In this paper, I supplement T. A. Cavanaugh's arguments against physician-assisted suicide in his book,Hippocrates' Oath and Asclepius' Snake, by focusing more specifically on the dangers of the misuse of physician power and on the virtues essential to restrain such power. Since Cavanaugh's starting point is similar to Edmund Pellegrino's views on the fundamental ends of medicine, I start with the question of the proper ends of medicine. Cavanaugh's interpretation of the Hippocratic Oath as the limitation of physician power to heal and to kill raises the issue of the proper use of physician power over the patient. In order to support and strengthen Cavanaugh's case, I use Richard Zaner's discussion of physician power over the patient and the attendant duty to use such power in a responsible way. Finally, I supplement Cavanaugh's discussion with a fuller account of physician virtues as they relate to physician-assisted suicide. I first discuss the ends of medicine, medical power, and physician-assisted suicide. Second, I discuss the relationship between virtue and physician-assisted suicide. Third, I draw some final conclusions.

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President's Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.

This paper considers the possibility of a disembodied conscious soul, arguing that a great deal of current research converges in a direction that denies the possibility of a bodiless consciousness for human beings. Contemporary attacks on Cartesianism also serve as attacks on the view of some hylomorphist Catholics, such as Thomas Aquinas, that there can be a disembodied consciousness between death and resurrection, a view that violates the Catechism of the Catholic Church. However, there may be a way out for the Catholic hylomorphist which was suggested by Dante—the possibility of a temporary body. The first section of the paper will summarize the contemporary attack against both the Cartesian soul and physicalist systems that reduce the mind to the brain. The alternative position proposed is that the human being is a psychosomatic unity at the level of the organism as a whole, and that both mind-body and brain-body dualism should be avoided. Such a position, I will argue, supports the notion that a disembodied soul, including a disembodied consciousness, is not possible for human beings. Finally, I will discuss Dante’s views on temporary bodies and explore three ways of understanding a temporary body, any of which can preserve a conscious intermediate state between death and resurrection.

In recent years a number of books have been published that offer short autobiographical essays of academics, focusing on their research and how their life history affected their scholarly development. These could be labeled as "intellectual journey narratives." Some volumes focus on philosophers and their religious faith or lack thereof (e.g., Clark, 1997, Antony, 2007). Psychology has its own version of the intellectual journey narrative, in T. S. Krawiec's (1972, 1974, 1978) multivolume set of autobiographical essays by contemporary psychologists. In 1987, Rosemary Pilkington edited her first volume of essays entitled Men and Women of Parapsychology: Personal Reflections, Esprit Volume 1. It contains autobiographical essays by Jule Eisenbud, Montague Ullman, Jan Ehrenwald, Eileen Coly, Joseph H. Rush, Gertrude R. Schmeidler, Emilio Servadio, Renée Haynes, Hans Bender, Karlis Osis, George Zorab and Bernard Grad. The second (2013) volume contains autobiographical essays by Mary Rose Barrington, Eberhard Bauer, William Braud (now deceased), Stephen Braude, Richard S. Broughton, Larry Dossey, Sally Rhine Feather, Erlendur Haraldsson, Arthur Hastings, Stanley Krippner, Lawrence LeShan, Roger Nelson, John Palmer, Guy Leon Playfair, William G. Roll (now deceased), Serena Roney-Dougal, Stephan A. Schwartz, Rex G. Stanford, Russell Targ, Charles T. Tart, and Walter von Lucadou. Between the two volumes almost every significant contemporary parapsychologist is represented, with the major exceptions being the late John Beloff and the late Ian Stevenson.

Recently, several articles in the scholarly literature on medical ethics proclaim the need for "responsible scholarship" in the debate over the proper criteria for death, in which "responsible scholarship" is defined in terms of support for current neurological criteria for death. In a recent article, James M. DuBois is concerned that academic critiques of current death criteria create unnecessary doubt about the moral acceptability of organ donation, which may affect the public's willingness to donate. Thus he calls for a closing of the debate on current death criteria and for journal editors to publish only critiques that "substantially engage and advance the debate." We argue that such positions as DuBois' are a threat to responsible scholarship in medical ethics, especially scholarship that opposes popular stances, because it erodes academic freedom and the necessity of debate on an issue that is literally a matter of life and death, no matter what side a person defends.

