Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

The editors have incurred many debts in preparing this book, and both etiquette and ethics would be contravened if they were not discharged here. Above all, we wish to thank the contributors for so cheerfully complying with our suggestions for preparing their papers for publication and efficiently meeting our schedules. It is thanks to their cooperation that this volume has appeared speedily and painlessly; their revisions have helped to give it internal coherence. This volume has emerged from papers delivered at a conference on the History of Medical Ethics, held at the Wellcome Institute for the History of Medicine, London, 1 December, 1989. We are most grateful to the Wellcome Trust for having underwritten the costs of the conference, and to Frieda Houser and Stephen Emberton whose organizational skills contributed so much to making it a smoothly-run and enjoyable day. In addition to the papers delivered at the conference, we are delighted to have secured further contributions from David Harley and Johanna Geyer-Kordesch. Our thanks to them for their eager help. From start to finish, we have received splendid encouragement from all those connected with the Philosophy and Medicine series, especially Professor Stuart Spicker, and Martin Scrivener at Kluwer Academic Publishers. Their enthusiasm has lightened our load, and expedited the editorial process.

Positive conceptions of healthy aging are rightly displacing negative ageist perceptions of older members of our society. Nevertheless, at some stage, most elderly citizens will require some form of assistance from other members of society. When the body or mind begins to fail, a legitimate need for intervention and care will arise. This second volume on Aging discusses this theme.

K. Danner Clouser is one of the most important figures in establishing and shaping the fields of medical ethics, bioethics, and the philosophy of education in the second half of the twentieth century. Clouser challenged many established approaches to moral theory and offered innovative strategies for integrating the humanities into professional education, especially that of physicians and nurses. The contributions published in Building Bioethics: Conversations with Clouser and Friends on Medical Ethics are unique both in their devotion to a critical review of his contributions, and in bringing together internationally known figures in bioethics, medical ethics, and philosophy of medicine to comment upon Clouser's work. These leaders of the field include Tom Beauchamp, Daniel Callahan, James Childress, Nancy Dubler, H. Tristram Engelhardt, Al Jonsen, Loretta Kopelman, Larry McCullough, John Moskop, and Robert Veatch. This book merits special attention from those interested in bioethics, philosophy of medicine, medical ethics, philosophy, medical education, religious studies, and nursing education.

On May 13-15, 1982, some 50 scientists and scholars - physicians, philos ophers and social scientists - convened at Hasselby Castle in Stockholm for the first Nordic Symposium on the Philosophy of Medicine. The topics for the symposium included (1) the concepts of health and disease, (2) classification in medicine, and (3) causality and causal explanations in medicine. The majority of the participants were Scandinavian but the symposium was also able to welcome four distinguished guests from other parts of the world, Professors Stuart F. Spicker and H. Tristram Engelhardt, Jr., U.S.A., Dr Anne M. Fagot, France, and Dr Werner Morbach, West Germany. The latter represented Professor Kazem Sadegh-zadeh, who unfortunately was prevented from attending. One of the main purposes of this symposium was to bring together people in Scandinavia who at present work within the field of Philosophy of Medi cine. This group is still relatively small but is growing rapidly, and the scholarly activity has recently been notable. This fact is clearly demonstrated by the presentation of 'Philosophy of Medicine in Scandinavia' in the Appendix of this volume."

Nanobiotechnology is the convergence of existing and new biotechnology with the 1 ability to manipulate matter at or near the molecular level. This ability to manipulate matter on a scale of 100 nanometers (nm) or less is what constitutes the nanotechnology revolution occurring today, the potentially vast economic and social implications of which are yet to be fully understood (Royal Society, 2004). The most immediate way to understand the implications of nanobiotechnology for ethics is to consider the real life concerns of communities that are mobilizing within civil society. The conflicts and ethical debates surrounding nanotechnology will, almost by definition, emerge on the fault lines between different civil society actors, researchers and financial interests associated with nanobiotechnology, as well as (potentially) government regulators. These fault lines are all reflected within the concerns (as expressed d- cursively) of the communities mobilizing. This chapter will explore converging d- courses regarding converging technologies. Converging Technologies (CT) are already a familiar theme in the next gene- tion of biotechnology, nanotechnology, pharmacogenomics and proteomics research 2 and development. Nanobiotechnology means that previously separate disciplines (IT, physics, chemistry, and biology) are merging and converging to create new applications and even new life forms through converged technological platforms. Schummer (2004), and Glimell and Fogelberg (2003, p. 43), note the predominance of interdisciplinarity as a core theme of nano-discourse.

