To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons “wise.” Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle’s intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and (...) psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the Other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and (...) psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

We briefly respond to Bursztajn and colleagues’ commentary on our article, “Clinical Wisdom in Psychoanalysis and Psychodynamic Psychotherapy: A Philosophical and Qualitative Analysis.”.

In response to the article by Baum-Baicker and Sisti, I will consider the kind of wisdom involved in therapeutic listening; the role of life wisdom; and the challenge of imparting clinical wisdom to young health professionals’ education.

A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice (“clinical wisdom”) is, or could be, compatible with empirically validated medicine (“evidence-based medicine”—EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly (...) defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are—by necessity—complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy. (shrink)

In this issue of JCE, Baum-Baicker and Sisti present senior psychoanalysts’ views of wisdom.Although views on wisdom differ widely, there is agreement that when ethical conflicts arise, wisdom may be critical in bringing about an optimal result. Here I will present recent empirical findings on wisdom and the ways careproviders may acquire and apply it, especially in ethical conflicts. The findings are not well-known and may seem counterintuitive; I selected them, in large part, for those reasons. A core (...) challenge may be to decide when to give patients standard care and when to make exceptions. In this issue of JCE, Baum-Baicker and Sisti discuss exceptions and Bursztajn and colleagues consider how these exceptions may be further validated as evidence-based treatments. (shrink)

Purpose This paper aims to formalize long-term trajectories of human civilization as a scientific and ethical field of study. The long-term trajectory of human civilization can be defined as the path that human civilization takes during the entire future time period in which human civilization could continue to exist. -/- Design/methodology/approach This paper focuses on four types of trajectories: status quo trajectories, in which human civilization persists in a state broadly similar to its current state into the distant future; catastrophe (...) trajectories, in which one or more events cause significant harm to human civilization; technological transformation trajectories, in which radical technological breakthroughs put human civilization on a fundamentally different course; and astronomical trajectories, in which human civilization expands beyond its home planet and into the accessible portions of the cosmos. -/- Findings Status quo trajectories appear unlikely to persist into the distant future, especially in light of long-term astronomical processes. Several catastrophe, technological transformation and astronomical trajectories appear possible. -/- Originality/value Some current actions may be able to affect the long-term trajectory. Whether these actions should be pursued depends on a mix of empirical and ethical factors. For some ethical frameworks, these actions may be especially important to pursue. (shrink)

This paper discusses means for promoting artificial intelligence that is designed to be safe and beneficial for society. The promotion of beneficial AI is a social challenge because it seeks to motivate AI developers to choose beneficial AI designs. Currently, the AI field is focused mainly on building AIs that are more capable, with little regard to social impacts. Two types of measures are available for encouraging the AI field to shift more toward building beneficial AI. Extrinsic measures impose constraints (...) or incentives on AI researchers to induce them to pursue beneficial AI even if they do not want to. Intrinsic measures encourage AI researchers to want to pursue beneficial AI. Prior research focuses on extrinsic measures, but intrinsic measures are at least as important. Indeed, intrinsic factors can determine the success of extrinsic measures. Efforts to promote beneficial AI must consider intrinsic factors by studying the social psychology of AI research communities. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

Understanding of the human genome and its functional significance has increased exponentially since the completion of the Human Genome Project in 2003. The HGP fueled the discovery of more than 1,800 disease genes and paved the way for researchers to identify and test for genes suspected of causing inherited diseases. Currently, there are more than 1000 genetic tests for human diseases and conditions on the market. These tests can play an integral role in the delivery of health care by providing (...) information that could potentially form the basis for profound life decisions, such as whether to undergo a prophylactic mastectomy, whether to terminate a pregnancy, or whether to take a particular drug or medication dose. (shrink)

I argue for the possibility of posthumous harm based on an account of the harm of murder. I start with the deep-seated intuition that when someone is murdered he (or she) is harmed (over and above the pain of injury or dying), and argue that Feinberg's account that assumes that harm is an invasion of an interest cannot plausibly accommodate this intuition. I propose a new account of the harm of murder: it is an irreversible loss of functions necessary for (...) worthwhile existence. I suggest a (partial) loss analysis of harm in general, and then go on to apply it to posthumous harm and defend the idea that there can be posthumous losses. (shrink)

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of (...) six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors’empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. (shrink)