REALITY BEGINS WITH CONSCIOUSNESS: A PARADIGM SHIFT THAT WORKS (E-book) by Vernon M. Neppe and Edward R. Close. 2nd edition. At: brainvoyage. com, March 2012. Vernon Neppe and Edward Close's book Reality Begins With is an interesting exercise in speculative metaphysics by two physicists. However, this is not the way they envision their work--they consider it a meta-paradigm that has philosophical implications but which belongs in the realm of science. Theoretical physicists are fond of writing philosophical metaphysics in the name of science, for example, David Bohm (1980), Amit Goswami (1995), and Fred Alan Wolf (2011). These physicists usually make use of the alleged implications of quantum mechanics to make broad claims about the nature of reality as a whole: reality is inconnected, everything is one, made the physical world, or we made the physical world. An alternate approach is offered by the biologist Rupert Sheldrake in his theory of resonance, a view with affinities to the philosophical theory of forms, although unlike Plato and Aristotle's forms, his morphic are dynamic and evolving. What these systems have in common is a tendency toward metaphysical monism (often in some version of panpsychism or pantheism). The physics-based systems use nonlocality enshrined in Bell's Theorem in quantum mechanics to assert the interconnectedness of all things. Sheldrake's fields perform a similar role. The physics-based systems focus on the role that consciousness plays in quantum mechanics and assert a strong causal role for consciousness in the formation and functioning of the universe. Neppe, a neuropsychiatrist, and Close, a physicist, have developed what they label a metaparadigm, which is a large-scale research program for the scientific enterprise. Their program is in the general tradition of metaphysical monistic systems that are based on alleged implications of quantum mechanics, although it is broader in scope. For those interested in psi, they discuss in detail how their theory allows psi phenomena to occur. The authors label their paradigm the Triadic Dimensional-Distinction Vortical Paradigm model (TDVP) (Neppe, Author's Preface). This begins one of the chief difficulties with understanding their work--the number of neologisms. Neologisms may be justified, and a revolutionary theory may require multiple neologisms, but when they are used they should be sufficiently clear. Neppe and Close's stipulative definitions of their neologisms are often no clearer than the neologisms themselves. The authors use so many neologisms because they believe that introducing consciousness into the science of nature changes the paradigm that has dominated science since the 17th-century scientific revolution. Their model posits a unified reality of space-time-consciousness. Reality is an infinite unity, nonlocal on a finite level, [existing] as a reality essence (a metareality) involving a persuasive consciousness (information expressed through meaning as metaconsciousness) and order (ordropy [another neologism, M.R--ordropy is defined as the opposite of entropy]) with metalife (all encompassing life in the infinite: potential life--polife)--which then manifests as physical life in the finite when linked with the correct current physiology. (p. 2) Now nonlocality is a fundamental principle of quantum mechanics, and the view that the universe is infinite may or may not be correct, but it is a defensible philosophical position (Neppe and Close's interpretation of infinity will be discussed below). Metaconsciousness is unclear. The system posits consciousness at the lowest levels of reality, including inanimate objects. It is difficult to understand what it means for a subatomic particle in a rock to be conscious. Consciousness is notoriously difficult to define, but Thomas Nagel makes sense when he states: But fundamentally an has conscious mental states if and only if there is something that it is to be that organism--something it is like for the organism (Nagel, 1974, p. …

Although we agree with Whyte, Selinger, Caplan, and Sadowski (2012) that Thaler and Sunstein's (2008) mandated choice proposal is problematic, we disagree with their views (1) that the most rationa...

It is worrying to see that, while acknowledging that “deciding when human beings are dead” is one of the “ethical issues involved in the area of organ transplantation,”1 the American Academy of Pediatrics set it …

Since the introduction of the concept of brain death by the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death in 1968, the validity of this concept has been challenged by medical scientists, as well as by legal, philosophical, and religious scholars. In light of increased criticism of the concept of brain death, Stephen Napier, a staff ethicist at the National Catholic Bioethics Center, set out to prove that the whole-brain death criterion serves as good evidence for death in the Catholic bioethical framework, on the grounds that when whole-brain death has occurred the soul has already departed from the body. Opponents have argued that (1) brain death does not disrupt the somatic integrative unity and coordinated biological functioning of a living organism and (2) clinical tests outlined in the practice guidelines for determining brain death lack sufficient power to exclude persisting function and fail to detect elements of the brain that, although currently functionless, may retain potential for recovery under conditions of optimal medical care. It is therefore possible that heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of active euthanasia and physician-assisted death, both of which, either concealed or overt, the Catholic Church opposes.

