In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case (...) study developed from our day-to-day experience working as clinical practitioners in primary care. (shrink)

Primary health care is characterised by timely and appropriate health care access, delivered continuously over time to a specific population, providing a comprehensive service, with coordination of care for those that need it. Practitioners deal with a multiplicity of clinical issues within longitudinal relationships, embedded in the context of families and communities. We propose that these aspects of primary care have a bearing on how matters of decision making are considered and implemented. Further, the standard account of autonomous decision making (...) is not wholly adequate when applied to clinician–patient encounters in primary care. We add considerations of the impact of illness (however defined) and self-identity as also relevant to a more measured and full account. The context of primary care is quite different from that of secondary care. Although there are generalists who work in hospitals, we argue that this aspect and the other attributes of primary care generate special ethical considerations. One of these is how autonomy, or more fully, how respect for the principle of autonomy is considered and operationalised in community practice. In this study, we describe some theoretical aspects of autonomy and seek to apply, and challenge, these aspects in the context of clinical work in primary care. In doing so we will review the descriptors of primary care: why in essence it is different from other contexts of clinical work. (shrink)

The relationship between animal ownership and owners' health has received increasing attention in the recent human-companion animal literature. This article considers a new aspect of the human-companion animal relationship, that of compatibility between pet and owner. Compatibility is viewed as the fit between the animal and the owner on physical, behavioral, and psychological dimensions. A postal survey was used to test the hypothesis that compatibility has influences on physical and mental health that are independent of those due to owners' level (...) ofpet attachment and human social support. A sample group of 176 pet owners completed a questionnaire containing a new measure of compatibility as well as standard measures of pet attachment, human social support, and mental and physical health. Results of multiple regression analyses indicated that people who are relatively more compatible with their pets report better mental health overall and fewer physical symptoms. Social support was positively associated with mental health. Pet attachment was also positively associated with mental health, but negatively with physical health. (shrink)

Next SectionMany jurisdictions require cyclists to wear bicycle helmets. The UK is currently not one of these. However, an increasing number of interest groups, including the British Medical Association, want to change the status quo. They argue that mandatory cycle helmet laws will reduce the incidence of head injuries and that this will be both good for cyclists (because they will suffer fewer head injuries) and good for society (because the burden of having to treat cyclists suffering from head injuries (...) will be reduced). In this paper we argue against this position. We suggest that cycle helmets may not be especially effective in reducing head injuries and we suggest that the imposition of such a restrictive law would violate people's freedom and reduce their autonomy. We also argue that those who accept such a restrictive law would be committed to supporting further legislation which would force many other groups – including pedestrians – to take fewer risks with their health. We conclude that cycle helmet legislation should not be enacted in the UK unless, perhaps, it is restricted to children. (shrink)

This Handbook offers much-needed insights into the ethics of primary healthcare. Topics range from the issues arising in primary care interactions, to working with different sources of vulnerability among patients, from contexts connected with teaching and learning, to issues in relation to justice and resources.

We suggest that in the particular context of medical education, ethics can be considered in a similar way to other kinds of knowledge that are categorised and shaped by academics in the context of wider society. Moreover, the study of medical ethics education is translational in a manner loosely analogous to the study of medical education as adjunct to translational medicine. Some have suggested there is merit in the idea that much as translational research attempts to connect the laboratory scientist's (...) work to its implications for patient care, translational ethics focuses on bringing ethics scholarship into the sphere of personal and public action. We distinguish the term ‘translational ethics’ (the study of ethics being translated between academy, classroom and clinic) from other prominent definitions in the bioethics literature. To do this, we build off a notion of knowledge translation that focuses on the nonlinear movement of information that comes to professionals through multiple competing sources. We suggest that this knowledge, and particularly knowledge about ethics, becomes embodied by the individual. It is through a reflective practice that internally embedded ethics knowledge might be modified, and this work might be best carried out with a moral community that maintains a sense of practical wisdom. Applying this translational approach to the study of medical ethics education can be both academically relevant and practically useful. This view of translation can help bridge the evident, multidirectional relationships between research, education and performance. It might also create further opportunities to develop medical ethics education theory. (shrink)

We are sceptical of concerns over the opacity of algorithmic decision tools. While transparency and explainability are certainly important desiderata in algorithmic governance, we worry that automated decision-making is being held to an unrealistically high standard, possibly owing to an unrealistically high estimate of the degree of transparency attainable from human decision-makers. In this paper, we review evidence demonstrating that much human decision-making is fraught with transparency problems, show in what respects AI fares little worse or better and argue that (...) at least some regulatory proposals for explainable AI could end up setting the bar higher than is necessary or indeed helpful. The demands of practical reason require the justification of action to be pitched at the level of practical reason. Decision tools that support or supplant practical reasoning should not be expected to aim higher than this. We cast this desideratum in terms of Daniel Dennett’s theory of the “intentional stance” and argue that since the justification of action for human purposes takes the form of intentional stance explanation, the justification of algorithmic decisions should take the same form. In practice, this means that the sorts of explanations for algorithmic decisions that are analogous to intentional stance explanations should be preferred over ones that aim at the architectural innards of a decision tool. (shrink)

