The Nobel Laureate Illya Prigogine compares the recent breakthroughs in human biology to the major changes that occurred when the Neolithic period succeeded the Paleolithic, 12,000 years ago. Although there is disagreement about the meaning of these changes, most opposing views recognize that a “major transformation” took place. Some interpret the recent breakthroughs in neuroscience as the first step toward “our posthuman future” whereas others see the consequences of these achievements as the end of humankind. Genomics and neuroscience are the (...) main fields that, at this point, give rise to such a debate, some authors stating that neuroscience raises even greater anthropological and ethical challenges than does genomics. This article focuses on neuroscience. Its main object is to critically assess these diverging opinions on the impact of neuroscience and to determine whether both sides are not telling us something important about ourselves and how neuroscience could enlighten healthcare ethics. (shrink)

Dans l'univers des soins de santé, l'éthique doit se construire D à partir de l'expérience de la personne malade et s'adapter à elle. Mais de quelle éthique parle-t-on au juste? Sur les valeurs qui la fondent – l'autonomie, la bienfaisance, la non-malfaisance et la justice –, tout le monde semble s'entendre. Pourtant, à observer un groupe de médecins ou d'infirmières discuter d'une situation problématique, une autre conclusion s'impose : le rapport à l'éthique change selon la conception qu'on se fait de (...) la tâche clinique. Hubert Doucet, spécialiste reconnu, expose ici les principales théories de l'éthique clinique et cherche à les faire dialoguer, en convoquant au passage la pensée du philosophe Paul Ricoeur. Il en présente les fondements et le vocabulaire, s'attarde à son histoire et pose la résolution de problème au coeur de son action. Ce faisant, il apporte une contribution autant théorique que pratique à tous ceux qui, étudiants et professionnels, veulent en comprendre le sens et en tirer le meilleur parti dans le cadre de leur travail. (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.

BackgroundThe overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.MethodsThe qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal (...) of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.ResultsThe results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.ConclusionsThe participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed. (shrink)

Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically (...) on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation. (shrink)

More than 40 primary studies, and three recent systematic reviews and meta-analyses, have shown a clear association between pharmaceutical industry funding of clinical trials and pro-industry results. Industry sponsorship biases published scientific research in favour of the sponsors, a result of the strong interest commercial sponsors have in obtaining favourable results.Three proposed remedies to this problem are widely agreed upon among those concerned with the level of sponsorship bias: financial disclosure, reporting standards and trial registries. This paper argues that all (...) of these remedies either fail to address the mechanisms by which pharmaceutical companies’ sponsorship leads to biased results—design bias, multiple trials with predictable outcomes, fraud, rhetorical effects and publication bias—or else only inadequately address those mechanisms. As a result, the policies normally proposed for dealing with sponsorship bias are unable to eliminate it. Only completely separating public clinical research from pharmaceutical industry funding can eliminate sponsorship bias. (shrink)

Prior work on weakness of will has assumed that it is a thoroughly psychological phenomenon. At least, it has assumed that ordinary attributions of weakness of will are purely psychological attributions, keyed to the violation of practical commitments by the weak-willed agent. Debate has recently focused on which sort of practical commitment, intention or normative judgment, is more central to the ordinary concept of weakness of will. We report five experiments that significantly advance our understanding of weakness of will attributions (...) by showing that the ordinary concept of weakness of will is less thoroughly psychological than the philosophical debate has assumed. We begin by showing that a sizable minority of people attribute weakness of will even in the absence of a violated commitment (Experiment 1). We then show that weakness of will attributions are sensitive to two important non-psychological factors. First, for actions stereotypically associated with weakness of will, the absence of certain commitments often triggers weakness of will attributions (Experiments 2–4). Second, the quality of an action’s outcome affects the extent to which an agent is viewed as weak-willed: actions with bad consequences are more likely to be viewed as weak-willed (Experiment 5). Our most important finding is that the ordinary concept of weakness of will is sensitive to two non-psychological factors and is thus much broader than philosophers have thus far imagined. We conclude by suggesting a two-tier model that unites our findings with traditional philosophical theorizing about weakness of will. (shrink)

