Bernard Gert

On the definition and criterion of death.

The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death. We suggest the total and irreversible loss of functioning of the whole brain as the sole criterion of death; this has always been an implicit criterion of death. If artificial ventilation is present, only completely validated brain dysfunction tests should be used to show that this criterion of death is satisfied. In most cases without artificial ventilation, permanent loss of cardiopulmonary function is sufficient. We propose a statutory definition of death based on the criterion of total and irreversible cessation of whole brain functions but allowing physicians to declare death according to their customary practices in most cases.

Patient Refusal of Hydration and Nutrition: An Alternative to Physician-Assisted Suicide or Voluntary Active Euthanasia

PUBLIC AND scholarly debates on legalizing physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) have increased dramatically in recent years.1-5 These debates have highlighted a s ignif icant moral controversy between those who regard PAS and VAE as morally permissible and those who do not. Unfortunately, the adversarial nature of this controversy has led both sides to ignore an alternative that avoids moral controversy altogether and has fewer associated practical problems in its implementation. In this article, we suggest that educating chronically and terminally ill patients about the feasibility of  Full Text Share

Common morality and computing

This article shows how common morality can be helpful in clarifying the discussion of ethical issues that arise in computing. Since common morality does not always provide unique answers to moral questions, not all such issues can be resolved, however common morality does provide a clear answer to the question whether one can illegally copy software for a friend.

Rationality, Human Nature, and Lists

The concept of rationality is one of the most fundamental concepts in philosophy. Except for skeptics, rationality is taken, either explicitly or implicitly, as the basic normative concept. In philosophy, as well as in ordinary life, to show that an action, desire, or belief is irrational is taken as showing that it should be avoided or given up. In this paper, I am primarily concerned with rational and irrational actions although what I say will have obvious implications for rationality applied to desires. I shall explicitly consider the view of rational actions as actions that maximize the satisfaction of ones desires. The implications for rationality applied to beliefs are much less obvious, and I shall have nothing to say on that matter here. I shall, however, talk about the view of rational actions as actions based on true beliefs. Almost all contemporary accounts of rational and irrational actions share a feature that is never defended, namely, that the basic definition of rationality must be given by means of a formula or a procedure, that is, in some formal way that mentions no specific content. Philosophers as diverse as Brandt, Gauthier, Gewirth, Hare, and Rawls do not even consider the possibility that the basic definition of rationality must be given in terms of a specific content, for example, a list, and that there is no formal way to generate that list. This failure to even consider that the basic definition of rationality must be given in terms of a list has resulted in all of their accounts being seriously inadequate. Further, it has fostered distorted accounts of human nature, for no formal account allows rationality to take its proper place as a significant feature of what we call human nature. Whether it is explicitly acknowledged or not, most philosophers who put forward a descriptive account of rational action do so in order to commend that way of acting. When they or anyone for whom they are

Sex, Immorality, and Mental Disorders

Although the definition of a mental disorder has remained essentially the same from Diagnostic and Statistical Manual of Mental Disorder, Third Edition, Revised (DSM-III-R) through DSM-IV to DSM-IV-TR, the account of the paraphilias has changed continually. Although the definition in all the DSMs explicitly rules out deviant sexual behavior as sufficient for labeling someone as having a mental disorder, deviant sexual behavior counts as sufficient for all the paraphilias in DSM-III-R. In DSM-IV, the account of all the paraphilias is made consistent with the definition. In DSM-IV-TR, mere deviant sexual behavior is not sufficient for being classified as having a paraphilia, but immoral deviant sexual behavior is. Thus, in DSM-IV-TR, only those paraphilias that involve immoral deviant sexual behavior are inconsistent with the definition, but deviant sexual behavior by itself does not count as a mental disorder.

Core Curriculum : Research Ethics for Radiology Residents

RATIONALE AND OBJECTIVES Scholarly activity, which may include research, is now a required element of resident training. In addition, residents are required to participate in a systems-based practice or quality improvement project. Residency programs are expected to provide training for these endeavors but may lack the necessary resources. This work is intended to provide a core curriculum in research ethics for radiology residents to help fulfill that need. MATERIALS AND METHODS The material was developed through discussion and collaboration of the authors, review of pertinent literature, and consultation with experts in the field. RESULTS This work includes a brief introduction to the topic, followed by cases designed to highlight the issues inherent in informed consent, privacy, the disclosure of results, authorship, study subjects, and health services research. CONCLUSION Radiology residents are expected to learn about the design, performance, reporting, and critical evaluation of research. All of these elements can potentially raise ethical issues. Understanding the underlying ethical issues is critical for the future of radiology research.

Morally relevant features

This article summarizes the account of morality presented in Morality: Irs Nature and Justification (Oxford, 1998), with emphasis on that aspect of morality that deals with justifying violations of the moral rules. Such justification requires a two-step procedure; the first is describing the situation using only morally relevant features. I list these features, noting how diverse they are, and describe their characteristics. The second step is estimating the consequences of publicly allowing a violation with the same morally relevant features, that is, allowing a violation when everyone knows that it is allowed to violate the rule in the same circumstances, and comparing this to the estimated consequences of not publicly allowing that kind of violation. I then explain why fully informed, impartial rational persons can sometimes disagree about whether a violation should be publicly allowed and note that such weakly justified violations are the controversial cases.

Hobbes on reason

Most commentators view Hobbess account of reason as purely formal, that is, as having no necessary content: either an instrumental account of reason, that whether particular ends of people are rational or irrational depends entirely on their compatibility with their other ends; or that reason is nothing but reckoning of the consequences of general names. I argue instead that, for Hobbes, natural reason, according to which a rational person seeks to avoid death, pain, and disability, is the basic sense of reason. The laws of nature are the dictates of natural reason, supplemented by instrumental reason and reason as reckoning.

Family coercion and valid consent.

Coercion is commonly said to invalidate consent, and that is always true if the source of the coercion is the physician. However, if it is a family member who coerces the patient to consent, the resultant consent may be quite valid and treatment should proceed.

The Morality of Involuntary Hospitalization

There is a good deal of recent dispute both within and outside of psychiatry about the procedure of involuntary hospitalization. (We use ‘involuntary hospitalization’ to cover both 2–3 day ‘emergency’ detentions and longer civil commitments. We discuss mainly detention here but do refer to commitment when appropriate.) While writers such as Szasz [10] believe that involuntary hospitalization should be eliminated entirely, it is more common to find disagreement about how wide or narrow the grounds for detaining patients should be.