Journal of Medicine and Philosophy

This essay argues that what is central to Christopher Boorse’s biostatistical theory of disease as statistically subnormal part function (BST) are comparisons of the “functional efficiency” of parts and processes and that statistical considerations serve only to pick out a healthy level of functional efficiency. On this interpretation, the distinction between health and pathology is less important than comparisons of functional efficiency, which are entirely independent of statistical considerations. The clarifications or revisions of the BST that this essay offers are friendly amendments that render moot some of the most prominent criticisms of Boorse’s account.

Variants on two approaches to the concept of health have dominated the philosophy of medicine, here referred to as ‘reductionist’ and ‘relativis’. These two approaches share the basic assumption that the concept of health cannot be both based on an empirical biological foundation and be evaluative, and thus adopt either the view that it is ‘objective’ or evaluative. It is here argued that there are a subset of value concepts that are formed in recognition of certain fundamental facts about living organisms, among which is the concept of health. These are not yet moral concepts, but they are ‘normative’ or ‘evaluative’. The view is defended that health, so understood, is a fundamental concept in the process of medical diagnosis and treatment.

The prevailing view in bioethics is that the relationship between doctors and their patients was largely a silent one before the landmark court decisions of the twentieth century. Some have proposed that this was not always the case. This paper provides historical evidence of consent and negotiation in one nineteenth century gynecological practice. The Clinical Records and writings of Dr. Alexander J.C. Skene, who practiced in Brooklyn, New York from 1863 to 1900, have been examined for evidence of discussion, consent and even negotiation with patients. Although this evidence comes from only one practice, it is especially significant because it was largely a gynecological practice with women who were varied in socioeconomic status and ethnic origin. The importance of documenting physician-patient relationships which included patients in decision-making before Schloendorff (1914) established the legal doctrine of informed consent cannot be underestimated.

Medico-philosophical reflections were developed in the 19th and the 20th centuries by three consecutive generations of Polish physicians, active in what was later named the Polish School of Philosophy of Medicine. The second generation of this school published its own journal, Medical Critique [Krytika Lekarska], from 1897 to 1907. Medical Critique included numerous articles on the nature of medical knowledge, the reductionism versus holism debate in biology and medicine, the importance of teleologically-oriented approaches in medicine, the influence of theories and of a priori ideas on clinical observations and on 'clinical facts', the problem of classification of diseases, the normative and ethical dimension of medicine, and the ion relationships between philosophy, history and medicine. The existence of a journal dealing specifically with theoretical reflections on medicine undoubtedly contributed to the propagation of original work in the philosophy of medicine in Poland.

From the end of the First World War, a broad discussion took place within the framework of the revived German constitutional teaching on the question of the physical normality of man. The founder of the so-called statistical concept of normality, which preceded the still widespread normal (reference) interval concept, is H. Rautmann, who gave it the character of a tool for discriminating between health and disease. Among some of his successors (Bauer, Borchardt, Günther), however, it was considered more a means of establishing a type, without supposing any precise relation between the frequency of a character in the population and the probability of the occurrence of disease. The concept of a statistical norm as a certain region of the variation range of a character determined by the parameters of Gaussian distribution was criticized both by the supporters of the ideal norm (Hildebrandt) and those who were in favour of a 'personal' norm (Grote). The underlying motifs of these three conceptions of normality influenced German constitutional doctrine until after the end of the Second World War, but without a satisfactory solution to the diagnosis of physical normality being found. Since the 1950s, world medicine has moved more and more in the direction of prevention, with the emphasis on a study of individual dispositions to disease and its precursors. In this connection a new view of health has gained importance whereby it is considered a smoothly gradated condition, not sharply distinguished from disease ('continual' model of health and disease as opposed to the previous 'alternative' model). The purpose of diagnostic characters is no longer merely to place patients in clearly defined categories as healthy or affected by one disease or another, but has taken on the function of indices of the disposition to disease among those who exhibit 'gross normality'. Discrimination between the alternative and continuous models allows a clarification to be made of the sources of the confusion in which the pre-war concept of statistical normality had found itself. Today many exceptions are known to the rule that the functional optimum lies in the region of the population mean, both for the population as a whole and for individuals; and immense variability has been found in the manner in which individuals in the population attain health.(ABSTRACT TRUNCATED AT 400 WORDS)

