Tag: philosophy

Blog Posts (22)

September 12, 2016

“Humanists,” Academic Philosophers, Critical Distance, and Clinical Ethicists

The October 2016 Annual Meeting of the American Society for Bioethics and Humanities (ASBH) announced its theme for the Washington, D.C., convocation several months ago: “After over half a century of work, and as ASBH celebrates its coming-of-age, we have chosen to focus on ‘critical distance’ and our ‘insider-outsider’ status at our 18th annual meeting.” Some may be relatively unfamiliar with these notions of “critical distance” and “insider-outsider” status.

            In the early 1970s, when medical center and medical school thought leaders began hiring “humanists” to teach, round with teams, and attend morning reports and noon conferences, it was unclear what – if any - specific outcomes might result. However, the center executives and deans wanted to try something to help inject human values and humanistic thought into the educational process to offset the very strong influences of advancing technologies, specialization, and materialism, and to assure the outraged public in the face of recently revealed research scandals.

            These pioneer “humanists” were theologians, religious studies scholars, and philosophers. In just a few years, the philosophers were predominating in this growing field of applied ethics educators and scholars. In explaining this transition, Art Caplan wrote: “It proved very difficult to do bioethics in public in anything approximating a religious voice. ... [I]t quickly became clear that to command the attention of scientists and physicians, as well as policy-makers, a more secular voice was required. Philosophy, emerging out of decades of mainly futile wrangling about meta-ethical issues, was more than happy to oblige ... .” Caplan AL. The birth and evolution of bioethics. In Ravitsky V, Fiester A, Caplan AL. The Penn Center Guide to Bioethics. New York: Springer Publishing Co., 2009, p. 5.

            But, the philosophers who taught applied ethics or their philosophy colleagues in the academy challenged medical ethics in the classroom and at the bedside. The academic philosophers were concerned that the medical school philosophers might be losing their bearings. This difference of opinion was stated by Harvard philosophy professor F.M. Kamm in 1988: “[P]hilosophers should try to bring ‘real-life’ problems (and those that have them) up to the abstractions of philosophy, rather than just bring philosophy down to the level of the problems. [Emphasis in original.]” Kamm FM. Ethics, applied ethics, and applying applied ethics. In Rosenthal DM, Shehadi F, eds. Applied Ethics and Ethical Theory. Salt Lake City: University of Utah Press, 1988, p. 170.  To be even clearer, she continued: “[C]reative solutions to practical problems come only after a period of detaching ourselves from them to consider more fundamental concepts. ... [E]mphasizing the discovery of solutions to problems conflicts with a detached interest that goes wherever an illuminating, but not obviously or immediately useful, aspect of a questions leads one.” Ibid, p. 170-171. “If philosophers who do applied ethics do not maintain such attitudes, in common with academic philosophers, they run the risk of being bad philosophers and becoming merely the bearers of simplified, falsely reassuring news from the theorists.” Ibid, p. 171.

            In thinking back, it must have been a phenomenal trial for several medical school philosophers to attempt to satisfy the academic philosophers while taking a new path. For the academics the question must have been how does one comment upon the matters at hand without learning so much about related topics and processes or becoming deeply enmeshed in the milieu that one is no longer an “outsider” but an “ insider” without critical distance? This turf battle must have been particularly worrisome for some distinguished philosophers who gained national and international reputations as academic philosophers and who then moved to medical school and clinical settings. Of course, a good many philosophers and theologians thought doctors were too close to the problem  (that is, lacked critical distance) to be part of any solution. (And quite naturally, some of the doctors thought the theologians and philosophers lacked a sufficient clinical knowledge base to fully understand the contexts in which they were involved.) History has shown that many of the medical school philosophers transitioned and cared little about what the academic philosophers said anyway.

            By the early and middle 1980s, other professionals joined the philosophers and theologians in broadening the bioethics or clinical ethics base and voice: physicians, nurses, social workers, chaplains and pastoral care workers, and lawyers, just to name a few. For health care professionals, chaplains, and lawyers, this notion of “critical distance” as not an overriding factor. If these bioethicists gave any thought to “detachment,” they probably interpreted it as “objectivity.” Objectivity calls to mind: “impartiality,” “lack of bias,” “fairmindedness,” “neutrality,” “open-mindedness,” “fairness,” and “justice.”

