This volume, which has developed from the Fourteenth Trans Disciplinary Symposium on Philosophy and Medicine, September 5-8, 1982, at Tel Aviv University, Israel, contains the contributions of a group of distinguished scholars who together examine the ethical issues raised by the advance of biomedical science and technology. We are, of course, still at the beginning of a revolution in our understanding of human biology; scientific medicine and clinical research are scarcely one hundred years old. Both the sciences and the technology of medicine until ten or fifteen years ago had the feeling of the 19th century about them; we sense that they belonged to an older time; that era is ending. The next twenty-five to fifty years of investigative work belong to neurobiology, genetics, and reproductive biology. The technologies of information processing and imaging will make diagnosis and treatment almost incomprehensible by my generation of physicians. Our science and technology will become so powerful that we shall require all of the art and wisdom we can muster to be sure that they remain dedicated, as Francis Bacon hoped four centuries ago, "to the uses of life." It is well that, as philosophers and physicians, we grapple with the issues now when they are relatively simple, and while the pace of change is relatively slow. We require a strategy for the future; that strategy must be worked out by scientists, philosophers, physicians, lawyers, theologians, and, I should like to add, artists and poets."

Bioethics developed as an academic and clinicaldiscipline during the later part of the 20th century due to a variety of factors. Crucial to this development was the increased secularization of American culture as well as the dissolution of medicine as a quasi-guild with its own professional ethics. In the context of this moral vacuum, bioethics came into existence. Its raison d'etre was opposition to the allegedpaternalism of the medical community and traditional moral frameworks, yet at the same time it set itself up as a source of moral authority with respect to biomedical decision making. Bioethics serves as biopolitics in so far as it attempts to make determinations about how individuals ought to make medical decisions and then attempts to codify that in law.Progressivism and secularism are ultimately the ideology of bioethics."

This volume developed from and around a series of six lectures sponsored by Rice University and the University of Texas Medical Branch at Galveston in the Fall of 1976. Though these lectures on the concepts of mental health, mental illness and personal responsibility, and the social treatment of the mentally ill were given to general audiences in Houston and Galveston, they were revised and expanded to produce six extensive formal essays by Dan Brock, Jules Coleman, Joseph Margolis, Michael Moore, Jerome Neu, and Rolf Sartorius. The five remaining contributions by Daniel Creson, Corinna Delkeskamp, Edmund Erde, James Speer, and Stephen Wear were in various ways engendered by the debates occasioned by the original six lectures. In fact, the majority of the last five contributions emerged from informal dis. cussions occasioned by the original lecture series. The result is an interlocking set of essays that address the law and public policy insofar as they bear on the treatment of the mentally ill, special atten. tion being given to the defmition of mental illness, generally and in the law, to the issues of the bearing of mental incompetence in cases of criminal and civil liability, and to the issue of involuntary commitment for the purpose of treatment or for institutional care. There is as well a critical defense of Thomas Szasz's radical proposal that mental illnesses are best understood as problems in living, not as diseases."

Although the investigation and regulation of the faculties of the human mind appear to be the proper and sole concern of philosophers, you see that they are in some part nevertheless so little foreign to the medical forum that while someone may deny that they are proper to the physician he cannot deny that physicians have the obliga tion to philosophize. Jerome Gaub, De regimine mentis, IV, 10 ( 10], p. 40) The Second Trans-Disciplinary Symposium on Philosophy and Medicine, whose principal theme was 'Philosophical Dimensions of the Neuro-Medical Sciences, ' convened at the University of Connecticut Health Center at the invitation of Robert U. Massey, Dean of the School of Medicine, during May 15, 16, and 17, 1975. The Proceedings constitute this volume. At this Symposium we intended to realize sentiments which Sir John Eccles ex pressed as director of a Study Week of the Pontificia Academia Scientiarum, CiWl del Vaticano, in the fall of 1964: "Certainly when one comes to a study] . . . devoted to brain and mind it is not possible to exclude relations with philosophy" ( 5], p. viii). During that study week in 1964, a group of distinguished biomedical and behavioral scientists met under the director ship of Sir John C. Eccles to relate psychology to what Sir John called 'the Neurosciences. ' The purpose of that study week was to treat issues con cerning the functions of the brain and, in particular, to concentrate upon the relations between brain functions and consciousness."

