Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To continue (...) the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)

Poems and Commentaries by Amit Majmudar, Kelly Sievers, Bonnie Salomon, David Watts, Paul Boor, and Beth Lown.Jack Coulehan, Editor.

In his story entitled "Toenails," the surgeon Richard Selzer (1982) warns readers that total immersion in medicine is wrongheaded. Rather, to ensure their own health, doctors should discover other passions that permit them periodically to disconnect from medical practice. Selzer's surgeon character devotes his Wednesday afternoons to the public library, where he joins "a subculture of elderly men and women who gather … to read or sleep beneath the world's newspapers" (p. 69). Among these often eccentric personages is Neckerchief, an (...) arthritic man in his 80s who suffers from severe foot pain. His toenails, never trimmed because of his inability to reach them, have grown so long that they curve beneath his toes and .. (shrink)

Hope helps alleviate suffering. In the case of terminal illness, recent experience in palliative medicine has taught physicians that hope is durable and often thrives even in the face of imminent death. In this article, I examine the perspectives of philosophers, theologians, psychologists, clinicians, neuroscientists, and poets, and provide a series of observations, connections, and gestures about hope, particularly about what I call “deep hope.” I end with some proposals about how such hope can be sustained and enhanced at the (...) end of life. Studies of terminally ill patients have revealed clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, lightheartedness, uplifting memories, and affirmation of personal worth enhance hope, while uncontrollable pain and discomfort, abandonment and isolation, and devaluation of personhood suppress hope. I suggest that most of these factors can be modulated by good medical care, utilizing basic interpersonal techniques that demonstrate kindness, humanity, and respect. (shrink)

Robert Coles' sentiment characterizes well the moral tenor of medical education today. Indeed, medical educators are frequently “seized by spasms of genuine moral awareness,” as they try to cope with the massive social and economic problems that face medical schools and teaching hospitals. The perception among educators that we currently fail to adequately teach several core aspects of doctoring, including professional values and behavior, constitutes one such spasm. In this case, the proposed remedy has generated considerable enthusiasm, but whether the (...) “core competencies” curriculum will make a difference, or simply “accommodate to the prevailing rhythms of the world we inhabit,” remains to be seen. (shrink)

What makes a biological entity an individual? Jack Wilson shows that past philosophers have failed to explicate the conditions an entity must satisfy to be a living individual. He explores the reason for this failure and explains why we should limit ourselves to examples involving real organisms rather than thought experiments. This book explores and resolves paradoxes that arise when one applies past notions of individuality to biological examples beyond the conventional range and presents an analysis of identity and (...) persistence. The book's main purpose is to bring together two lines of research, theoretical biology and metaphysics, which have dealt with the same subject in isolation from one another. Wilson explains an alternative theory about biological individuality which solves problems which cannot be addressed by either field alone. He presents a more fine-grained vocabulary of individuation based on diverse kinds of living things, allowing him to clarify previously muddled disputes about individuality in biology. (shrink)

Bioregionalists have championed the utility of the concept of the watershed as an organizing framework for thought and action directed to understanding and implementing appropriate and respectful human interaction with particular pieces of land. In a creative analogue to the watershed, permaculturist Arthur Getz has recently introduced the term “foodshed” to facilitate critical thought about where our food is coming from and how it is getting to us. We find the “foodshed” to be a particularly rich and evocative metaphor; but (...) it is much more than metaphor. Like its analogue the watershed, the foodshed can serve us as a conceptual and methodological unit of analysis that provides a frame for action as well as thought. Food comes to most of us now through a global food system that is destructive of both natural and social communities. In this article we explore a variety of routes for the conceptual and practical elaboration of the foodshed. While corporations that are the principal beneficiaries of a global food system now dominate the production, processing, distribution, and consumption of food, alternatives are emerging that together could form the basis for foodshed development. Just as many farmers are recognizing the social and environmental advantages to sustainable agriculture, so are many consumers coming to appreciate the benefits of fresh and sustainably produced food. Such producers and consumers are being linked through such innovative arrangements as community supported agriculture and farmers markets. Alternative producers, alternative consumers, and alternative small entrepreneurs are rediscovering community and finding common ground in municipal and community food councils. Recognition of one's residence within a foodshed can confer a sense of connection and responsibility to a particular locality. The foodshed can provide a place for us to ground ourselves in the biological and social realities of living on the land and from the land in a place that we can call home, a place to which we are or can become native. (shrink)