            Today, as clinical ethics consultants move toward professionalization, the outsider-insider issue has lost its relevance. Few may even understand the context of the initial problem now. Clinical ethics consultants exist in great part to improve patient care and the patient care experience; they are undoubtedly insiders. And, whether one thinks in terms of critical distance or not, objectivity in providing service to others remains critically important.

April 28, 2016

Expanding The Moral Community: Why is it so hard?

Much of American history can be described as the struggle to expand the moral community in which an increasing number of human beings are seen as having basic rights under the constitution. We forget sometimes that though the inclusion of all people was perhaps implied in our early documents, as in “We hold these truths to be self-evident, that all men are created equal…” from the Declaration of Independence, it has taken historical time and struggle to come closer to realizing that ideal. This struggle has been the quest for recognition of more and more individuals not assumed initially to have the right to vote and exercise control over their lives, which included African Americans, women, minorities, and more recently the LGBT community. The growing recognition of more and more individuals as being full fledged citizens has been a slow, often painful, birthing process of freedom, in the sense of unleashing human potential and possibilities, within the democratic process.

 

The recent uproar over the Anti-LGBT law passed in North Carolina is a reminder of how difficult it is for many states and communities to accept and accommodate historically marginalized people into the mainstream of society. This law was a quick reaction by the right wing North Carolina legislature and governor to an ordinance passed in Charlotte, similar to what other cities around the country are doing, allowing transgender people to use restrooms according to their gender identity. Perhaps this law also should be seen as a reaction to the Supreme Court ruling in 2015 legalizing same-sex marriage, which has been propelling society toward greater openness and acceptance of LGBT life styles, integrating them into the mainstream. Many who favor the Anti-LGBT law claim that individuals born as male, but are now identifying as female, could pose a risk to women and girls in public bathrooms, though there seems to be no substantial evidence whatsoever of such a risk. My sense is that the individuals who support this law in fact are using risk as a smokescreen in attempting to preserve what they perceive as waning values and norms in society: In the name of conservatism they hang on to an exclusionary vision of society that no longer fits the conditions of expanding freedom and opportunity.

 

So what some see as waning values and norms, others see as moral progress toward more robust democratic ideals and values. This inherent, historical struggle of opposing social and political forces has resulted with unexpected rapidity in the social and legal acceptance of gays and lesbians in the past 20 years in the United States. Most young people today especially those living in metropolitan areas, like Charlotte, where cultural diversity is a daily reality, readily accept that people naturally have different sexual orientations and gender identities, which people should be free to express in their lives. This liberal openness to diversity likely stems from the fact that they live in the midst of, and have normal interactions and friendships with, people of diverse sexual orientations and gender identities, which prompts them to look upon them as neighbors and as normal people. On the other hand, my guess is that many of the advocates of the Anti-LGBT Bill in North Carolina have little or no contact (of which they are aware) and no or limited relationships with LGBT individuals. Also, part of the resistance to greater inclusion of the LGBT community could be stem from the anxiety of having to recognize one’s own uncomfortable feelings and inclinations about sexuality and gender.

 

An additional factor to explain the reluctance of many self-identified conservatives to accept alternative sexual and gender orientations may be related to religion. Particularly, in the “bible belt” regions, regardless of whether or not they are followed by church leaders and members, clear notions of basic moral norms of right and wrong are assumed. Sadly, religious morality has been historically integrated with and used to justify a range of regional cultural values and norms—even heinous ones such as the use of Christianity to justify the institution of slavery. But in fairness even many Christians outside the bible belt follow Catholic natural law theory based on certain features about human nature from which basic norms are predicated about what is “normal” as well as “right” and “wrong” in a content rich, objective sense. In short, the point is if one believes that members of the LGBT community are engaging in a personal life style that is assumed to be inherently immoral, a barrier to inclusion is created.

 

So we in America today are in the midst of a culture war between conservative communities in rural and smaller towns on the one side espousing religious assumptions about human nature (which affects how they perceive risks) and liberals celebrated diversity in more progressive, metropolitan areas on the other. Advocates on either side of this divide bring to bear ideas and theories in an effort to convince others of their position. However, my sense is that articulating arguments to defend the root moral assumptions of either side is unlikely to change the minds of individuals on the other side. The result seems to be communities of individuals living in parallel universes with alternate moral vocabularies who “talk at” each other. Though I am for a liberal, moral vocabulary to account for moral progress within the democratic process, the real change that many of us liberals seek really is at the emotional, and even spiritual, level relating to how human beings are able to show empathy and respect for their fellow human beings in their communities.

