Navigating Ethics: Death, Religion, and Feminism

1. Defining Death Religious Ethics, Feminism, Virtue

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

3. Success of Whole Brain Death • Adopted as legal standard • Widely applied in clinical practice • 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 • Conceptual: We care about the deaths of persons, not bodies (so higher brain standard better) • Scientific: Whole brain death is a myth (but: brain has lost its coordinating role among body systems)

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

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

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

8. Objections • Many (but not all) religious arguments can be reframed or reformulated as secular arguments • 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 • If all people thought alike in terms of religion, little insight or learning from give and take • We all become wiser when more different viewpoints are raised in public discussion • Therefore, narrow liberal theory robs public discourse of a valuable resource

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

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

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

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

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

15. Dilemma Ethics vs. Preventive Ethics • Resolve dilemma-- exciting; demands action now • 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? • Men tend to resolve ethical problems in terms of rules and principles • Women tend to resolve ethical problems in terms of maintaining important relationships • Is this biology or socialization? • Why one or the other?

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

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

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

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

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