A repackaged edition of the revered author's classic work that examines the four types of human love: affection, friendship, erotic love, and the love of God—part of the C. S. Lewis Signature Classics series. C.S. Lewis—the great British writer, scholar, lay theologian, broadcaster, Christian apologist, and bestselling author of Mere Christianity, The Screwtape Letters, The Great Divorce, The Chronicles of Narnia, and many other beloved classics—contemplates the essence of love and how it works in our daily lives in one of (...) his most famous works of nonfiction. Lewis examines four varieties of human love: affection, the most basic form; friendship, the rarest and perhaps most insightful; Eros, passionate love; charity, the greatest and least selfish. Throughout this compassionate and reasoned study, he encourages readers to open themselves to all forms of love—the key to understanding that brings us closer to God. (shrink)

While human beings might be rational animals, they are emotional animals as well. Emotions play a central role in all areas of our lives and if we are to have a proper understanding of human life and activity, we ought to have a good grasp of the emotions. Michael S. Brady structures Emotion: The Basics around two basic, yet fundamental, questions: What are emotions? And what do emotions do? In answering these questions Brady provides insight into a core component of (...) all our lives, covering: the nature of emotion; emotion, knowledge, and understanding; emotion and action; emotions and social groups; emotion, morality, and art. In this concise and insightful introduction, Brady explains why we are often better off as a result of emotion rather than reason being in the driving seat, as our lives, both individual and social, would be significantly impoverished without the emotions. With a glossary of key terms and suggestions for further reading, Emotion: The Basics is an ideal starting point for anyone seeking a full introduction to the philosophical study of emotion. (shrink)

Suffering, in one form or another, is present in all of our lives. But why do we suffer? On one reading, this is a question about the causes of physical and emotional suffering. But on another, it is a question about whether suffering has a point or purpose or value. In this ground-breaking book, Michael Brady argues that suffering is vital for the development of virtue, and hence for us to live happy or flourishing lives. After presenting a distinctive account (...) of suffering, and a novel account of its core element, unpleasantness, Brady proceeds to focus on three claims that are central to his picture. The first is that forms of suffering, like pain and remorse, can themselves constitute virtuous responses. The second is that suffering is essential for four important classes of virtue - virtues of strength, such as fortitude and courage; virtues of vulnerability, such as adaptability and humility; moral virtues, such as compassion; and the practical and epistemic excellences that make up wisdom. His final claim third is that suffering is vital for the social virtues of justice, love, and trust, and hence for the flourishing of social groups. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks a (...) theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

In this article I examine the proposition that severe cognitive disability is an impediment to moral personhood. Moral personhood, as I understand it here, is articulated in the work of Jeff McMahan as that which confers a special moral status on a person. I rehearse the metaphysical arguments about the nature of personhood that ground McMahan’s claims regarding the moral status of the “congenitally severely mentally retarded” (CSMR for short). These claims, I argue, rest on the view that only intrinsic (...) psychological capacities are relevant to moral personhood: that is, that relational properties are generally not relevant. In addition, McMahan depends on an argument that species membership is irrelevant for moral consideration and a contention that privileging species membership is equivalent to a virulent nationalism (these will be discussed below). In consequence, the CSMR are excluded from moral personhood and their deaths are less significant as their killing is less wrong than that of persons. To throw doubt on McMahan’s conclusions about the moral status and wrongness of killing the CSMR I question the exclusive use of intrinsic properties in the metaphysics of personhood, the dismissal of the moral importance of species membership, and the example of virulent nationalism as an apt analogy. I also have a lot to say about McMahan’s empirical assumptions about the CSMR. (shrink)

It will be seen how in place of the wealth and poverty of political economy come the rich human being and rich human need. The rich human being is simultaneously the human being in need of totality of human life-activities — the man in whom his own realization exists as an inner necessity, as need. Marx, Economic and Philosophical Manuscripts of 1844 Svetaketu abstained from food for fifteen days. Then he came to his father and said, `What shall I say?' (...) The father said: `Repeat the Rik, Yagus, and Saman verses.' He replied, `They do not occur to me, Sir.' The father said to him... `Go and eat! Then wilt thou understand me.' Then Svetaketu ate, and afterwards approached his father. And whatever his father asked him, he knew it all by heart.... After that, he understood what his father meant when he said: `Mind, my son, comes from food, breath from water, speech from fire.' He understood what he said, yea, he understood it. Chandogya-Upanishad, VI Prapathaka, 7 Kanda When you love a man you want him to live and when you hate him you want him to die. If, having wanted him to live, you then want him to die, this is a misguided judgment. `If you did not do so for the sake of riches, you must have done so for the sake of novelty.' Confucius, Analects, Book 12. 10. (shrink)