 

We know human identity is based largely on social identity within a particular group or groups related to broad social categories such as religion, race, ethnicity, social class, etc. and to more specific ones such as professions, sports teams, political parties, etc. One of the inherent features of social identity is that individuals have a sense of self-identity by virtue of their group affiliations, which is also defined in terms of groups with which they are not affiliated and to which they stand in opposition. When group identities become rigid, to the point of engendering animus toward other groups, barriers are created which can marginalize the rights of individuals in those groups. But through exposure to, and openness to personal relationships with, individuals outside one’s own group, group identity becomes more flexible and open to change—this is an inner change of heart and disposition toward others.

 

Perhaps many of those who self-identify as conservatives in North Carolina who favor the Anti-LGBT law, and who also are predominantly Christian, should remember the ministry of the central character of their faith tradition. The thrust of Jesus’ ministry as defined by scholars like John Dominic Crossan is one of radical inclusion and hospitality. Jesus spent his time interacting with, eating with, and drinking wine with those on the margins of society who were outcasts and viewed as unclean and dangerous according the prevailing hygiene laws. His message to these people was that they too can be included in the moral community and be loved like all others. This is a robust message of compassion and love.

 

Ultimately, struggle for expanding inclusion can only succeed when opponents of bills like the Anti-LGBT Bill are able to show members of the LGBT community the kind of compassion and love Jesus showed to those on the margins of society in his day. The struggle of inclusion really is the struggle to expand what one thinks of as the moral community, or more simply, the neighborhood.

 

 

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

March 18, 2016

Meditations on the Flood

When I first moved to Albany several months ago in pursuit of the exciting and glamorous life of a clinical ethics fellow, I brought with me only a handful of my earthly possessions; if the Fates have their way with me, I will likely leave with even less.

During this past month, in the late-night hours one night I awoke from my slumber to discover that while I had slept the majority of my basement apartment had been transformed into a bog. Yes, I was experiencing wintery real-life application of the law of thermal expansion as it applies to dihydrogen monoxide (i.e., a water pipe burst). After an emergency call to my landlord, I proceeded with my own separation of sheep from goats: what could be saved and salvaged was transported to the little dry land remaining in my now water-logged kingdom, while those items clearly destined to doom and decay were left languishing amidst the advancing liquid army. Few of my books survived, but among them was one I thought quite fitting to the circumstances: Marcus Aurelius’ Meditations.

Essential reading for any good Stoic (and, to my mind, useful if not essential reading for all human beings), Meditations, and the ancient words of wisdom it contains, helped me to navigate through and reflect upon my experience of the flood and its corresponding aftermath. Some choice morsels include:

Casting aside other things, hold to the precious few; and besides bear in mind that every man lives only the present, which is an indivisible point, and that all the rest of his life is either past or is uncertain. Brief is man’s life and small the nook of earth where he lives… (Book III, Number 10)

But among the things readiest to hand to which you should turn, let there be these two: One is that things do not touch the soul, for they are external and remain immovable; so our perturbations come only from our inner opinions. The other is that all the things you see around you change immediately and will no longer be; and constantly bear in mind how many of these changes you have already witnessed. The universe is transformation: life is opinion. (Book IV, Number 3)

Everything is only for a day, both that which remembers and that which is remembered. (Book IV, Number 35)

“I am unhappy, because this has happened to me.” Not so: say, “I am happy, though this has happened to me, because I continue free from pain, neither crushed by the present nor fearing the future.” For such a thing as this might have happened to every man; but every man would not have continued free from pain on such an occasion. Why then is that rather a misfortune than this a good fortune? (Book IV, Number 49)

One of the main life lessons Marcus Aurelius (and indeed all stoics) reiterates time and again is that the essential nature of our human existence is flux and fleetingness. Another is that our ability to respond to this flux and fleetingness, and how we choose to respond, constitute a great human power and our capacity for nobility. Our ability to bear the small things – minor losses of time, possessions, or our sense of control – help to prepare us for the inevitable big things with which we will one day be faced. The major losses.

