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PubMed2001

The importance of time/space in diagnosing the causality of phylogenetic events: towards a "chronobiogeographical" paradigm?

A shift from a traditional biogeographical paradigm in cladistic biogeography to a chronobiogeographical paradigm is proposed. The chronobiogeographical paradigm aims to utilize temporal data in conjunction with spatial data in the detection of discrete historical events, such as vicariance and vicariant speciation, in cladograms. The concepts of primary and secondary congruency are introduced in relation to the distinction between repeated area relationships (primary congruency) and common extrinsic causality (secondary congruency). Simple hypothetical examples demonstrate that area cladograms cannot be safely interpreted purely as representing the sequence of area fragmentation; rather, they reflect recency of biotic interaction. Temporal data are shown to have a direct and potentially profound influence on the results of traditional cladistic biogeographical analyses, indicating the necessity of developing a chronobiogeographical approach. The implementation of the paradigm is considered first from a theoretical viewpoint and then in the context of the type of empirical data usually available. An as yet undevised "time/space algorithm" is deemed necessary for the latter, and guidelines are presented for the development of such an algorithm. Finally, we argue that the most rigorous and philosophically justified approach to the detection of phylogenetic causal events can be found only when temporal and spatial data are considered simultaneously. Consequently, the chronobiogeographical paradigm is seen as a logical elaboration of, not a replacement for, the biogeographical paradigm.

Algorithms↗
PubMed2002

Bioethics and conflicting ethical criteria.

Some of the major problematic issues in contemporary ethical discourse are highlighted in the field of bioethics. The need to incorporate new understandings and foundational shifts in essential criteria because of technological advances in the areas of medicine and human sciences increasingly challenges traditional and accepted notions of ethics. As the possibilities of technical progress increase, more and more pressure is put on traditional understandings of the human person, identity, and value. In the face of ethical relativism and emotivism, which are already widespread in social and political discourse, the immediacy of bioethics as a response to technology and its impact on human lives reinforces the need for ethics to become interdisciplinary, while attempting to provide some coherence to both the questions and the responses that contemporary life generates. In this paper, the author intends to sketch the outlines of some of these problems, and suggest one approach which might allow a certain methodical intelligibility to emerge which takes into account shifts in consciousness and the dependence on historically grounded perspective.

Bioethics↗
PubMedDate not supplied

Decisions about life and death: assessing the Law Reform Commission and the Presidential Commission Reports.

This paper compares the critically comments upon certain aspects of the Canadian Law Reform Commission Report, Euthanasia, Aiding Suicide and Cessation of Treatment, and the United States Presidential Commission Report, Deciding to Forego Life-Sustaining Treatment. It focuses on their positions on euthanasia and on the general principles, values, and procedures that ought to govern practices of foregoing life-sustaining treatment. The paper first comments on the recent debate over the moral relevance of the killing/letting die distinction, since this issue appears crucial in assessing the rationality of the current, absolute prohibitions of direct killing in medical contexts, embodied both in law and in codes of ethics. This issue bear upon a question in the closing section--whether the withdrawal of foods and fluids is ever morally permissible.

Advisory Committees↗
PubMed1998

A theory of international bioethics: the negotiable and the non-negotiable.

The preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that "moral fundamentalism," the position that international bioethics rests on "basic" or "fundamental" moral prinicples that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of Hobbes and Locke -- as reinterpreted by David Gauthier, Robert Nozick, and John Rawls -- for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.

Bioethics↗
PubMed1995

Embryo experimentation and the murder prohibition: a casuistic examination of the utilitarian and pro-life positions on the moral status of the embryo.

Argument concerning the permissibility of embryo experimentation has tended to proceed from the opposed ethical principles of utilitarianism and the sanctity of human life, neither of which entirely reflects Western society's present position on murder and moral obligations. Singer's utilitarian arguments propose a test of subject attributes for admission to the protection of morality, and it is argued that this approach is entirely at odds with our current axiomatic application of the murder prohibition of post-birth humans. Similarly, those arguing from a pro-life position do not take account of the ambivalence of our application of this principle to the pre-birth human, as seen in abortion. In the attempt to deal with the quandary of the moral position of the embryo, we should, following the philosophical precedent of casuistry, start from the position of our current moral certainties, rather than expose ourselves to the social dangers of an untried rationality divorced from practice.

