This paper explains how to use a new software tool for argument diagramming available free on the Internet, showing especially how it can be used in the classroom to enhance critical thinking in philosophy. The user loads a text file containing an argument into a box on the computer interface, and then creates an argument diagram by dragging lines from one node to another. A key feature is the support for argumentation schemes, common patterns of defeasible reasoning historically know as (...) topics . Several examples are presented, as well as the results of an experiment in using the system with students in a university classroom. (shrink)

A prolonged professional interest in the problems of obsessional disorder has led me to a consideration of Professor Hare's arguments for prescriptivism. It is perhaps a tribute to the elegance of Hare's argument and the lucidity with which it is presented that the present paper is concerned with the exceptions he cites.

This article presents a detailed study of an early section of the actual works and days of Hesiod's Works and Days. The treatment consistently eschews obsolete assumptions about this poem, in particular that it reduces to a didactic presentation to the early Greek farmer. A key principle of the method followed is to pay closer attention to the text's relation to epic forms than has been typical among the poem's commentators. The result is to find that a certain literary figure (...) gradually develops in the section discussed. Namely, the plowing nominally covered there stands for the section's portion on the human condition, a condition implicitly compared with that associated with traditional epic. The figure evokes a well-rounded person, aware of the divine and of the world's uncertainties, with a long-term sense of purpose involving good organization of one's life, as opposed to someone engaged in helter-skelter pursuit of transitory activities, perhaps war specifically. With this identification of virtual protagonist established by the end of the section, the ground is prepared for any further development of the figure as that entity's undertakings or adventures in the remainder of the poem. (shrink)

In this first part, Matthew Lipman offers the reader a glimpse at the thought processes that resulted in Philosophy for Children and, in so doing, ...

The terms of the upper and lower central series of a nilpotent computable group have computably enumerable Turing degree. We show that the Turing degrees of these terms are independent even when restricted to groups which admit computable orders.

A prolonged professional interest in the problems of obsessional disorder has led me to a consideration of Professor Hare's arguments for prescriptivism. It is perhaps a tribute to the elegance of Hare's argument and the lucidity with which it is presented that the present paper is concerned with the exceptions he cites.

We establish that the isomorphism problem for the classes of computable nilpotent rings, distributive lattices, nilpotent groups, and nilpotent semigroups is \-complete, which is as complicated as possible. The method we use is based on uniform effective interpretations of computable binary relations into computable structures from the corresponding algebraic classes.

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

Epistemic circularity occurs when a subject forms the belief that a faculty F is reliable through the use of F. Although this is often thought to be vicious, externalist theories generally don't rule it out. For some philosophers, this is a reason to reject externalism. However, Michael Bergmann defends externalism by drawing on the tradition of common sense in two ways. First, he concedes that epistemically circular beliefs cannot answer a subject's doubts about her cognitive faculties. But, he argues, subjects (...) don't have such doubts, so epistemically circular beliefs are rarely called upon to play this role. Second, following Thomas Reid, Bergmann argues that we have noninferential, though epistemically circular, knowledge that our faculties are reliable. I argue, however, that Bergmann's view is undermined by doubts a subject should have and that there is no plausible explanation for how we can have noninferential knowledge that our faculties are reliable. (shrink)

Epistemic circularity occurs when a subject forms the belief that a faculty F is reliable through the use of F. Although this is often thought to be vicious, externalist theories generally don't rule it out. For some philosophers, this is a reason to reject externalism. However, Michael Bergmann defends externalism by drawing on the tradition of common sense in two ways. First, he concedes that epistemically circular beliefs cannot answer a subject's doubts about her cognitive faculties. But, he argues, subjects (...) don't have such doubts, so epistemically circular beliefs are rarely called upon to play this role. Second, following Thomas Reid, Bergmann argues that we have noninferential, though epistemically circular, knowledge that our faculties are reliable. I argue, however, that Bergmann's view is undermined by doubts a subject should have and that there is no plausible explanation for how we can have noninferential knowledge that our faculties are reliable. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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This short work is a collection of four essays by nineteenth-century author and transcendentalist Samson Reed. "A Dissertation: On the Evidence from the Light of Nature of a Future Retribution" is a religious treatise that laid the groundwork for his aesthetic theory; the "Oration on Genius" is a vibrant speech which is probably America's earliest Romantic manifesto; "Observations on the Growth of the Mind" reflects the aesthetic theory embraced by Ralph Waldo Emerson and the New England transcendentalists; and (...) class='Hi'>Reed's preface to the 1838 edition of "Observations," which showed his growing disenchantment with the transcendentalist movement he helped to inspire. Edited by George F. Dole, the collection contains a preface by Sylvia Montgomery Shaw giving the historical context to these writings. (shrink)

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 regarding books they would like to see reviewed or books they are interested in reviewing.

‘Flute’, as Jenny Strauss Clay notes, is a mistranslation of αλς since the ancient Greek aulos consisted of ‘two reed mouthpieces and two pipes, sometimes of different lengths, played simultaneously. Its dual structure permitted antiphonal execution; one pipe could produce the melody, the other, some sort of accompaniment or perhaps a drone.’ She believes that the dual structure and dual sound of the aulos are implicit in the following passage in which Pindar describes Athena‘s invention of the art of (...) playing this instrument. (shrink)

Review of: War Surgery in Afghanistan and Iraq: A Series of Cases, 2003–2007. Falls Church, VA: Office of the Surgeon General, United States Army; Washington, DC: Borden Institute: Walter Reed Army Medical Center; 2008.

Pascal described human beings as ‘thinking reeds’, weak in flesh but magnificent in mind. While it is a poetic image, it is also an ambivalent one and may suggest an inappropriately dualist view of human nature. It is important to realise that not only are we thinking reeds but that we are thinking because we are reeds. In fact, rationality is reed-like itself, very much of a kind with the rest of human nature. It is now more than two (...) and half centuries since David Hume first pointed out the lack of an argument that would fully justify claims about matters of fact. Being neither made evident by our observations nor arising out of the mere considera-tion of relations of ideas, claims such as that the turkey will be fed dinner tomo-rrow – rather than being had for dinner have remained problematic ever since. Many attempts have been made to show that something of the beauty and certainty of reasoning about relations of ideas could be recaptured in our dealings with matters of fact, but all attempts have remained mere shadows of what we tried to grasp. Hume’s argument stands. An infinite being might watch countless sun-sets and yet should witness each new sun-rise with surprise, always withholding its judgement regarding what will follow. (shrink)