I sometimes think that one of the most valuable things we can do as clinical ethicists is to help people – patients, families, physicians, etc. – with these particular life lessons. For many, the hospital experience is the epitome of flux, the reason for hospitalization a reminder of life’s fleetingness. Whatever the official reason for requesting an ethics consultation, minor and major losses are always there, whether in the present situation or looming on the horizon. We are consulted, I believe, in large part to help people bear these losses. 

And this becomes another part of my meditation: that this experience, and indeed each of my experiences, has the potential to become a tool for me to help others. The patient’s flood or the family’s flood may not be the same as my own flood, but in reflecting on how I could bear my flood, hopefully I can help guide or companion others as they bear theirs.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
March 4, 2016

Clinical Ethics Consultation As Practical Philosophy

As a philosopher who works in a large health science center where the scientific method and perspective reign supreme, it is common to hear comments about the abstract and ideal nature of philosophy. As though those who think about human problems from a philosophical perspective do so from an abstract, insular perspective with little or no practical impact. Though I hear such dismissive comments about philosophy less often than I used to, say 20 or more years ago, I sense there is still a commonly held view that those who think from a philosophical perspective as not well oriented to practical affairs. And with some justification do people have this view of philosophy.

 

As I have written in previous blogs, philosophy has long and even proud part of its tradition for being, well, useless. If we assume that the basis of philosophical truth and wisdom lay in some ultimate, objective form that only those who think in certain ways can grasp, then knowledge becomes privileged to the philosophical few as an end it itself. This type of Platonic philosophical truth quickly divides the here and now inferior world from the more exclusive understandings of reality. Because of this basic influence of Platonic philosophy, much of the history of philosophy in the Western tradition has been focused on the search for a rational, objective basis of truth, value, and reality. Not surprisingly, the goal has not been reached. But the quest continued through most of last century and philosophical got its more or less justified reputation for being an insulated, esoteric, and detached form of intellectual activity. Put bluntly, philosophers, with a few exceptions, rarely got their hands dirty in the real world of practical activity.

 

The role of philosophy vis-à-vis practical life began to change with the advent of applied ethics in the 1970’s. In the field of bioethics and clinical ethics, after a few decades of many philosophers actually working closely with practitioners, learning their language and the nature of their concerns about value laden dilemmas that arise in the experience of carrying out their responsibilities to patients and to society, philosophers I think are less useless. In fact I am pretty sure we are helpful, at least at times. Most of the time I interact with physicians and nurses about clinical cases in the hospital, or even with basic scientists about issues related to scientific integrity, I feel pretty sure we usually have constructive conversations and there is a sense of mutual respect as I attempt to make a recommendation that might help manage problematic situations. As someone nearing retirement (nothing definite) I am part of the first generation of bioethicists or as I prefer to think of myself, clinical ethics consultants, who were first trained as philosophers and then went on to become deeply involved in the practical and complex world of medicine and scientific research.

 

As I think about my work during the past 25 years and the nature of the problems that I now think about in my work experience, I am becoming more convinced that I am getting in touch with philosophy in a way I did not expect as a gradate student: as a natural human, practical activity meant to make a difference for the better. To be honest, I have always been attracted to a less influential lineage of philosophers, who believed philosophy is grounded in the most human concerns. Philosophy from this view, beginning in pre-Socratic philosophy, was very much like a medical art—in the same way medicine sought to treat bodily ills, philosophy sought to treat illnesses of the soul. Epicurus (341–270 BC) for example, famously said, “empty is that philosopher’s argument by which no human suffering is therapeutically treated.” Schools of philosophy sought to understand the world and human beings for the purpose of living a better life and relieving the soul of its natural tendency to be disturbed in a myriad of ways. Thus, philosophers who followed the teachings of Epicureanism, Stoicism, Skepticism, as well as Aristotelianism, were trained individuals who could be helpful in this regard—who could coach their students and prepare them for a life that brought out the most important characteristics necessary for well being, which always included prominently the emotions. In all of these philosophies, there is a keen focus on how the emotions could be regulated by correct or constructive belief, which leads to desired action and habit formation, and a change of internal disposition. The central focus for these schools of philosophy was eudaimonia, which generally means for those who study ethics, those actions that lead to a state of well-being or ataraxia (undisturbed soul or inner tranquility). The task of being a philosopher from this perspective is to learn those methods and approaches that would lead those being served or taught to such ends.