This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

I examine the familiar criterial view of personhood, according to which the possession of personal properties such as self-consciousness, emotionality, sentience, and so forth is necessary and sufficient for the status of a person. I argue that this view confuses criteria for personhood with parts of an ideal of personhood. In normal cases, we have already identified a creature as a person before we start looking for it to manifest the personal properties, indeed this pre-identification is part of what makes (...) it possible for us to see and interpret the creature as a person in the first place. This pre-identification is typically based on biological features. Except in some interesting special or science-fiction cases, some of which I discuss, it is human animals that we identify as persons. (shrink)

Philippa Foot has for many years been one of the most distinctive and influential thinkers in moral philosophy. Long dissatisfied with the moral theories of her contemporaries, she has gradually evolved a theory of her own that is radically opposed not only to emotivism and prescriptivism but also to the whole subjectivist, anti-naturalist movement deriving from David Hume. Dissatisfied with both Kantian and utilitarian ethics, she claims to have isolated a special form of evaluation that predicates goodness and defect only (...) to living things considered as such; she finds this form of evaluation in moral judgements. Her vivid discussion covers topics such as practical rationality, erring conscience, and the relation between virtue and happiness, ending with a critique of Nietzsche's immoralism. This long-awaited book exposes a highly original approach to moral philosophy and represents a fundamental break from the assumptions of recent debates. Foot challenges many prominent philosophical arguments and attitudes; but hers is a work full of life and feeling, written for anyone intrigued by the deepest questions about goodness and human. (shrink)

In this article I examine the proposition that severe cognitive disability is an impediment to moral personhood. Moral personhood, as I understand it here, is articulated in the work of Jeff McMahan as that which confers a special moral status on a person. I rehearse the metaphysical arguments about the nature of personhood that ground McMahan’s claims regarding the moral status of the “congenitally severely mentally retarded” (CSMR for short). These claims, I argue, rest on the view that only intrinsic (...) psychological capacities are relevant to moral personhood: that is, that relational properties are generally not relevant. In addition, McMahan depends on an argument that species membership is irrelevant for moral consideration and a contention that privileging species membership is equivalent to a virulent nationalism (these will be discussed below). In consequence, the CSMR are excluded from moral personhood and their deaths are less significant as their killing is less wrong than that of persons. To throw doubt on McMahan’s conclusions about the moral status and wrongness of killing the CSMR I question the exclusive use of intrinsic properties in the metaphysics of personhood, the dismissal of the moral importance of species membership, and the example of virulent nationalism as an apt analogy. I also have a lot to say about McMahan’s empirical assumptions about the CSMR. (shrink)

We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, (...) pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the (...) spiritual condition of the patient. (shrink)

The book challenges the values of much of contemporary bioethics and health care policy by confronting their failure to secure the moral norms they seek to apply.

Marie was 15 when her abdominal pain began. After two years of negative work-ups, countless visits to gastroenterologists, and over 70 days of high school missed, she found herself readmitted to the hospital. “Refractory abdominal pain” was her ostensible diagnosis; “troubled teen” who was “going to be difficult” was embedded in the emergency department’s sign-out. When the medical team arrived to meet Marie, she was huddled in the corner of her hospital bed, silent and withdrawn. Her intern noted the numerous (...) scars cutting across her forearms as she felt for her radial pulses. Marie squirmed in pain when the intern palpated her abdomen.The ED’s work-up had been negative for abdominal pathology. When the... (shrink)

Many declare the debate about abortion to be hopelessly polarised, between conservatives and liberals, between forces religious and secular. In this book Mumford upends this received wisdom and challenges consensus, arguing that many dominant attitudes and argument fail to take into account the particular way human beings 'emerge' in the world.

Wandering in Darkness reconciles the existence of an omniscient, omnipotent, perfectly good God with suffering in the world. Eleanore Stump presents the moral psychology and value theory within which the theodicy of Thomas Aquinas is embedded. She explicates Aquinas's account of the good for human beings, including the nature of love and union among persons, and then argues that some philosophical problems are best considered in the context of narratives. In the context of famous biblical stories and against the backdrop (...) of Aquinas's other views, Stump argues that Aquinas's theodicy gives a powerful explanation for God's allowing suffering. This explanation constitutes a consistent and cogent defense for the problem of suffering. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

In this work, Jamie Mayerfeld undertakes a careful inquiry into the meaning and moral significance of suffering. Understanding suffering in hedonistic terms as an affliction of feeling, he claims that it is an objective psychological condition, amenable to measurement and interpersonal comparison, although its accurate assessment is never easy. Mayerfeld goes on to examine the content of the duty to prevent suffering and the weight it has relative to other moral considerations. He argues that the prevention of suffering is morally (...) more important than the promotion of happiness, and that the duty to relieve suffering is much stronger than most of us acknowledge. (shrink)

This work examines contemporary views on medical ethics, such as preventing death, defining family relations, and reproductive and disabled issues.