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D. , joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J.

Over a period of a year, the symposium on clinical judgment has taken shape as a volume devoted to the analysis of how knowledge claims are framed in medicine and how choices of treatment are made. We hope it will afford the reader, whether layman, physician or philosopher, a useful perspective on the process of knowing what occurs in medicine; and that the results of the dis cussions at the Fifth Symposium on Philosophy and Medicine will lead to a better understanding of how philosophy and medicine can usefully challenge each other. As the interchange between physicians, philosophers, nurses and psychologists recorded in the major papers, the commentaries and the round table discussion shows, these issues are truly interdisciplinary. In particular, they have shown that members of the health care professions have much to learn about themselves from philosophers as well as much of interest to engage philosophers. By making the structure of medical reasoning more apparent to its users, philosophers can show health care practitioners how better to master clinical judgment and how better to focus it towards the goods and values medicine wishes to pursue. Becoming clearer about the process of knowing can in short teach us how to know better and how to learn more efficiently. The result can be more than (though it surely would be enough ) a powerful intellectual insight into a major cultural endeavor, medicine."

Charles Bonnet began his career as a naturalist, from an early age establishing a reputation as a careful observer. It is for those youthful observations, as well as for some suggestive speculations proposed relative to this field, that he is best remembered in English-speaking countries: regarding the taxonomic de mands of natural history he refurbished the idea of a chain of beings; regarding the question of generation he marshaled evidence in support of preforma tion theory; and regarding the analysis of the physiology of the nervous system he advanced a theory that individual nerve fibers receive and retain specific sensations. Following his loss of eyesight in his mid-twenties Bonnet entered a more reflective period, turning to philosophy and pondering the nature of human understanding - considerations he had formerly disdained, but that now seemed a natural outgrowth of his reflections on nature. This essay focuses on the philosophical and psychological works of the later period, the period in which he wrote all his major books. By giving these writings a broader exposure it has been one of my hopes that Bonnet's audience would also be broadened, releasing him, so to speak, from the charge of historians of science so that he might fmd his way, in general books on the "Enlightenment," from scattered footnotes into the texts themselves."

Medical healing implies knowledge of the assumptions that underlie our understanding of "health," and, concomitantly, how we define well being and its opposites, illness and disease. Today, health, health care (business, wellness, recreation), and medicine (especially research-driven scientific medicine) have become separate entities with different institutions, budgets, marketing philosophies and "corporate cultures." Furthermore, healing is individual and subjective, yet at the same time also culturally determined. The present volume brings together papers on these topics in an unique interdisciplinary approach. The book provides an ethical framework for healthcare from a political perspective. It discusses definitions of the terminology of healing and health and their ethical and medical implications including their historical contexts. A separate section expands the theme of the cultural constructedness of healing by the concepts of traditional Chinese medicine and homeopathy. Modern medicine has a strong focus on acute care, which urgently needs to place greater emphasis on preventive medicine including the crucial importance of social factors on health and on the emergence of "public health." The point of view of Business Concepts, their potential and limitations are by no means neglected and the legal ramifications of genetic research and innovative medical strategies with regard to some of our most foundational notions are discussed.

In this remarkable book, Gary Wright focuses thirty years experience as a family physician, and his Ph.D. in philosophy, to address the nature of good medical reasoning. Wright folds cognitive science into a pragmatist framework developed by John Dewey; this alternative view of mind and medical judgment leads to a model of reasoning that offers realistic guidance for medical decisions, one that each of us would want our own physicians to adopt.

The question of whether there might be a duty to die was first raised by Margaret Battin in 1987 in her ground-breaking essay, "Age Distribution and the Just Distribution of Health Care: Is There a Duty to-Die?" In 1997 the issue was reprised when two new articles appeared on the topic written by John Hardwig and the other by former Colorado Governor Richard D. Lamm. Given the renewed interest in the topic, as well as its undeniable importance, Biomedical Ethics Re views sought to initiate an in-depth discussion of the issue by soliciting articles and issuing a general call for papers on the topic "Is There a Duty to Die?" The twelve articles in this volume represent the ultimate fruits of those initiatives. The first seven essays in this text are sympathetic to the claim that there is a duty to die. They argue either: (a) that some form of a duty to die exists, or (b) that arguments that might be offered against the existence of such a duty cannot be sustained. By way of contrast, the last five articles in the text are critical of duty-to-die claims: The authors of the first three of these five articles attempt to cast doubt on the existence of a duty to die, and the writers of the last two essays argue that if such a duty did exist, severe problems would arise when ever we attempted to implement it."