At the centre of discussion lies the reception of Plato’s philosophy, particularly his theory of Ideas, in Kant’s moral philosophy, his ethics and his doctrine of right. Kant saw himself as a follower of Platonism insofar as its anti-empiri­cist principles of human conduct are concerned, although his own version of practical rationalism differs considerably from Plato’s. This is also true of Kant’s conception of freedom and of human rights. The greatest impact on Kant’s moral philosophy is due to the doctrine (...) of the two worlds, the mundus sensibilis and the mundus intelligibilis, which did not originate in Plato himself, but in the Jewish Platonist Philo of Alexandria. Kant reinterpreted this doctrine by taking the intelligible world as a moral world consisting of free rational agents who ought to transform the empirical world of human society and history according to the norms and standards of moral laws. This was meant to be a programme for a moral reform of the human world, both with regard to individual moral­ity and to the cosmopolitical task of the establishment of an international order of legal institutions. Kant’s practical Platonism insists on the creation of a moral world order through human actions that take their lead from pure practical reason. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Experiments may contribute to understanding the basic processes of cultural evolution. We drew features from previous laboratory research with small groups in which traditions arose during several generations. Groups of four participants chose by consensus between solving anagrams printed on red cards and on blue cards. Payoffs for the choices differed. After 12 min, the participant who had been in the experiment the longest was removed and replaced with a naı¨ve person. These replacements, each of which marked the end of (...) a generation, continued for 10 – 15 generations, at which time the day’s session ended. Time-out duration, which determined whether the group earned more by choosing red or blue, and which was fixed for a day’s session, was varied across three conditions to equal 1, 2, or 3 min. The groups developed choice traditions that tended toward maximizing earnings. The stronger the dependence between choice and earnings, the stronger was the tradition. Once a choice tradition evolved, groups passed it on by instructing newcomers, using some combination of accurate information, mythology, and coercion. Among verbal traditions, frequency of mythology varied directly with strength of the choice tradition. These methods may be applied to a variety of research questions. D 2004 Elsevier Inc. All rights reserved. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 22-24, February 2012.

The Hebrew Bible mentions 12 precious stones arranged in four rows of three each on the high priest’s breastpiece in two lists (Ex 28:17–20 and 39:10–13). Nine of these precious stones reappear in the Tyrian king’s ‘covering’ in Ezekiel 28:13 in three groups of three. Although the two lists in Exodus are identical, the order in Ezekiel is slightly different. In Septuagint (LXX) Ezekiel there are 12 precious stones. However, the number and order in the LXX lists (LXX-Ex 28:17–20 and (...) 36:17–20; LXX-Ezk 28:13) are constant in all three cases. The same 12 stones as in the LXX appear, but with variation in order, in two accounts found in Josephus ( The Wars of the Jews Book 5, Chapter 5, Section 7; The Antiquities of the Jews Book 3, Chapter 7, Section 5). The list of precious stones in Revelation 21:19–20 that adorn the 12 foundations of the New Jerusalem is reminiscent of the breastpiece, but it shows four new names along with eight that are known from the LXX; it is not clear if it is a fresh translation from the Hebrew list. This article focuses on the relationships amongst these lists by examining the arrangement, translation and symbolism of these precious stones. Contribution: The precious stones in the high priest’s breastpiece (Exod 28:17–20, 39:10–13) were rendered differently and re-arranged by the Septuagint and other later versions for new contexts, audiences and theological purposes. Unknown stones were rendered with similar stones known to the translator or the incipient text terms were transliterated. (shrink)

While it is generally agreed that the concept of homology refers to individuated traits that have been inherited from common ancestry, we still lack an adequate account of trait individuation or inheritance. Here I propose that we utilize a counterfactual criterion of causation to link each trait with a developmental-causal (DC) gene. A DC gene is made up of the genetic information (which might or might not be physically contiguous in the genome) that is needed for the production of the (...) organismic attributes that comprise the trait. I argue that individuated traits—phenes—correspond to organismic features that are caused by DC genes. Using such an approach, we can define a DC map, which shows the relations between each pair of phenes and provides a succinct summary of genotype-phenotype relationships and phenotypic complexity. Phenes in parents and offspring are judged to be homologous if their DC genes are composed of orthologous genetic factors. When comparing more distantly related organisms, traits are homologous when linked by a chain of parent-offspring homologs along the path of ancestry that links the two organisms. There are three possible ways to deal with the potential for multiple equivalent DC genes: maximal, minimal, and consensus homology. Whereas maximal homology has limited utility, the other two approaches have value and can help to guide research at the intersection of evolution and development. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 27-29, December 2011.

Objective Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why. Methods Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season. Results Twelve of 15 260 employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors (...) voluntarily identified their religious affiliation, and most were Christian. Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1–5 categories. The most frequently cited category was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved. Conclusions Less than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors’ concerns. (shrink)

I defend the claim that posthumous harm is possible against a simple but powerful and appealing argument for the impossibility of harm from posthumous events. I produce a counterargument against one of its assumptions. My conclusion is that the boundaries of welfare-affecting events may extend beyond the existence of the person whose welfare is in question. My case for rejecting the contrary claim avoids an objection to some familiar arguments for posthumous harm and is superior to another argument for posthumous (...) harm. To my knowledge, the case for posthumous harm presented here is a novel one, though it is of the same form as arguments made in 1984 by Feinberg and Parfit. My case for posthumous harm is not complete, for I argue for the satisfaction of what many people regard as only a necessary condition for harm. But I hope to have cleared away one obstacle to the possibility of posthumous harm. (shrink)

Mill contends that the fullest publicity and freedom of discussion is essential for all citizens to share in political freedom. Previous commentators have focused on Mill's strictures against censorship; they have paid little attention to his understanding of how freedom of discussion and political will formation are mediated in the public sphere by the distribution of social power in civil society, particularly control of the means of communication. This article shows that Mill's account of the sociology and political economy of (...) how public opinion forms is central to his understanding of freedom of discussion and democratic political freedom. (shrink)