 

Perhaps the closest iteration of such a philosophy in recent times is American Pragmatism, particularly the works of William James and John Dewey, which unlike the pre-Socratics, particularly Dewey, is colored profoundly by the modern scientific method. Truth becomes a matter of what works based in experimental methods and that can bring about desire ends for better human living. Dewey’s hope was that philosophy would become part of the fabric of democratic life and be used to make a positive practical difference in society. His hope did not happen during his lifetime, but with the rise of applied ethics, this philosophical perspective of philosophy being connected the practical world, much like the ancient pre-Socratics, is now able to take a new contemporary shape in bioethics.

 

In spite of the obvious constraints of working in a contemporary hospital where patients have well articulated ethical and legal rights and physicians have clear professional obligations and responsibilities, many of the encounters I have as an ethics consultant involve individuals facing many of the same challenges that motivated ancient philosophers to develop remedies for treating their distressed emotions. When a family member of a dying patient is facing the loss of a loved one and the obligation to make excruciatingly difficult decisions about when to discontinue life supportive treatments, there is a deep emotional disturbance. Individuals in these situations are stressing, grieving, and often confused. The beliefs they have relative to the decisions they must make can have an enormous impact on their emotional state. For example if someone falsely believes that their making a decision to follow their loved one’s wishes and to withdraw ventilatory support for a dying patient was tantamount to them being personally responsible for the patient’s demise, the feelings of guilt and indecisiveness can be overwhelming.

 

In talking to individuals in these situations, much my goal is to help ease their emotional suffering if possible, or as Epicurus would say, is to offer words that provide therapy for the soul. There is nothing necessarily deeply philosophical to grasp. I start by seeing where the individual is. Why he or she is so distressed. What is the source of the disturbed emotions? Then a dialogue can occur to examine the beliefs he or she has that is connects to those emotions. As the ethics consultant, my role is facilitate, lead the dialogue, and allow the individual to critically examine his or her belief and to come to new understandings. Following someone’s stated wishes, for example, can be construed as a way of showing respect for your loved one; permitting the physicians to disconnect artificial life supports is not the cause of the patient’s death; it is rather the removal of burdens that are only prolong his terminal illness. A new narrative can often emerge. A new understanding that sheds light on one’s former beliefs and that brings some relief to suffering.

 

In a very different historical context than ancient philosophy, one of high technology and democratic life, applied ethicists have similar functions and practice with similar methods as practical philosophers of the past. The next time you hear someone disparaging philosophy as irrelevant or impractical, don’t believe them.

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

August 3, 2015

A Stoic on Pluto

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Two notable things happened this past month that I feel compelled to write about: NASA’s </span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="http://www.nytimes.com/2015/07/15/science/space/nasa-new-horizons-spacecraft-reaches-pluto.html?ref=topics">New Horizons spacecraft reached Pluto</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">; NASA engineer and manager</span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="http://www.nytimes.com/2015/07/20/us/claudia-alexander-nasa-manager-who-led-jupiter-mission-dies-at-56.html?_r=0">Claudia Alexander died of cancer</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">. These events highlight some very powerful lessons in bioethics, and indeed about the human condition itself.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><strong style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Lesson #1: We can do so much.</strong></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">New Horizons is the <a href="https://www.nasa.gov/mission_pages/newhorizons/overview/index.html">first spacecraft to visit Pluto</a>, a mission taking almost ten years (or more, if you count pre-launch), traveling over <a href="http://www.nasa.gov/sites/default/files/atoms/files/nh-fact-sheet-2015_0.pdf">three billion miles</a>, and costing around <a href="http://www.forbes.com/sites/alexknapp/2015/07/14/how-do-new-horizons-costs-compare-to-other-space-missions/">seven-hundred million dollars</a>. It will be our first opportunity to truly investigate an ice <a href="http://solarsystem.nasa.gov/planets/profile.cfm?Object=Dwarf">dwarf planet</a>, and the information gleaned from it holds the potential to complete much of our knowledge of the planetary types in our own solar system. Over eighty years after its discovery by <a href="https://en.wikipedia.org/wiki/Clyde_Tombaugh">Clyde Tombaugh</a>, Pluto – our final (local) planetary frontier – is within our grasp.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 15, 2015

Welcoming the Concept of Alief to Medical Ethics

Welcoming the Concept of Alief to Medical Ethics

 by J.S. Blumenthal-Barby, Ph.D.

