Monday, January 27, 2014

My Apologies to Past Inamorata

By: Matthew Cuffaro 

This post introduces semiotics, the study of signs, in a philosophical formulation of sex. This claim is not principally bioethical, if we understand that bioethics is the extension of ethics to fields with a technicality that often demands both a masterful technical understanding and philosophical prowess. However, this method of conceptualizing sex utilizes understandings from a previously distant intellectual tract to forge a novel method of contemporary ethical thought. Current bioethics has failed on this point, much to its detriment.

Firstly, two disclaimers:
While the themes of sexual semiotics papers may stress the boundaries of bioethics, it is helpful to know that the roots of philosophy are in that body— the distinction between ethics and bioethics blurs at the flesh.
Further, because “sex” is such a vague term in academic discussion, I leave it undefined. Sex could be from foreplay, penetration, or even a particularly witty discussion-courtship. A couple will be used as the example, but the specifics, such as sex and gender, style, orientation, setting, etc. are variable.
Not all sexual encounters appear out of the void; they are usually prefaced by something to arouse the mood. Whatever arouses the mood is usually based off a list of characteristics that the interpreter can vividly imagine but probably murkily articulate. These characteristics, such as swaying hips, musculature, skin tone, are articulations themselves, because they speak for the otherwise silent figure flying across the ballroom, which only leaves impressions (like footprints in the sand).

These characteristics are then positively buzzing with the possibility of influencing the impression of the person of interest; this potential influence is a recharacterization of them, so that the next impression will be accompanied by recognizably sexual features. We can, with an almost offensive ease, recharacterize the space enclosing this encounter. If the person of interest perhaps stole your mortal soul when they picked up that punch, the very room and its objects will be irradiated with meaning, each like a phylactery. I understand this happens frequently to couples with particular songs, movies, classes, workplaces, pen pads, etc.

Room, song, or person, each item then becomes its own place, because they are spaces infused with interpreter’s wild and private meanings.[1] A lover can use this to the couple’s advantage by uncovering old songs, re-enacting older charms of the relationship, or transforming a space into a loving place with the insertion of these meaningful signs. Yet, there can always be novelty, and either way the lover guides the mood through articulations—the most arousing actions from a lover can move a couple to a sexual encounter the same way a rogue percussive sound can invoke horrors in a PTSD-afflicted veteran; both open a world unto themselves.

Whether or not the arousal was arranged or accidental, it appears that it automates the couple into the sexual mode as if they were guided there. In a sexual encounter, each phase seems to proceed fluidly as if the lovers were guided as well. The idea that each sign is not just an indicator but a motivator is the theme here, because it seems to relieve the lovers’ self-consciousness. Neuroticisms, ninny-picking, wandering trains of thought are eroded as the sexual encounter assumes small tiers of consciousness in its participants. This is more prominent in sex; actions seem to be reflexive and talking seems absurd. In the more passionate throes of sex, lovers may be consumed with each other. The lovers become responsible for a spectrum of emotions in the other: they become their pain, struggle, angst, suspension, hope, and pleasure. It is almost if the lovers, only for a moment, wish to –in a very physiological way—forget that there is a psychic difference between them, and while they may object to physical fusion, the emotional will have to do.

If such potent experience is accurately described here, then it summarizes how many fields of contemporary philosophical thought can discuss sexuality in a cogent way. Though sexuality is still intellectually murky, it is suspended between what we might say are medical and philosophical realms desperate for each other’s enrichment. Cooperation may be difficult because the canonical, arcane concepts from philosophy can quickly annex and impede comprehension from other professions.

To ameliorate this problem, bioethics is the representative of ethical study in the very least; it mediates between two academically distant fields providing insight into political issues such as fetal and patient rights while formulating theory and architecture. The semiotic argument above, is another form of this philosophical application—preparing a consistent framework into our understanding of sexual practice to illuminate its influence in our social and individual practice.