Existential phenomenologists hold that the two most basic forms of intelligent behavior, learning, and skillful action, can be described and explained without recourse to mind or brain representations. This claim is expressed in two central notions in Merleau-Ponty's Phenomenology of Perception: the intentional arc and the tendency to achieve a maximal grip. The intentional arc names the tight connection between body and world, such that, as the active body acquires skills, those skills are “stored”, not as representations in the mind, (...) but as dispositions to respond to the solicitations of situations in the world. A phenomenology of skill acquisition confirms that, as one acquires expertise, the acquired know-how is experienced as finer and finer discriminations of situations paired with the appropriate response to each. Maximal grip names the body's tendency to refine its responses so as to bring the current situation closer to an optimal gestalt. Thus, successful learning and action do not require propositional mental representations. They do not require semantically interpretable brain representations either.Simulated neural networks exhibit crucial structural features of the intentional arc, and Walter Freeman's account of the brain dynamics underlying perception and action is structurally isomorphic with Merleau-Ponty's account of the way a skilled agent is led by the situation to move towards obtaining a maximal grip. (shrink)

For Descartes, knowledge exists as ideas in the mind that represent the world. In a radical critique, Hubert Dreyfus and Charles Taylor argue that knowledge consists of much more than the representations we formulate in our minds. They affirm our direct contact with reality—both the physical and the social world—and our shared understanding of it.

Abstract: This paper considers the question of whether it is possible to be mistaken about the content of our first-order intentional states. For proponents of the rational agency model of self-knowledge, such failures might seem very difficult to explain. On this model, the authority of self-knowledge is not based on inference from evidence, but rather originates in our capacity, as rational agents, to shape our beliefs and other intentional states. To believe that one believes that p, on this view, constitutes (...) one's belief that p and so self-knowledge involves a constitutive relation between first- and second-order beliefs. If this is true, it is hard to see how those second-order beliefs could ever be false.I develop two counter-examples which show that despite the constitutive relation between first- and second-order beliefs in standard cases of self-knowledge, it is possible to be mistaken, and even self-deceived, about the content of one's own beliefs. These counter-examples do not show that the rational agency model is mistaken—rather, they show that the possibility of estrangement from one's own mental life means that, even within the rational agency model, it is possible to have false second-order beliefs about the content of one's first-order beliefs. The authority of self-knowledge does not entail that to believe that one believes that p suffices to make it the case that one believes that p. (shrink)

Philosophers who have written on modesty have largely agreed that it is a virtue, and that it therefore has an important psychological component. Mere modest behavior, it is often argued, is actually false modesty if it is generated by the wrong kind of mental state. The philosophical debate about modesty has largely focused on the question of which kind of mental state—cognitive, motivational, or evaluative—best captures the virtue of modesty. We therefore conducted a series of experiments to see which philosophical (...) account matches the folk concept of modesty. Surprisingly, we found that the folk concept is primarily behavioral. This leads us to argue that modesty may not be a virtue, but that if it is none of the extant philosophical accounts have properly explained why. (shrink)

McDowell's claim that "in mature human beings, embodied coping is permeated with mindedness",1 suggests a new version of the mentalist myth which, like the others, is untrue to the phenomenon. The phenomena show that embodied skills, when we are fully absorbed in enacting them, have a kind of non-mental content that is non-conceptual, non-propositional, non-rational and non-linguistic. This is not to deny that we can monitor our activity while performing it. For solving problems, learning a new skill, receiving coaching, and (...) so forth, such monitoring is invaluable. But monitoring what we are doing as we are doing it degrades performance to at best competence. On McDowell's view, there is no way to account for such a degradation in performance since the same sort of content would be involved whether we were fully absorbed in or paying attention to what we were doing. McDowell claims that it is an advantage of his conceptualism that it avoids any foundationalist attempt to build up the objective world on the basis of an indubitable Given or any other ground-floor experience. And, indeed, if the world is all that is the case and our minds are unproblematically open to it, all experience is on the same footing. But one must distinguish motor intentionality, and the interrelated solicitations our coping body is intertwined with, from conceptual intentionality and the world of propositional structures it opens onto. The existential phenomenologist can then agree with McDowell in rejecting traditional foundationalisms, while yet affirming and describing the ground-floor role of motor intentionality in providing the support on which all forms of conceptual intentionality are based. (shrink)