1. GENERAL The term "diagnostics" refers to the general theory of diagnosis, not to the study of specific diagnoses but to their general framework. It borrows from different sciences and from different philosophies. Traditionally, the general framework of diagnostics was not distinguished from the framework of medicine. It was not taught in special courses in any systematic way; it was not accorded special attention: students absorbed it intuitively. There is almost no comprehensive study of diagnostics. The instruction in diagnosis provided in medical schools is exclusively specific. Clinical instruction includes (in addition to vital background information, such as anatomy and physiology) specific instruction in nosology, the theory and classification of diseases, and this includes information on diagnoses and prognoses of diverse diseases. What is the cause of the neglect of diagnostics, and of its integrated teaching? The main cause may be the prevalence of the view of diagnostics as part-and parcel of nosology. In this book nosology is taken as a given, autonomous field of study, which invites almost no comments; we shall freely borrow from it a few important general theses and a few examples. We attempt to integrate here three studies: ll of the way nosology is used in the diagnostic process; of the diagnostic process as a branch of applied ethics; ~ of the diagnostic process as a branch of social science and social technology.

Pope John Paul II surprised much of the medical world in 2004 with his strongly worded statement insisting that patients in a persistent vegetative state should be provided with nutrition and hydration. This collection of essays featuring some of the most prominent Catholic bioethicists addresses the Pope s statements, the moral issues surrounding artificial feeding and hydration, the refusal of treatment, and the ethics of care for those at the end of life."

The idea for an anthology on personhood grew out of two things, viz., the work I did with Martin Benjamin during the Summer of 1982 at Michigan State University on the question, What is a person?, and the amount of time, effort, and expense required for serious research on the topic itself. The former experience taught me the importance of, among other things, attempting to get clear about what we are to mean by 'person, ' while the latter experience suggested a possible course of action whereby getting clear might be made more manage able simply by having relatively convenient access to some of the most insightful and stimulating writings on the topic. The problems of personhood addressed in this book are central to issues in ethics ranging from the treatment or termination of infants with birth defects to the question whether there can be rational suicide. But before questions on such issues as the morality of abortion, genetic engineering, infanticide, and so on, can be settled, the prob lems of personhood must be clarified and analyzed. Hence What Is a Person? has as its primary theme the examination of various proposed conditions of personhood."

Internationally recognized scientists, clinicians, and technologists review and explain the fundamental molecular and cellular biology that has been applied to the emerging field of transplant immunology and xenotransplantation, and what impact these advances might optimally have on medicine and science. The authoritative experts writing here-many of whom made the basic discoveries underlying the recent advances-examine the biological and immunological hurdles to xenotransplantation, illuminating how the immune system interacts with the xenograft and laying a practical foundation for the use of genetic engineering and animal transplants in the treatment of human disease.

Prominent bioethicists whose work is rooted in philosophy, religion, medicine, nursing, literature, history, and policy analysis join together to discuss their methods and professional insights, as well as to better define the field and its future development. Writing from the perspective of their own specialties, the authors: review just how their personal disciplines have contributed to bioethics, debate the current and future bioethical issues they face, and identify the most significant strengths and weaknesses in the current practice of bioethics. Seeking a sound foundation for the discipline, they also consider what basic knowledge and skills are necessary to be competent in bioethics, what methods and theoretical approaches are most promising for its future development, and what issues or perspectives have been neglected.

Any list of the most influential figures of the second half of the twentieth century would arguably have to begin with the name of Pope John Paul II. From 1978, when he was inaugurated, to the present, over a quarter of a century later, the Pope has been a dominant force in the world, both within the Catholic and Christian Church, and in the larger international community. Among the areas in which the Pope has been of signal importance to contemporary discussion, argument, and policy has been the field of bioethics. This collection brings together for the first time in an accessible and readable form a summary and assessment of John Paul II's contribution to bioethical issues and theories. It includes discussion of the Pope's views on the dignity of the person and the sanctity of human life, and the application of these views to various difficulties in medical ethics such as abortion and embryo research, the right to health care and the problem of suffering. Throughout, attention is paid to the way in which the Pope stands as a recognizably authentic voice for the Catholic faith in the medical arena.

