Conscience and the Way of Medicine.

Disputes about conscientious refusals reflect, at root, two rival accounts of what medicine is for and what physicians reasonably profess. On what we call the "provider of services model," a practitioner of medicine is professionally obligated to provide interventions that patients request so long as the interventions are legal, feasible, and are consistent with well-being as the patient perceives it. On what we call the "Way of Medicine," by contrast, a practitioner of medicine is professionally obligated to seek the patient's health, objectively construed, and to refuse requests for interventions that contradict that profession. These two accounts coexist amicably so long as what patients want is for their practitioners to use their best judgment to pursue the patient's health. But conscientious refusals expose the fact that the two accounts are ultimately irreconcilable. As such, the medical profession faces a choice: either suppress conscientious refusals, and so reify the provider of services model and demoralize medicine, or recover the Way of Medicine, and so allow physicians to refuse requests for any intervention that is not unequivocally required by the physician's profession to preserve and restore the patient's health.

Family Consent and Organ Donation.

This paper asks whether investigation into the ontology of the extended family can help us to think about and resolve questions concerning the nature of the family's decision-making authority where organ donation is concerned. Here, "extended family" refers not to the multigenerational family all living at the same time, but to the family extended past its living boundaries to include the dead and the not yet living. How do non-existent members of the family figure into its ontology? Does an answer to this question help to resolve questions about the distribution of authority within the extended family?

Religious Perspectives on Human Suffering: Implications for Medicine and Bioethics.

The prevention and relief of suffering has long been a core medical concern. But while this is a laudable goal, some question whether medicine can, or should, aim for a world without pain, sadness, anxiety, despair or uncertainty. To explore these issues, we invited experts from six of the world's major faith traditions to address the following question. Is there value in suffering? And is something lost in the prevention and/or relief of suffering? While each of the perspectives provided maintains that suffering should be alleviated and that medicine's proper role is to prevent and relieve suffering by ethical means, it is also apparent that questions regarding the meaning and value of suffering are beyond the realm of medicine. These perspectives suggest that medicine and bioethics have much to gain from respectful consideration of religious discourse surrounding suffering.

The ontological status of embryos: a reply to Jason Morris.

In various places we have defended the position that a new human organism, that is, an individual member of the human species, comes to be at fertilization, the union of the spermatozoon and the oocyte. This individual organism, during the ordinary course of embryological development, remains the same individual and does not undergo any further substantial change, unless monozygotic twinning, or some form of chimerism occurs. Recently, in this Journal Jason Morris has challenged our position, claiming that recent findings in reproductive and stem cell biology have falsified our view. He objects to our claim that a discernible substantial change occurs at conception, giving rise to the existence of a new individual of the human species. In addition, he objects to our claim that the embryo is an individual, a unified whole that persists through various changes, and thus something other than a mere aggregate of cells. Morris raises a number of objections to these claims. However, we will show that his arguments overlook key data and confuse biological, metaphysical, and ethical questions. As a result, his attempts to rebut our arguments fail.

Fission, fusion, and the simple view.

In this essay, I defend three Simple Views concerning human beings. First, that the human embryo is, from the one-cell stage onwards, a single unitary organism. Second, that when an embryo twins, it ceases to exist and two new embryos come into existence. And third, that you and I are essentially human organisms. This cluster of views shows that it is not necessary to rely on co-location, or other obscure claims, in understanding human embryogenesis.

Abortion and the human animal.

I discuss three topics. First, there is a philosophical connecting thread between several recent trends in the abortion discussion, namely, the issue of our animal nature, and physical embodiment. The philosophical name given to the position that you and I are essentially human animals is "animalism." In Section II of this paper, I argue that animalism provides a unifying theme to recent discussions of abortion. In Section III, I discuss what we do not find among recent trends in the abortion discussion, namely "the right to privacy." I suggest some reasons why the right to privacy is conspicuous by its absence. Finally, I address Patrick Lee's claim that the evil of abortion involves "the moral deterioration that the act brings to those who are complicit in it, and to the culture that fosters it."