It is by now no secret that some scientific articles are ghost authored – that is, written by someone other than the person whose name appears at the top of the article. Ghost authorship, however, is only one sort of ghosting. In this article, we present evidence that pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles. Ghost management allows the pharmaceutical industry (...) to shape the literature in ways that serve its interests. This article aims to reinforce and expand publication ethics as an important area of concern for bioethics. Since ghost-managed research is primarily undertaken in the interests of marketing, large quantities of medical research violate not just publication norms but also research ethics. Much of this research involves human subjects, and yet is performed not primarily to increase knowledge for broad human benefit, but to disseminate results in the service of profits. Those who sponsor, manage, conduct, and publish such research therefore behave unethically, since they put patients at risk without justification. This leads us to a strong conclusion: if medical journals want to ensure that the research they publish is ethically sound, they should not publish articles that are commercially sponsored. (shrink)

MICHAEL WHEELER Cambridge, MA: MIT Press, 2005432 pages, ISBN: 0262232405 (hbk); $35.001.When I was teaching at MIT in the 1960s, students from the Artificial Intelligence Laboratory would come to...

A Critique of Artificial Reason Hubert L. Dreyfus . HUBERT L. DREYFUS What Computers Still Can't Do Thi s One XZKQ-GSY-8KDG What. WHAT COMPUTERS STILL CAN'T DO Front Cover.

It is generally argued that if the wave-function in the de Broglie–Bohm theory is a physical field, it must be a field in configuration space. Nevertheless, it is possible to interpret the wave-function as a multi-field in three-dimensional space. This approach hasn’t received the attention yet it really deserves. The aim of this paper is threefold: first, we show that the wave-function is naturally and straightforwardly construed as a multi-field; second, we show why this interpretation is superior to other interpretations (...) discussed in the literature; third, we clarify common misconceptions. (shrink)

In previous work I urged that the perceptual experience we rational animals enjoy is informed by capacities that belong to our rationality, and - in passing - that something similar holds for our intentional action. In his Presidential Address, Hubert Dreyfus argued that I thereby embraced a myth, "the Myth of the Mental". According to Dreyfus, I cannot accommodate the phenomenology of unreflective bodily coping, and its importance as a background for the conceptual capacities exercised in reflective intellectual activity. (...) My paper responds to this accusation. Dreyfus misreads my invocation of Aristotle, and is thereby led to suppose, wrongly, that I conceive rationality as detached, brought to bear on practical predicaments from a standpoint other than one of immersion in them. I urge that even unreflective bodily coping, on the part of rational animals, is informed by their rationality. Dreyfus mentions Heidegger’s distinction, which is picked up by Gadamer, between being oriented towards the world and merely inhabiting an environment. But he sets it aside, whereas it is crucial for the issue between us. Engaged bodily coping involves responsiveness to affordances, and responsiveness to affordances on the part of rational animals belongs to their relation to the world. I explain how the idea that conceptual capacities are actualized in our perceptual experience is connected with the thought that our perceptual experience opens us to the world. Finally, I suggest that the real myth in this area is the conception of rationality underlying Dreyfus’s resistance to my picture. (shrink)