It is commonly believed that disability disqualifies people from full participation in or recognition by society. This view is rooted in eugenic logic, which tells us that our world would be a better place if disability could be eliminated. In opposition to this position, I argue that that disability is inherent in the human condition and consider the bioethical question of why we might want to conserve rather than eliminate disability from our shared world. To do so, I draw together (...) an eclectic, rather than systematic, configuration of counter-eugenic arguments for conserving disability. The idea of preserving intact, keeping alive, and even encouraging to flourish denoted by conserve suggests that disabilities would be better understood as benefits rather than deficits. I present, then, a reading of disability as a potentially generative resource rather than unequivocally restrictive liability. In other words, what I consider here is the cultural and material contributions disability offers to the world. (shrink)

Book reviewed in this article: Suffering Presence: Theological Reflections on Medicine, the Mentally Handicapped, and the Church. By Stanley Hauerwas.

In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...) a child with life-limiting illness is prolonged, how much suffering will she experience and can any of it be alleviated? Is there a risk that negative experiences for such a child will remain despite the provision of palliative care? We argue that both the subjective and objective components of well-being for children could be greatly reduced if they are anticipated to have a short life that is affected by profound cognitive impairment. This does not mean that their overall well-being will be negative, but rather that there may be a higher risk of negative overall well-being if they are expected to experience pain, discomfort, or distress. Furthermore, we point to some of the practical limitations of therapies aimed at relieving suffering, such that there is a risk that suffering will go partially or completely unrelieved. Taken together, these considerations imply that some life-prolonging treatments are not in the best interests of infants with severe life-limiting illness. (shrink)

This paper examines one particular justification for the screening and termination of embryos/fetuses which possess genetic features known to cause disability. The particular case is that put forward in several places by John Harris. He argues that the obligation to prevent needless suffering justifies the prevention of the births of disabled neonates. The paper begins by rehearsing Harris's case. Then, drawing upon claims advanced in a recent paper in the Journal of Medical Ethics, it is subjected to critical scrutiny, focusing (...) on Harris's “suffering claim” .1 It is argued that the suffering claim must be false if understood as an empirical claim. And, even if understood as a conceptual truth, it mistakenly assimilates the concepts of harm and suffering. Finally, again focusing on Harris's recent work in this area, his characterisation of disability as a “harmed condition” is shown not to apply in the case of at least some moderate forms of intellectual disability. (shrink)

This article develops a phenomenology of suffering with an emphasis on matters relevant to medical practice and bioethics. An attempt is made to explain how suffering can involve many different things—bodily pains, inability to carry out everyday actions, and failure to realize core life values—and yet be a distinct phenomenon. Proceeding from and expanding upon analyses found in the works of Eric Cassell and Elaine Scarry, suffering is found to be a potentially alienating mood overcoming the person and engaging her (...) in a struggle to remain at home in the face of loss of meaning and purpose in life. Suffering involves painful experiences at different levels that are connected through the suffering-mood but are nevertheless distinguishable by being primarily about my embodiment, my engagements in the world together with others, and my core life values. Suffering is in essence a feeling , but as such, it has implications for and involves the person’s entire life: how she acts in the world, communicates with others, and understands and looks upon her priorities and goals in life. Suffering-moods are typically intense and painful in nature, but they may also display a rather subconscious quality in presenting things in the world and my life as a whole in an alienating way. In such situations, we are not focused directly upon the suffering-mood—as in the cases of pain and other bodily ailments—but rather, upon the things that the mood presents to us: not only our bodies, but also other things in the world that prevent us from having a good life and being the persons we want to be. Such suffering may in many cases be transformed or at least mitigated by a person’s identifying and changing her core life values and in such a manner reinterpreting her life story to become an easier and more rewarding one to live under the present circumstances. (shrink)

Western thinkers have usually falsified our experience of suffering in trying to make sense of it. In a postmodern age, their accounts seem implausible. We need a way of making sense of suffering while admitting its horror.

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the (...) academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)