Matthew Cuffaro is a philosophy student at the University of South Florida with a concentration in the philosophies of mathematics and religious studies. 

[1] People are not necessarily spaces insofar as they take some up, and songs are on an entirely different physical order, but they are both invitations to a completely different world themselves.

Monday, January 20, 2014

Creating Children for Children

This piece begins a bi-weekly column devoted to reproductive issues. 

By Naomi Scheinerman

Those thinking of having children or who find themselves accidentally pregnant ask many important questions: Am I ready to be a parent? Am I financially able to support myself and a child? Do I have the time and energy? Though these questions are undoubtedly crucial, they are incomplete. One should also ask: would the child want its life?

The politics of childbirth in the United States are replete with problems: states passing draconian anti-abortion legislation, a hospital keeping a brain-dead pregnant woman on a ventilator because of her nonviable fetus, employers denying paid maternal or parental leave, and religious groups denying their employees the freedom to choose contraception. Our system is also hypocritical: we stigmatize teen or single mother pregnancy while fighting contraceptive access; we fight expanding needed health care to poor and impoverished children while mistreating obese pregnant women; and we harass abortion clinics while pushing for abstinence-only education in schools.

When deciding whether to conceive, it is crucial to ask whether the fetus’s future life is optimal, rather than whether our life is optimal with a child in it. This does not mean that we are obligated to have a child when we can provide an optimal life, nor does it mean that we must define optimal according to one rigid standard. Rather, it means that we should reformulate “Are we ready to have a child?” as “Is the child going to be happy with this life?” I do not posit that either a woman’s right to reproduce or her interests and welfare should ever be compromised because of our concern for the fetus. Indeed, we too often disproportionately value the welfare of the fetus over the mother, resulting at times in tragic death. Though a fetus deserves our respect and women do have certain obligations to maintain a reasonable level of health for the fetus’s welfare, fetuses do not carry nearly the same moral standing as the mothers. Further, there is a connection between the above questions: if a woman, or man, is neither emotionally nor financially ready to have a child, then that child most likely will not want the life offered at that point in time.

There are certain philosophical objections one could raise with my position. First, the classic nonidentity problem: it is wrong to say that being born in a diminished state of existence has harmed a child because the child could not have existed otherwise, For example, a woman who gives birth to a child she knows has a debilitating genetic disorder has not harmed the child because that unique child could not have lived any other way. The problem with the nonidentity objection is that it assumes it is always good to create life, no matter what quality that life has. Further, it does not make sense to talk about eggs, sperm, embryos, and early stage fetuses as though they have consciousness and autonomous rights over their future selves.

A second possible objection is that precisely because the fetus does not have autonomous rights over its future self, we cannot project its preferences regarding life into the future. I agree with this statement, however it does not do enough to dispute my claim. I am arguing for reframing procreative decision-making to place the child as the most important recipient of its life, rather than the parents. This is not because the fetus has a right to that life, but rather because the child who is born has a right to the best life possible.

Many posit that having a child is a selfish act. However, this does not concern me: if it is selfish and the child is happy, what’s the problem? And if it’s not selfish, and the child is happy, again what’s the problem? There are many decisions prospective parents or parents thinking of having another child must consider. Reframing the question in terms of the perspective of the newborn child and the development of that individual would yield a far more desirous outcome for all involved.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. 

Monday, January 13, 2014

Unintended Consequence: Obstructing Patient Choice for Death with Dignity

By: Sue Dessayer Porter

Oregon was the first state to legalize aid-in-dying. Since 1998 it has implemented “Death With Dignity (DWD),” which allows eligible terminally ill people to end their lives peacefully with a legal prescription. 

Contrary to fears asserted by the opposition, there have been neither slippery slopes, nor granny panels, nor hordes of people clamoring to Oregon to die. With over sixteen years of experience, DWD has demonstrated successfully that cautious adherence to the law provides safe choice and dignity with aid-in-dying.