The article starts by offering a definition of fake kindness focused on the dissociation between the behavioural components of kindness and the intent to sincerely pay some heed to the needs of others. Using the sociological theory of Pierre Bourdieu, this definition is then used to articulate how fake kindness can be conceptualized as a specific form of symbolic violence. Such a view allows explanations as to how and why the prevalence and effectiveness of fake kindness vary according to microsociological (...) norms and values. The generic definition and conceptualization of fake kindness as a form of symbolic violence are then used to discuss how nursing’s enthrallment with the concept of caring and its operationalization as a moral compass likely fosters the growth of fake kindness within the profession. In this view, the institutional enforcement of propriety and well-behaved professionalism is more likely to lead to toxic environments than to healthy workplaces. We hope that being able to understand how professional norms and institutional rules are sometimes turned into social tools to enforce obedience and existing hierarchies can empower victims of those phenomena to resist them more effectively. It might also contribute to increasing the awareness of well-meaning nurses or people in position of authority who have been socialized in environments where fake kindness is normalized. (shrink)

The creation and consolidation of a memory can rest on the integration of any number of disparate features and contexts. How is it that these bind together to form a coherent memory? This book offers an unrivalled overview of one of the most debated hotspots of modern memory research: binding, and will instigate innovative and pioneering ideas for future research.

The war on drugs is widely criticized as unjust. The idea that the laws prohibiting drugs are unjust can easily lead to the conclusion that those laws do not deserve our respect, so that our only moral reason to obey them flows from a general moral obligation to obey the law, rather than from anything morally troubling about drug use itself. In this paper, I argue that this line of thinking is mistaken. I begin by arguing that the drug laws (...) are indeed unjust. However, so long as they remain prohibited, I argue that we have strong moral reasons to avoid drug use. First, drug users are partly responsible for the violent and exploitative conditions in which many drugs are produced and distributed. Second, the unequal ways in which drug laws are enforced make drug use by many an unethical exercise of privilege. These reasons do not depend on the existence of a general moral obligation to obey the law; we ought to refrain from illegal drug use even if prohibition is unjust and even if we have no general obligation to obey the law. In fact, drug laws turn out to represent an interesting exception case within the broader debate about this obligation, and I argue that it is the very injustice of the law that generates the reasons not to violate it. (shrink)

The ArgumentDevelopments in theoretical physics, even when they are revolutionary for physics, usually donotenter public awareness. The reaction to the special relativity theory is one of the few exceptions. The conceptual changes brought by special relativity to our notions of space and time, induced a lively debate not only within intellectual circles but in many strata of the educated middle class. In this article, I focus on a particular moment of public reaction to special and general relativity theory and to (...) its creator Albert Einstein. I try to paint a picture of the anti-Einstein campaign in Germany of 1920, with finer brush strokes than those applied previously by others. My aim is to embed the campaign into the cultural and political climate of the Weimar republic. Without leaving the realm of physics only a superficial understanding of what happened seems possible. My thesis is that the anti-Einstein-campaign was organized, and the physicists involved in it used, mainly in order to rally support for one of the German right-wing parties, the Deutschnationale Volkspartei. (shrink)

The effectiveness of complaint handling and service recovery policies in customer retention has been the focus of both scholars and service organizations. In the past decade, Justice Theory has provided the basis of the dominant theoretical framework for complaint management and service recovery. However, it does not explicitly address unfair trade practices, which constitute an ethical issue. Favorable outcomes in complaint handling may not be able to restore the reputation of a company and the potential harm perceived by consumers. Using (...) face-to-face interviews, this study applies Fairness Theory to explore the psychological responses of consumers in the post-complaint phase, particularly in ethical judgment. The findings suggest that an unfavorable outcome in the post-complaint stage leads to counterfactual thinking by the consumer about the consumer's state of well-being. The complaint must be due to the discretionary actions of the service provider whose accountability is assessed. Those harmful actions are then judged against an ethical standard. Explanations can reduce blame, and their effectiveness is moderated by outcome favorability but not ethical judgment. Favorable outcome, captured by "Would Perception," has only limited influence on Perceived Potential Harm (PPH), which is an important determinant of ethical judgment. This study makes both theoretical and practical contributions. It is the first study to validate Fairness Theory empirically and apply it to complaint handling as a complement of Justice Theory in the information and communication technology (ICT) service context. The study indicates that customers may condemn a service provider because of PPH even though the outcome is favorable. Unfair trade practices are what make customers hate ICT service providers. (shrink)

