Christopher Tollefsen

What is medicine and what is it for? What does it mean to be a good doctor? Answers to these questions are essential both to the practice of medicine and to understanding the moral norms that shape that practice. The Way of Medicine articulates and defends an account of medicine and medical ethics meant to challenge the reigning provider of services model, in which clinicians eschew any claim to know what is good for a patient and instead offer an array of “health care services” for the sake of the patient’s subjective well-being. Against this trend, Farr Curlin and Christopher Tollefsen call for practitioners to recover what they call the Way of Medicine, which offers physicians both a path out of the provider of services model and also the moral resources necessary to resist the various political, institutional, and cultural forces that constantly push practitioners and patients into thinking of their relationship in terms of economic exchange.

Curlin and Tollefsen offer an accessible account of the ancient ethical tradition from which contemporary medicine and bioethics has departed. Their investigation, drawing on the scholarship of Leon Kass, Alasdair MacIntyre, and John Finnis, leads them to explore the nature of medicine as a practice, health as the end of medicine, the doctor-patient relationship, the rule of double effect in medical practice, and a number of clinical ethical issues from the beginning of life to its end. In the final chapter, the authors take up debates about conscience in medicine, arguing that rather than pretending to not know what is good for patients, physicians should contend conscientiously for the patient’s health and, in so doing, contend conscientiously for good medicine. The Way of Medicine is an intellectually serious yet accessible exploration of medical practice written for medical students, health care professionals, and students and scholars of bioethics and medical ethics.

Lying and Christian Ethics defends the controversial "absolute view" of lying, which maintains that an assertion contrary to the speaker's mind is always wrong, regardless of the speaker's intentions. Whereas most people believe that a lie told for a good cause, such as protecting Jews from discovery by Nazis, is morally acceptable, Christopher Tollefsen argues that Christians should support the absolute view. He looks back to the writings of Augustine and Aquinas to illustrate that lying violates the basic human goods of integrity and sociality and severely compromises the values of religion and truth. He critiques the comparatively permissive views espoused by Cassian, Bonhoeffer, and Niebuhr and argues that lies often jeopardize the good causes for which they are told. Beyond framing a moral absolute against lying, this book explores the questions of to whom we owe the truth and when, and what steps we may take when we should not give it.

A March of 2021 "Statement from Pro-Life Catholic Scholars on the Moral Acceptability of Receiving COVID-19 Vaccines," released by the Ethics and Public Policy Center argued that in accepting one of the Covid vaccines that had recently become available, one would not be "in any way endorsing or contributing to the practice of abortion, or. .. in any way showing disrespect for the remains of an unborn human being." That statement received criticism from some opponents of abortion. Here, I raise six questions about the claims or implications of the "Statement" in order to defend it in its main assertions, correct it in some minor matters, and extend its analysis as needed.

In this essay, I discuss the role that vocation plays in assessing the proportion of burdens to benefits in end-of-life options. I then look at the case of patients in a persistent vegetative state. What vocational considerations are relevant for persons considering what care to accept should they ever be in a PVS or for those caring for patients in such a state? Ultimately, I argue that the vocational shape of a patient's life ought not to be a consideration for a caregiver in favor of removing artificial nutrition and hydration.

In this article, we first give a normative account of the doctor–patient relationship as: oriented to the good of the patient’s health; motivated by a vocational commitment; and characterized by solidarity and trust. We then look at the difference that Christianity can, and we believe, should, make to that relationship, so understood. In doing so, we consolidate and expand upon some claims we have made in a forthcoming book, Ethics and the Healing Profession (Curlin and Tollefsen, 2021).1

