The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

Comparative environmental philosophy is valuable in many ways. Perhaps it is most valuable because it reveals some of the foundational assumptions that run so deep in the poles of comparison that they might otherwise have gone unnoticed. These revelations may invite us to challenge those assumptions that have led to the kind of thinking responsible for much of the environmental degradation that we see today. Japanese Environmental Philosophy gathers papers focused on the environmental problems of the twenty-first century. Drawing from (...) Japanese philosophical traditions they investigate our relationships with other humans, nonhuman animals, and the environment. The heart of the book consists of chapters written by fifteen top scholars from Japan, the United States, Europe, and Australia. The essays cover a broad range of topics drawn from various strains of Japanese thought—including Zen Buddhism, Shintoism, the Kyoto school, and Japanese philosophy of art and aesthetics—as well as from traditional Japanese culture and the contemporary science of planning for natural disasters. These articles demonstrate that Japanese scientific, philosophical, religious, and cultural traditions can provide meaningful insight to address the current global environmental crisis. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide better answers (...) to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Selected Letters by William, Henry JamesWilliam James EarleWilliam and Henry James. Selected Letters. Edited by Ignas K. Skrupskelis and Elizabeth M. Berkeley. Introduction by John J. McDermott. Charlottesville VA: University Press of Virginia, 1997. Pp. xxxi + 570. $ 39.95.Almost fifty years of letters to and from the very diversely brilliant James brothers: in this volume a generous, and probably ample, selection of 216 from (...) a total of 740 surviving letters or postcards, from an original total, according to the present editors, of twice as many. This volume of correspondence reflects the deep, unquestioned, unshakable familial (and virtually statutory) closeness of William and Henry who happened, as adults, to be seldom in the same place. There is, it must be said, very little explicit philosophy, narrowly or broadly defined, in these letters, but the philosophical reader will—or ought to—find much raw material for philosophical reflection. For example, a reasonable historicist thesis of how brotherhood, or family connection generally, plays itself out is supported by these documents. The nineteenth century is not the same as the twentieth. For example, here is William’s comment on the will of his sister, Alice, who left more to her companion and care-giver, Katherine Loring, a [End Page 479] women of extraordinary virtue and burden, than to her brother Robertson: “I can well sympathize with Alice’s desire to leave her something handsome; but I must say that her own consent (being apparently privy to the will) strikes me as tant soit peu lacking in delicacy. Surely no one of us would like to be in such a position in her family or any other” (271). This would be, in 1998, a rather unenlightened and ungenerous attitude, but is natural enough in 1892, even if not quite inevitable, not being shared by Alice herself. There is, incidentally, much discussion of wills and bequests, for the Jameses were of the genteel class, people with small family money and modest private incomes for whom the wherewithal to maintain homes with servants and to provide themselves with country houses and recuperative European vacations was always a faintly embarrassing, and occasionally a pressing, problem.It is probably also true that the much-discussed question of Henry’s homosexuality has, somehow, to be recast in historically relative terms. Here is an early report—1869—of Henry’s from Oxford: “As I walked along the river I saw hundreds of the mighty lads of England, clad in white flannel & blue, immense, fair-haired, magnificent in their youth, lounging down the stream in their punts or pulling in straining crews & rejoicing in their godlike strength” (41). This could not, the point is, be said by anyone, gay or straight, in 1998. Yet Henry is neither generally naive nor uncritically anglophile. He says of the Warwickshire scenery, which in a way he likes, that it is “too monotonously sweet & smooth—too comfortable, too ovine, too bovine, too English in a word.” And he adds, a little surprisingly: “It seems like a vast show region kept up at the expense of the poor” (41). This is only one of many appealing comments not sparsely scattered, but unpredictably, in letters of more ordinary news. Here’s one I liked occasioned by seeing theater in Paris: “We talk about it & write about it & criticize & dogmatize & analyse to the end of time: but those brave players stand forth & exemplify it & act—create—produce!” (66).Of course the “wit and wisdom” are not the monopoly of Henry. Here is William being wise: “We all learn sooner or later that we must gather ourselves up and more or less arbitrarily concentrate our interests, throw much overboard to save any” (55–56). Again: “It is a sweet world, in the interstices of its bedevilment & brutality” (321). And William being funny: “Boils are surely the most slowly evolving things in nature—Christian doctrine is nothing to them” (393). He is talking about his own boils and was subject, at every period, to ailments and infirmities: “Since writing to you, I have been swimming in deep seas of influenza, gout and Erysipelas of the face” (443). Or as he, in 1900, sums it up: “My... (shrink)

A full separation theorem for the derivable rules of intuitionistic linear logic without bounds, 0 and exponentials is proved. Several structural consequences of this theorem for subreducts of (commutative) residuated lattices are obtained. The theorem is then extended to the logic LR+ and its proof is extended to obtain the finite embeddability property for the class of square increasing residuated lattices.

