R-3 Repository :: Browsing by Author "Engelhardt, H. Tristram, Jr."

Browsing by Author "Engelhardt, H. Tristram, Jr."

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A philosophical exploration of the possibility and implications of institutional moral responsibility
(2003) Iltis, Ana Lucia Smith; Engelhardt, H. Tristram, Jr.
Moral integrity has been a long-standing focus of philosophy. Attention has been on the integrity of individual persons understood as the state in which persons' actions are well-focused and guided by persons' moral commitments. Although other interpretations of integrity have been offered, the etymology of 'integrity' suggests that coherence is a critical element. Here I argue that certain types of institutions can have moral integrity. It is important to recognize this dimension of social reality in order to give a complete account of institutions and their moral obligations. Without an appreciation of moral integrity we cannot recognize an agent's actions as having a purpose and we cannot understand it as having particular moral obligations. Moral integrity is a distinctly moral, not legal, property. Institutional moral responsibilities cannot be reduced to their legal obligations. I make four central claims in this study. First, I argue how the concept of integrity should be understood. Second, I make the ontological claim that institutions have an identity that cannot be fully reduced to their constituent individuals without loss of meaning such that the properties institutions bear are not reducible fully to the those individuals. I also recognize that institutions depend on their constituent individuals for their ontological status. Third, I show that one predicate institutions can bear is moral responsibility, which is distinct from legal responsibility. Fourth, I show that because of their unique ontology, institutions can come to possess and lose their moral integrity in a way distinct from how individuals do so. Institutional integrity is a social phenomenon that cannot be understood independently of the individuals associated with institutions but it also cannot be understood exclusively in terms of the integrity of the individuals associated with them. Many of the traditional implications of understanding an agent to be morally responsible are unavailable when the agent is an institution: An institution cannot feel remorseful, for example. This study explores the extent to which we can hold that institutions are morally responsible, the senses in which moral responsibility can be attributed to institutions, what is entailed in holding institutions morally responsible, and how we can understand institutional moral responsibility.
Clinical bioethics: Analysis of a practice
(2003) Rasmussen, Lisa Marie; Engelhardt, H. Tristram, Jr.
This project is a philosophical analysis of the practice of bioethics consultation---what might be called the philosophy of bioethics. It assesses claims made about the purposes and appropriate aims of the field, in order to establish whether an identifiable conceptual unity underlies the practice. The conclusion is that no such unity exists. The project begins by assessing the history of the field, in the hope that a historical analysis will explain why the field arose at all, which reason could then be used as a basis for claiming a particular purpose for bioethics consultation. However, it becomes clear that history has bequeathed diverse and sometimes conflicting goals to bioethics consultation. History suggests that the field exists both as a service to physicians and as a service to patients, though the interests of these two parties may be in tension. This work also assesses contemporary accounts of bioethics consultation (including the recent Core Competencies for Healthcare Ethics Consultation ) and shows that they are radically divergent and incommensurable, in addition to often being too vague to guide the practice. An investigation of possible philosophical arguments regarding bioethics consultation also fails to disclose a single coherent foundation for the field. The project ends with a conceptual geography of twelve possible roles a bioethics consultant may play, and finds that though some are in tension, none may be ruled out of court on independent grounds in the absence of an overarching account of the appropriate aims of the field. What this project demonstrates is that there is no conceptual unity underlying the practice of bioethics consultation. Instead, the enterprise must be understood as comprised of a plurality of roles serving a diversity of purposes and a heterogeneity of goods with no single uniting purpose.
Informed consent to rationing decisions by managed care organizations
(2002) Dorsett, Jeremy Robert; Engelhardt, H. Tristram, Jr.
It has been argued that the rationing of medical resources effected by managed care organizations violates the philosophical doctrine of informed consent, which is linked to the principle of respect for patient autonomy. Two models which purport to protect patient autonomy, in consonance with the doctrine of informed consent, and in the face of institutional rationing decisions, via prior disclosure, are examined. It is found that the 'prior global consent' model is less effective at preserving patient autonomy through prior disclosure than is the 'waiver of informed consent' model. The immediate conclusion for managed care is that institutional rationing need not be antithetical to the doctrine of informed consent. The broader philosophical conclusion is that the hierarchical notion of autonomy espoused by the 'waiver' model is, in some cases, more effective than the integrated notion espoused by the 'global consent' model.
Is someone in coma Dasein?
(1993) Phillips, Joan Raines; Engelhardt, H. Tristram, Jr.
