William Ruddick

In the late 1960s Van Rensselaer Potter, a biochemist and cancer researcher, thought that our survival was threatened by the domination of military policy makers and producers of material goods ignorant of biology. He called for a new field of Bioethics—“a science of survival.” Bioethics did develop, but with a narrower focus on medical ethics. Recently there have been attempts to broaden that focus to bring biomedical ethics together with environmental ethics. Though the two have many differences—in habits of thought, scope of concern, and value commitments—in this paper we argue that they often share common cause and we identify common ground through an examination of two case studies, one addressing drug development, the other food production.

After reviewing the history, rationale, and Jim Rachels’ varied uses of the notion of biographical lives, the essay further develops its social dimensions and proposes an ontological analysis. Whether one person is leading one life or more turns on the number of separate social worlds he or she creates and maintains. Furthermore, lives are constituted by narrated events in a story. Lives, however, are not stories, but rather are extended “verbal objects,” that is, “narrative objects” with a hybrid character, both linguistic and by inference non-verbal. In this they are like facts, propositions, and histories, grasped only through their verbal expression. Being narrative and socially embedded, lives can arguably be extended beyond the death of the principal liver of a life by the commemorative actions of those who shared it. Jim hoped to persuade doctors to shift from a traditional Sanctity of Life principle to a Sanctity of Lives principle. Accordingly, they could stop pointless prolongation of biological life once a patient permanently loses consciousness, his criterion of the end of a biographical life. It might seem that allowing lives to be extended past that point or death would forego that clinical benefit, but that is not so.

Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare

Summary. Disputes about pediatric, educational, and other child-related matters may reflect more general concepts of parenthood, including parental rights and responsibilities. These concepts may be child-centered, focusing either on a child’s needs or on a child’s development. Needs and development are not wholly distinct or in competition, but some parents may emphasize one or the other and, in case of conflict, favor one over the other. Such emphasis and preference tends to distinguish parents as child-carers and parents as child-raisers (in most cases, adult-raisers). So distinguished, these kinds of parental focus involve different temporal perspectives (present and future), as well of different categories of assessment and analogies (associated with nursing and teaching).

Philosophers have simplified brain death issues by drawing two distinctions--that between dead persons and dead bodies or organisms, and that between the concept of definition of death and the criteria for determining when and that death has occurred. The result has been protracted debates as to whether the death of patients is the death of persons or the death of organisms, and whether physicians should use cardio-respiratory criteria, whole brain criteria, or higher brain criteria. Advocates of the death of persons prefer higher brain criteria; advocates of the death of organisms prefer cardiovascular criteria; but both will compromise, for different reasons, on the whole brain criteria that most legislators have come to accept. Advocates of person -death regard whole brain criteria as unnecessarily demanding and woefully wasteful of transplantable organs and nursing care. Nonetheless, they accept current whole-brain based legislation as a first neurological step away from traditional cardio-respiratory

At graduation, some North American medical students repeat the Prayer of Maimonides "never to forget that the patient is a fellow creature in pain, not a mere vessel of disease." [2] How could a physician ever forget that a patient is in pain? Don't physicians confront constant reminders­moans, groans, winces, and other obvious manifestations of pain? Yes, but it is those very "reminders," as I shall explain, that provoke at least two kinds of forgetting common among physicians­one, psychological and the other, conceptual. The psychological kind of forgetting is primarily self-protective, but the conceptual kind has deeper roots in the very definition of modern Medicine as curative and life-preserving. If my analysis is right, more lecture time on pain and pain relief in medical schools will do little to correct this "forgetting" of pain. But there may be better remedies for pain-forgetting, some already at work in North American medical practices.

In the last decade many academic philosophers in the United States have "gone public." In television interviews, newspapers, and neighborhood meetings they have discussed misuse of animals, whistle-blowing, and world hunger. Philosophers sit on presidential commissions on medical experimentation, on scientific research review boards, on committees to draft codes of conduct for trial lawyers, social workers, and senators. They consult with town planners, prison officials and inmates, generals, corporation executives, and hospitals staffs. They run for political office, serve as congressional legislative aides, cruise in police cars. They write for law journals and new philosophy journals on environmental issues, privacy, vegetarianism, energy policy, population control, and other topics of public concern and debate