This paper builds upon previous work in which I argue that we should assess a provider's reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional's reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate (...) the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine. (shrink)

It is ccranonly supposed that what we know and believe influences what we do, that knowledge and beliefs provide us with considerations (rules, reasons, action-plans, etc.) which guide our action. Sane recent discussions of human behavior makes this appear dubious. In particular, by holding that influential considerations must be conscious occurrent events they make it appear that there is substantially less influence than we usually take for granted. In turn, this suggests that in large measure human action is unknowing, that (...) agents often do not know what they are doing. In my view accounts leading to such conclusions are themselves dubious. I show that these accounts give rise to puzzles and paradoxes if they are taken as applying to routine sorts of everyday behavior (as their authors intend). I hope, in this way, to raise substantial doubt about the viability of these counter-intuitive accounts of human action. (shrink)

Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on (...) their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association's conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the ‘objectionable’ activity itself in order to learn the necessary content and underlying principles. (shrink)

Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory refusals by healthcare professionals. Their argument is premised upon applying a free market mechanism to conscientious objections in medicine, yet I argue their Market View possesses a number of absurd and troubling implications. Furthermore, I (...) demonstrate that the fundamental logic of their main argument is flawed. Thinkers who wish to address the issues raised in this debate in general or by discriminatory conscience objections in particular should avoid the Market View and instead envisage theories that assess the reasons underlying conscientious refusals in medicine. (shrink)

American adults currently enjoy a widely accepted and legally well-settled right to refuse health care, including life sustaining treatment. Joel Feinberg provides a moral foundation for this right in liberal political theory. Feinberg's theory grounds the right to refuse in a broad right to self-determination, and it implements the right through a variable conception of voluntariness. This theory provides a plausible account that comports with the widely accepted right to refuse, commonsense, and ordinary practice. -/- Allen Buchanan and Dan Brock (...) contend, however, that Feinberg's priority for the right to self-determination is inconsistent with his variable scale of voluntariness. Although Feinberg presents his theory as one that grants categorical priority to self-determination over individual well-being, Buchanan and Brock argue that Feinberg's variable scale of voluntariness involves a balancing of self-determination and well-being. This balancing approach, which Buchanan and Brock endorse, seems to undermine the competent patient's right to refuse care because it allows concern for the patient's well-being to override that person's right to self-determination in some circumstances. Taken together, these arguments seem to suggest that we must give up either the competent patient's right to refuse treatment or the intuitively sensible variable scale. -/- In this paper, I argue that one can reconcile a categorical priority for self-determination with legal rules that incorporate a variable scale of competence. This integration requires careful examination of the practical and expressive functions of legal rules as well as of the manner in which these rules embody moral priorities. This analysis pursues specific and general projects. Specifically, it addresses the moral foundations of the legal right to refuse treatment, identifying a substantive difference between the balancing approach and the priority for self-determination that characterizes Feinberg's liberalism. Generally, it examines the types of priorities embodied by legal rules as practical decision guides and as expressions of the conventional morality represented by the law. This general project extends beyond the right to refuse treatment to the analysis of the manner in which legal rules express and apply moral priorities. (shrink)

ABSTRACT Don Marquis argues that abortion is morally wrong in most cases since it deprives the fetus of the value of its future. I criticize Marquis’s argument for the modified conservative view by adopting an argumentative strategy in which I work within his basic account: if it is granted that his fundamental idea is sound, what follows about the morality of abortion? I conclude that Marquis is faced with a dilemma: either his position must shift towards the extreme conservative view (...) on which abortion is never morally permissible, or he must abandon any recognizably conservative view. This dilemma suggests that Marquis’s view is either deeply implausible or that he cannot use this argument to successfully support his preferred position. (shrink)

Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, (...) can learn from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded. (shrink)

In _Pharmaceutical Freedom_ Professor Flanigan argues we ought to grant people self-medication rights for the same reasons we respect people’s right to give (or refuse to give) informed consent to treatment. Despite being the most comprehensive argument in favour of self-medication written to date, Flanigan’s _Pharmaceutical Freedom_ leaves a number of questions unanswered, making it unclear how the safe-guards Flanigan incorporates to protect people from harming themselves would work in practice. In this paper, I extend Professor Flanigan’s account by (...) discussing a hypothetical case to illustrate how these safe-guards could work together to protect people from harms caused by their own ignorance or incompetence. (shrink)

