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PubMed2006

[Free will and neurobiology: a methodological analysis].

Whether or not the neurobiological basis of mental processes is compatible with the philosophical postulate of free will is a matter of committed debating in our days. What is the meaning of those frequently-quoted experiments concerning voluntary action? Both convictions, being autonomous subjects and exercising a strong influence on the world by applying sciences, have become most important for modern human self-conception. Now these two views are growing apart and appear contradictory because neurobiology tries to reveal the illusionary character of free will. In order to cope with this ostensible dichotomy it is recommended to return to the core of scientific thinking, i. e. to the reflection about truth and methods. The neurobiological standpoint referring to Libet as well as the philosophical approaches to free will must be analysed, considering pre-conceptions and context-conditions. Hence Libet's experiments can be criticised on different levels: methods, methodology and epistemology. Free will is a highly complex system, not a simple fact. Taking these very complicated details into account it is possible to define conditions of compatibility and to use the term free will still in a meaningful way, negotiating the obstacles called pure chance and determinism.

Brain↗
PubMed1997

Bioethics: a balancing of concerns in context.

Ethics is a philosophical approach which is increasingly being used to identify acceptable behaviour in a health context. Bioethics has emerged as a term for ethics in health and medical contexts. Bioethics is about the application of reasoning to a health context. It relies on the people in each context to reflect on ethics concerns, and to make acceptable decisions on how to behave. This paper canvasses current concerns in bioethics, and demonstrates the essential features of context, and players in the context, in ethical discussion.

Altruism↗
PubMed2003

What is a death with dignity?

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances.

Euthanasia↗
PubMed2004

Collective moral imagination: making decisions for persons with dementia.

Much debate concerning 'precedent autonomy'--that is, the authority of former, competent selves to govern the welfare of later. non-competent selves--has assumed a radical discontinuity between selves, and has overlooked the 'bridging' role of intimate proxy decision-makers. I consider a recent proposal by Lynn et al. (1999) that presents a provocative alternative, foregrounding an imagined dialogue between the formerly competent patient and her/his trusted others. I consider what standards must be met for such dialogues to have moral force, appealing to narrative and feminist ethics. I then critique the dualistic construction of selves implicit in much of the advance directive literature, noting the continuities of dependence, character, and body, as well as the social dimension of the construction of selves.

Decision Making↗
PubMed2005

Empirical ethics, context-sensitivity, and contextualism.

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." Unlike descriptive ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position.

Empirical Research↗
PubMedDate not supplied

New directions in the treatment of men who batter women.

Singular paradigms and simple solutions are not sufficient in addressing the complex and historically sanctioned practice of wife battering. In this article I examine two philosophical approaches to the treatment of men who beat women and how epistemology shapes the assumptions that drive interventions and guide research. A selected review of 8 years of outcome research in batterer intervention reveals inconsistencies in measuring both physical and psychological violence and in how and when those measures are obtained. In addition, there has been a failure to examine violence in the context of community that includes court-ordered treatment and probation monitoring. Failure to address the epistemological assumptions behind why men beat women results in poorly developed interventions and may endanger women as well.

Anger↗
PubMed2006

Sin and suffering in a Catholic understanding of medical ethics.

Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients ("patients") of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of "natural law," and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to moral theory, and briefly contrast these with the influential alternative offered by the "principlism" of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological.

Attitude to Health↗
PubMed1997

Role of stress echocardiography in risk stratification early after an acute myocardial infarction. EPIC (Echo Persantin International Cooperative) and EDIC (Echo Dobutamine International Cooperative) Study Groups.

Resting and stress echocardiography is a 'one-stop shop', which enables a wide range of information to be collected on resting function, myocardial viability, and induced ischaemia, all of which are useful for prognostic stratification. Large scale, multicentre, prospectively collected data show the prognostic failure of resting function and inducible ischaemia, both independently and combined, which are especially effective in predicting cardiac death. The GISSI data show that the increment of risk as a result of reduction in ventricular function has a hyperbolic trend, with a relatively moderate increase in mortality for ejection fraction values between 50 and 30%, but with marked increases below 30%. The EPIC data show that the 1-year risk of cardiac death is as low as 2% in patients with negative dipyridamole stress echocardiography: it doubles if the test is positive at a high dose, and is almost four times higher if it is positive at a low dose. In the field of prognostic stratification, in the absence of carefully controlled studies, the choice between coronary angiography as the only essential study, or use of a non-invasive test to discriminate access to catheterization currently reflect alternate philosophical approaches rather than scientifically based decisions. In the invasive approach, stress echocardiography offers relief from the vicious circle of chest pain-coronary angiography revascularization. In the non-invasive and physiological approach, stress echo is capable of offering, in one sitting, an insight into the main determinants of survival: function, viability, and ischaemia.

Echocardiography↗
PubMed1985

Parental discretion and children's rights: background and implications for medical decision-making.

This paper argues that liberal tenets that justify intervention to promote the welfare of an incompetent do not suffice as a basis for analyzing parent-child relationships, and that this inadequacy is the basis for many of the problems that arise when thinking about the state's role in resolving family conflicts, particularly when monitoring parental discretion in medical decision-making on behalf of a child. The state may be limited by the best interest criterion when dealing with children, but parents are not. The state's relation with the child is formal while the parental relation is intimate, having its own goals and purposes. While the liberal canons insist on the incompetent one's best interest, parents are permitted to compromise the child's interest for ends related to these familial goals and purposes. Parents decisions should be supervened, in general, only if it can be shown that no responsible mode of thinking warrants such treatment of a child.

Adult↗
PubMed1985

Civil disobedience, conscientious objection, and evasive noncompliance: a framework for the analysis and assessment of illegal actions in health care.

This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as "mercy killing" and some decisions not to treat incompetent patients.

Abortion, Illegal↗
PubMed1985

A definition for paternalism.

Several definitions of paternalism from the contemporary literature are examined. These are all found to be more or less defective when tested against various counterexamples. An alternative definition is subsequently developed using two necessary conditions which taken together are considered sufficient to define paternalistic actions. Those conditions are (1) the paternalistic action is primarily intended to benefit the recipient, and (2) the recipient's consent or dissent is not a relevant consideration for the initiator.

Beneficence↗
PubMed1985

Informed consent: patient's right or patient's duty?

The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impunity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and a right of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it.

Comprehension↗
PubMed1989

Health science, natural science, and clinical knowledge.

The epistemological status of health science, natural science, and clinical knowledge is explored. It is shown that 'health science', a term increasingly used in association with the clinical knowledge of the therapies, nursing, and other health occupations, is not fully a science in the sense of the natural sciences. It is rather a hybrid which relates applications of natural science, behavioral science, and the humanities to problems in health. The same may be said of clinical knowledge which entails, as essentials, humanistic considerations involving the personal concerns of the patient, in addition to the more evident external aspects of diagnosis and treatment. The recent introduction of the term 'health science' reflects scientism in its approach to health issues. It also reflects confusion about the nature of clinical knowledge.

Behavioral Sciences↗
PubMed1990

Medicine and dialogue.

Physicians have for some time been questioning the prevailing view of medicine as applied biology. It is urged that medicine needs to be reconceived so as to provide appropriate emphasis on the patient's experience and understanding of illness. After reviewing these arguments and the scientific paradigm underlying the received view in light of certain themes in medicine's history and of current thinking, Pellegrino's thesis is analyzed: medicine should be understood as an inherently moral enterprise, a form of praxis focused on "the healing relationship". Understanding the illness experience and the professed healer's "compassion" supports Pellegrino's view, and suggests that the healing relationship is perhaps best conceived as a form of dialogue.

Communication↗