This volume is a contribution to the continuing interaction between law and medicine. Problems arising from this interaction have been addressed, in part, by previous volumes in this series. In fact, one such problem constitutes the central focus of Volume 5, Mental Illness: Law and Public Policy 1]. The present volume joins other volumes in this series in offering an exploration and critical analysis of concepts and values underlying health care. In this volume, however, we look as well at some of the general questions occasioned by the law's relation with medicine. We do so out of a conviction that medi cine and the law must be understood as the human creations they are, reflect ing important, wide-ranging, but often unaddressed aspects of the nature of the human condition. It is only by such philosophical analysis of the nature of the conceptual foundations of the health care professions and of the legal profession that we will be able to judge whether these professions do indeed serve our best interests. Such philosophical explorations are required for the public policy decisions that will be pressed upon us through the increasing complexity of health care and of the law's response to new and changing circumstances. As a consequence, this volume attends as much to issues in public policy as in the law. The law is, after all, the creature of human deci sions concerning prudent public policy and basic human rights and goods."

The concept 'health' is ambiguous [18,9, 11]. The concept 'mental health' is even more so. 'Health' compasses senses of well-being, wholeness, and sound ness that mean more than the simple freedom from illness - a fact appreci ated in the World Health Organization's definition of health as more than the absence of disease or infirmity [7]. The wide range of viewpoints of the con tributors to this volume attests to the scope of issues placed under the rubric 'mental health. ' These papers, presented at the Fourth Symposium on Philos ophy and Medicine, were written and discussed within a broad context of interests concerning mental health. Moreover, in their diversity these papers point to the many descriptive, evaluative, and, in fact, performative functions of statements concerning mental health. Before introducing the substance of these papers in any detail, I want to indicate the profound commerce between philosophical and psychological ideas in theories of mental health and disease. This will be done in part by a consideration of some conceptual developments in the history of psychiatry, as well as through an analysis of some of the functions of the notions of mental illness and health. 'Mental health' lays a special stress on the wholeness of human intuition, emotion, thought, and action.

As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different regions of the world. It is often difficult, however, to obtain accurate information about these matters. The Bioethics Yearbook series provides interested parties with analyses of how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withholding and withdrawing treatment, active euthanasia, the definition of death, and organ transplantation are being discussed in different religious traditions and regions. Volume Three discusses theological developments from 1990--1992 in Anglican, Baptist, Buddhist, Catholic, Continental Protestant, Eastern Orthodox, Hindu, Jewish, Latter-Day Saint, Lutheran, Methodist, Muslim, and Presbyterian traditions. Volume Four will continue coverage of official governmental and medical society policies on these topics throughout the world.

As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different parts of the world. It is often difficult, however, to get accurate information about these matters. The Bioethics Yearbook Series provides interested parties with analyses of how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withdrawing treatment, active euthanasia, the definition of death, and organ transplantation are being discussed in these different traditions and different parts of the world. The first volume, and every second succeeding volume, will discuss developments in the Anglican, Baptist, Buddhist, Catholic, Eastern Orthodox, Hindu, Jewish, LDS, Lutheran, Methodist, Muslim, and Presbyterian Traditions. The second volume, and every second volume succeeding it, will discuss official governmental and medical society policies on these topics throughout the world.

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge.

This volume inaugurates a series concerning philosophy and medicine. There are few, if any, areas of social concern so pervasive as medicine and yet as underexamined by philosophy. But the claim to precedence of the Proceedings of the First Trans-Disciplinary Symposium on Philos ophy and Medicine must be qualified. Claims to be "first" are notorious in the history of scientific as well as humanistic investigation and the claim that the First Trans-Disciplinary Symposium on Philosophy and Medicine has no precedent is not meant to be put in bald form. The editors clearly do not maintain that philosophers and physicians have not heretofore discussed matters of mutual concern, nor that individual philosophers and physicians have never taken up problems and concepts in medicine which are themselves at the boundary or interface of these two disciplines - concepts like "matter," "disease," "psyche. " Surely there have been books published on the logic and philosophy of medi 1 cine. But the formalization of issues and concepts in medicine has not received, at least in this century, sustained interest by professional phi losophers. Groups of philosophers have not engaged medicine in order to explicate its philosophical presuppositions and to sort out the various concepts which appear in medicine. The scope of such an effort takes the philosopher beyond problems and issues which today are subsumed under the rubric "medical ethics."

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."

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children . . . let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]).

Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping bioethics. It is inspired by Kazumasa Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply.

Much of contemporary philosophy, political theory, and social thought has been shaped directly or indirectly by Georg Wilhelm Friedrich Hegel, though there is considerable disagreement about how his work should be understood. He has been described both as a metaphysician and characterized as an ironic narrator who anticipated the character of philosophy after metaphysics. His position is equally ambiguous with regard to his political thought. He has been construed both as an enemy of the liberal state and as a friend of freedom. This volume's revisionist reassessment, building on the scholarship of Klaus Hartmann, explores these ambiguities in favor of a non-metaphysical reading of Hegel's arguments. It also shows how the foundations of his political thought support a liberal democratic state. This reappraisal of Hegel's arguments resituates him as a philosopher who anticipates the difficulties of post-modernity and offers a basis for reassessing ontology, aesthetics, and revolution. Philosophers and those doing work in political theory will find this volume of great interest.

