Politics in America are polarized and trivialized, perhaps as never before. In Congress, the media, and academic debate, opponents from right and left, the Red and the Blue, struggle against one another as if politics were contact sports played to the shouts of cheerleaders. The result, Ronald Dworkin writes, is a deeply depressing political culture, as ill equipped for the perennial challenge of achieving social justice as for the emerging threats of terrorism. Can the hope for change be realized? Dworkin, (...) one the world's leading legal and political philosophers, identifies and defends core principles of personal and political morality that all citizens can share. He shows that recognizing such shared principles can make substantial political argument possible and help replace contempt with mutual respect. Only then can the full promise of democracy be realized in America and elsewhere. Dworkin lays out two core principles that citizens should share: first, that each human life is intrinsically and equally valuable and, second, that each person has an inalienable personal responsibility for identifying and realizing value in his or her own life. He then shows what fidelity to these principles would mean for human rights, the place of religion in public life, economic justice, and the character and value of democracy. Dworkin argues that liberal conclusions flow most naturally from these principles. Properly understood, they collide with the ambitions of religious conservatives, contemporary American tax and social policy, and much of the War on Terror. But his more basic aim is to convince Americans of all political stripes--as well as citizens of other nations with similar cultures--that they can and must defend their own convictions through their own interpretations of these shared values. (shrink)

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of (...) conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

Physician assisted suicide or active euthanasia is analyzed as a medicalization of the needs of persons who are suffering interminably. As with other medicalized responses to personal needs, the availability of active euthanasia will likely divert attention and resources from difficult social and personal aspects of the needs of dying and suffering persons, continuing the pattern of privatization of the costs of caregiving for persons who are candidates for active euthanasia, limiting the ability of caregivers to assist suffering persons to (...) make their continued suffering tolerable, and casting doubt on the voluntariness of the choice of active euthanasia. Keywords: caregivers, euthanasia, family, medicalization, voluntariness CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper, I argue that distinctions between traditional and contemporary accounts of conscience protections, such as the account offered by Aulisio and Arora, fail. These accounts fail because they require an impoverished conception of our moral lives. This failure is due to unnoticed assumptions about the distinction between the traditional and contemporary articulations of conscience protection. My argument proceeds as follows: First, I highlight crucial assumptions in Aulisio and Arora’s argument. Next, I argue that respecting maximal play in values, (...) though a fine goal in our liberal democratic society, raises a key issue in exactly the situations that matter in these cases. Finally, I argue that too much weight is given to a too narrow conception of values. There are differences between appeals to conscience that are appropriately categorized as traditional or contemporary, and a way to make sense of conscience in the contemporary medical landscape is needed. However, the normative implications drawn by Aulisio and Arora do not follow from this distinction without much further argument. I conclude that their paper is a helpful illustration the complexity of this issue and of a common view about conscience, but insofar as their view fails to account for the richness of our moral life, they fail to resolve the issue at hand. (shrink)

Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our (...) society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided. (shrink)