This article describes and rejects three standard views of reason in secular clinical ethics. The first, instrumental reason view, affirms that reason may be used to draw conceptual distinctions, map moral geography, and identify invalid forms of argumentation, but prohibits recommendations because reason cannot justify any content-full moral or metaphysical commitments. The second, public reason view, affirms instrumental reason, and claims ethicists may make recommendations grounded in the moral and metaphysical commitments of bioethical consensus. The third, comprehensive reason view, also (...) affirms instrumental reason, but encourages ethicists to make recommendations grounded in the moral and metaphysical commitments of their private worldviews. A compatibilist view of public reason is then defended, which holds that each standard view captures an important role for reason in different aspects of secular clinical ethics. The article ends by identifying three implications for enduring theoretical debates in clinical ethics. (shrink)

Recently, Verheijde and Potts (2011) have called into question the whole-brain death (WBD) criterion and, in particular, have taken issue with my admittedly limited defense of WBD. I would like to thank Verheijde and Potts for their comments and for identifying key points in the debate that need further clarification and defense. This article is an attempt to provide such clarification and to focus on Verheijde and Potts’s key argument against me and other proponents of WBD. The structure of this (...) reply is first to clear away some misunderstandings and to articulate further some of my original arguments. These clarifications are necessary to acuminate attention to what is, I believe, the fundamental locus of disagreement between proponents of WBD and its detractors. Detractors assert that patients who satisfy WBD can still evince integrated functioning. On the assumption that persons are not dead yet if they can manifest integrated functioning, WBD is not a reliable indicator of death. In the second section, I address this fundamental point of disagreement, arguing that with no (known) exceptions, patients satisfying WBD require external support (e.g., ventilator) in order to maintain integrated functioning. This fact is important because on the account of the person I endorse, one which I think is plausible, the soul confers on the body certain vital potencies. When the body itself has lost such potencies, we have evidence of the soul not being present. Emphasizing the aspect of self-integration that is characteristic of living human beings avoids the challenge that WBD persons are still alive. In the third section, however, I address what I take to be Verheijde and Potts’s strongest objection against WBD criterion, namely the objection from spontaneous circulation. The responses to this objection point to the fundamental and limited role the WBD criterion is meant to play in organ donation decisions. (shrink)

Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria—including religious beliefs, misinformation, mistrust, and intellectual questions—and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do (...) business. Policymakers should establish minimum national standards for determining death to foster a trustworthy system; academics and publishers have a duty to publish only materials that substantially engage and advance the debate to minimize the harm caused by divided expert opinion; and opposition to the dead donor rule should be conceptually separated from doubts about death criteria. (shrink)

What is the proper role of a clinical ethics consultant’s religious beliefs in forming recommendations for clinical ethics consultation? Where Janet Malek has argued that religious belief should have no influence on the formation of a CEC’s recommendations, Clint Parker has argued a CEC should freely appeal to all their background beliefs, including religious beliefs, in formulating their recommendations. In this paper, I critique both their views by arguing the position envisioned by Malek puts the CEC too far from religion (...) and the position envisioned by Parker puts the CEC too close. For a CEC to give recommendations about what is morally prohibited, permissible, or obligatory in the clinic, I propose a view of the CEC that is neither religious nor non-religious but quasi-religious. I argue that a quasi-religious approach avoids the problems of both religious and non-religious views while preserving their benefits. Additionally, a quasi-religious view resists the marginalization of “religious” traditions that occurs when secular ethicists come to think of their approach as somehow distinctly non-religious. (shrink)

Moral pluralism poses a foundational problem for secular clinical ethics: How can ethical dilemmas be resolved in a context where there is disagreement not only on particular cases, but further, on...