In contemporary American poetry, poets practice open form. Charles Olson, Robert Duncan, Paul Blackburn, Robert Creeley, Jack Spicer, Denise Levertov, Gary Snyder, Allen Ginsberg, Edward Dorn, Louis Zukofsky, John Ashbery, and Frank O'Hara belong to this school of open form. Their open form advocates creative spontaneity, fragmentation, and juxtaposition. It repudiates thematic and formal closure and requires of its readers a willingness to value a poem as process and event. Recent studies of open form inform us that in (...) both theory and practice they descended from Pound and Williams. However, my intention is to establish the foreground of open form in the poetics and poetry of Yeats, Pound, and Eliot. My major objective is to establish Yeats as the precursor of the poetics of open form, and then to apply his poetics to his poetry, and to those of Pound and Eliot. ;Part I, with the aid of the theories of language by Paul de Man, Jacques Derrida, Jacques Lacan, and Martin Heidegger, examines the linguistic turn revealed in Yeats's A Vision which manifests the poetics of open form through the rhetoric of prophecy. Chapter One defines the concept of the Unity of Being. Chapter Two illustrates how Yeats disciplines himself in his poetic quest for the Unity of Being. Chapter Three defines prophecy and the rhetoric of prophecy. Exergue, an inter-chapter, surveys and assesses contemporary theories of language in an attempt to relate metaphor to rhetoric. Chapter Four closely examines A Vision in the light of the rhetoric of prophecy and poetics of open form. ;Part II demonstrates how the poetry of Yeats, Pound and Eliot provides the praxis of Yeats's poetics. Conclusion discusses the poetics of Duncan, Olson, and Levertov and show how they reflect Yeats's, thereby demonstrating the continuity between the poetry of modernism and postmodernism. (shrink)

The Kennedy Institute of Ethics is grateful for the vision, guidance, and dedication on behalf of the Kennedy Institute of Ethics Journal by Robert M. Veatch, PhD, its senior editor and senior research scholar at the KIE. For over twenty years, Bob has steered the journal along its path of success, and its partnership with the Johns Hopkins University Press, to arrive at the place it holds today—truly a "scholarly forum for diverse views on major issues in bioethics." Bob has (...) retired from the editorship effective January 2011 (though thankfully not from the KIE!).We also wish to express our appreciation to Carol M. Spicer, PhD, the journal's editor and hands-on manager of KIEJ. Carol received her doctorate in .. (shrink)

Kant’s philosophy of science takes on sharp contour in terms of his interaction with the practicing life scientists of his day, particularly Johann Blumenbach and the latter’s student, Christoph Girtanner, who in 1796 attempted to synthesize the ideas of Kant and Blumenbach. Indeed, Kant’s engagement with the life sciences played a far more substantial role in his transcendental philosophy than has been recognized hitherto. The theory of epigenesis, especially in light of Kant’s famous analogy in the first Critique, posed crucial (...) questions regarding the ‘looseness of fit’ between the constitutive and the regulative in Kant’s theory of empirical law. A detailed examination of Kant’s struggle with epigenesis between 1784 and 1790 demonstrates his grave reservations about its hylozoist implications, leading to his even stronger insistence on the discrimination of constitutive from regulative uses of reason. The continuing relevance of these issues for Kant’s philosophy of science is clear from the work of Buchdahl and its contemporary reception. (shrink)

The danger of human operators devolving responsibility to machines and failing to detect cases where they fail has been recognised for many years by industrial psychologists and engineers studying the human operators of complex machines. We call it “the control problem”, understood as the tendency of the human within a human–machine control loop to become complacent, over-reliant or unduly diffident when faced with the outputs of a reliable autonomous system. While the control problem has been investigated for some time, up (...) to this point its manifestation in machine learning contexts has not received serious attention. This paper aims to fill that gap. We argue that, except in certain special circumstances, algorithmic decision tools should not be used in high-stakes or safety-critical decisions unless the systems concerned are significantly “better than human” in the relevant domain or subdomain of decision-making. More concretely, we recommend three strategies to address the control problem, the most promising of which involves a complementary coupling between highly proficient algorithmic tools and human agents working alongside one another. We also identify six key principles which all such human–machine systems should reflect in their design. These can serve as a framework both for assessing the viability of any such human–machine system as well as guiding the design and implementation of such systems generally. (shrink)