In light of the variety of uses of the term autonomy in recent bioethics literature, in this paper, I suggest that competence, not being as contested, is better placed to play the anti-paternalistic role currently assigned to autonomy. The demonstration of competence, I will argue, can provide individuals with robust spheres of non-interference in which they can pursue their lives in accordance with their own values. This protection from paternalism is achieved by granting individuals rights to non-interference upon demonstration of (...) competence. In this paper, I present a risk-sensitive account of competence as a means of grounding rights to non-interference. On a risk-sensitive account of competence individuals demonstrate their competence by exercising three capacities to the extent necessary to meet a threshold determined by the riskiness of the decision. These three capacities are the capacity to acquire knowledge, use instrumental rationality, and form and revise a life plan. (shrink)

This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector's refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason. The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible (...) to the extent that it mimics the 'reason-giving requirement' for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient's request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy. (shrink)

The first edition of this book was published in 1977. At that time the field of thanatology, the study of death and dying, was still reasonably new and was dominated by research done by psychiatrists and social scientists. The most notable person in the field at the time was Elisabeth Kubler-Ross, who was widely credited with having brought thanatology into public view with the 1969 publication of her book On Death and Dying. Two research centers on death and dying were (...) gaining national reputations: The Foundation of Thanatology in New York (Austin Kutscher, director), and the Center for Death Education and Research (Robert Fulton, director) at the University of Minnesota. (shrink)

In Human Happiness and Morality, noted philosopher Robert Almeder provides lucid introductory explanations of the major ethical theories and traditions, as well as a clear and comprehensive discussion of the proposed answers to three basic questions in ethics: What makes a right act right? Why should I be moral? What is human happiness and how can I attain it? He then ventures beyond the basic questions, describing the relationship between morality and happiness; clearly defining human happiness; and raising the (...) question of whether happiness, so defined, is the likely product of a life lived morally. In the final chapter, Almeder details simple Stoic rules for happy living and shows how it is possible to live the good life despite the existence of unhappiness and failure in others. (shrink)

Robert Dobbin presents a new translation into clear modern English of the first book of Epictetus' Discourses, accompanied by the first ever commentary on the work in English. The Discourses, composed around AD 100, are a key source for ancient Stoicism, one of the most influential schools of thought in Western philosophy.

Much of traditional AI exemplifies the explicit representation paradigm, and during the late 1980''s a heated debate arose between the classical and connectionist camps as to whether beliefs and rules receive an explicit or implicit representation in human cognition. In a recent paper, Kirsh (1990) questions the coherence of the fundamental distinction underlying this debate. He argues that our basic intuitions concerning explicit and implicit representations are not only confused but inconsistent. Ultimately, Kirsh proposes a new formulation of the distinction, (...) based upon the criterion ofconstant time processing.The present paper examines Kirsh''s claims. It is argued that Kirsh fails to demonstrate that our usage of explicit and implicit is seriously confused or inconsistent. Furthermore, it is argued that Kirsh''s new formulation of the explicit-implicit distinction is excessively stringent, in that it banishes virtually all sentences of natural language from the realm of explicit representation. By contrast, the present paper proposes definitions for explicit and implicit which preserve most of our strong intuitions concerning straightforward uses of these terms. It is also argued that the distinction delineated here sustains the meaningfulness of the abovementioned debate between classicists and connectionists. (shrink)

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that (...) they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