Philosopher Tamar Gendler has introduced (circa 2008) a new concept in the philosophical literature that could be of interest to medical ethicists.…

May 27, 2015

MST3K is the perfect embodiment of postmodernism

The observers become part of the text. Criticism of the text exposes intertextual connections and undermines the intent of the author. Nothing in the text is treated with reverence, the forth wall is constantly broken, and reference to the film as a film while also taking its constructed reality at face value. Two of the observers [...]

February 20, 2015

The Physician-Patient Relationship: The basis for moral clarity in clinical ethics

<p><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">It is my sense that the majority, perhaps the vast majority, of cases on which clinical ethics consultants (CECs) are asked to consult and make an ethics recommendation, there is, or would be, a general consensus on the part of the CECs about what counts as the appropriate recommendation. However, the question arises of how clinical ethics as a field should deal with issues that come up about which there is not a clear consensus, such as in cases where a basic right to have an autonomous choice respected by the patient is pitted over and against the obligation of the physician to do no harm—the traditional tension between respect for patient autonomy and beneficence/nonmaleficence. This tension or conflict often occurs in cases of alleged medical futility where the patient or the patient’s surrogate requests a treatment option the physician deems will only cause harm and no benefit to the patient. For example, consider a patient’s surrogate who insists that she will not consent to a DNR order and in fact expects the physician to perform CPR if the patient arrests. For a patient without capacity dying of metastatic disease, this directive by the surrogate presents a stark dilemma to the physician—is it a violation of the physician’s obligation to the patient to “do no harm” (nonmaleficence)? Or is respect for the patient’s wishes or her representative’s wishes so sacrosanct that the physician’s obligation to follow the patient’s wishes is paramount and outweighs the obligation to do no harm?</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"> </span></p>
November 12, 2014

Wisdom Does Come with Age

<p style="line-height: 19.0400009155273px;">Reminders of our finitude always lurk close by, like <a href="http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/">Ezekiel Emanuel's</a> article in last month's Atlantic, "Why I Hope to Die at 75." The head of the <a href="http://bioethics.nih.gov/about/">Clinical Bioethics Department</a> at the National Institutes of Health gives reasons for not living beyond 75: inevitable decline, disability, incapacity, and diminishment of "creativity, originality, and productivity." According to Emanuel, we wish to be remembered for our good years, prior to decline.</p> <p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">There are grains of truth here. Many of us "die" well before we are officially declared dead. I've seen patients kept alive for far too long in permanent vegetative states, while family dynamics, emotions, finances and scarce medical resources are depleted. We pay a high price for medical "progress." I also know thriving, vibrant elderly, themselves significantly disabled and incapacitated.</span></p> <p style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
October 13, 2014

Belief In Ultimate Truth: Does it make for peaceful living?

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">As I have been saying in recent blogs, most of what we do in clinical ethics, but also in most areas of bioethics, is procedural ethics. That is when we are faced with an ethical dilemma, our approach, whether consciously or unconsciously is usually to try to reach a reasonable compromise or consensus among the key participants that are in conflict consistent with well-established values and principles. This tendency reflects an obvious reality about the nature of contemporary ethics that we often ignore: in the current Western moral setting, our only viable methodology for resolving value laden disputes, whether at the micro level in clinical ethics or macro level in healthcare policy, is to attempt to craft an agreement or consensus among those with a say. Whether we are dealing with patients and families at odds with their physician on how to define the goals of care in the hospital setting or trying to build a consensus of opinion among voters in the political arena, we assume there are no final, authoritative moral answers that avail themselves to us. Whether we like it or not, we humans must figure out ethical dilemmas for ourselves and learn to get along.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Yet the idea of procedural ethics remains very worrisome for many people, including such bioethicists and Tristram Engelhardt, Jr. He believes that procedural ethics, such much of what we do in clinical ethics, is not really ethics in because it is based on convention and legalistic type standards. For him ethics worthy of the name must flow from a content-rich, canonical moral tradition that provides moral authority to our everyday ethical and moral judgments. The prototype ethical tradition was the medieval Christian Natural Law perspective grounded in Aristotelian philosophy. Aristotle assumed the inherent order and intelligibility of the cosmos, which also permeated his understanding of ethics. Humans, like all natural things, had a natural function, which was to be rational. But rational did not mean to that ethics was about finding intellectual or theoretical basis for right action according to rational rules in order to know and perform one’s duty—this was Kant’s (1724-1804) ethics during the 18</span><sup style="line-height: 19.0400009155273px;">th</sup><span style="line-height: 19.0400009155273px;"> century following the rise of modern science. For Aristotle, the question was, how can one live and embody the good life; so rationality in this sense meant internal harmony between emotions and decision-making that resulted in well-established habits or states of character. This means finding in all of one’s activities the balance between excess and deficiency, or what he called the “mean”. Over time, forming the right habits according to the mean in all areas of life lead to excellence and happiness or what he called the good life. This was the natural fulfillment of the human function in practical terms consistent with the ancient Aristotelian.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a></strong></p>