Etiquette and other merely formal normative standards like legality, honor, and rules of games are taken less seriously than they should be. While these standards are not intrinsically reason-providing in the way morality is often taken to be, they also play an important role in our practical lives: we collectively treat them as important for assessing the behavior of ourselves and others and as licensing particular forms of sanction for violations. This chapter develops a novel account of the normativity of (...) formal standards where the role they play in our practical lives explains a distinctive kind of reason to obey them. We have this kind of reason to be polite because etiquette is important to us. We also have this kind of reason to be moral because morality is important to us. This parallel suggests that the importance we assign to morality is insufficient to justify it being substantive. (shrink)

This paper develops a hybridization of Newcomb’s Problem and the Frustrater (Spencer and Wells 2019 paper ‘Why take both boxes?’), underscoring how difficult it is to reconcile the rationality of taking both boxes in Newcomb’s Problem and the rationality of taking the envelope in the Frustrater.

I distinguish two ways of developing anti-exceptionalist approaches to logical revision. The first emphasizes comparing the theoretical virtuousness of developed bodies of logical theories, such as classical and intuitionistic logic. I'll call this whole theory comparison. The second attempts local repairs to problematic bits of our logical theories, such as dropping excluded middle to deal with intuitions about vagueness. I'll call this the piecemeal approach. I then briefly discuss a problem I've developed elsewhere for comparisons of logical theories. Essentially, the (...) problem is that a pair of logics may each evaluate the alternative as superior to themselves, resulting in oscillation between logical options. The piecemeal approach offers a way out of this problem andthereby might seem a preferable to whole theory comparisons. I go on to show that reflective equilibrium, the best known piecemeal method, has deep problems of its own when applied to logic. (shrink)

Anti-realism about the foundations of logic are curiously absent from the literature. This is especially striking given natural analogies with moral anti-realis.

This is an opinionated overview of the Frege-Geach problem, in both its historical and contemporary guises. Covers Higher-order Attitude approaches, Tree-tying, Gibbard-style solutions, and Schroeder's recent A-type expressivist solution.

Why do promises give rise to reasons? I consider a quadruple of possibilities which I think will not work, then sketch the explanation of the normativity of promising I find more plausible—that it is constitutive of the practice of promising that promise-breaking implies liability for blame and that we take liability for blame to be a bad thing. This effects a reduction of the normativity of promising to conventionalism about liability together with instrumental normativity and desire-based reasons. This is important (...) for a number of reasons, but the most important reason is that this style of account can be extended to account for nearly all normativity—one notable exception being instrumental normativity itself. Success in the case of promises suggests a general reduction of normativity to conventions and instrumental normativity. But success in the cases of promises is already quite interesting and does not depend essentially the general claim about normativity. (shrink)

This is a theoretical treatment of the term "Sha Zhu Pan" (杀猪盘) in Chinese, which translates to “Pig-Butchering” in English. The article critically examines the propagation and validation of "Pig Butchering," an animal metaphor, and its implications for the dehumanisation of victims of online fraud across various discourses. The study provides background information about this type of fraud before investigating its theoretical foundations and linking its emergence to the dehumanisation of fraud victims. The analysis highlights the disparity between academic literature, (...) subjected to rigorous peer-review processes, and sensationalised narratives prevalent in the media. While academic works subject "pig butchering" to critical scrutiny and refrain from endorsing derogatory terms to depict fraud victims, numerous media outlets employ this term uncritically, further worsening the predicament of these victims. "Pig butchering" is firmly rooted in the concept of dehumanisation, and this article underscores how language moulds perceptions of fraud and behaviour, extending to the development of preventive strategies. The role of law enforcement agencies in generating and disseminating materials is also a central theme, emphasising their responsibility as trusted sources of information. We suggest that these agencies should adopt non-victim shaming language to encourage victims to report crimes and alleviate the stigma attached to victimisation. Additionally, the article offers valuable cross-cultural insights by comparing metaphors from Chinese and Nigerian contexts. This comparative analysis enriches our comprehension of the global dimensions of online fraud and its cultural diversities, highlighting the substantial impact of language on perceptions and behaviours. We advocate for a departure from victim-blaming tendencies perpetuated by select media outlets, urging a more compassionate and accurate portrayal of those affected by online fraud. We, therefore, call for a more empathetic and accurate portrayal of individuals affected by online fraud, aligning with the broader objective of promoting understanding and support for these victims. (shrink)

I argue that we can and should extend Tarski's model-theoretic criterion of logicality to cover indefinite expressions like Hilbert's ɛ operator, Russell's indefinite description operator η, and abstraction operators like 'the number of'. I draw on this extension to discuss the logical status of both abstraction operators and abstraction principles.

