Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

Henri Bergson (1859-1941) was once the most famous philosopher in the world, but his reputation waned in the latter half of the 20th century. Barry Allen here makes the case for Bergson as a great philosopher, one whose thought has much to contribute to contemporary philosophical questions. Living in Time presents chapters on each of Bergson's four major works, explaining his theories of time, perception, memory, and panpsychic consciousness, his innovative concept of virtual existence, his objection to Darwin, his (...) controversy with Einstein, his philosophy of creative evolution, and his social philosophy of closed and open society. In particular Allen focusses on Bergson's powerful ideas on time. Classical arguments for determinism fallaciously apply spatial concepts to consciousness; once we take time seriously, which means acknowledging its reality as duration and its difference from space, Bergson showed that the arguments for determinism become insupportable. Bergson's ideas on time and evolution offer a comparison with Nietzsche, which Allen develops, exposing both philosophical concurrence and systematic difference. The book's conclusion discusses the question of Bergson and naturalism and summarizes the ontology of the virtual that emerges as a core part of Bergson's thought. (shrink)

Bringing together evolutionary biology, psychology, and philosophy, Henry Plotkin presents a new science of knowledge, one that traces an unbreakable link between instinct and our ability to know.

Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.The original essays in this ...

There is the world of ideas and the world of practice; the French are often for sup pressing the one and the English the other; but neither is to be suppressed. -Matthew Arnold The Function of Criticism at the Present Time From its inception, bioethics has confronted the need to reconcile theory and practice. At first the confrontation was purely intellectual, as writers on ethical theory (within phi losophy, theology, or other humanistic disciplines) turned their attention to topics from the (...) world of medical practice. Recently the confrontation has grown more intense. The ap pointment of clinical ethicists in hospitals and other health care settings is an accelerating trend in North America. Concomitantly, those institutions involved in training peo ple in clinical ethics have added organized exposure to the world of practice, in the form of placement requirements, to the normal academic course load. In common with other dis ciplines, bioethics has begun to see clinical training as a con dition of didactic theory and apprenticeship. (shrink)

This paper defends a realist interpretation of theories and a modest realism concerning the existence of quantities as providing the best account both of the logic of quantity concepts and of scientific measurement practices. Various operationist analyses of measurement are shown to be inadequate accounts of measurement practices used by scientists. We argue, furthermore, that appeals to implicit definitions to provide meaning for theoretical terms over and above operational definitions fail because implicit definitions cannot generate the requisite descriptive content. The (...) special case of establishing a temperature scale is examined to show that nonrealist accounts fail to provide insight into the theoretical connections that scientific laws postulate to hold among quantities. (shrink)

Vulnerability does not mean much for our contemporary morality. It is antithetical to our emphasis on individualism and rationality; it requires that we attend to the body and to our feelings. Yet only by recognizing the depth and breadth of our vulnerability can we affirm our humanity.

The internal language of a monoidal category yields simple proofs of results about a natural numbers object therein.

1. Introduction. Professor Nagel's account of the “cognitive status” of scientific theories has been attacked by P. K. Feyerabend [5] and M. B. Hesse [8] in terms of his alledgedly misguided distinction between experimental laws and theories. The difficulty lies, these critics agree, in Nagel's attempt to find a stable basis for scientific theories in an observational basis of experimental laws. Both Feyerabend and Hesse note the vacillation in Nagel's account of the stability of the meaning of experimental terms and (...) in his discussion of the status of observational as opposed to theoretical terms. They find Nagel too “positivistic” and see as a first step toward a more adequate account of scientific theories the abandonment of the theoretical-observational dichotomy as having more than a pragmatic significance. Nagel's discussion of the theoretical-observational dichotomy is, I agree, inadequate in certain respects. I shall, however, suggest a quite different remedy from those of Feyerabend and Hesse, one that depends neither on a phenomenalistic reduction of theoretical entities nor on a blurring of the theoretical-observational dichotomy. (shrink)

This volume provides an integrated and wide-ranging set of primary-source readings on the relationship between moral values and economic activity, as articulated by some of the leading figures in Western civilization.

How developing a more expansive, non-formal conception of reason produces richer ethical understandings of human situations, explored and illustrated with many real examples. In Re-Reasoning Ethics, Barry Hoffmaster and Cliff Hooker enhance and empower ethics by adopting a non-formal paradigm of rational deliberation as intelligent problem-solving and a complementary non-formal paradigm of ethical deliberation as problem-solving design to promote human flourishing. The non-formal conception of reason produces broader and richer ethical understandings of human situations, not the simple, constrained depictions (...) provided by moral theories and their logical applications in medical ethics and bioethics. Instead, it delivers and vindicates the moral judgment that complex, contextual, and dynamic situations require. Hoffmaster and Hooker demonstrate how this more expansive rationality operates with examples, first in science and then in ethics. Non-formal reason brings rationality not just to the empirical world of science but also to the empirical realities of human lives. Among the many real cases they present is that of how women at risk of having children with genetic conditions decide whether to try to become pregnant. These women do not apply the formal principle of maximizing expected utility (as advised by genetic counselors) and instead imagine scenarios of what their lives could be like with an affected child and assess whether they could accept the worst of these scenarios. Hoffmaster and Hooker explain how moral compromise and a liberated, extended, and enriched reflective equilibrium expand and augment rational ethical deliberation and how that deliberation can rationally design ethical practices, institutions, and policies. (shrink)