Celem artykułu jest pogłębiona analiza przyczyn i konsekwencji rozdwojenia sejmiku wiszeńskiego w 1597 r. z naciskiem na relacje polityczno-społeczne obejmujące teren dawnego województwa ruskiego oraz głównych politycznych aktorów zdarzeń: Stanisława Stadnickiego z Łańcuta, Stanisława Żółkiewskiego i Jana Zamoyskiego. Pomimo stosunkowo obfitego materiału źródłowego w postaci listów, protestacji i sejmowych diariuszy jedyna poważna próba zbadania tego tematu podjęta przez Jana Rzońcę okazała się dalece niewystarczająca, zawężając temat rozbicia sejmiku jedynie do obszaru wpływu na późniejsze obrady sejmu oraz ogólną kondycję państwa. Przeprowadzona (...) w artykule krytyczna analiza zachowanych źródeł pozwoliła w dużym stopniu zrekonstruować obrady tytułowego sejmiku, ustalić dokładne przyczyny jego rozbicia oraz powiązać zaszłe na nim zdarzenia z politycznym przesileniem, do którego doszło w województwie ruskim pod koniec roku 1597 w postaci lokalnego sojuszu Jana Zamoyskiego ze Stanisławem Stadnickim z Łańcuta. Poznanie kulis zawarcia powyższego porozumienia oraz powodów jego fiaska pozwoliło natomiast lepiej zrozumieć mechanizmy funkcjonowania stronnictwa kanclerskiego pod koniec XVI w. i stanu, w jakim się wówczas znalazło. W artykule podjęta została ponadto próba rozwikłania problemu uczestnictwa w sejmiku żołnierzy kwarcianych/prywatnych oraz zbadania ich rzeczywistego wpływu na obrady sejmiku w Wiszni. Bezrefleksyjnie przyjmowana do tej pory teoria personalnie obarczająca winą za rozbicie sejmiku hetmana polnego Stanisława Żółkiewskiego wydaje się co najmniej przesadzona, zupełnie pomijając własnowolność służących w wojsku żołnierzy oraz przysługujące im jako szlachcie prawa do uczestnictwa w życiu publicznym Rzeczypospolitej. (shrink)

This book is the first to provide a sustained, coherent analysis of Foucault's work as a whole. To demonstrate the sense in which Foucault's work is beyond structuralism and hermeneutics, the authors unfold a careful, analytical exposition of his oeuvre. They argue that during the of Foucault's work became a sustained and largely successful effort to develop a new method - "interpretative analytics" - capable of explaining both the logic of structuralism's claim to be an objective science and the apparent (...) validity of the hermeneutical counterclaim that the human sciences can proceed only by understanding the deepest meaning of the subject and his tradition. (shrink)

It is by now no secret that some scientific articles are ghost authored – that is, written by someone other than the person whose name appears at the top of the article. Ghost authorship, however, is only one sort of ghosting. In this article, we present evidence that pharmaceutical companies engage in the ghost management of the scientific literature, by controlling or shaping several crucial steps in the research, writing, and publication of scientific articles. Ghost management allows the pharmaceutical industry (...) to shape the literature in ways that serve its interests.This article aims to reinforce and expand publication ethics as an important area of concern for bioethics. Since ghost‐managed research is primarily undertaken in the interests of marketing, large quantities of medical research violate not just publication norms but also research ethics. Much of this research involves human subjects, and yet is performed not primarily to increase knowledge for broad human benefit, but to disseminate results in the service of profits. Those who sponsor, manage, conduct, and publish such research therefore behave unethically, since they put patients at risk without justification. This leads us to a strong conclusion: if medical journals want to ensure that the research they publish is ethically sound, they should not publish articles that are commercially sponsored. (shrink)