This is the first re-publication and first English translation of regulations concerning Human Experimentation which were binding law prior to and during the Third Reich, 1931 to 1945. The introduction briefly describes the duties of the Reichsgesundheitsamt, which formulated these regulations. It then outlines the basic concept of the Richtlinien for protecting subjects and patients on the one hand and for encouraging New Therapy and Human Experimentation on the other hand. Major issues, like personal responsibility of the physician or researcher, teaching of ethics of research and therapy, and research and therapy on vulnerable populations, are compared with the regulations in the Nuremberg Code and subsequent regulations influenced by the Nuremberg Code. KIE Sass translates and comments on the Richtlinien, the pre-Nuremberg regulations concerning human experimentation which were binding law in Germany from 1931 through the end of the Third Reich in 1945. Stricter in some respects than the Nuremberg Code and subsequent regulations, these laws were intended to foster a morally aware system of public health care while encouraging research. Responsibility for maintaining professional and ethical standards within a medical institution was assigned more to the chief physician than to the individual physician or researcher, and no mention was made of advisory boards or committees. The article concludes with a re-publication in German of the original regulations.

Is Portmann's concept of inwardness objectively useful in understanding biological phenomena? If it is, it would seem that there is no unity to the physical sciences, because biology is as fundamental as physics. On the other hand, Portmann's interpretation of inwardness as a meaning or significance that we have to give our interpretation of biological phenomena suggests that it is sheerly subjective, and so should be reduced to objective correlates. This dilemma is false, however. One should realize that scientists construe physical and chemical processes as processes devoid of intrinsic meaning, just as they construe biological processes as having this meaning, which is Portmann's inwardness. From this angle we can integrate the significance of physical and biological processes in a way which does not reduce the latter to the former.

Recommandations have been formulated in 1985 with reference to socialist morality and law and as a result of interdisciplinary discussion by the IAME (Interdisciplinary Working Party on Medical Ethics at the GDR Academy of Postgraduate Medical Education) for clinical application of in vitro fertilization and for the use of human oocytes and early embryonic stages.

To properly comply with the Health Sector Act of 1992 a functioning competition should be introduced in the interests of the insured of the German Statutory Health Insurance, while still maintaining the principle of solidarity. This is a critical order-political aim, because the principles of solidarity and selfresponsibility as typically understood are functionally in contradiction. This paper analyzes the important measures of the Organizational Reform and concludes, that the principle of self-responsibility ought to obtain priority. Therefore, the German legislature ought to focus on further competitively oriented reform steps.

While a national health care system may be greeted with enthusiasm on many grounds, it poses substantial moral problems – not the least of which would be the clash between the ‘standardization’ of care for the sake of efficiency and the needs of individual patients. Such problems are best seen in the treatment of dying patients.

In his writings, Edmund Pellegrino analyzes four deficiencies in the humanity of those who fall ill: the loss of (1) freedom of action, (2) freedom to make rational choices, (3) freedom from the power of others, and (4) a sense of the integrity of the self. Since Pellegrino's analysis and commitment to virtuebased ethics preceded much of the attention later given by philosophers to the importance of the moral principle of autonomy (in contrast to beneficence) in patient care, it is helpful to trace the source of his commitment to virtue-based ethics and his account of freedom to Aristotle's analysis of the human soul, as an entelechy of an intact and healthy living organism that, unimpeded by illness, moves itself to act, to actualize its intellectual potential in the form of making rational choices, and to free itself from the power of others by remaining independent and without need of continuous assistance, while at the same time retaining the integrity of a unified self that can act, think, and choose for itself autonomously.

The 1990 Americans with Disabilities Act enacted a conceptual shift in the meaning of 'disability.' Rather than defining 'disability' as a disadvantageous physical or mental deficit of persons, it codifies the understanding of 'disability' as a defective state of society which disadvantages these persons. In contrast, the standard medical model incorrectly conceptualizes disabled persons as biologically inferior, and thus confines them to the role of recipients of benevolence or care. Turning to an ethic of caring yields counter-intuitive results that conflict with the conceptual apparatus of the ADA. It is argued that in order to liberate social thought from this medical model and thus move the disabled from being socially marginalized to being socially enabled, one must re-conceptualize current practice by adopting the ADA's conceptual framework.