Moore’s paradox, the infamous felt bizarreness of sincerely uttering something of the form “I believe grass is green, but it ain’t”—has attracted a lot of attention since its original discovery (Moore 1942). It is often taken to be a paradox of belief—in the sense that the locus of the inconsistency is the beliefs of someone who so sincerely utters. This claim has been labeled as the priority thesis: If you have an explanation of why a putative content could not be (...) coherently believed, you thereby have an explanation of why it cannot be coherently asserted. (Shoemaker 1995). The priority thesis, however, is insufficient to give a general explanation of Moore-paradoxical phenomena and, moreover, it’s false. I demonstrate this, then show how to give a commitment-theoretic account of Moore Paradoxicality, drawing on work by Bach and Harnish. The resulting account has the virtue of explaining not only cases of pragmatic incoherence involving assertions, but also cases of cognate incoherence arising for other speech acts, such as promising, guaranteeing, ordering, and the like. (shrink)

Biology lacks a central organism concept that unambiguously marks the distinction between organism and non-organism because the most important questions about organisms do not depend on this concept. I argue that the two main ways to discover useful biological generalizations about multicellular organization--the study of homology within multicellular lineages and of convergent evolution across lineages in which multicellularity has been independently established--do not require what would have to be a stipulative sharpening of an organism concept.

Much current work in the social sciences seeks to understand the effects of trust and social capital on economic and political outcomes. However, the sources of trust remain unclear. In this article, the authors articulate a basic theory of the relationship between institutions and trust. The authors apply this theory to industrial districts, geographically concentrated areas of small firm production, which involve extensive cooperation in the production process. Changes in power relations affect patterns of production;the authors suggest that they also (...) have knock-on consequences for trust and cooperation among actors. (shrink)

I argue that in order to apply the most common type of criteria for logicality, invariance criteria, to natural language, we need to consider both invariance of content—modeled by functions from contexts into extensions—and invariance of character—modeled, à la Kaplan, by functions from contexts of use into contents. Logical expressionsshould be invariant in both senses. If we do not require this, then old objections due to Timothy McCarthy and William Hanson, suitably modified, demonstrate that content invariant expressions can display intuitive (...) marks of non-logicality. If we do require this, we neatly avoid these objections while also managing to demonstrate desirable connections of logicality to necessity. The resulting view is more adequate as a demarcation of the logical expressions of natural language. (shrink)

I defend normative subjectivism against the charge that believing in it undermines the functional role of normative judgment. In particular, I defend it against the claim that believing that our reasons change from context to context is problematic for our use of normative judgments. To do so, I distinguish two senses of normative universality and normative reasons---evaluative universality and reasons and ontic universality and reasons. The former captures how even subjectivists can evaluate the actions of those subscribing to other conventions; (...) the latter explicates how their reasons differ from ours. I then show that four aspects of the functional role of normativity---evaluation of our and others actions and reasons, normative communication, hypothetical planning, and evaluating counternromative conditionals---at most requires our normative systems being evaluatively universal. Yet reasonable subjectivist positions need not deny evaluative universality. (shrink)

In this article, I examine Adam Smith's theory of the ways individuals in society bridge social and biological difference. In doing so, I emphasize the divisive effects of gender, race, and class to see if Smith's account of social unity can overcome such fractious forces. My discussion uses the metaphor of “proximity” to mean both physical and psychological distance between moral actors and spectators. I suggest that education – both formal and informal in means – can assist moral judgment by (...) helping agents minimize the effects of proximity, and, ultimately, learn commonality where difference may otherwise seem overwhelming. This article uses the methods of the history of philosophy in order to examine an issue within contemporary discourse. While I seek to offer an authentic reading of Smith representative of his eighteenth-century perspective, I do so with an eye towards determining the extent to which Smith anticipated central issues in modern multiculturalism. (Published Online April 18 2006) Footnotes1 I would like to thank Luc Bovens, Kim Donehower, David Levy, Elizabeth Sund, and Leah M. McClimans, for their help on previous drafts of this article. (shrink)