This paper aims to do two things. First, it describes the place that Adam Smith actually occupies in current research occurring at the boundaries of new interdisciplinary social-science fields such as evolutionary anthropology, evolutionary psychology, neuro-economics and behavioral economics. Second, it suggests a way in which Smith's place in the debates with which these subjects are concerned may be more properly defined and conceptualized. Specifically, the paper focuses on the controversial new theory of strong reciprocity, and on the reputation effects (...) that its critics think that theory neglects. (shrink)

This study provides an evaluation of ethical business perception of busIness students from three countries: Australia, Taiwan and the United States. Although statistically significant differences do exist there is significant agreement with the way students perceive ethical/unethical practices in business. The findings of this paper indicate a universality of business ethical perceptions.

Recent philosophical discussions have failed to clarify the roles of the concept fitness in evolutionary theory. Neither the propensity interpretation of fitness nor the construal of fitness as a primitive theoretical term succeed in explicating the empirical content and explanatory power of the theory of natural selection. By appealing to the structure of simple mathematical models of natural selection, we separate out different contrasts which have tended to confuse discussions of fitness: the distinction between what fitness is defined as versus (...) what fitness is a function of, the contrast between adaptedness as an overall property of organisms and specific adaptive capacities, the distinction between actual and potential reproductive success, the role of chance versus systematic causal relations, fitness as applied to organisms as opposed to fitness applied to genotype classes, heritable adaptive capacities of genotypes as opposed to relations between genotypes and the environment. We show how failure to distinguish and properly interrelate these different aspects of “fitness” adds confusion to a number of already complex issues concerning evolutionary theory. On the basis of our discussion of these different aspects of “fitness”, we propose a terminology which makes the necessary distinctions. A central result of our analysis is that the concept of fitness as the overall adaptedness of organisms does not enter into the causal structure of evolutionary explanation, at least to the extent that this structure is represented in the mathematical models of natural selection. (shrink)

achieved by the actions of a single animal. The concerted activity is coordinated by a multiplicity of cues and signals diffused between groups of ...

Abstract: The optimum definition of the term "genocide" has been hotly contested almost since the term was coined. Definitional boundaries determine which acts are covered and excluded and thus to a great extent which cases will benefit from international attention, intervention, prosecution, and reparation. The extensive legal, political, and scholarly discussions prior to this article have typically (1) assumed "genocide" to be a fixed social object and attempted to define it as precisely as possible or (2) assumed the need for (...) a fixed convention and sought to stipulate the range of events that should be denoted by the term. Even if its meaning is a matter of convention, however, "genocide" is not a fixed object but varies by context and evolves in methods and forms over time. In fact, as relevant laws, legal interpretations, and political commitments develop, so do would-be perpetrators modify what genocide is in order to avoid political and legal consequences. This article advances an approach to a definition of "genocide" that allows even legal definitions to keep pace with this evolutionary process. (shrink)

Benjamin Constant (1767–1830) is the most important French liberal that most casual liberals have never heard of. Everyone knows something about Montesquieu because checks and balances and the separation of powers are household terms. Tocqueville’s Democracy in America and The Old Regime and the Revolution are both established classics. But Constant is largely terra incognita even for those with a university degree—to their loss.

The rapid emergence of digital media has created both new economic opportunities and new risks for authors, publishers, and users in regards to intellectual property. There is a theoretical conflict raging between those who believe "information should be free" and those attempting to protect intellectual property through surveillance and control of access. The Intellectual Commons works to develop a theory of intellectual property that is based on a theory of natural rights that assumes the existence of a "natural world" of (...) intellectual resources. (shrink)

: Once cast aside as of no value, Charles S. Peirce manuscript 1570 "The First of Six Lessons . . ." and its context, provides uniquely valuable access to Peirce's religious practice (as distinct from his theology). Chronically unemployed, Peirce seized an opportunity to put in a bid for a vacant post in elocution at the Episcopal Church's major (and only "official") theological seminary, The General Theological Seminary in New York City. Peirce had on occasion appealed to nearby members of (...) the Episcopalian hierarchy seeking patronage for his scholarly work—to no avail. In this case, however, he was encouraged and aided by the current scholarly vicar of his own parish. The incumbent had pursued advanced education abroad and was also active in the seminary's affairs. And, of course, Peirce was confident about his expertise in elocution, which "General's" Dean claimed as well. Both the contextual narrative and the substantive theological content of his "lesson" are a rich resource for insights into the much vexed (if too often muddled) question of his lifelong commitment to a faith stemming from his earlier conversion to trinitarianism. (shrink)