In Roper v. Simmons (2005) the United States Supreme Court announced a paradigm shift in jurisprudence. Drawing specifically on mounting scientific evidence that adolescents are qualitatively different from adults in their decision-making capacities, the Supreme Court recognized that adolescents are not adults in all but age. The Court concluded that the overwhelming weight of the psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than adult persons. The Supreme Court further solidified its position regarding adolescents as less than fully mature and responsible decisionmakers in Graham v. Florida (2010) and Miller v. Alabama (2012). In each case, the Court concluded that the scientific evidence does not support the conclusion that children under 18 years of age possess adult capacities for personal agency, rationality, and mature choice. This study explores the implications of the Supreme Court decisions in Roper v. Simmons, Graham v. Florida, and Miller v. Alabama for the "mature minor" standard for medical decision making. It argues that the Supreme Court's holdings in Roper, Graham, and Miller require no less than a radical reassessment of how healthcare institutions, courts of law, and public policy are obliged to regard minors as medical decisionmakers. The "mature minor" standard for medical decision making must be abandoned.

In a recent critique of informed consent, Robert Veatch argues that the practice is in principle unable to attain the goals for which it was developed. We argue that Veatch's focus on the theoretical impossibility of determining patients' best interests is misapplied to the practical discipline of medicine, and that he wrongly assumes that the patient-physician communication fails to provide the knowledge needed to insure the patient's best interests. We further argue that Veatch's suggested alternative, value-based patient-professional pairing, is, on his own terms, impossible to implement. Finally, we reexamine the philosophical and practical justifications for informed consent and conclude that the practice should be retained.

This paper discusses attempts to define health within a public policy arena and practical and conceptual difficulties that arise. An Australian Aboriginal definition of health is examined. Although there are certain difficulties of translation, this definition is prominent in current Australian health policy and discourse about health. The definition can be seen as broadly holistic in comparison to other holistic definitions such as that of the World Health Organization. The nature of this holism and its grounding within the context of Aboriginal Australia is discussed. In particular, its implications for the phenomenon of medicalization, which may be associated with a holistic notion of health, is critically explored, as is the link of notions of health to culture and the question of the possibility of a universal definition of health. The question of to what extent a definition of health is inspirational or operational is also raised.

In Defending Life: A Moral and Legal Case Against Abortion Choice (2007) and an earlier article in this journal, “Defending Abortion Philosophically”(2006), Francis Beckwith argues that fetuses are, from conception, prima facie wrong to kill. His arguments are based on what he calls a “metaphysics of the human person” known as “The Substance View.” I argue that Beckwith’s metaphysics does not support his abortion ethic: Moral, not metaphysical, claims that are part of this Substance View are the foundation of the argument, and Beckwith inadequately defends these moral claims. Thus, Beckwith’s arguments do not provide strong support for what he calls the “pro-life” view of abortion.

The Catholic Church in the United States provides extensive health care service through its more than 600 health facilities. The Church, on the basis of its moral teaching, sees health care as a basic human right and supports universal coverage. At the same time, the Church considers abortion morally wrong and opposes coverage of abortion as a health service in a national health plan. Mandated coverage of abortion would violate the moral commitments of Catholic hospitals and the consciences of Catholics who would be required to financially support provision of abortion services.

Rights to life for unborn humans and to abortion with impunity are incompatible. This observation by the German legal philosopher Norbert Hoerster contains a fundamental criticism of the state regulation on abortion in Germany. The regulation regards abortion as unlawful, but declines to prosecute if the abortion is conducted within the first three months of pregnancy and the pregnant woman received counseling at least three days prior to terminating the pregnancy. In contrast to the German legislature, Hoerster is in favor of setting the beginning of a right to life at birth. With this suggestion and the consequent demand for a general legalization of abortion, Hoerster himself has become the target of harsh criticism. The following article analyzes Hoerster's position and that of his opponents against the background of the current abortion debate in Germany. The consequences for dealing with the handicaps of Hoerster's suggested regulations will also be addressed.

