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Topic: Philosophy
April 11, 2013 | Posted By Wayne Shelton, PhD

Much of the history of philosophy, including the history of philosophical ethics, can be summarized as the quest for a basis in an objective, rational truth. My sense is that many ethicists, both philosophers and non-philosophers, today have not let go of this quest entirely. The purpose of this short blog to is sketch briefly the philosophical landscape of our tradition and what I think is the proper response to it in terms of how we should view ethics.

Early Greek philosophers, such as Thales, Democritus, Parmenides and Heraclitus were seeking an understanding of the natural phenomena independent from traditional mythology. Their goal was to find an explanation that accounted for both diversity and change in nature, but also the unity and continuity. A basic question became, what is the ultimate source or the most basic element of the universe that helps us understand the universe, as well as what we know and how we should live? Plato, through his dialogues using Socrates as his mouthpiece, postulated that ultimate Truth or Good is to be found in the Forms, which were in a separate, higher realm from everyday human experience. For Plato, what we come to know in the realm of earthly experience is always an approximation of their ultimate counterparts in the Forms. Of course a special realm of truth requires a special understanding, which not surprisingly he believed was accessible only to the Philosopher King, whose understanding was oriented to such a level.

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.

February 14, 2013 | Posted By Wayne Shelton, PhD

Medical educators over the past six decades have designed educational objectives and curricula as though it was the educational process itself that determines students’ values and their behavior as professionals, without considering the influence of the structural environment on medical trainees. From the 1950’s on, asSamuel Bloom observed in 1988, there are examples, continuing to present day, of medical schools devising curricula with the goal “…to repair what were believed to be the dehumanizing effects of scientific specialization, but with the retention of the best of science.” To achieve these goals educators drew from the social sciences and humanities, and by the 1970s, from the growing interest in medical humanism and specifically from the field of medical ethics, which now is mostly referred to as bioethics. Bloom claims these subjects, like science, have been split off from the context of how they impact medical practice and taught mostly as an intellectual activity, thus creating a dualism between theory and practice. The curriculum has been assumed on its own to be an instrument of behavioral change that follows from knowledge. The essential process of social organization is sadly lost from view and deemphasized. How can we account for this rift?

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.

October 10, 2012 | Posted By Wayne Shelton, PhD

The modern era in the West marks the beginning of a new way of understanding the purpose of a social system and how people fit in to it. The transition to the modern world was from a medieval world that was perceived to have inherent ends and truths, based on Aristotelian metaphysics and Catholic moral theology, that provided authoritative answers to fundamental questions about the nature of ultimate reality, knowledge, human nature and morality. In Europe during the 15th and 16th centuries, the radical political turmoil, stemming from the Protestant Reformation, and a growing sense of the rights of humans were leading philosophers like Hobbes (1588-1679), Locke (1632-1704) and Rousseau (1712-1778) to articulate a fundamentally new type of social and political system. Instead of the divine rights of kings to assert complete rule over subjects, which created an obligation for subjects to obey those divine rights, there emerged the concept that the social and political order should be structured so as to protect and preserve the natural rights of human beings qua citizens. This new understanding of how to understand society and individuals—later called social contract theory—provided the conceptual underpinnings of the eventual emergence of democratic systems: The idea that the social system should be structured in a manner so as to allow individual citizens to be free to live according to their life goals and values within the limits of respecting those same rights of others. This meant that individual citizens should agree to give up some of their rights, e.g. to steal and kill, for the larger benefit of living safely and in a manner of one’s own choice. 

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 ourwebsite.

July 12, 2012 | Posted By Wayne Shelton, PhD

Those of us who work in clinical ethics focus most of our intellectual energy on addressing ethical dilemmas in individual cases. Clinical ethics allows little time for armchair reflection. The urgent cases presented to us require fairly quick decisions. That is, if we are to be helpful, we have to find thoughtful ways to analyze ethical questions and reach prudent recommendations. But even for clinical ethicists, it is worthwhile from time to time to take a step back and consider the historical philosophical context in which we work and the challenges it poses for ethical reflection and judgments.

Clinical ethics has been criticized by some not having an adequate basis on which to give substantive answers to pressing ethical questions in medicine. I want to show how this concern is not only, not a problem, but is a sign of progress. First a little background about the state of contemporary western ethics as expressed in one of the most important critiques of philosophical ethics and morality in the past 100 years.

In his 1981 work entitled After Virtue, Alasdair McIntyre claims the actual moral world in which we live is in “a state of grave disorder”. The concepts and terms we use in contemporary ethical discourse, he believes, are nothing more than fragments of prior conceptual schemes that have largely lost their moral import. Even worse, we use ethical discourse in talking about obligation, rights and duties without fully realizing the lost moral orders in which these words once had their original meaning. This is a concerning charge for clinical ethicists since much of our daily work involves using just these kinds of terms. Do we have a clear grasp of what our moral terms mean and how they are being used?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 27, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

“Human speech is like a cracked kettle on which we tap crude rhythms for bears to dance to, while we long to make music that will melt the stars.” — Gustave Flaubert, Madame Bovary

“The chances of factual truth surviving the onslaught of power are very slim indeed … ” — Hannah Arendt, Between Past and Future

Although this may be more apparent than real, it seems as if the lying and the lies are increasing in frequency on the national level. Politics has long been characterized as a blood sport, but the escalation of vicious contentiousness since 2008 is unusual and extreme. Factual truth has been cast aside, casually thrown to the wind as if one were systematically ripping the petals off a roadside wildflower and tossing them into the air as so much refuse. The losers are the public, of course, the citizens who depend on the government for sound fiscal policies, welfare for those unable to care for themselves, and protection in the form of national defense.

