Jeffrey P. Bishop

Reviving the Conversation Around CPR/DNR

This paper examines the historical rise of both cardiopulmonary resuscitation (CPR) and the do-not-resuscitate (DNR) order and the wisdom of their continuing status in U.S. hospital practice and policy. The practice of universal presumed consent to CPR and the resulting DNR policy are the products of a particular time and were responses to particular problems. In order to keep the excesses of technology in check, the DNR policies emerged as a response to the in-hospital universal presumed consent to CPR. We live with this historical concretion, which seems to perpetuate a false culture that the patients wishes must be followed. The authors are critical of the current U.S. climate, where CPR and DNR are viewed as two among a panoply of patient choices, and point to UK practice as an alternative. They conclude that physicians in the United States should radically rethink approaches to CPR and DNR.

Bioethics as biopolitics

From its inception, bioethics has claimed to be a project of reflection on the moral issues raised by new technologies. Yet, in its present form there is a perception of a gradual transformation in bioethics. This transformation is characterized by an increasing politicization of bioethical issues, that is, one’s “bio-ethical views” will reflect one’s political assumptions concerning the nature, goals and values that should guide the biomedical sciences. Or, perhaps better stated, bioethics has always been a biopolitics and the politicaldimension is only now coming into relief for bioethicists.

Biopsychosociospiritual Medicine and Other Political Schemes

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. RCOPE is an instrument designed to categorize religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control.

Transhumanism, Metaphysics, and the Posthuman God

After describing Heideggers critique of metaphysics as ontotheology, I unpack the metaphysical assumptions of several transhumanist philosophers. I claim that they deploy an ontology of power and that they also deploy a kind of theology, as Heidegger meant it. I also describe the way in which this metaphysics begets its own politics and ethics. In order to transcend the human condition, they must transgress the human.

Biopolitics, Terri Schiavo, and the Sovereign Subject of Death

Humanity does not gradually progress from combat to combat until it arrives at universal reciprocity, where the rule of law finally replaces warfare; humanity installs each of its violences in a system of rules and thus proceeds from domination to domination. (Foucault, 1984, 85) In this essay, I take a note from Michel Foucault regarding the notion of biopolitics. For Foucault, biopolitics has both repressive and constitutive properties. Foucaults claim is that with the rise of modern government, the state became exceedingly concerned about the body politic, the bodies that make up the polis, including the health of those bodies. However, Giorgio Agamben claims that Foucault and all western political philosophy misses the relationship between power and Sovereignty, with disastrous results and totalizing tendencies. I explore the case of Terri Schiavo claiming that the social conservatives have attempted to politicize bare life in its legal maneuverings, but I also show how the social liberals open an uncontrollable space between life and death. Both the left and the right miss the aporia at the heart of western political philosophy, and bioethics is complicit in the totalizing effects of contemporary medicine.

Euthanasia, efficiency, and the historical distinction between killing a patient and allowing a patient to die

Voluntary active euthanasia and physician assisted suicide should not be legalised because too much that is important about living and dying will be lost

Efficient, Compassionate, and Fractured: Contemporary Care in the ICU

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyres overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever-present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care.

Foucauldian Diagnostics: Space, Time, and the Metaphysics of Medicine

This essay places Foucaults work into a philosophical context, recognizing that Foucault is difficult to place and demonstrates that Foucault remains in the Kantian tradition of philosophy, even if he sits at the margins of that tradition. For Kant, the forms of intuition-space and time-are the a priori conditions of the possibility of human experience and knowledge. For Foucault, the a priori conditions are political space and historical time. Foucault sees political space as central to understanding both the subject and objects of medicine, psychiatry, and the social sciences. Through this analysis one can see that medicines metaphysics is a metaphysics of efficient causation, where medicines objects are subjected to mechanisms of efficient control.

Retroactive prayer: lots of history, not much mystery, and no science

Many claims are made for the power of prayer, but the idea that it could work retrospectively has caused considerable controversy. It is also beyond current scientific knowledge

Bioethical Pluralism and Complementarity

This essay presents complementarity as a novel feature of bioethical pluralism. First introduced by Neils Bohr in conjunction with quantum physics, complementarity in bioethics occurs when different perspectives account for equally important features of a situation but are mutually exclusive. Unlike conventional approaches to bioethical pluralism, which attempt in one fashion or another to isolate and choose between different perspectives, complementarity accepts all perspectives. As a result, complementarity results in a state of holistic, dynamic tension, rather than one that yields singular or final moral judgments.