The debate over surgical abortion is certainly one of the most divisive in ethical discourse and for many it seems interminable. However, this paper argues that a primary reason for this is confusion with regard to what issues are actually under dispute. When looking at an entrenched and articulate figure on one side of the debate, Peter Singer, and comparing his views with those of his opponents, one finds that the disputed issue is actually quite a narrow one: the moral status of potential persons. Finding this common ground clears the conceptual space for a fruitful argument: the thesis of which is that most, including Singer, who argue that potential persons do not have full personal moral status fail to make the necessary distinction between natural potential (which confers moral status) and practical potential (which admittedly does not).

This paper reviews the practice of late abortion in China and summarizes the arguments for morally justifying the ‘one couple, one child’ policy.

Discussions regarding abortion are often misguided and confused. This paper critically examines the extreme liberal view, which argues that neither the fetus, at any stage of development, nor the young infant has a right to life. It focuses on the general argumentative strategy employed by a number of philosophers in arriving at an extreme liberal view. An evaluative critique of an extreme liberal view is offered as a step toward clarifying and expanding upon the abortion debate.

Notwithstanding the question of whether abortion is generally or exceptionally a legitimate means of family planning, it is basically agreed that abortion is not justifiable without free and informed consent of the pregnant woman. However, if abortion is held by the legislature to be a “ground of justification” (i.e., a far-reaching exception to criminal liability), is it true that abortion may also be carried out for the benefit of a pregnant woman who is not able to give free and informed consent? Should a substituted-judgment approach be applied in cases where the woman is incompetent to decide? Or should the pregnant woman's relatives' interests be taken into account exclusively? The author tries to answer these questions, which were tackled by the Austrian Supreme Court in a recent case.

I challenge the idea that the argument from potential (AFP) represents a valid moral objection to abortion. I consider the form of AFP that was defended by Hare, which holds that abortion is against the interests of the potential person who is prevented from existing. My reply is that AFP, though not unsound by itself, does not apply to the issue of abortion. The reason is that AFP only works in the cases of so-called same number and same people choices, but it falsely presupposes that abortion is such a kind of choice. This refutation of AFP implies that (1) abortion is not only morally permissible but sometimes even morally mandatory and (2) abortion is morally permissible even when the potential person’s life is foreseen to be worth living.

Abortion critics have argued that one should err on the side of life and prohibit abortion since the status of the fetus is uncertain. David Boonin has criticized this precautionary argument, but his criticism has been ignored. The aim is to elaborate on the precautionary argument by responding to Boonin’s criticism. Boonin considers three versions of the precautionary argument—the disaster avoidance argument, the maximin argument, and the expected utility argument; yet all three are judged unsuccessful for the same reasons: they lead to unacceptable implications, they lead to conclusions that are too weak, and they undermine the integrity of moral reasoning. I respond to this criticism by arguing that one can avoid unacceptable implications by considering a criterion of realism, that the weaker conclusions are rather an advantage, and that the application of the precautionary principle makes room for considerations which maintain the integrity of moral reasoning. I also consider some criticism beyond Boonin’s objections.

The epistemological and sociological consequences of post-modernity include the inability to show moral strangers, in terms they can see as binding, the moral wrongness of activities such as abortion. Such activities can be perceived as morally disordered within a content-full moral narrative, but not outside of the context it brings. Though one can salvage something of the Enlightenment project of justifying a morality that can bind moral strangers, one is left with moral and metaphysical views that can be recognized as impoverished and incomplete by those who live their lives within the embrace of a content-full moral narrative. The cardinal dualism of post-modernity is not that which separates mind from body, but the gulf between the morality binding moral strangers and that binding moral friends.

The variety of general issues and particular controversies in biomedical ethics can be understood as reflecting a deeper unity than normally supposed. The principle of plenitude and the paradigm of the "chain of Being" form the tie among the phenomena. They are defined, and their presence is tracked especially through some of the ideas and language in the debate about the ethics of abortion.