Australia↗
PubMed2002

Extending human lifespan and the precautionary paradox.

This paper argues that a precautionary approach to scientific progress of the sort advocated by Walter Glannon with respect to life-extending therapies involves both incoherence and irresolvable paradox. This paper demonstrates the incoherence of the precautionary approach in many circumstances and argues that with respect to life-extending therapies we have at present no persuasive reasons for a moratorium on such research.

Aging↗
PubMed2000

The commodification of the body and its parts.

The human body--and its parts--has long been a target for commodification within myriad cultural settings. A discussion of commodification requires that one consider, first, the significance of the body within anthropology and, second, what defines a body "part." After exploring these initial questions, this article outlines dominant theoretical approaches to commodification within anthropology, with Mauss and Marx figuring prominently. The discussion then turns to historically well-documented forms of body commodification: These include slavery and other oppressive labor practices; female reproduction; and the realms of sorcery and endocannibalism. An analysis here uncovers dominant established approaches that continue to drive current studies. The remainder of this article concerns emergent biotechnologies, whose application in clinical and other related scientific arenas marks a paradigmatic shift in anthropological understandings of the commodified, fragmented body. The following contexts are explored with care: reproductive technologies; organ transplantation; cosmetic and transsexual surgeries; genetics and immunology; and, finally, the category of the cyborg. The article concludes with suggestions for an integrated theoretical vision, advocating greater cross-fertilization of analytical approaches and the inclusion of an ethics of body commodification within anthropology.

Anthropology, Cultural↗
PubMed2005

The bioethical principles and Confucius' moral philosophy.

This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".

Bioethical Issues↗
PubMed2000

Two alternative notions of health.

Contemporary health care as well as medical ethics deal with the problem of priorities while the invariable priority of any treatment across all cultures remains health. Health as such is, however, rather a symbolic word which refers to two different paradigms coined in two ancient traditions which contributed profoundly to European culture as we know it: the two traditions referred hereto are the Hebraic and the Greek. The Greek tradition considered health as a good life, which is the utmost goal of human endeavor. To achieve this it was necessary to contemplate truth and to become acquainted with certainty (episteme) beyond any doubt. On the contrary a totally different approach can be found in the Hebraic tradition which referred particularly to faith grasped as the hope (tikva) being based on a reliance upon the future ahead. Modern medicine hesitates between these two notions of health.

Culture↗
PubMed1998

Postmodernity and a hypertensive patient: rescuing value from nihilism.

Much of postmodern philosophy questions the assumptions of Modernity, that period in the history of the Western world since the Enlightment. These assumptions are that truth is discoverable through human reason; that certain knowledge is possible; and furthermore, that such knowledge will provide a basis for the ineluctable progress of Mankind. The Enlightenment project is underwritten by the conviction that knowledge gained through the scientific method is secure. In so far as biomedicine inherits these assumptions it becomes fair game for postmodern deconstruction. Today, perhaps more than ever, plural values compete, and contradictory approaches to health, for instance, garner support and acquire supremacy through consumer choice and media manipulation rather than evidence-based science. Many doctors feel a tension between meeting the needs of the patient face to face, and working towards the broader health needs of the public at large. But if the very foundations of medical science are questioned, by patients, or by doctors themselves, wherein lies the value of their work? This paper examines the issues that the anti-foundationalist thrust of postmodernism raises, in the light of a case of mild hypertension. The strict application of medical protocol, derived from a nomothetic, statistical perspective, seems unlikely to furnish value in the treatment of an individual. The anything goes, consumerist approach, however, fares no better. The author argues that whilst value cannot depend on any rationally predetermined parameters, it can be rescued, and emerges from the process of the meeting with the patient.

Antihypertensive Agents↗
PubMed1999

The lived body as aesthetic object in anthropological medicine.