None of this is a surprise. As Arendt states in her essay “Truth and Politics”, modern ideologies “ openly proclaim them to be political weapons and consider the whole question of truth and truthfulness irrelevant”. Further, “it may be in the nature of the political realm to deny or pervert truth of every kind”. As the nature of truth as such is limiting (in other words, it is what it is) , politicians will naturally bend the truth to fit their purposes. As citizens, we need to be on our guard and strive to identify factual truth or the lack thereof in political pronouncements. But such activity requires substantial effort. Thinking is required, as is the concomitant ability to simultaneously hold two contrasting concepts or points of view in mind. A broad education is required, as is a good facility with language. Sadly for us, most of these requirements and capabilities are now in short supply.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 11, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Does a person have a disease or disorder? Or is the person unwell with an illness? Are the concepts of disease and illness distinct? If we have been lulled to sleep by 100 years of Cartesian diktats from the medical establishment, we may miss the point. But if our thinking is super-sharp, we may be able to detect a critical difference.

A prominent legacy of Cartesian dualism, the mind/body problem, causes a split between the “I” that I know myself to be and the physical body that the “I” inhabits. “I” am a passenger in my body. My body carries “me” around, but we are two separate entities. Thus, my body is something separate from “me” and things can happen to it, e.g., my body can become diseased.

The practice of modern medicine is based on this seemingly real separation. But if that’s all there is, much is being missed. Investigation of the illness vs. disease antinomy offers a profound opportunity for improved medical care of people as patients.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

May 29, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

April 2012 brought news of the latest shot fired over the bow of genetic inheritance as we know it. Ever since the discovery of the structure of DNA by Watson and Crick in 1953 and the subsequent elucidation of the triplet nature of the genetic code by Marshall Nirenberg and others in the early 1960s, many scientists have fantasized about obtaining mastery over this primordial biomolecule.

An interim pinnacle of achievement in this hopeful process would be to create a DNA-like molecule whose information content would be both heritable and evolvable. Synthetic Genetic Polymers Capable of Heredity and Evolution presents elegant work along this path which may signal a substantive shift in humankind’s ability to manipulate the language of life.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

April 11, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Scientists now have the capability of changing the world. Literally. A prominent researcher observed in a 2011 Science article that "our genome engineering technologies treat the chromosome as an editable and evolvable template". The advent of such technologies is disturbing from many points of view.

Until very recently scientific research contributed to the advancement of knowledge about the world around us without simultaneously creating tools for altering the characteristics and parameters of that world. None of these activities threatened the integrity of the biosphere — namely, that of planet earth. The ability to do so should give all of us, primarily scientists, pause, but they do not. As Hans Jonas observed, the deeds of biological engineering are irrevocable.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

January 27, 2012 | Posted By Wayne Shelton, PhD

For most of the past 20 years I have had the privilege of talking with and learning from medical students in small group discussions. As medical students leave the classrooms of the first and second year and transition into the third year, they confront a new reality: they are now actually encountering patients directly for the first time and are working with physicians in the daily care of patients. The more encounters they have with patients and their families and with their clinical mentors, the more stories they have to tell, which often lead to vexing questions that shed light on many of the problems of our health care system in the United States. 

One of the common themes throughout each year is the growing disenchantment with primary care, for a variety of reasons. Most of the students are assigned at some point to a clinical mentor who is a practicing internist seeing many patients each day in a primary care setting. Students often present cases of patients with complex medical and psychosocial issues that require interaction with and support from the physician. Not infrequently do we hear accounts of how patient non-compliance is a barrier to a constructive outcome. The idea of seeing patients over time with the same medical problems, while not heeding medical advice, strikes many students as a frustrating aspect of primary care. Also the students talk of these same physicians continuing to work into the evening, doing mountains of administrative work because of multiple insurance forms to complete. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

November 3, 2011 | Posted By Michael Brannigan, PhD

During a high school cross-country race last month in Minnesota, Andover's Josh Ripley stopped to aid injured opponent Mark Paulauskas from Lakeville South, carried him more than 100 yards to medical help and then jumped back into the race. As Ripley came to the finish line 211th in a field of 261, the Lakeville squad greeted him with cheers (http://tinyurl.com/3bjzhsv).

If "Winning isn't everything; it's the only thing," Ridley failed miserably. We worship winners and assign the losers to public recognition's dustbin.

Yet did you know that Vince Lombardi, just before he died, regretted his one-liner?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

 

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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