Howard Brody identifies “drug-centered care” as a contrast to “patient-centered care” and asks whether drug-centered care promotes the same outcomes that justify patient-centered care—health and dignity for patients and virtue in providers. Answering in the negative, Brody provides a sobering account of how the pharmaceutical industry molds our disease concepts and our perspectives on medications as medical tools. Brody’s new concept was set up to fail, much as if he had named it “money-centered care” or simply “bad care.” This (...) essay asks whether there is a way to reconceptualize drug-centered care such that, even if it does not promote health, dignity, and virtue, it is at least not obviously at odds with these goals. I identify four ways to show that drug-centered care has, in limited cases, morally legitimate application. I show that whether the morally legitimate application of drug-centered care is in the service of health per se, enhancement or quality of life depends on the theoretical background adopted. (shrink)

The concept of lying is generally assumed to be closely related to the concept of assertion. However, the literature on lying has focused almost exclusively on lies expressed by unqualified assertions. Sometimes a speaker chooses to qualify her assertion by hedging, making her utterance a hedged declarative. This paper defends the thesis that lies can be expressed by untruthful hedged declaratives, and explores the implications of this thesis for the definition of lying. Many standard approaches to the definition of lying (...) allow lies to be expressed by untruthful hedged declaratives, which may explain why these cases have been ignored in the literature. However, untruthful hedged declaratives present a problem for a recently-proposed theory that analyzes lying in terms of the Knowledge Norm of Assertion. According to this theory, a necessary condition on lying is that in asserting that p, the speaker represents herself as knowing that p; however, in making an untruthful hedged declarative a speaker represents herself as having an epistemic attitude weaker than knowledge. The fact that such a theory fails to adequately explain untruthful hedged declaratives provides a reason to prefer alternative theories of lying. The discussion draws out some important observations about the concepts of lying, assertion, belief, and the relations between them. (shrink)

We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system—prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We (...) argue that consciousness originally developed as part of the episodic memory system—quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system. (shrink)

We consider two categorical syllogisms, valid or invalid, to be equivalent if they can be transformed into each other by certain transformations, going back to Aristotle, that preserve validity. It is shown that two syllogisms are equivalent if and only if they have the same models. Counts are obtained for the number of syllogisms in each equivalence class. For a more natural development, using group-theoretic methods, the space of syllogisms is enlarged to include nonstandard syllogisms, and various groups of transformations (...) on that space are studied. (shrink)

Howard J. Curzer presents a fresh new reading of Aristotle's Nicomachean Ethics, which brings each of the virtues alive. He argues that justice and friendship are symbiotic in Aristotle's view; reveals how virtue ethics is not only about being good, but about becoming good; and describes Aristotle's ultimate quest to determine happiness.

Ethicists, researchers and policy makers have paid increasing attention to the ethical conduct of research, especially research involving human beings. Research performed with and by undergraduates poses a specific set of ethical challenges. These challenges are often overlooked by the research community because it is assumed that undergraduate student researchers do not have a significant impact on the research community and that their projects are not host to research posing important ethical issues. This paper identifies several features characteristic of research (...) in undergraduate environments. The paper pays special attention to selective small liberal arts colleges, an important segment of higher education in the US, and advocates integrating instruction in research ethics wherever undergraduates are engaged in research. (shrink)

This book explores the controversial relationship between physicians and the pharmaceutical industry, identifies the ethical tensions and controversies, and proposes numerous reforms both for medicine's own professional integrity and for effective public regulation of the industry.

In this new lexical survey of Kant's works, Howard Caygill presents Kantian concepts and terminology in terms that will introduce and clarify his ideas for students and general readers alike.

Although the physician’s use and misuse of power have been discussed in the social sciences and in literature, they have never been explored in medical ethics until now. In this book, Dr. Howard Brody argues that the central task is not to reduce the physician’s power, as others have suggested, but to develop guidelines for its use, so that the doctor shares with the patient both information and the responsibility for deciding on appropriate treatment. Dr. Brody first reviews literary (...) works dealing with medical power, from Dostoevsky’s “The Grand Inquisitor” to stories by William Carlos Williams, Vonda McIntyre, and Richard Selzer. These works, he shows, reveal the healers’ ambivalence over their own powers and patients’ fears of the abuse of power. Dr. Brody then points out important but neglected ethical issues that emerge from an analysis of power, such as the tension between care of individual patients and the pressures of the doctor’s workload; the rescue fantasy that impels some physicians to extraordinary lengths to save a life; and the economic system, which rewards surgeons and other specialists more than it does physicians who spend time talking with patients about their problems. He also shows how the perspective of shared power can shed new light on standard topics in medical ethics—from informed consent and confidentiality to resource allocation and cost containment. (shrink)

Howard Caygill systematically explores for the first time the relationship between Levinas' thought and the political. From Levinas' early writings in the face of National Socialism to controversial political statements on Israeli and French politics, Caygill analyses themes such as the deconstruction of metaphysics, embodiment, the face and alterity. He also examines Levinas' engagement with his contemporaries Heidegger and Bataille, and the implications of his rethinking of the political for an understanding of the Holocaust.

This book attempts to synthesize two apparently contradictory views of psychology: as the science of internal mental mechanisms and as the science of complex external behavior. Most books in the psychology and philosophy of mind reject one approach while championing the other, but Rachlin argues that the two approaches are complementary rather than contradictory. Rejection of either involves disregarding vast sources of information vital to solving pressing human problems--in the areas of addiction, mental illness, education, crime, and decision-making, to name (...) but a few. Where previous books have focused either on psychology as an abstract science of the mind or as a strictly empirical approach to behavioral problems, this is the only book that attempts to show how the best modern theoretical work on mental mechanisms relates to the best modern empirical work on complex behavioral problems. It will be of considerable interest to psychologists and philosophers across many disciplines and perspectives. (shrink)

There seem to be two kinds of pain: fundamental pain, the intensity of which is a direct function of the intensity of various pain stimuli, and pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and the sociocultural setting in which the stimulus occurs.

