Ethico-legal issues by medical specialism N–V

This chapter covers Ethico-legal issues by medical specialism and includes topics on the following subjects (N-V): Neurology: The clash of rights between a child and parents, Neonatal Surgery: Jehovah’s Witnesses, Neonatology: Consent, Neurosurgery: Information Governance, Neurosurgery: Innovation, Neurosurgery: Preservation of Evidence, Obstetrics: Needle Phobia, Ophthalmology: Statutory Disclosures, Paediatric Cardiology: Unlicensed Equipment, Plastics; Disclosure, Renal: Capacitous adult refusing treatment, Respiratory: Unwise Decisions, Speech: Capacity, Rheumatology: Doctrine of Double Effect, Trauma & Orthopaedics: Necessity, Urology: DOLS, Vascular Surgery: Disclosure

Evil and Divine Power: A Response to James Sterba’s Argument from Evil

In this article, I offer a response to James P. Sterba’s moral argument for the non-existence of God. Sterba applies to God the so-called Pauline Principle that it is not permissible to do evil in order that good may come. He suggests that this is the underlying element in discussions of the Doctrine of Double Effect, a doctrine that has been largely overlooked by philosophers of religion. Although, as hypothetical trolley cases demonstrate, human beings sometimes cannot avoid doing or permitting evil in order to prevent a greater evil, Sterba argues that the same cannot be said of an omnipotent God and that, since our world contains horrendous evils, the existence of a God who is both omnipotent and good is therefore logically impossible. I argue that, if God is thought to be a conscious being with unlimited power to prevent horrendous evils, Sterba’s argument might be valid. I also argue, however, that divine power need not be construed in this way. Drawing on some ideas derived from the work of Charles Hartshorne, I suggest that God is not a kind of divine micromanager and that it is more coherent and, indeed, helpful to think of God as a social influencer whose power is a source of positive energy for the promotion of goodness.

Ethical Considerations in Chemotherapy and Vaccines in Cancer Patients in Times of the COVID-19 Pandemic

The COVID-19 situation is a worldwide health emergency with strong implications in clinical oncology. In this viewpoint, we address two crucial dilemmas from the ethical dimension: (1) Is it ethical to postpone or suspend cancer treatments which offer a statistically significant benefit in quality of life and survival in cancer patients during this time of pandemic?; (2) Should we vaccinate cancer patients against COVID-19 if scientific studies have not included this subgroup of patients? Regarding the first question, the best available evidence applied to the ethical principles of Beauchamp and Childress shows that treatments (such as chemotherapy) with clinical benefit are fair and beneficial. Indeed, the suspension or delay of such treatments should be considered malefic. Regarding the second question, applying the doctrine of double-effect, we show that the potential beneficial effect of vaccines in the population with cancer (or those one that has had cancer) is much higher than the potential adverse effects of these vaccines. In addition, there is no better and less harmful known solution.

Introduction

This Introduction sets the background and scenario for the chapters that follow. It begins by sketching the public impact that terrorist acts have had in the past few decades and how that impact has been affected by the terrible coronavirus of 2020 with its staggering worldwide death toll. It then charts the development of philosophical responses to the dangers of terrorism that begin surprisingly slowly in the 1970s, increase in volume in the 1980s and 1990s, and accelerate dramatically in the wake of the September 11, 2001 hijacked plane attacks on New York and Washington. It also gives an indication of the broader sense of “meaning” in the book’s title that underpins much of the discussion in the later chapters that relies upon but goes beyond the very necessary conceptual clarifications developed in the early chapters. Finally, there are summaries of the themes and arguments in the book’s eight chapters, concluding with a note on the doctrine of double effect and the role of intention in the moral discussion of terrorist acts.

The Doctrine of Double Effect

The aim of the article is to present some of the differences and similari- ties in various versions of the double effect principle (DDE or PDE). The following formulations will be analyzed: that of Thomas Aquinas and two contemporary ap- proaches, namely those of Mangan and Boyle. It will be shown that the presented modern versions vary significantly and the distinction between their intended and only predicted effects is far from clear. As a result, the different contemporary for- mulations of DDE lead to contradictory conclusions, with some justifying what the others condemn. Moreover, it will be demonstrated that, unlike Aquinas, contem- porary authors mostly concentrate on unintentionality condition while neglecting the proportionality requirement. So, unlike Aquinas, they only take into account a narrow scope of cases, where the evil effect occurs with certainty, which leads to a complicated and intricate hypothetical intention test like Donagan’s. It will be shown that, besides its theoretical indistinctness, DDE lead to serious pragmatic risks. It can be quite easily misused as a kind of psychological mechanism to protect self-esteem from a sense of guilt since wrong-doing is treated as merely a predicted unintended effect.

Responsibility Rationalized

Three tetralogies attributed to Antiphon survive, and while all three depict trials for homicide, the second and third are often treated en bloc. Antiphon’s third tetralogy describes a case in which the defendant is accused of intentional homicide. Though commentators typically read the tetralogy as a discussion of causation as such, “Responsibility Rationalized: Action and Pollution in Antiphon’s Tetralogies” reconstructs it as an early attempt to deal with issues of intention and action surrounding around what twentieth-century philosophy came to call the doctrine of double effect. While Antiphon does not articulate the doctrine, he develops a nuanced view that addresses the same concerns about responsibility for consequences that motivate its defenders.