This landmark volume brings together the work of the world's leading researchers in sublimated perception. This compilation marks a fundamental shift in the current study of subliminal effects: No longer in question is the notion that perception without awareness occurs. Now, the emphasis is on elucidating the parameters of subliminal effects and understanding the conditions under which stimuli perceived without awareness significantly influence affect, cognition, and behavior. PERCEPTION WITHOUT AWARENESS firmly establishes subliminal perception within the mainstream of psychological science. Well (...) represented here are the two main research branches that have emerged: One directly investigates the nature of subliminal effects; the other uses subliminal techniques as tools for investigating psychological phenomena such as hypnosis, dreaming, repression, social judgment and inference, psychopathology, and symptom formation. Broadly grouped into three main sections, the contributed chapters explore * The cognitive perspective--including implicit memory and implicit perception, the measurement of unconscious perceptual processes, and methods for revealing unconscious processes * The clinical perspective--exploring the cognitive and dynamic aspects of subliminal perception, memory, and consciousness; direct recovery of subliminal stimuli; and validation of subliminal psychodynamic activation * The social perspective--discussing subliminal mere-exposure effects, affect and social perception, and the role of subliminality in social psychology Timely and thought-provoking, PERCEPTION WITHOUT AWARENESS is sure to be of enormous interest to all psychoanalytic clinicians and scholars, as well as cognitive, clinical, and social psychologists whose work touches upon issues relating to psychopathology, perception, cognition, and memory. (shrink)

The identity of the Caesar at "Aeneid", 1.286 is a long-standing problem. The prevailing opinion since Heyne favors Augustus, but a few scholars agree with Servius that the Dictator is meant. In recent years the suggestion that Vergil was being deliberately ambiguous has been advanced as a solution to the problem. I argue the case for Julius Caesar anew. The paper is in five sections. The first four deal respectively with the question of nomenclature; chronology; the descriptive epithets applied to (...) Caesar, especially spoliis Orientis onustum in 289; and the rhetoric of the passage. The fourth section confronts the challenge posed to my reading by the well-known view of Ronald Syme, held to throughout his lifetime, that Julius Caesar was a virtual non-person in the Rome of Vergil's day because the princeps tried to avoid awkward comparison with the Dictator. But this view has been challenged, and I draw on recent work in this area. In the fifth and final section I support my reading with references to Vergil's earlier poetry, attending especially to what it can tell us about Vergil's attitude toward Julius Caesar. Of particular relevance is the use he makes of the sidus Iulium, an image found in the Eclogues and important in connection with the apocalyptic outlook abroad at the time of Caesar's assassination. This section of the paper expands on Servius' generally neglected note, which maintains that the Caesar in question is Julius. (shrink)

Fodor's and Pylyshyn's stand on systematicity in thought and language has been debated and criticized. Van Gelder and Niklasson, among others, have argued that Fodor and Pylyshyn offer no precise definition of systematicity. However, our concern here is with a learning based formulation of that concept. In particular, Hadley has proposed that a network exhibits strong semantic systematicity when, as a result of training, it can assign appropriate meaning representations to novel sentences (both simple and embedded) which contain words in (...) syntactic positions they did not occupy during training. The experience of researchers indicates that strong systematicity in any form is difficult to achieve in connectionist systems.Herein we describe a network which displays strong semantic systematicity in response to Hebbian, connectionist training. During training, two-thirds of all nouns are presented only in a single syntactic position (either as grammatical subject or object). Yet, during testing, the network correctly interprets thousands of sentences containing those nouns in novel positions. In addition, the network generalizes to novel levels of embedding. Successful training requires a, corpus of about 1000 sentences, and network training is quite rapid. The architecture and learning algorithms are purely connectionist, but classical insights are discernible in one respect, viz, that complex semantic representations spatially contain their semantic constituents. However, in other important respects, the architecture is distinctly non-classical. (shrink)

In this paper I defend the Reasonability View: the position that medical professionals seeking a conscientious exemption must state reasons in support of their objection and allow those reasons to be subject to evaluation. Recently, this view has been criticized by Jason Marsh as proposing a standard that is either too difficult to meet or too easy to satisfy. First, I defend the Reasonability View from this proposed dilemma. Then, I develop this view by presenting and explaining some of the (...) central criteria it uses to assess whether a conscientious objection is proper grounds for extending an exemption to a medical practitioner. (shrink)

This paper explores the comparative dynamics of self-mutilation among young, contemporary, female self-cutters, and the holy stigmatics of the Middle Ages. It addresses the types of personalities that engage in self-mutilation and how some manipulate their self-inflicted pain into a method for healing and empowerment. The similarities between teenage cutters and female stigmatics are striking in their mutual psychoanalytical need for self-alteration as a means of escaping their own disassociative identities; and offers evidence of how their mutual bricolage of pain, (...) imagining, languaging, and subsequent self-mutilation often provide a transformation from bodies under siege to a resemblance of health and transformation. (shrink)

This book offers an in-depth analysis of the wide range of issues surrounding "passive euthanasia" and "allow-to-die" decisions. The author develops a comprehensive conceptual model that is highly useful for assessing and dealing with real-life situations. He presents an informative historical overview, an evaluation of the clinical settings in which treatment abatement takes place, and an insightful discussion of relevant legal aspects. The result is a clearly articulated ethical analysis that is medically realistic, philosophically sound, and legally viable.