An ontological investigation into the way of Being for someone in irreversible coma through Martin Heidegger's Dasein-analysis. Ambiguity in the designation 'human being' leads to the conceptual confusion one experiences when encountering someone in irreversible coma, because the designation of 'human being' indicates both 'Homo Sapien' and 'Homo Sapien plus Dasein'. However, considering what he requires for Dasein, Heidegger's Dasein-analysis supports a higher brain function definition of death. Thus on an Heideggerian interpretation, someone in irreversible coma has died as Dasein, remaining in the world as a 'living corpse'.
Nanotechnology, bioethics and the techno-scientific revolution: Philosophical and ethical assessment of nanotechnology and its applications in medicine
(2006) Jotterand, Fabrice; Engelhardt, H. Tristram, Jr.; Wyschogrod, Edith
This study draws on analyses on a number of levels. First, it clarifies certain concepts often used loosely in the literature pertaining to nanotechnology. In particular, it focuses on the concept of "revolution" in order to determine whether nanotechnology is a revolution in the making or simply an evolution of scientific and technological development. I then examine the context in which nanotechnology has developed (i.e., postmodernity) and consider how the new scientific culture within the postmodern context ties the production of knowledge to the three key elements of what John Ziman calls post-academic science (i.e., transdisciplinarity; the marketability of knowledge; and the norm of utility). However, the context of postmodernity challenges the resolution of technopolitical controversies due to competing rationalities (modes of explanation) and moralities. To this end, I develop a procedural integrated approach that takes into account the consequences of postmodernity for moral theorizing and our understanding of science and technology. Other attempts have been proposed as integrated model in the field of medical ethics, i.e., principlism. However, this work shows why principlism fails as an integrated model and favors an integrated model based on H. T. Engelhardt, Jr. and Kevin Wm. Wildes' procedural ethics. Finally, I examine further philosophical and ethical implications of nanotechnology in the biomedical sciences. I argue that in order to prevent the absence of more robust reflections that characterizes bioethical reflections in contemporary debates, it is essential to create the conditions for moral substantial reflections (better integration of "trans-epistemic values" at the core of scientific research and technological development). This requires building bridges across disciplines within the natural sciences as well as between the natural sciences (nanotechnology) and the humanities social sciences. Subsequently, I raise some suggestive ethical and philosophical questions concerning the impact of these new technologies on the practice of medicine but also in relation to the use of humanized technologies that could transform our understanding of what it means to be a human being and our conception of the human body.
Out of the In-Between: Moses Mendelssohn and Martin Buber's German Jewish Philosophy of Encounter, Singularity, and Aesthetics
(2013-10-04) Atlas, Dustin; Kripal, Jeffrey J.; Stroup, John M.; Engelhardt, H. Tristram, Jr.; Wolfson, Elliot R
This dissertation seeks to clarify and articulate a trajectory in Germanic Jewish thought, beginning with the work of Moses Mendelssohn and ending with Martin Buber; the two concepts mapped by this trajectory are the in-between [zwischen] and singularity [die Singularität]. These ideas are developed in light of their philosophical context, and brought into dialogue with contemporary thought. Singularities are individuals that are not particulars, meaning: not particular instantiations of either a general or universal concept. Singularities cannot be grasped in terms of their differences and similarities to other things. Singularity is what makes something what it is, independent of its predicates or containment in a universal. The in-between is the ontological space that allows for an encounter between singularities, such that this encounter helps constitute the singularities meeting. In this sense, the in-between is the chief conceptual support of the idea of singularity. Because singularities are autonomous and cannot be defined by their differences from other singularities, the space where singularities encounter each other cannot be thought of as a container without transforming the singulars into particulars. This dissertation takes the modest goal of formalizing and clarifying these concepts, preparing the concepts of the in-between and singularity such that they can one day be used in the study of religion. I suggest that these concepts are useful insofar as they allow us to take a middle path between theology and reductive analysis, viewing the transcendent claims of religions in a manner that is at once sympathetic and critical.
Owning organs: Theory, bioethics, and public policy
(1999) Cherry, Mark Joseph; Engelhardt, H. Tristram, Jr.