Despite the scrutiny that has been given to John Finnis's masterwork, Natural Law and Natural Rights, relatively little attention has been given to a feature of that work that plays a recurring role, namely, the place of the basic human good of play in the book. In addition to a number of passing references, that good is discussed in an extended way on three occasions. The first is when the good of play is introduced, as part of Finnis's taxonomy of basic human goods; the second is in his discussion of Aristotle's understanding of friendship, when Finnis refra-mes Aristotle's friendship of pleasure as instead friendship of play; and then finally, in Finnis's concluding chapter, with its discussion of the «further point» of morality, where Finnis, following Plato, describes the point of morality as participation in a divine play. Play's presence at the end of Natural Law and Natural Rights, indeed, in one of the culminating passages of the book, suggests that this good should be paid more attention than has been given to it. After a review of Finnis's various discussions of play, I argue that Finnis's account provides resources for answering Thomas Nagel's skeptical doubts about life's meaning; and for furthering Finnis's own claims about the authority of law. Keywords: Natural Law, basic goods, play, friendship, meaning of life, authority of law. Resumen: A pesar del análisis a que se ha visto sometida la obra maestra de Finnis, Natural Law and Natural Rights, se le ha prestado relativamente poca atención a un rasgo de la misma: el recurrentemente citado bien humano del juego y el lugar que su estudio ocupa en dicho libro. La primera referencia aparece con ocasión de la presenta-ción de dicho bien como parte de la taxonomía de bie-nes humanos básicos finnisianos. La segunda, figura de la mano de un análisis sobre la amistad aristotélica, en el que Finnis reformula dicha noción, originalmente enten-dida como relación de placer, en términos de relación de participación en un juego. Finalmente, en el último capí-tulo, Finnis, se refiere al juego, siguiendo a Platón, cuando sostiene que la referencia adicional de la moralidad queda descrita como participación en una obra divina. La pre-sencia del juego al final de Natural Law and Natural Rights, de hecho, en uno de los pasajes culminantes del libro, sugiere que a este bien se le debe prestar más atención de la que se le ha venido dispensado. Después de revisar las diversas discusiones de Finnis sobre el juego, sostengo que su relato ofrece recursos para responder a las dudas escépticas de Thomas Nagel sobre el sentido de la vida y para ofrecer un mayor recorrido a las afirmaciones de Fin-nis acerca de la autoridad del derecho. Palabras clave: Ley Natural, bienes básicos, juego, amis-tad, sentido de la vida, autoridad de la ley.

This chapter seeks to identify the basic human goods that are the foundational principles of the natural law; a derived set of moral norms that emerge from consideration of the integral directiveness or prescriptivity of those foundational principles; and the implications of these norms for medical practice and medical law as regards four questions. First, how should medical practice and medical law be structured with respect to the intentional taking of human life by members of the medical profession? Second, who, in the clinical setting, has authority for medical decision making, and what standards should guide their decisions? Third, what standards should govern the distribution of health-care resources in society, and do those standards give reasons for thinking, from the natural law standpoint, that there is a ‘right to health care’? Fourth, what concern should be shown in medical practice and medical law for the rights of ‘physician conscience’?

From Snell and McGuire, eds., Subjectivity: Ancient and Modern

The New Natural Law theory takes the first-person agential~tandpoint very seriously, and this methodological emphasis, I'll argue, explains several characteristic features that distinguish the NNL theory from many otl).er styles of Thomistic natural law theory.  I'll discuss four: first, its well-known claim that "ought" cannot be derived from "is"; second, its account of human action and intention; third, its claims concerning the limited nature of the state and the instrumental nature of the political common good; and fourth/its claims about the nature of our ultimate end: the Kingdom, and not the Beatific Vision alone. Across four areas of controversy, then, the methodological approach that privileges the agential standpoint plays an important role.

Two hard cases have generated controversy regarding the application of the principle of double effect in recent years. As regards the first, the case of the conjoined twins of Malta, there has been considerable convergence: most natural law ethicists seem to agree that separation of the twins was morally permissible. By contrast, the so-called “Phoenix case,” involving an abortion at a Catholic hospital for a woman with pulmonary arterial hypertension, has become a touchstone of disagreement between defenders of the so-called “new” natural law theory, and more “traditional” Thomists. I argue in this essay that, contrary to widespread opinion, the two cases were alike in the following respect: in neither need the principal agents have intended the death of anyone.

Could a human being survive the complete death of his brain? I will argue that the answer is no. No human organism can survive the loss of its irreplaceable parts. Hence, when an irreplaceable part is gone, whatever remains is not numerically identical with the organism that existed previously. If you were the original organism, then you do not survive as the residuum. In this paper I give an explanation of what is meant by " irreplaceable part " ; explain why an human being cannot survive the loss of such a part; and argue that the brain is such a part.

Several critiques of the New Natural Law theory of action are to be found in a special issue of the National Catholic Bioethics Quarterly dedicated to criticizing the NNL theory as a whole.  This essay addresses three of the articles in that issue. Those essays, by Steven A. Long, Matthew O’Brien, and Fr. Kevin Flannery, SJ, as well as a more recent essay by Edward Furton (in Ethics and Medics), eventually converge on a variation of the “closeness” criticism that I will address in the second part of the paper.  In the first part, I address three further issues, raised, respectively, by Flannery, Long, and O’Brien.

