Baruch Brody

(1943 - 2018)

This paper distinguishes four major types of futility (physiological, imminent demise, lethal condition, and qualitative) that have been advocated in the literature either in a patient dependent or a patient independent fashion. It proposes five criteria (precision, prospective, social acceptability, significant number, and non-agreement) that any definition of futility must satisfy if it is to serve as the basis for unilaterally limiting futile care. It then argues that none of the definitions that have been advocated meet the criteria, primarily because their proponents have not paid sufficient attention to the problematic nature of the data supporting the use of their definitions.

There is a growing interest in comparison of international health care data with the hope that such studies will enable individual systems to learn from other systems. Such comparisons, however, presuppose that there exist common criteria for evaluating health care systems. The main thesis of this paper is that these comparative studies are misleading because they employ inappropriate operationalizations of these criteria because the operarionalizations are based upon mistaken global conceptualizations of the criteria in question. The essay provides a methodological critique of what has been done and sets a new agenda for future research.

Until a few years ago, the works of Thomas Reid were known only by specialists in the history of philosophy, and, insofar as people did think at all about Reid and his school of common sense philosophy, it was generally thought that Kant had been right in dismissing them as naive thinkers who did not really understand what philosophical skepticism was all about. This attitude about Reid changed very rapidly in recent years. More and more people now realize that Reid was one of the most important British philosophers, and that his works are full of deep insights that have only recently been rediscovered.

Recent years have witnessed a proliferation of philosophical discussion about such concrete moral issues as just war, distribution of food aid, euthanasia, reverse discrimination, etc. Much of this discussion implicitly assumes that there are true and false positions on these issues, valid or invalid arguments for these positions, etc. Recent years have not witnessed, however, a proliferation of philosophical defenses of these assumptions. With the decline of metaethical discussions, these assumptions have remained just assumptions rather than the conclusions of a philosophical argument.

This paper will attempt to defend the thesis that it is impossible to understand the proper role of private philanthropy in a free and democratic society without examining certain fundamental questions about the proper roles of the state and about the rights and obligations of owners of private property. It will defend that thesis by presenting arguments for four subordinate theses: there are historical and philosophical reasons for being skeptical about the role of private philanthropy in a free and democratic state; these reasons can be met by certain familiar responses, but these responses are not fully satisfactory; certain radical libertarian views, and more moderate versions of those views, would provide a basis for an alternative understanding of the role of private philanthropy in a free and democratic state; whether or not one accepts those views, one can also better understand that role if one adopts a view of the state which emphasizes its role in the promotion of the virtues. Historical and Philosophical Doubts The skeptical challenge to the claim that there is an important role for private philanthropy in a free and democratic state can be put very simply. It is the challenge that the emergence of strong but democratic states, with the concurrent emergence of a proper understanding of the extensive nature of legitimate state functions, has undercut the need for private philanthropy and its corresponding favorable tax treatment. It is the further claim that these developments, both historical and conceptual, have left private philanthropy with no significant role.