This is a book about the role that psychological impairment should play in a theory of criminal liability. Criminal guilt in the Anglo-American legal tradition requires both that the defendant committed some proscribed act and did so with intent, knowledge, or recklessness. The second requirement corresponds to the intuitive idea that people should not be punished for something they did not do 'on purpose' or if they 'did not realize what they were doing'. Unlike many works in this area, this (...) book addresses the automatism and insanity defences by examining the types of functional impairment that typical candidates for these defences actually suffer. What emerges is a much wider conceptual framework that allows us to understand the significance of psychological states and processes for the attribution of criminal responsibility in a manner that is logically coherent, morally defensible, and consistent with research in psychopathology. (shrink)

Comparative Education examines the common problems facing education systems around the world as the result of global economic, social, and cultural forces. Issues related to the governance, financing, provision, processes, and outcomes of education systems for differently situated social groups are described and analyzed in specific regional, national, and local contexts.

In their provocative 1988 paper, Fodor and Pylyshyn issued a formidable challenge to connectionists, i.e. to provide a non‐classical explanation of the empirical phenomenon of systematicity in cognitive agents. Since the appearance of F&P's challenge, a number of connectionist systems have emerged which prima facie meet this challenge. However, Fodor and McLaughlin (1990) advance an argument, based upon a general principle of nomological necessity, to show that one of these systems (Smolensky's) could not satisfy the Fodor‐Pylyshyn challenge. Yet, if Fodor (...) and McLaughlin's analysis is correct, it is doubtful whether any existing connectionist system would fare better than Smolensky's. In the view of Fodor and McLaughlin, humans and classical architectures display systematicity as a matter of nomological necessity (necessity by virtue of natural law), but connectionist architectures do not. However, I argue that the Fodor‐Pylyshyn‐McLaughlin appeal to nomological necessity is untenable. There is a sense in which neither classical nor connectionist architectures possess nomological (or‘nomic’) necessity. However, the sense in which classical architectures do possess nomic necessity applies equally well to at least some connectionist architectures. Representational constituents can have causal efficacy within both classical and connectionist architectures. (shrink)

Adolescents who are critically, chronically, and terminally ill traditionally have been given little voice in their health care treatment. But over the last three decades attitudes have begun to shift. The legal and medical professions as well as parents and children's advocates have started to recognize that cognitively normal adolescents have decisionmaking capacity and believe these patients ought to have the opportunity to participate in even the toughest of health treatment decisions. Advance directives, if used with sensitivity and care, could (...) prove a valuable means of giving these older pediatric patients a say in their care. (shrink)

Sixteen essays on epistemology, metaphysics, & history & politics, treating aspects of the writings of Descartes, Locke, Hume, Kant, Leibniz, & Hobbes.

Ayn Rand’s Objectivist epistemology is the foundation of an impressive, comprehensive, and integrated system of political philosophy, psychology, art, and literature. Friedrich Hayek’s operational system of epistemology and his analysis of the psychology of perception (presented primarily in The Sensory Order) is not as clearly integrated with his economics and political philosophy—and many have debated their consistency with one another. This paper engages in a comparative analysis of Rand’s and Hayek’s epistemology.

This major study advances an interpretation of criminal justification defences that views them as an integral component of the structure of the criminal law. Criminal law is defined here as the institutional representation of the underlying principles of political morality in a liberal society. The book extends the traditional scope of the legal and philosophical discussion of justification defences. It integrates philosophical analysis with a consideration of contemporary applications, it shows how these defences are key components of criminal law, and (...) it explores the relationship between legal and moral justification. (shrink)

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at (...) hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)