A form of Kripke's schema turns out to be equivalent to each of the following two statements from metric topology: every open subspace of a separable metric space is separable; every open subset of a separable metric space is a countable union of open balls. Thus Kripke's schema serves as a point of reference for classifying theorems of classical mathematics within Bishop-style constructive reverse mathematics.

The loss of the federally protected constitutional right to an abortion is a threat to the already tenuous autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions. Even before Roe’s demise, pregnancy led to constraints on autonomy evidenced by clinician-led legal incursions against patients who refused obstetric interventions. In Dobbs v. Jackson Women’s Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a (...) pregnant person’s right to an abortion. With Roe’s demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse. Here we discuss how the elevation of fetal and embryonic rights may lead to a cascade of medical intrusions and deprivations of liberty against pregnant persons, and offer an argument opposing these improprieties. (shrink)

In challenging the prevailing paradigm for understanding how the human mind works, Patterns, Thinking, and Cognition is certain to stimulate fruitful debate.

: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)

Current legal standards of informed consent send the wrong message to physicians about their moral and legal expectations. A “transparency” model that sees consent as a conversation process can enhance good medical practice and patient autonomy without foreclosing appropriate judicial review.

Self-control, so important in the theory and practice of psychology, has usually been understood introspectively. This target article adopts a behavioral view of the self (as an abstract class of behavioral actions) and of self-control (as an abstract behavioral pattern dominating a particular act) according to which the development of self-control is a molar/molecular conflict in the development of behavioral patterns. This subsumes the more typical view of self-control as a now/later conflict in which an act of self-control is a (...) choice of a larger but later reinforcer over a smaller but sooner reinforcer. If at some future time the smaller-sooner reinforcer will be more valuable than the larger-later reinforcer, self-control may be achieved through a commitment to the largerlater reinforcer prior to that point. According to some, there is a progressive internalization of commitment in the development of self-control. This presents theoretical and empirical problems. In two experiments temporal patterning of choices increased self-control. (shrink)

Once upon a time, medicine dismissed narrative as unimportant and uninteresting. Then, in the late 1980s, physicians and scholars became interested in how the study of narrative could enhance our understanding of illness and health care, and the field that came to be known as “narrative medicine” developed. Some of this scholarly activity focused on the idea of narrative ethics.After a flurry of activity around the turn of the twenty‐first century, narrative ethics seemed to stall. The general interest in narrative (...) in medicine continued but with few new ideas on how one might use narrative toward ethical ends. In the last few years, however, forward momentum has returned. The timing seems appropriate, therefore, for a “state of the field” report of sorts. (shrink)

In this major reinterpretation, Howard Caygill argues that all of Benjamin's work is characterized by its focus on a concept of experience derived from Kant but applied by Benjamin to objects as diverse as urban experience, visual art, literature and philosophy. The book analyzes the development of Benjamin's concept of experience in his early writings showing that it emerges from an engagement with visual experience, and in particular the experience of colour. By representing Benjamin as primarily a thinker of (...) the visual field, Caygill is able to bring forward previously neglected texts on inscription and the visual field and to cast many of his more familiar texts, for instance the Work of Art in an Age of Mechanical Reproduction in a new light. (shrink)

As the debate over how to manage or discourage physicians? financial conflicts of interest with the drug and medical device industries has become more heated, critics have questioned or dismissed the concept of ?conflict of interest? itself. A satisfactory definition relates conflict of interest to concerns about maintaining social trust and distinguishes between breaches of ethical duty and temptations to breach duty. Numerous objections to such a definition have been offered, none of which prevails on further analysis. Those concerned about (...) conflicts of interest have contributed to misunderstandings, however, by failing to demonstrate when social arrangements leading to temptations to breach duties are in themselves morally blameworthy. Clarifying ?conflict of interest? is important if we are eventually going to develop productive modes of engagement between medicine and for-profit industry that avoid the serious ethical pitfalls now in evidence. (shrink)

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality (...) is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. (shrink)

Bioethics' interdisciplinary base -- Patient-centered care -- Evidence-based medicine and pay-for-performance -- Community dialogue -- Overview : bioethics, power, and learning to see -- Cross-cultural concerns -- Race and health disparities -- Disabilities -- Environmental and global issues -- New technologies -- Conclusion.

There is considerable evidence that the hippocampal system contributes both to the temporary maintenance of memories and to the processing of a particular type of memory representation. The findings on amnesia suggest that these two distinguishing features of hippocampal memory processing are orthogonal. Together with anatomical and physiological data, the neuropsychological findings support a model of cortico-hippocampal interactions in which the temporal and representational properties of hippocampal memory processing are mediated separately. We propose that neocortical association areas maintain shortterm memories (...) for specific items and events prior to hippocampal processing as well as providing the final repositories of long-term memory. The parahippocampal region supports intermediate-term storage of individual items, and the hippocampal formation itself mediates an organization of memories according to relevant relationships among items. Hippocampal-cortical interactions produce strong and persistent memories for events, including their constituent elements and the relationships among them, and a capacity to express memories flexibly across a wide range of circumstances. (shrink)

Most accounts of why physicians have a duty to treat patients during a pandemic look to the special ethical standards of the medical profession. An adequate account must be deeper and broader: it must set the professional duty alongside other individual commitments and broader social values.