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Pragmatic principles--methodological pragmatism in the principle-based approach to bioethics.

In this paper it will be argued that Beauchamp and Childress' principle-based approach to bioethics has strongly pragmatic features. Drawing on the writings of William James, I first develop an understanding of methodological pragmatism as a method of justification. On the basis of Beauchamp's and Childress' most recent proposals concerning moral justification in the fifth edition of their Principles of Biomedical Ethics (2001), I then discuss different aspects that the principle-based approach and methodological pragmatism have in common.

Bioethics↗

Kurt Goldstein--a philosophical scientist.

Kurt Goldstein was one of the major proponents of the holistic movement which was opposed to the classical connectionist Wernicke-Lichtheim-Model in aphasiology at the beginning of the 20th century. Influenced by Kant, Husserl and Cassirer, his work goes beyond purely empirical research and approaches traditionally philosophical questions: How can we proceed from empirical data to a theory adequately reflecting reality? How can we understand man as mind and body? What is the relation between language and cognition? Goldstein's concepts of biological knowledge, self-actualization and abstract attitude seek to address these questions. His work thus becomes attractive for philosophers. It was taken up and interpreted by Cassirer, Merleau-Ponty and Gurwitsch.

Aphasia↗

The virtues of evidence.

Evidence-based medicine has been defined as the conscientious and judicious use of current best evidence in making clinical decisions. This paper will attempt to explicate the terms "conscientious" and "judicious" within the evidence-based medicine definition. It will be argued that "conscientious" and "judicious" represent virtue terms derived from virtue ethics and virtue epistemology. The identification of explicit virtue components in the definition and therefore conception of evidence-based medicine presents an important starting point in the connection between virtue theories and medicine itself. In addition, a unification of virtue theories and evidence-based medicine will illustrate the need for future research in order to combine the fields of virtue-based approaches and clinical practice.

Canada↗

Can it ever be better never to have existed at all? Person-based consequentialism and a new repugnant conclusion.

Broome and others have argued that it makes no sense, or at least that it cannot be true, to say that it is better for a given person that he or she exist than not. That argument can be understood to suggest that, likewise, it makes no sense, or at least that it cannot be true, to say that it is worse for a given person that he or she exist than that he or she never have existed at all. This argument is of critical importance to the question of whether consequentialist theory should take a traditional, aggregative form or a less conventional, person-affecting, or person-based form. I believe that, potentially, the argument represents a far more serious threat to the person-based approach than does, for example, Parfit's two medical programmes example. Parfit's example nicely illuminates the distinction between aggregative and person-based approaches and raises important questions. But the example--though not, I think, by Parfit--is sometimes pressed into service as a full-fledged counterexample against the person-based approach. As such, I argue, the example is not persuasive. In contrast, the Broomeian argument, if correct, is definitive. For that argument relies on certain metaphysical assumptions and various uncontroversial normative claims--and hence nicely avoids putting into play the controversial normative claims that lie at the very heart of the debate. The purpose of the present paper, then, is to evaluate the Broomeian argument. I argue that this potentially definitive challenge to a person-based approach does not in fact succeed.

Ethical Theory↗

The embodiment of birth.

This paper rejects dualism between mind and body to view the self as an embodied biological entity. Rather than seeing the body operating by passive mechanisms as Descartes argues, it holds it actively moves in and even defines its world. Carrying this perspective to medicine presents an attempt to incorporate or work with internal processes of the body; it is sensitive to how patients identify with their bodies. The current discussion over the extent to which women should try to have natural childbirths provides a concrete example of the differences between mechanistic and embodied approaches to medicine.

Ego↗

The future of philosophy.

There is no sharp dividing line between science and philosophy, but philosophical problems tend to have three special features. First, they tend to concern large frameworks rather than specific questions within the framework. Second, they are questions for which there is no generally accepted method of solution. And third they tend to involve conceptual issues. For these reasons a philosophical problem such as the nature of life can become a scientific problem if it is put into a shape where it admits of scientific resolution. Philosophy in the 20th century was characterized by a concern with logic and language, which is markedly different from the concerns of earlier centuries of philosophy. However, it shared with the European philosophical tradition since the 17th century an excessive concern with issues in the theory of knowledge and with scepticism. As the century ends, we can see that scepticism no longer occupies centre stage, and this enables us to have a more constructive approach to philosophical problems than was possible for earlier generations. This situation is somewhat analogous to the shift from the sceptical concerns of Socrates and Plato to the constructive philosophical enterprise of Aristotle. With that in mind, we can discuss the prospects for the following six philosophical areas: (1) the traditional mind-body problem; (ii) the philosophy of mind and cognitive science; (iii) the philosophy of language; (iv) the philosophy of society; (v) ethics and practical reasons; (vi) the philosophy of science. The general theme of these investigations, I believe, is that the appraisal of the true significance of issues in the philosophy of knowledge enables us to have a more constructive account of various other philosophical problems than has typically been possible for the past three centuries.