In spite of this flawless record, there is ever-increasing obstruction against choosing this autonomous and personal end-of-life option. The problem? As religious hospitals merge with financially imperiled medical centers or acquire independent medical practices, they are enforcing policies which prohibit doctors from participation with DWD. This restriction applies to all doctors; therefore, a Muslim physician treating a Jewish patient is dictated by another religious doctrine. Doctors are not even allowed to have a conversation with their patients about DWD, so the “duty to refer” is not a consideration.

An unintended consequence?  Oregon’s DWD Act, Section 127.885 s.401 (5) (a), allows a health care provider to prohibit another health care provider from participating in DWD. [1] This was intended as a well-meaning compromise to appease the opposition and move the law forward. In retrospect, lawmakers in the early 1990’s could not have predicted the merger activity by religious hospitals twenty years into the future. However, the state of medical economics has changed so dramatically in the last two decades that private practitioners cannot sustain independently. Therefore, doctors who previously supported patients through DWD can no longer do so, because they are now employed by religious medical organizations. 

Washington state voted DWD into law in 2008 and is facing the same obstacles.

These health care leaders state that they are in savior mode, in that if it were not for them, many communities would be bereft of medical care. They say that they are “driven by a mission to serve the underserved,” with a commitment to help every human being. [2] However, patients requesting end-of-life choices are being denied lawful alternatives. This pervasive barrier to aid-in-dying affects increasing numbers of qualified terminally ill patients who try to avail themselves to DWD. Because their states voted DWD into law, residents of Oregon and Washington reasonably assume that health policy, combined with their doctor-patient relationship, entitles them access to aid-in-dying. Although this is a credible expectation, it is proving to be false too frequently.

Doctors are individually protected by conscience clauses to deny services that are in conflict with their personal beliefs.  Alternatively, as long as freedom of choice is protected for doctors who do not want to participate in specific procedures, the same principle of choice should be guaranteed for doctors who do choose to offer what they consider responsible, ethical, legal and dutiful medical care.  And logically, patients should be assured their rights to legitimate choice and self-determination.

Medical beneficence should be defined by the doctor and patient; it should not be dictated by a separate entity which controls with economic power by acquiring medical practices that cannot sustain independently, due to the current medical business model.

Sue has been a client case manager for Compassion & Choices since 2001, stewarding patients through Oregon’s Death with Dignity Act. She has a Masters of Science in Bioethics from Union Graduate / Mt. Sinai Med. Center (NY), a Masters in Business Admin. from St. Mary's College (CA)  and a diploma from Yale's Interdisciplinary Center for Bioethics (2013). Sue is also a national board member for Compassion and Choices, the leading advocacy organization for end-of-life issues.


Tuesday, January 7, 2014

Sustainability: an Ethical and Cosmological Perspective

 By: Laura Ballantyne-Brodie  

Among the doomsday predictions and naysaying climate skeptics have you stopped to appreciate that you are the result of around 3.8 billions years of evolution?  It strikes me sometimes that in the midst of doom and gloom scenarios we forget to rejoice the fact that despite the odds human life has evolved in a truly remarkable way.  We are alive to experience the world wide wake-up call challenging us to shift our paradigm and start to take care of the Earth. 

Despite the turmoil that surrounds us (disruptive technology, economic woes and environmental degradation), we live at a fascinating time.  We are witnessing the evolution of human consciousness before our eyes.  The news has been delivered telling us that the way we are living is at odds with the physical systems of the planet and we are fast approaching crisis point. [1]  We are at a fork in the road and it is up to us to choose the path to a safe, clean and free society for current generations and for future generations after us.

A changing paradigm - ethics and cosmology

We’re moving from a worldview that prioritizes nations to one that prioritizes planet. Peter Ellyard a renowned futurist and intellectual, coined the term planetism to describe the worldview where our first allegiance is to the planet.  As a concept planetism recognizes that humanity exists as part of a whole in an interconnected system. 