One common objection to fetal tissue transplantation (FTT) is that, if it were to become a standard form of treatment, it would encourage or entrench the practice of abortion. This claim is at least factually plausible, although it cannot be definitively established. However, even if true, it does not constitute a compelling ethical argument against FTT. The harm allegedly brought about by FTT, when assessed by widely accepted nonconsequentialist criteria, has limited moral significance. Even if FTT would cause more abortions to be performed, and abortion is taken to be a serious moral wrong, this is not sufficient in itself to make FTT wrong.

Joseph Boyle raises important questions about the place of the double-effect exception in absolutist moral theories. His own absolutist theory (held by many, but not all, Catholic moralists), which derives from the principles that fundamental human goods may not be intentionally violated, cannot dispense with such exceptions, although he rightly rejects some widely held views about what they are. By contrast, Kantian absolutist theory, which derives from the principle that lawful freedom must not be violated, has a corollary – that it is a duty, where possible, to coerce those who try to violate lawful freedom – which makes superfluous many of the double-effect exceptions Boyle allows. Other implications of the two theories are contrasted. Inter alia, it is argued that, in Boyle's theory, that a violation of a fundamental human good can be viewed as a cost proportionate to a benefit obtained, cannot yield a double-effect exception to the prohibition of intentionally violating that good, because paying a cost cannot be unintentional.

If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain one's moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate.

Central concepts and consensus views in clinical ethics are marked by instability. The papers in this number of the Journal take up two such central concepts, quality of life and moral status, and two such consensus views, that germ-line gene transfer should not be undertaken for the purposes of enhancement of human traits and that the ethical obligation of physicians to treat HIV-infected patients rests on consent of the physician. One outcome of these philosophical investigations is that these two concepts and consensus views are less stable than one might have thought. I explore the possibility of generalizing this outcome in a reflection on clinical ethics as the management of instability and incompleteness, including the instability and incompleteness of clinical ethics itself. In the course of this reflection I liken clinical ethics to abstract expressionism in mid-twentieth century Western art.

Kevin Wildes has recently argued in the Journal that Albert Jonsen's model of casuistry is ill-suited to a secular world context, because this model is rooted in a particular history and because of the moral pluralism of contemporary society in which a content-specific method of moral reasoning cannot readily be deployed. Contra Wildes, two arguments are offered. First, casuistry is not tied exclusively to Roman Catholic theology; casuistry also has deep roots in Classical thought, roots that Jonsen and Toulmin underscore. Second, the context of Roman Catholic theology can be distinguished from the method of casuistry, permitting that method to be deployed successfully in morally pluralistic contexts.

Un modele ethique a ete etabli afin de respecter les interets des enfants et informer les parents et les cliniciens sur le choix d'un traitement des enfants malades, equilibrer les avantages et les inconvenients et selectionner le traitement le plus approprie a l'enfant

The Oregon Basic Health Services Act of 1989 seeks to establish universal access to basic medical care for all currently uninsured Oregon residents. To control the increasing cost of medical care, the Oregon plan will restrict funding according to a priority list of medical interventions. The basic level of medical care provided to residents with incomes below the federal poverty line will vary according to the funds made available by the Oregon legislature. A rationing plan such as Oregon's which potentially excludes medically necessary procedures from the basic level of health care may be just, for the right to publically-sponsored medical care is restricted by opposing rights of private property. However, the moral acceptability of the Oregon plan cannot be determined in the absence of knowing the level of resources to be provided. Finally, Oregon to date has failed to include the individuals being rationed in discussions as to how the scarce resources are to be distributed.

Donum Vitae argues that, by failing to respect the connection between the conjugal act and procreation, in vitro fertilization – even in the homologous or “simple case”, where both gametes come from a married couple and the resulting embryo is transferred to the wife – shows itself to be morally unacceptable. On the other hand, the document refers approvingly to other technological interventions which “facilitate” or “assist” the conjugal act in achieving its objective. Although none of the latter interventions are mentioned by name, the recently developed gamete intrafallopian transfer (GIFT) and certain associated techniques have found favor with many orthodox Roman Catholic thinkers, as well with some church authorities. The present article explores this situation in the Catholic moral tradition, and offers reasons for believing that, given relevantly similar conditions, if GIFT is morally acceptable so also is homologous IVF-ET.