Language↗

Euphoria, ecstacy, inebriation, abuse, dependence, and addiction: a conceptual analysis.

A conceptual analysis of basic notions of addictiology, i.e., Euphoria, Ecstasy, Inebriation, Abuse, Dependence, and Addiction was presented. Three different forms of dependence were distinguished: purely psychic, psycho-physiological, and purely somatic dependence. Two kinds of addiction were differentiated, i.e. appetitive and deprivative addiction. The conceptual requirements of addiction were discussed. Keeping these in mind some ethical problems of drug therapy and psychotherapy were explained. Criteria for the assessment of therapeutic approaches are suggested: effectiveness, side effects, economic, ethic, and esthetic valuation.

Behavior, Addictive↗

On the possibility of a pragmatic discourse bioethics: Putnam, Habermas, and the normative logic of bioethical inquiry.

Pragmatic bioethics represents a novel approach to the discipline of bioethics, yet has met with criticisms which have beset the discipline of bioethics in the past. In particular, pragmatic bioethics has been criticized for its excessively fuzzy approach to fundamental questions of normativity, which are crucial to a field like bioethics. Normative questions need answers, and consensus is not always enough. The approach here is to apply elements of the discourse ethics of Habermas and Putnam to the sphere of bioethics, in order to develop a normative structure out of the framework of bioethical inquiry as it stands. The idea here is that the process of inquiry contains its own normative structure as it aims to discover norms. Such an approach, which fuses pragmatic bioethics with discourse ethics (which equally draws on pragmatism), may rightly be called a "Pragmatic Discourse Bioethics."

Bioethics↗

What does it mean to use someone as "a means only": rereading Kant.

Debates about commodification in bioethics frequently appeal to Kant's famous second formulation of the categorical imperative, the formula requiring us to treat the rational (human) being as "an end in itself" and "never as a means only." In the course of her own treatment of commodification, Margaret Jane Radin observes that Kant's application of this formula "does not generate noncontroversial particular consequences." This is so, I argue, because Kant offers three different--and largely incompatible--interpretations of the formula. One focuses on the obligation to preserve rational willing; the second stresses respect for human (physical) dignity and integrity; the third views respect for others as "ends in themselves" as primarily involving a willingness to govern one's conduct by a procedure of impartial co-legislation. Only the third of these interpretations, I conclude, offers a reasonable and coherent approach to moral judgment about the limits of commodification.

Bioethics↗

Physician-assisted suicide, euthanasia, and Christian bioethics: moral controversy in Germany.

Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients' wishes, be made in light of commonly shared values, unless these violate the principle of "in dubio pro vita". The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life.

Advance Directives↗

The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis.

Kantian deontology is one of three classic moral theories, among virtue ethics and consequentialism. Issues in medical ethics are frequently addressed within a Kantian paradigm, at least --although not exclusively--in European medical ethics. At the same time, critical voices have pointed to deficits of Kantian moral philosophy which must be examined and discussed. It is argued that taking concrete situations and complex relationships into account is of paramount importance in medical ethics. Encounters between medical or nursing staff and patients are rarely symmetrical relationships between autonomous and rational agents. Kantian ethics, the criticism reads, builds on the lofty ideal of such a relationship. In addition to the charge of an individualist and rationalist focus on autonomy, Kantian ethics has been accused of excluding those not actually in possession of these properties or of its rigorism. It is said to be focussed on laws and imperatives to an extent that it cannot appreciate the complex nuances of real conflicts. As a more detailed analysis will show, these charges are inadequate in at least some regards. This will be demonstrated by drawing on the Kantian notion of autonomy, the role of maxims and judgment and the conception of duties, as well as the role of emotions. Nevertheless the objections brought forward against Kantian moral theory can help determine, with greater precision, its strengths and shortcomings as an approach to current problems in medical ethics.

Emotions↗

Stoicism, the physician, and care of medical outliers.

BACKGROUND: Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. DISCUSSION: The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. SUMMARY: Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

Attitude of Health Personnel↗

Views of the person with dementia.

In this paper I consider, in connection with dementia, two views of the person. One view of the person is derived from Locke and Parfit. This tends to regard the person solely in terms of psychological states and his/her connections. The second view of the person is derived from a variety of thinkers. I have called it the situated-embodied-agent view of the person. This view, I suggest, more readily squares with the reality of clinical experience. It regards the person as embedded in a history and culture. The human person is also an embodied agent. I contend that this view encourages a more appropriate approach towards the ethical issues that arise in dementia and towards people with dementia.

Advance Directives↗