Technologies for feeding permanently incapacitated patients enterally or parenterally through various forms of artificial nutrition and hydration (ANH) have generated moral questions and controversies. Particularly for patients in a persistent vegetative state or in advanced Alzheimer disease but also for terminally ill newborns, there are questions about whether ANH should be withheld or withdrawn. Is ANH extraordinary
or even futile care? Do its burdens outweigh its benefits? For patients provided with terminal sedation at the end of life, there are questions about the accompaniment of sedation with withdrawal of ANH. Is that removal a form of euthanasia? Or is it a justified part of the palliative care being provided at the end of life. Two further kinds of cases raise different sets of issues. First, is the forced feeding, by means of ANH, of hunger-striking
prisoners, as, for example, the detainees at Guantanamo Bay, morally
permissible, or is it a violation of bodily integrity and perhaps a form of
torture? And second, is the failure to provide more adequate nutrition and
hydration, including ANH, for Ebola patients in the developing world a
matter of global injustice? This entry looks at each of these issues in turn.

In this essay, I look first at Pope Francis’s treatment of the issue of abortion. His teaching on the subject is, I show, substantially continuous with that of other twentieth century popes. I then look at some of the more discomfiting remarks that Pope Francis has made, such as his comment that the Church should be less “obsessed” with the issue. Some of these remarks, I will argue, do indeed raise important questions, yet can seem to create unnecessary and unhelpful opportunities for confusion and distortion; moreover, they appear to stand in some tension with other remarks of the Pope on the subject. I then suggest a framework for thinking about how the Pope is approaching this issue. That approach emphasizes two central concepts: God’s mercy, and accompaniment. In closing, I argue that the Pope’s approach must also emphasize eschatological significance if it is to be fully fruitful.

This paper has three parts; in the first, I look at the role that God plays as an explainer of morality. In the second part, I ask what difference Christianity makes to us, as practical and moral agents.  In the third part I ask about God’s communication of normative matters to us.

I argue that the role and understanding of the humanities in American higher education has been deformed by its relationship to modern science. This deformation tracks three features of contemporary science: its rigor and characteristic method; its turn towards the technological; and the claims made by some of its practitioners and defenders to self-sufficiency and unlimited authority in all matters of knowledge. Contemporary defenses of the value of the humanities often go wrong by seeking to make the humanities either too much like science, or by asserting on behalf of the humanities the same claims to supremacy made on behalf of the sciences. I conclude by making some claims both about the intrinsic goodness of education in the humanities and about the role that study of the arts should play in a humanities education.

Soulignant le role des emotions dans la vie morale et dans le debat ethique, l'A. etudie la notion d'emotion d'auto-evaluation definie par J. Rawls et reprise par G. Taylor dans son ouvrage intitule «Pride, shame and guilt: emotions of self-assessment» (1985). Developpant l'exemple de la honte, l'A. se propose d'ajouter a la liste des emotions etudiees par Taylor celle de la peur, definie par Platon dans sa theorie des vertus. Examinant la conception du courage formulee au Libre IV de la «Republique», l'A. etablit un parrallele entre la peur et la these celebre selon laquelle il vaut mieux souffrir de l'injustice plutot que de la commettre

The geography of the debate concerning practices destructive of the youngest members of the human species is by now rather well worked out. Of the questions to be answered, there is first the following: are you, the readers of this essay, and I, the author, and others substantially like us, essentially human beings, living biological organisms of the species Homo sapiens? Or are we some other kind of entity, a person, perhaps, or a mind, a brain, or a soul? This is a question of metaphysics.1

... NAME: CHRISTOPHER TOLLEFSEN * BIO: * Professor of Philosophy, University of South Carolina. SUMMARY: ... ... Thomas Aquinas and his successors, has typically attended to some of the crucial concerns at the intersection of economic activity and human well-being. ...

There are two perspectives available from which to understand an agent's intention in acting. The first is the perspective of the acting agent: what did she take to be her end, and the means necessary to achieve that end? The other is a third person perspective that is attentive to causal or conceptual relations: was some causal outcome of the agent's action sufficiently close, or so conceptually related, to what the agent did that it should be considered part of her intention? Recent goods based views in ethics are divided as to whether only the first person perspective, or a mix of both perspectives, are necessary to understand intention and action. But resolution of the issue is necessary if goods based views are to be able to deploy to principle of double effect; for that principle requires an account of how to distinguish what is genuinely a matter of intention in human action from what is not. I argue that the pure first person account is better than the mixed account.