It is now well-known that Newton–Cartan theory is the correct geometrical setting for modelling the quantum Hall effect. In addition, in recent years edge modes for the Newton–Cartan quantum Hall effect have been derived. However, the existence of these edge modes has, as of yet, been derived using only orthodox methodologies involving the breaking of gauge-invariance; it would be preferable to derive the existence of such edge modes in a gauge-invariant manner. In this article, we employ recent work by Donnelly (...) and Freidel in order to accomplish exactly this task. Our results agree with known physics, but afford greater conceptual insight into the existence of these edge modes: in particular, they connect them to subtle aspects of Newton–Cartan geometry and pave the way for further applications of Newton–Cartan theory in condensed matter physics. (shrink)

We argue that in contemporary business organizations, in which fundamental purpose is construed to be increased value—especially in ‘participative’ organizations, in which non–hierarchal interaction (for example, work teams) is the norm; and in ‘adaptive’ organizations, in which unpredictable change is the rule—a process of values covenanting will be much more valueable than just espoused values or even values covenants. We propose such a process model for organizational values covenanting and argue that such covenanting reflects an anthropomorphism of the human character (...) development process, validated in terms of the theory of viable systems. (shrink)

Army Officers face increased moral pressure in modern warfare, where character judgement and ethical judgement are vital. This article reports the results of a study of 242 junior British Army officers using the Army Intermediate Concept Measure, comprising a series of professionally oriented moral dilemmas developed for the UK context. Results are suggestive of appropriate application of Army values to the dilemmas and of ethical reasoning aligning with Army excellence. The sample does slightly less well, however, for justification than for (...) action reasoning, and there are differences following initial training for infantry and artillery officers versus other branches of service. Dilemmas involving anti-torture methods and not covering up soldiers' failings generated best results compared to those requiring balance between compassion and mission, and negotiating personal relationships with military needs. Gender differences favouring women were less than those observed for other professional groups using similar measures. This research further develops a much-needed measure of ethical reasoning among junior Army officers, with potential for use among other ranks. This approach is advocated for other professional groups. (shrink)

Global cycles of rising and declining hegemonies within the world-system have been associated with periods of war and peace, free trade and protectionism, and economic expansion and contraction. Periods of hegemonic decline are also associated with the cultural production of a certain strain of self deprecating, or even self-hating, literary output. And, because we are dealing with the world-system, the popularity of such icons of national self-deprecation should be gappreciated within other countries. We see this in the fact that (...) Don Quixote, poking fun at Spanish chivalry was an immensely popular book outside as well as inside Spain. Similarly, the James Bond books, and particularly the movies had a huge audience world wide, and, the same could be said for the Rambo movies which poked fun at the chivalric Green Beret American military figure. We see, then, three instances of hegemonic decline—Spain, Britain, United States—and three instances of self-deprecating literary figures—Don Quixote, James Bond, and Rambo. (shrink)

This study compares college students with other adults in terms of the Muncy–Vitell (1992) consumer ethics scale. Further, the study updates the Muncy–Vitell consumer ethics scale with modifications that include rewording and the addition of new items. These new items can be grouped into three distinct categories – (1) downloading/buying counterfeit goods, (2) recycling/environmental awareness and (3) doing the right thing/doing good. The study also compares these two groups in terms of their attitude toward business. Results show that there is (...) indeed a significant difference between these two groups in terms of ethical perceptions, but not in terms of the “recycling” items and the “doing good” items. There was also little difference between the groups in terms of their attitude toward business indicating that attitude toward business does not explain their different ethical perspectives. (shrink)

A standard line in the contemporary philosophical literature has it that physical theories are equivalent only when they agree on their empirical content, where this empirical content is often understood as being encoded in the equations of motion of those theories. In this article, we question whether it is indeed the case that the empirical content of a theory is exhausted by its equations of motion, showing that (for example) considerations of boundary conditions play a key role in the empirical (...) equivalence (or otherwise) of theories. Having argued for this, we show that philosophical claims made by Weatherall (2016) that electromagnetism in the Faraday tensor formalism is equivalent to electromagnetism in the vector potential formalism, and by Knox (2011) that general relativity is equivalent to teleparallel gravity, can both be called into question. We then show that properly considering the role of boundary conditions in theory structure can potentially restore these claims of equivalence and close with some remarks on the pragmatics of adjudications on theory identity. (shrink)

In this chapter we consider three philosophical perspectives (including those of Stalnaker and Lewis) on the question of whether and how the principle of conditional excluded middle should figure in the logic and semantics of counterfactuals. We articulate and defend a third view that is patterned after belief revision theories offered in other areas of logic and philosophy. Unlike Lewis’ view, the belief revision perspective does not reject conditional excluded middle, and unlike Stalnaker’s, it does not embrace supervaluationism. We adduce (...) both theoretical and empirical considerations to argue that the belief revision perspective should be preferred to its alternatives. The empirical considerations are drawn from the results of four empirical studies (which we report below) of non-experts’ judgments about counterfactuals and conditional excluded middle. (shrink)

Previous plan‐based models of dialogue understanding have been unable to account for many types of subdialogues present in naturally occurring conversations. One reason for this is that the models have not clearly differentiated between the varoius ways that an utterance can relate to a plan structure representing a topic. In this paper we present a plan‐based theory that allows a wide variety of utterance‐plan relationships. We introduce a set of discourse plans, each one corresponding to a particular way that an (...) utterance can relate to a discourse topic, and distinguish such plans from the set of plans that are actually used to model the topics. By incorporating knowledge about discourse into a plan‐based framework, we can account for a wide variety of subdialogues while maintaining the computational advantages of the plan‐based approach. (shrink)

The contributors to this new philosophi­cal and historical examination of Vico, Herder, Schiller, and Goethe are Karl J. Fink, James W. Marchand, Harry Ritter, K. Michael Seibt, and David R. Ste­venson. Their essays and commentary address the question why this generation represent­ed by its great minds suddenly discov­ered science—a question posed previ­ously but only tentatively explored. Taken together, the essayists reveal significant new insights into the roles of language, imagination, intuition, em­pathy, modes of perception, and indiv­idualism in scientific creativity (...) and pro­vide important new contributions to the history of arts and sciences. (shrink)

This major new book contains a collection of papers that examine the current state-of-the-art in the valuation of environmental resources. In particular, they assess the meaningfulness of environmental resource values obtained through the contingent valuation metho.