The term bioethics' was coined in 1971, just as interest in the medical humanities claimed a prominent place in medical education. Out of this interest, a substantial area of research and scholarship took shape: the philosophy of medicine. This field has been directed to the epistemological, ontological, and value-theoretical issues occasioned by medicine and the biomedical sciences. Bioethics is nested in this field and can only be fully understood in terms of the foundational issues it addresses. This collection of essays in honor of Stuart F. Spicker, one of the individuals who gave shape to the philosophy of medicine, lays out the broad scope of concerns from the philosophy of embodiment, to issues of the role of ethics consultants, to concepts of disease, equity and the meaning of history.

Is there only one bioethics? Is a global bioethics possible? Or, instead, does one encounter a plurality of bioethical approaches shaped by local cultural and national traditions? Some thirty years ago a field of applied ethics emerged under the rubric bioethics'. Little thought was given at the time to the possibility that this field bore the imprint of a particular American set of moral commitments. This volume explores the plurality of moral perspectives shaping bioethics. It is inspired by Kazumasa Hoshino's critical reflections on the differences in moral perspectives separating Japanese and American bioethics. The essays include contributions from Hong Kong, China, Japan, Texas, the United States, Germany, Switzerland, and Italy. The volume offers a rich perspective of the range of approaches to bioethics. It brings into question whether there is unambiguously one ethics for bioethics to apply.

Much of contemporary philosophy, political theory, and social thought has been shaped directly or indirectly by Georg Wilhelm Friedrich Hegel, though there is considerable disagreement about how his work should be understood. He has been described both as a metaphysician and characterized as an ironic narrator who anticipated the character of philosophy after metaphysics. His position is equally ambiguous with regard to his political thought. He has been construed both as an enemy of the liberal state and as a friend of freedom. This volume's revisionist reassessment, building on the scholarship of Klaus Hartmann, explores these ambiguities in favor of a non-metaphysical reading of Hegel's arguments. It also shows how the foundations of his political thought support a liberal democratic state. This reappraisal of Hegel's arguments resituates him as a philosopher who anticipates the difficulties of post-modernity and offers a basis for reassessing ontology, aesthetics, and revolution. Philosophers and those doing work in political theory will find this volume of great interest.

As noted in Volume 1, the Yearbook series alternates between a biennial volume tracing recent theological discussions on topics in bioethics and a biennial volume tracing recent regional discussions in bioethics. Volume 2 provides for the first time a comprehensive single-volume summary of recent international and regional developments on specific topics in bioethics. To give uniformity to the discussions all authors were asked to report on the following topics: new reproductive technologies, abortion, maternal-fetal conflicts, case of severely disabled newborns, consent of treatment and experimentation, confidentiality, equitable access to health care, ethical concerns raised by cost-containment measures, decisions to withhold or withdraw life-sustaining treatment, active euthanasia, the definition of death, organ donation and transplantation. The internationally respected contributors report on the following 16 areas: the United States, Canada, Latin America, the United Kingdom and Ireland, France, the Netherlands, Germany/Austria/Switzerland, Eastern Europe, Spain/Portugal/Italy/Scandinavia, India, Southeast Asia, China, Japan, Australia/New Zealand, Council of Europe/EEC. The commentators draw on three sets of resources: Statutes, legislative proposals, and regulatory changes that directly influence, or have implications for, areas of bioethical concern; Case law and court judgments that shape, either decisively or suggestively, recent legal interpretations of particular issues of areas in bioethics; Formal statements of governmentally appointed commissions, advisory bodies, and representative professional groups, as well as less formal statements and recommendations of other organisations. In addition to providing timely summaries of recent developments, the volume offers rich and useful bibliographical references to a wide array of documents, many of which would be difficult for readers to learn about, given the lack of centralized international collection of such documents. The Yearbook should be widely consulted by all bioethicists, public policy analysts, lawyers and theologians.

As the field of bioethics has matured, increasing attention is being paid to how bioethical issues are treated in different moral and religious traditions and in different parts of the world. It is often difficult, however, to get accurate information about these matters. The Bioethics Yearbook Series provides interested parties with analyses of how such issues as new reproductive techniques, abortion, maternal-fetal conflicts, care of seriously ill newborns, consent, confidentiality, equitable access, cost-containment, withdrawing treatment, active euthanasia, the definition of death, and organ transplantation are being discussed in these different traditions and different parts of the world. The first volume, and every second succeeding volume, will discuss developments in the Anglican, Baptist, Buddhist, Catholic, Eastern Orthodox, Hindu, Jewish, LDS, Lutheran, Methodist, Muslim, and Presbyterian Traditions. The second volume, and every second volume succeeding it, will discuss official governmental and medical society policies on these topics throughout the world.

