of the species.” In other words, the perceivable appearance of organisms cannot be reduced to its chemical, physiological, morphological or functional causes, but must be understood as a phenomenon in its own right. The aim of the following contribution is (...) threefold. First, it aims at establishing the relevant context for the bold claim by embedding the claim in Portmann’s broader view of biology. Secondly, it aims at reconstructing Portmann’s rather scattered argument for the bold claim by recasting it as an appeal to what Portmann calls “unaddressed authentic appearances”. Finally, it presents Portmann’s partly phenomenological approach to biological phenomena as a reluctant relative of Goethe’s approach, thereby claiming that Portmann is no advocate of a genuine Goethean science of nature. (shrink)

The author of Look Back in Anger, Inadmissible Evidence, and The Entertainer has created a brilliant dramatization of this classic about a man who retains his youth while the decay of advancing years and moral corruption appears on a portrait painted by one of his lovers.