Medicine does not usually consider the human body from an aesthetic point of view. This article explores the notion of the lived body as aesthetic object in anthropological medicine, concentrating on the views of Buytendijk and Straus on human uprightness and gracefulness. It is argued that their insights constitute a counter-balance to the way the human body is predominantly approached in medicine and medical ethics. In particular, (1) the relationship between anthropological, aesthetic and ethical norms, (2) the possible danger of a naturalistic fallacy, (3) the implications for the care of disabled people and (4) the intrinsic aesthetic quality of the human body are dealt with.

Anthropology↗
PubMed2004

Therapeutic doubt and moral dialogue.

This paper aims at analysing the problem of remainder and regret in moral conflicts. Four different approaches are subject of investigation: a moral-theoretical strategy aimed at consistency; a narrative approach of moral coherence and open consensus; Plato's moral methodology of dialogue and aporetic resolution of moral conflicts and finally, an approach deduced from Greek tragedy of emotional resolution of moral conflicts. A central argument is that since there exists no theoretically convincing way of solving the problem of remainder and regret, the attention should instead be directed towards finding alternative ways of coping with this problem. The three last approaches subject of investigation attempt--each in their own way--to do this. Teaching medical ethics to medical students and the burning issue of medical fallibility is used to demonstrate the relevance of these forms of resolution in a medical context.

Adaptation, Psychological↗
PubMed1997

Health care, human worth and the limits of the particular.

An ethics concerned with health care developments and systems must be historically continuous, especially as it concerns the application to managed structures of key moral-epistemic concepts such as care, love and empathy. These concepts are traditionally most at home in the personal, individual domain. Human beings have non-instrumental worth just because they are human beings and not by virtue of their capacities. Managed health care systems tend to abstract from this worth in respect of both individuals' distinctness and individual identity. The first, a common feature of quantitative approaches to health care assessment and delivery, is avoidable. The second, by contrast, is necessarily sacrificed in impersonally managed structures. Failure to distinguish the two encourages confusion and distress, and the demand for impossible medico-moral relationships.

Ethics, Medical↗
PubMed2000

Towards an alternative approach to personhood in the end of life questions.

Within the Western bioethical framework, we make a distinction between two dominant interpretations of the meaning of moral personhood: the naturalist and the humanist one. While both interpretations of moral personhood claim to promote individual autonomy and rights, they end up with very different normative views on the practical and legal measures needed to realize these values in every day life. Particularly when we talk about the end of life issues it appears that in general the arguments for euthanasia are drawn from the naturalist interpretation of moral personhood while the arguments against euthanasia, for their part, are derived from the idealist and/or humanist understanding of the same concept. This article focuses on examining the metaphysical assumptions and internal contradiction found behind the opposing arguments presented by two prominent philosophers of these two traditions: Peter Singer and Ludger Honnefelder. The author claims that neither side of the debate succeeds in defending its normative position without reconsidering how to take the social aspects of moral personhood into account. The author holds that, despite our need to set individual's decision making into social context, the current communitarian narrative concept of personhood fails to offer a convincing alternative. Instead of merely trying to replace psychological and atomistic view of personhood with a collective understanding of an individual's moral identity, we need to discuss the normative relation between the concept of 'moral personhood' and the demand for respect of individual autonomy in Western bioethics within a wider philosophical perspective.

Euthanasia↗
PubMed1995

Not just autonomy--the principles of American biomedical ethics.

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that the methods offered for specification and balancing of principles are inadequate.

Beneficence↗
PubMed2005

Blinkered objections to bioethics: a response to Benatar.

In a recent commentary, S R Benatar criticised the debates over organ donation and kidney selling for being located within a "narrow and inadequate framework". Benatar levels four charges against those who engage in the current organs debate: that they myopically focus on saving lives; that they accept the dominance of market orientated approaches to health care; that they reify individualism, and that they engage in limited moral arguments. Given the importance of the organs debate it is imperative that the misunderstandings of it on which Benatar's criticisms are based are dispelled. Accordingly, I will consider and reject each of his objections in turn.

Bioethics↗
PubMed2005

Identity and moral responsibility of healthcare organizations.

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.

Delivery of Health Care↗