In its policy statement on pediatric organ donation and transplantation, the American Academy of Pediatrics1 argued that it is important that there be a “timely declaration of neurologic death” of the potential organ donor. Three justifications were presented: (1) the patient's family can begin the “grieving process”; (2) “it improves the success associated with the acquisition of organs”; and (3) “it avoids continued life support for a person who has died and is no longer a potential donor.” There are a number of flaws in this reasoning. First, it is by no means certain that a patient declared “neurologically dead” is actually dead; both physicians and philosophers have attacked the medical and philosophical arguments for brain-death criteria to the point that there should at least be reasonable doubt concerning their validity.2,3 Second, given that there is reasonable doubt about brain-death criteria, it is quite possible that organs are being removed from living patients. Yet, parents of potential donors are not informed of the current debate over brain death, which raises serious doubt as to their level of informed consent.4 Third, improving organ-allocation success involves treating donors not for their benefit, but for another's. If brain-dead donors are alive (and advocates of donation after cardiac death freely admit that many donation-after-cardiac-death donors are alive before ventilator and organ removal), it is wrong for the medical profession to provide treatments that provide no benefit for, and may cause harm to, a patient.5 Fourth, life support can already be removed from ventilator-dependent patients without their being declared “dead.” These difficulties raise serious concerns about the ethical justification for this American Academy of Pediatrics policy.

Verheijde, Joseph L.; Potts, Michael; Rady, Mohamed Y.; Shewmon, Alan D. Author Information

The donation of organs after cardiac death in infants is not morally justified and should not be continued.

Ben Saunders claims that actual consent is not necessary for organ donation due to 'normative consent', a concept he borrows from David Estlund. Combining normative consent with Peter Singer's 'greater moral evil principle', Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of 'mandatory consent'. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society.

PurposeTo explore students' perceptions of virtual patient use in the clinical clerkship and develop a framework to evaluate effects of different integration strategies on students' satisfaction and perceptions of learning effectiveness with this innovation.MethodA prospective, multiinstitutional study was conducted at six schools' pediatric clerkships to assess the impact of integrating Web-based virtual patient cases on students' perceptions of their learning during 2004-2005 and 2005-2006. Integration strategies were designed to meet the needs of each school, and integration was scored for components of virtual patient use and elimination of other teaching methodologies. A student survey was developed, validated, and administered at the end of the clerkship to 611 students. Data were analyzed using confirmatory factor analysis and structural equation modeling.ResultsA total of 545 students (89%) completed the survey. Overall student satisfaction with the virtual patients was high; students reported that they were more effective than traditional methods. The structural model demonstrated that elimination of other teaching methodologies was directly associated with perceived effectiveness of the integration strategies. A higher use score had a significant negative effect on perceived integration, but a positive effect on perceived knowledge and skills gain. Students' positive perceptions of integration directly affected their satisfaction and perception of the effectiveness of their learning.ConclusionsIntegration strategies balancing the use of virtual patients with elimination of some other requirements were significantly associated with students' satisfaction and their perceptions of improved knowledge and skills.

Robert Truog and Franklin Miller have recently argued against the dead donor rule in organ transplantation. We question their position that it is morally right for doctors to kill their patients when the patients would be allowed to die anyway and when such killing would yield benefits to others. Assuming, for the sake of argument, Truog and Millers position that both brain dead organ donors and donors by cardiac death are alive before organ removal, we argue that physicians are not morally justified in such killing. Medicines fundamental end involves a healing relationship between a vulnerable patient and a physician with both the knowledge and power to help that patient. Killing a patient violates the nature of this healing relationship and is neither justified through utilitarian considerations nor through informed consent. Thus killing patients for their organs is morally wrong and inimical to the proper practice of medicine.

In this paper, we argue that living kidney donation involves a violation of the principle of non-maleficence, to "do no harm." It is, therefore, morally wrong for physicians, surgeons, and other medical professionals to be involved in such a practice. Using kidney donation as an example, we discuss recent literature on both short-term and long-term risks to the kidney donor and argue that such risks make the practice of living donor nephrectomy unethical. By extension, the even more risky donation of other solid organs during life is also unethical.