This study examines arguments for and against the sale of human organs for transplantation by exploring the ways in which one can conceptualize the ownership of organs. The conclusions I offer lead to bringing into question current prohibitions against the selling of human organs. Despite the considerable disparity between the number of patients who could significantly benefit from organ transplantation and the number of organs available for transplant, as well as the apparent potential of a market in human organs to increase the efficiency and effectiveness of organ procurement and the number of organs available for transplantation, an emerging consensus holds such a market to be morally impermissible and promotes global prohibition. This study critically assesses the grounds for such proscription. I examine the moral, ontological, and political theoretical concerns at issue in a human organ market. The various advantages and disadvantages of such a market are explored. In each chapter, I mark out the grounds for holding that the global consensus to proscribe organ sales does not have the force usually assumed; indeed, how it may be misguided. First, it fails adequately to appreciate the phenomenological and physiological distinctions among different body parts, the relative strength of ownership rights, as well as the general significance of forbearance and privacy rights. Second, the global consensus fails as well to take adequate account of the closeness of the analogy between dominion/possession/ownership of one's body and dominion/possession/ownership of other types of things, or of the ground and e0xtent of moral political authority. Moreover, third, maximizing health care benefits, promoting equality, liberty, altruism, and social solidarity, protecting persons from exploitation, and preserving regard for human dignity are more successfully supported through permitting a market rather than through its prohibition. Finally, I consider foundational arguments from the history of philosophy, including the positions of Aquinas, Locke, and Kant, which would usually be held to prohibit the sale of organs. In each case the arguments on closer examination do not unequivocally preclude the selling of redundant internal organs or those from cadaveric sources. On balance the analysis supports a market in human organs, rather than its prohibition. Indeed, such prohibition likely causes more harm than benefit.
Social justice in health care: A critical appraisal
(1999) Fan, Ruiping; Engelhardt, H. Tristram, Jr.
This work offers a philosophical appraisal of accounts of social justice in health care. By analyzing and comparing seven different accounts, it shows what is involved in advancing such an account and discloses what is involved in providing a moral justification, identifying a tripartite interplay among moral accounts, theories, and perspectives regarding the proper allocation of health care. Based on a distinction between substantive and procedural accounts of justice in health care allocation, it concludes that the prospect of agreement regarding substantive accounts of health care justice is unlikely. This study illustrates that it is moral perspectives, rather than moral theories, that are foundational to accounts of justice in health care. A moral perspective includes the complete content of a morality lived by a group of people, while a moral theory identifies general statements formulateable within a moral perspective, a moral account restructures in a systematic way a moral perspective regarding a domain of issues, such as that of justice in health care. Although a moral theory contributes to an account a general framework that arranges moral commitments into a discursive system, only a full-bodied moral perspective can provide a moral account the substance that it needs. Through closely looking at various moral perspectives embodied by different accounts of just health care, it becomes clear that disagreements in morality are extensive and deep. It is impossible to justify a particular substantive account of just health care without begging the question. Finally, a theoretical reconstruction of Singapore's Confucian moral perspective regarding health care justice is provided so as to offer a picture of a quite different theoretical foundation as well as a substantively different moral perspective from those that are often taken for granted in the West. It shows that moral perspectives are different from people to people, from community to community. A successful account of just health care will thus require more than what can be drawn from theories of justice.
The Concept of Disability: A Philosophical Analysis
(2012) Ralston, David Christopher; Engelhardt, H. Tristram, Jr.
At the most general level, this project seeks to engage the question, "What is disability?" The conceptual exploration is undertaken against the background of the philosophical literature addressing the nature of disease, illness, and disability. This work contends that much of the literature bearing on the nature of disability fails to distinguish sufficiently between different domains of philosophical explanation and concern--ontological, non-moral normative, and moral normative, respectively. Specifically, this involves a failure to distinguish among (a) disputes regarding the proper ontological characterization of disability, particularly as expressed in medical-scientific explanations of the phenomenon; (b) disputes regarding the role of non-moral (aesthetic, epistemic, cultural) values or norms in the constitution of those explanations (i.e., non-moral normative concerns); and (c) disputes regarding moral and political considerations that shape the character of the social reality within which persons with disabilities live (i.e., moral normative concerns). This work advances the thesis that disabilities, like diseases, are "natural," in the sense that they are not mere social constructions, but that values of various sorts nevertheless do enter into the identification of states of affairs as disability, and that the "disability" designation has important socio-cultural implications that are inevitably the subject of ongoing political negotiation. Specifically, this work argues that "disability" involves a complex interplay of ontological realities, non-moral normative, and moral normative considerations or values. This interplay is captured well by a "biopsychosocial" (BPS) approach to disability, one which incorporates these various considerations into a single account, involving an integration of different levels of explanation (biological, psychological, social) of the disability phenomenon. This work first develops the theoretical underpinnings and rationale for a BPS approach to disability (Chs. 1-3), then explores in detail some of the relevant ontological (Ch. 4), non-moral and moral normative (Ch. 5), and sociological and political (Ch. 6) considerations that enter into the identification of states of affairs as "disability," concluding (in Ch. 7) with a brief consideration of some of the study's implications for understanding the nature of disability, the future of disability studies and the disability rights movement, and the relationship between the disabled and the broader society.

Browsing by Author "Engelhardt, H. Tristram, Jr."

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