The shift that we're experiencing is a shift in paradigm from a worldview in which:
  • individual is king to community being paramount;
  • autocracy and hierarchy rule to democracy taking a deeper hold;
  • humanity working against nature (or from above) to one where humanity sees itself as inextricably linked to nature.
Consciously or unconsciously the predominant worldview stresses that life (you, me and all the creatures of the biosphere) is insignificant because we are so tiny in comparison to the infinite universe.  This is recognized by the expression 'in the scheme of things, I'm insignificant' or 'one person won't change a thing'.  We must challenge this view.  While the Earth may be 'insignificant' in space (i.e. we are tiny in comparison to the rest of space) we are significant in time. [2]  Earth has been around such a long time that it has allowed complex human life and everything in the biosphere to flourish.  This fact alone means there is no justification for us to continue approaching our relationship with the Earth and life itself with indifference.  Our fundamental relationship with the Earth needs some counselling so that collectively we recognize we're flying in the face of 3.8 billion years of miraculous design, destroying the planet for the benefit of a relative few.

The rise of civil society: citizens and entrepreneurs

With the rise of the civil sector, we're witnessing an extraordinary shift in the way in which people are grappling with and responding to the global challenge of sustainability.  The organisation I founded, Rent to the World started because we recognized the need to catalyze the paradigm shift and get on with the task of looking after the commons.

The metaphor of paying ‘rent’ to the world is unmistakable because it challenges our worldview and encourages us to recognize there's a corresponding duty (or fee!) for our place on the planet.  As a noun, rent is defined as "a fee for use, service or privilege".  The concept encourages us to recognize the symbiotic nature of our existence and that we each have a role (or duty depending on your point of view) to give something back.  As everyone has a concept of money it is a powerful tool to remind us that we all have an impact, and therefore a responsibility to give back to the Earth - our home - for the gift of life and the use of its resources - valuable, beautiful and quite often finite.


For the moment we are trying to fit a square peg into a round hole but the message is resoundingly clear: we cannot continue on our current course.  Once we make the mental shift placing cooperation, collaboration and responsibility as the central principles of our worldview, we can harness our energy and ingenuity to begin the task of looking after the commons.  Our hope at Rent to the World is that many more people are ready to join with us to turn things around.  Wendell Berry, the remarkable American poet, farmer and activist has said "the world and life it holds are conditional gifts.  We have the world to live in on condition that we take good care of it".  Humanity is receiving a wake-up call, after many years of taking our place on Earth for granted.  It is our responsibility to take care of the planet, so that in return, it will look after us.

Laura is an climate change lawyer, social entrepreneur and budding bio-ethicist, based in Sydney Australia. She is interested in the intersection between law, policy and ethics and in particular the application of ethical and sustainability principles to some of the big environmental challenges.

[1] Intergovernmental Panel on Climate Change (IPCC), Climate Change 2013 The Physical Science Basis (October 2013) <>
[2] Sasselov, D. (July, 2010). Dimitar Sasselov: How we found hundreds of potential Earth-like planets retrieved from <>
Welcome to BioEthx Under 25!
By: Mohini Banerjee

This blog will serve as a forum for young (and young at heart) voices to contribute on issues concerning medical or environmental ethics and society. As a research assistant at The Hastings Center, my own interests span topics such as dementia, inequalities in access to healthcare, internet privacy and information flow, and resource distribution during disasters. It is my hope to bring younger people into discussions of bioethics that are accessible and open to an exchange of knowledge and values. Those of us who are under 25 will be decision-makers for our parents and have children or our own, making it necessary to ponder decisions at the end-of-life and genetic screening. Given the necessity of technology and instantaneous communication provided to this generation I believe there needs to be an informal, yet structured forum for people to grapple with these and other relevant bioethics issues.

Please email me at if you have a post idea and would like to contribute.