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Published Articles (6)

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

Rethinking Roe v. Wade: Defending the Abortion Right in the Face of Contemporary Opposition

American Journal of Bioethics: Volume 9 Issue 9 - Sep 2009

Mirror Neurons and the Reenchantment of Bioethics

American Journal of Bioethics: Volume 9 Issue 4 - Apr 2009

Review of Imagine What It's Like: A Literature and Medicine Anthology

American Journal of Bioethics: Volume 9 Issue 4 - Apr 2009

Review of R. S. Downie and Jane Macnaughton Bioethics and the Humanities: Attitudes and Perceptions

American Journal of Bioethics: Volume 8 Issue 8 - Aug 2008

Ethics, Pandemics, and the Duty to Treat

American Journal of Bioethics: Volume 7 Issue 12 - Dec 2007

Clash of Definitions: Controversies About Conscience in Medicine

News (5)

May 17, 2012 9:54 am

“The Self” in the Future: Will it be Extinguished, by Neuroscience? (Institute for Emerging Ethics & Technologies)

Will “the self” survive because it can provide people with a greater sense of happiness? Or is it – perhaps along with the constructs “Free Will” and “Determinism” – doomed to the dustbin of history? Should cyborgs, avatars, and a rewired human brain be developed with a stronger or weaker sense of self? An interview with Dr. Garret Merriam, Assistant Professor of Philosophy at University of Southern Indiana.

May 10, 2012 11:30 am

Neurononsense: Why brain sciences can't explain the human condition (ABC News)

The new sciences in fact have a tendency to divide neatly into two parts. On the one hand there is an analysis of some feature of our mental or social life and an attempt to show its importance and the principles of its organisation. On the other hand, there is a set of brain scans. Every now and then there is a cry of “Eureka!” – for example, when Joshua Greene showed that dilemmas involving personal confrontation arouse different brain areas from those aroused by detached moral calculations. But since Greene gave no coherent description of the question, to which the datum was supposed to suggest an answer, the cry dwindled into silence.

April 10, 2012 11:07 pm

Check This Box: Science Is Getting Easier/Harder/Both/Neither? (Huffington Post)

A core concept of the Enlightenment was that the more that reasoning is based on experimentation the more we can learn about the world. Manipulation of variables, recommended in the 17th century by Francis Bacon, proved to be a turning point in the history of science. By uncovering previously invisible truths and giving human beings novel and effective ways to manage their environment scientific method gave the idea of progress a whole new meaning. Until then it wasn’t at all clear that civilization wasn’t in some kind of steady state, or even that we weren’t in decline from some “golden age.” But it turned out that the golden age was still ahead of us, if we were smart enough to invest in it and wise enough not to misuse the knowledge being gained.

March 10, 2012 9:35 am

Why It's OK to Let Apps Make You a Better Person (The Atlantic)

Evan Selinger considers the ramifications of using apps to improve our habits. And also whether willpower as we normally think about it even exists. #bioethics #neuroethics #brain #philosophy

March 2, 2012 4:50 pm

Abortion Article Author Receives Death Threats (Telegraph (UK))

Dr Francesca Minerva, a former Oxford University ethicist, who co-wrote a controversial article that argued killing newborn babies should be as permissible as abortion, has said she has received death threats over the paper. #philosophy #bioethics