This volume, which has developed from the Fourteenth Trans Disciplinary Symposium on Philosophy and Medicine, September 5-8, 1982, at Tel Aviv University, Israel, contains the contributions of a group of distinguished scholars who together examine the ethical issues raised by the advance of biomedical science and technology. We are, of course, still at the beginning of a revolution in our understanding of human biology; scientific medicine and clinical research are scarcely one hundred years old. Both the sciences and the technology of medicine until ten or fifteen years ago had the feeling of the 19th century about them; we sense that they belonged to an older time; that era is ending. The next twenty-five to fifty years of investigative work belong to neurobiology, genetics, and reproductive biology. The technologies of information processing and imaging will make diagnosis and treatment almost incomprehensible by my generation of physicians. Our science and technology will become so powerful that we shall require all of the art and wisdom we can muster to be sure that they remain dedicated, as Francis Bacon hoped four centuries ago, "to the uses of life." It is well that, as philosophers and physicians, we grapple with the issues now when they are relatively simple, and while the pace of change is relatively slow. We require a strategy for the future; that strategy must be worked out by scientists, philosophers, physicians, lawyers, theologians, and, I should like to add, artists and poets."

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge.

This volume is a contribution to the continuing interaction between law and medicine. Problems arising from this interaction have been addressed, in part, by previous volumes in this series. In fact, one such problem constitutes the central focus of Volume 5, Mental Illness: Law and Public Policy 1]. The present volume joins other volumes in this series in offering an exploration and critical analysis of concepts and values underlying health care. In this volume, however, we look as well at some of the general questions occasioned by the law's relation with medicine. We do so out of a conviction that medi cine and the law must be understood as the human creations they are, reflect ing important, wide-ranging, but often unaddressed aspects of the nature of the human condition. It is only by such philosophical analysis of the nature of the conceptual foundations of the health care professions and of the legal profession that we will be able to judge whether these professions do indeed serve our best interests. Such philosophical explorations are required for the public policy decisions that will be pressed upon us through the increasing complexity of health care and of the law's response to new and changing circumstances. As a consequence, this volume attends as much to issues in public policy as in the law. The law is, after all, the creature of human deci sions concerning prudent public policy and basic human rights and goods."

This volume developed from and around a series of six lectures sponsored by Rice University and the University of Texas Medical Branch at Galveston in the Fall of 1976. Though these lectures on the concepts of mental health, mental illness and personal responsibility, and the social treatment of the mentally ill were given to general audiences in Houston and Galveston, they were revised and expanded to produce six extensive formal essays by Dan Brock, Jules Coleman, Joseph Margolis, Michael Moore, Jerome Neu, and Rolf Sartorius. The five remaining contributions by Daniel Creson, Corinna Delkeskamp, Edmund Erde, James Speer, and Stephen Wear were in various ways engendered by the debates occasioned by the original six lectures. In fact, the majority of the last five contributions emerged from informal dis. cussions occasioned by the original lecture series. The result is an interlocking set of essays that address the law and public policy insofar as they bear on the treatment of the mentally ill, special atten. tion being given to the defmition of mental illness, generally and in the law, to the issues of the bearing of mental incompetence in cases of criminal and civil liability, and to the issue of involuntary commitment for the purpose of treatment or for institutional care. There is as well a critical defense of Thomas Szasz's radical proposal that mental illnesses are best understood as problems in living, not as diseases."

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."

The concept 'health' is ambiguous [18,9, 11]. The concept 'mental health' is even more so. 'Health' compasses senses of well-being, wholeness, and sound ness that mean more than the simple freedom from illness - a fact appreci ated in the World Health Organization's definition of health as more than the absence of disease or infirmity [7]. The wide range of viewpoints of the con tributors to this volume attests to the scope of issues placed under the rubric 'mental health. ' These papers, presented at the Fourth Symposium on Philos ophy and Medicine, were written and discussed within a broad context of interests concerning mental health. Moreover, in their diversity these papers point to the many descriptive, evaluative, and, in fact, performative functions of statements concerning mental health. Before introducing the substance of these papers in any detail, I want to indicate the profound commerce between philosophical and psychological ideas in theories of mental health and disease. This will be done in part by a consideration of some conceptual developments in the history of psychiatry, as well as through an analysis of some of the functions of the notions of mental illness and health. 'Mental health' lays a special stress on the wholeness of human intuition, emotion, thought, and action.