1. Defining Death Religious Ethics, Feminism, Virtue

2. Whole Brain Death n Zero likelihood of recovery n Easily used diagnostic criteria n Claim: Not a new idea of death as much as a new way to find out when respirator obscures “usual” signs n Views us as biological organisms not “persons”-- consistent with standard terminology

3. Success of Whole Brain Death n Adopted as legal standard n Widely applied in clinical practice n Still misunderstandings over concept and terminology-- can mislead families –“Brain dead” vs “dead” –“Life support machines” –Ask permission to stop respirator

4. Challenges to Whole Brain n Conceptual: We care about the deaths of persons, not bodies (so higher brain standard better) n Scientific: Whole brain death is a myth (but: brain has lost its coordinating role among body systems)

5. Religious exemptions n New Jersey law n Inconsistent? –Patients in adjacent ICU beds, same physiological state, one dead and one alive based on religion –Resurrection by crossing state line? n Value of consistency vs. respect for “minority” religious beliefs

6. Religious Approaches n What is proper role of religious arguments in a democratic, liberal, pluralistic state? n “Liberal” here means trying to maximize individual freedom, similar view to what is expressed in Declaration of Independence

7. One Liberal Theory n Distinguish private vs. public n Private practice of religion fully protected as basic right n Public appeal to religion as basis for law, policy is a violation of separation of church and state n Therefore, religious arguments out of bounds in public arena

8. Objections n Many (but not all) religious arguments can be reframed or reformulated as secular arguments n The more deeply one feels committed to a religious source for ethics, the more one is forced to misrepresent the origins of one’s thought when debating in public

9. Religious Differences as a Social Good n If all people thought alike in terms of religion, little insight or learning from give and take n We all become wiser when more different viewpoints are raised in public discussion n Therefore, narrow liberal theory robs public discourse of a valuable resource

10. A Broader Theory n Distinguish two arguments: n “Let me explain my religious-ethical conclusions so that you can rationally evaluate them and see if you can learn from them” n “My religious-ethical position is right and all others are wrong, so mine should be the basis for law”

11. A Broader Theory n First argument totally consistent with liberal goals n Second argument is illiberal (would create state religion) –Cannot prohibit (free speech) –Should not be encouraged

12. Feminist Ethics n No one unified feminist theory n A spectrum of feminist positions n In popular press “feminism” often confused with most extreme positions n Basic stance: “Exploitation of women based solely on their gender is wrong”

13. Feminist Critique n History of Western thought is largely a history written by males about males n This history often treats the experiences and lives of women as invisible n Thus Western thought is half-thought, impoverished by elimination of much valuable human experience

14. Palliative Care n Men n Cure disease n Medicine n Tough n Science n Highest priority in today’s medicine n Women n Care for symptoms n Nursing n Tender n Sympathy n Much lower priority in today’s medicine

15. Dilemma Ethics vs. Preventive Ethics n Resolve dilemma-- exciting; demands action now n Prevent dilemma from arising in first place-- often requires relatively boring attention to repetitive detail such as developing and implementing sound hospital policies (“women’s work”)

16. Justice vs. Care? n Men tend to resolve ethical problems in terms of rules and principles n Women tend to resolve ethical problems in terms of maintaining important relationships n Is this biology or socialization? n Why one or the other?

17. Emotion in Ethics n Traditional rationalism: no room for emotion (seeing the world through a cloudy lens) n Lack of emotion as an ethical weakness? n Emotions as an important ethical data even if not enough to resolve issue?

18. Virtue Ethics n Virtues = excellences in human conduct n Virtuous behavior is good in and for itself, not because it produces other goods n To be truly virtuous often requires a lifetime of practice n Virtuous behavior is done for the right reasons and with the right attitude

19. Holier than thou? n Ideally I am concerned about my own virtue, not pointing fingers at others n Is a scold or petty gossip an example of “excellence in human conduct”? n The “obituary test” (videotape vs. snapshot view of ethics; living a morally good life)

20. Virtuous Behavior n What would a virtuous person do in this situation? n Requires careful inquiry into the details n Requires application of judgment or prudential wisdom-- cannot be reduced to rules or formula n Aristotle: prudential wisdom as “master virtue”

21. Assessing Virtue n Sometimes focus on self might lead to neglect of others’ rights n Best suited to issues of character and integrity n Important virtues in health care –Compassion –Courage