KIE Morreim introduces six articles that evaluate, criticize, and project future developments in the United States health care system. The articles, are (1) "Unhealthy health care costs," by Jack K. Shelton and Julia Mann Janosi; (2) "Universal health care coverage -- pitfalls and promise of an employment-based approach," by Peter Budetti; (3) "Equity, autonomy, and efficiency: what health care system should we have?," by Paul T. Menzel; (4) "Dying in 559 beds: efficiency, 'best buy', and the ethics of standardization in national health care," by Margaret P. Battin; (5) "An ethical framework for rationing health care," by Nancy S. Jecker and Robert A. Pearlman; and (6) "Justice and the moral acceptability of rationing medical care: the Oregon experiment," by Robert M. Nelson and Theresa Drought.

Recent debates have led some to question the legitimacy of physicians refusing to provide legally permissible services for reasons of conscience. In this paper, I will explore the question of whether medical professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all medical services. I will argue that they do not. I will also argue for an approach to dealing with intractable moral disagreements between patients and physicians that gives both parties veto power with regards to participation. Finally, I will respond to three objections to allowing physicians broad freedom to act on their consciences: such allowances would violate the conscience of the patient, would lead to unfairness, and would thwart important societal goals.

Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss a few of the proposed solutions to the problem and conclude with an argument in support of our preferred course of action. In this article we argue for compulsory licensing of essential AIDS medications in the current conditions of public health emergency. We argue on broadly consequentialist grounds that compulsory licensing is preferable both morally and pragmatically to the alternatives, notably the currently offered price cuts and drug donation schemes.

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published in March of 1983 its Report, Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services. Concluding that there are "ethical obligations" on behalf of society which are balanced by individual obligations, the Report provides an ethical framework for ensuring "ultimate responsibility" of the Federal government to arrange for equitable access to health and to a fair share of cost. In doing so the Report neither makes justice nor beneficence the prime moral principle in public health care, it rather calls for a common sense approach in "approximating adequacy". But how to define equality without creating uniformity in a society rich in its diversity, including attitudes towards health? KIE Sass discusses the ethical framework adopted by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its March 1983 report, Securing Access to Health Care. He commends the commission for choosing a "common sense" approach to determining an equitable public policy for health care resource allocation rather than an approach based on selecting either justice or beneficence as the prime value.

In this article, I offer an abridged reconstruction of the foundational elements of Confucian moral commitments, which, I will argue, still provide the background moral substance for moral reflection in mainland China, Hong Kong, Taiwan, Singapore, and Korea. The essay presents implications of Confucianism for establishing an appropriate health care system and critically assesses the features of current health polices in mainland China, Hong Kong, and Singapore. The goal is to offer a family-oriented, non-individualist account of resource allocation that takes family authority and responsibility seriously.

Norman Daniels’s theory of health justice is the most comprehensive and systematic such theory we have. In one of the few articles published so far on Daniels’s new book, Just Health, Benjamin Sachs argues that Daniels’s core “principle of equality of opportunity does not do the work Daniels needs it to do.” Yet Sachs’s objections to Daniels’s framework are deeply flawed. Where these arguments do not rely on significant misreadings of Daniels, they ignore sensible strands in Just Health that considerably dull their force. After disarming Sachs’s arguments against Daniels’s theory, I explain why I agree with Sachs’s conclusion: Daniels’s equality of opportunity-based account of health justice rests on shaky foundations.

In addressing bioethical issues at the beginning of human life, such as abortion, in vitro fertilization, and embryonic stem cell research, one primary concern regards establishing when a developing human embryo or fetus can be considered a person. Thomas Aquinas argues that an embryo or fetus is not a human person until its body is informed by a rational soul. Aquinas's explicit account of human embryogenesis has been generally rejected by contemporary scholars due to its dependence upon medieval biological data, which has been far surpassed by current scientific research. A number of scholars, however, have attempted to combine Aquinas's basic metaphysical account of human nature with current embryological data to develop a contemporary Thomistic account of a human person's beginning. In this article, I discuss two recent interpretations in which it is argued that a human person does not begin to exist until a fetus has developed a functioning cerebral cortex.