In this book, developed by a group of collaborating scholars in bioethics from different European countries, an overview is given of the most salient themes in present-day bioethics. The themes are discussed in order to enable the reader to have an in-depth overview of the state of the art in bioethics. Introductory chapters will guide the reader through the relevant dimensions of a particular area, while subsequent case discussions will help the reader to apply the ethical theories to specific clinical problems and health policy queries. The book focuses on perspectives typical for the European context. This highlights not only particular bioethical themes such as social justice, choices in health care, and health policy (e.g., in post-communist countries), it also emphasizes specific approaches in ethical theory, in relation to Continental philosophies such as phenomenology and hermeneutics.
Because of its articulation of what is typical for the European health care setting as well as for bioethical debate, this book is unique in comparison to existing textbooks in bioethics.
The book is an introductory textbook acquainting the reader with the major issues in present-day health care as well as the various theoretical and practical approaches to clarify these issues.

Efforts to evaluate the clinical encounter in terms of autonomous agents governed by rationally justified moral principles continue to be criticised. These essays, written by physicians, ethicists, theologians and philosophers, examine various models of the clinical encounter emerging out of these criticisms and explore the prospects they offer for theological and religious discourse. Individual essays focus on the reformulation of covenant models; revisions of principles approaches; and topics such as power, authority, narrative, rhetoric, dialogue, and alterity. The essays display a range of conclusions about whether theology articulates generally accessible religious insights or is a tradition-specific discipline. Hence the volume reflects current debates in theology while analysing current models of the clinical encounter. Students, professionals, and scholars who find themselves at the intersection of theology and medicine will welcome these voices in an ongoing conversation.

In the second half of the 20th century, the body has become a central theme of intellectual debate. How should we perceive the human body? Is it best understood biologically, experientially, culturally? How do social institutions exercise power over the body and determine norms of health and behavior? The answers arrived at by phenomenologists, social theorists, and feminists have radically challenged our cenventional notions of the body dating back to 17th century Cartesian thought. This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine. Its authors suggest that many of the problems often found in modern medicine -- dehumanized treatment, overspecialization, neglect of the mind's healing resources -- are directly traceable to medicine's outmoded concepts of the body. New and exciting alternatives are proposed by some of the foremost physicians and philosophers working in the medical humanities today.

Religion is a dominant force in the lives of many Americans. It animates, challenges, directs and shapes, as well, the legal, political, and scientific agendas of the new Age of Biotechnology. In a very real way, religion, biomedical technology and law are - epistemologically - different. Yet, they are equal vectors of force in defining reality and approaching an understanding of it. Indeed, all three share a synergetic relationship, for they seek to understand and improve the human condition.

This book strikes a rich balance between thorough analysis (in the body), anchored in sound references to religion, law and medical scientific analysis, and a strong scholarly direction in the end notes. It presents new insights into the decision-making processes of the new Age of Biotechnology and shows how religion, law and medical science interact in shaping, directing and informing the political processes.

This volume will be of interest to both scholars and practitioners in the fields of religion and theology, philosophy, ethics, (family) law, science, medicine, political science and public policy, and gender studies. It will serve as a reference source and can be used in graduate and undergraduate courses in law, medicine and religion.

Section I examines historical philosophical understandings of expertise in order to situate the current institution of bioethics. Section II focuses on philosophical analyses of the concept of expertise, asking, among other things, how it should be understood, how it can be acquired, and what such expertise warrants. Finally, section III addresses topics in bioethics and how ethics expertise should or should not be brought to bear in these areas, including expertise in the court room, in the hospital room, in the media, and in making policy. 2. A GUIDED HISTORICAL TOUR As Scott LaBarge points out, Plato's dialogues can be viewed as an extended treatment of the concept of moral expertise, so it is fitting to begin the volume with an examination of "Socrates and Moral Expertise." Given Socrates' protestations (the Oracle at Delphi notwithstanding) that he knows nothing, LaBarge observes that it would be interesting to determine both what a Socratic theory of moral expertise might be and whether Socrates qualified as such an expert. Plato's model of moral expertise is what LaBarge calls "demonstrable expertise," which is concerned mainly with the ability to attain a goal and to explain how one did it. The problem with this account is that when one tries to solve the various problems in the model - for example, allowing that moral expertise is not an all-or-nothing skill - then one is immediately faced with the "credentials problem." As LaBarge puts it, ." . .