Practical reasoning is a process of reasoning that concludes in an intention. One example is reasoning from intending an end to intending what you believe is a necessary means: 'I will leave the next buoy to port; in order to do that I must tack; so I'll tack', where the first and third sentences express intentions and the second sentence a belief. This sort of practical reasoning is supported by a valid logical derivation, and therefore seems uncontrovertible. A more contentious (...) example is normative practical reasoning of the form 'I ought to φ, so I'll φ', where 'I ought to φ' expresses a normative belief and 'I'll φ' an intention. This has at least some characteristics of reasoning, but there are also grounds for doubting that it is genuine reasoning. One objection is that it seems inappropriate to derive an intention to φ from a belief that you ought to φ, rather than a belief that you ought to intend to φ. Another is that you may not be able to go through this putative process of reasoning, and this inability might disqualify it from being reasoning. A third objection is that it violates the Humean doctrine that reason alone cannot motivate any action of the will. This paper investigates these objections. (shrink)

The leading hypothesis concerning the “reuse” or “recycling” of neural circuits builds on the assumption that evolution might prefer the redeployment of established circuits over the development of new ones. What conception of cognitive architecture can survive the evidence for this hypothesis? In particular, what sorts of “modules” are compatible with this evidence? I argue that the only likely candidates will, in effect, be the columns which Vernon Mountcastle originally hypothesized some 60 years ago, and which form part of the (...) well-known columnar hypothesis in neuroscience—systems that cannot handle gross cognitive functions as distinct from strictly exiguous subfunctions. This is in stark contrast to the modules postulated by much of cognitive psychology, cognitive neuropsychology, and evolutionary psychology. And yet the fate of this revised notion is unclear. The main issue confronting it is the effect of the neural network context on local function. At some point the effects of context are so strong that the degree of specialization required for modularity is not able to be met. Still, despite indications from neuroimaging that peripheral and central systems deploy shared circuitry, some skills clearly do seem to display modularization and autonomy. This article: provides an in-depth analytical and historical review of the fortunes of modular thinking in cognitive science; offers a systematic calibration of brain regions in terms of degrees of functional specificity and robustness; and suggests another way of accounting for the partially encapsulated character of expertise and other highly practiced skills without having to resort to domain-specific modules. (shrink)

The past two decades have witnessed a revival of interest in multiple realization and multiply realized kinds. Bechtel and Mundale’s (1999) illuminating discussion of the subject must no doubt be credited with having generated much of this renewed interest. Among other virtues, their paper expresses what seems to be an important insight about multiple realization: that unless we keep a consistent grain across realized and realizing kinds, claims alleging the multiple realization of psychological kinds are vulnerable to refutation. In this (...) paper I argue that, intuitions notwithstanding, the terms of their recommendation make it impossible to follow, while also misleadingly insinuating that its application virtually guarantees mind-brain identity. Instead of a matching of grains, what multiple realization really requires is a principled method for adjudicating upon differences between tokens. Shapiro’s (2000) work on multiple realization can be understood as an attempt to adumbrate just such a method. While his “causal relevance” criterion can easily be mistaken for Bechtel and Mundale’s grain requirement, my analysis reveals exactly where and why these two tests diverge. (shrink)

Modularity is a fundamental doctrine in the cognitive sciences. It holds a preeminent position in cognitive psychology and generative linguistics, as well as a long history in neurophysiology, with roots going all the way back to the early nineteenth century. But a mature field of neuroscience is a comparatively recent phenomenon and has challenged orthodox conceptions of the modular mind. One way of accommodating modularity within the new framework suggested by these developments is to go for increasingly soft versions of (...) modularity. One such version, which I call the “system” view, is so soft that it promises to meet practically any challenge neuroscience can throw at it. In this paper, I reconsider afresh what we ought to regard as the sine qua non of modularity and offer a few arguments against the view that an insipid “system” module could be the legitimate successor of the traditional notion. (shrink)

"From the 1930 Reiser edition of the Ars logica, itself comprising the first two parts of the five part Cursus philosophicus of 1631-1635, by the same author.".

Derek Parfit takes an externalist and cognitivist view about normative reasons. I shall explore this view and add some arguments that support it. But I shall also raise a doubt about it at the end.

Evidence of the pervasiveness of neural reuse in the human brain has forced a revision of the standard conception of modularity in the cognitive sciences. One persistent line of argument against such revision, however, cites the evidence of cognitive dissociations. While this article takes the dissociations seriously, it contends that the traditional modular account is not the best explanation. The key to the puzzle is neural redundancy. The article offers both a philosophical analysis of the relation between reuse and redundancy (...) as well as a plausible solution to the problem of dissociations. (shrink)

This is a classic volume in the "library of Living Philosophers" and includes a collection of essays on Dewey's work by his contemporaries at the time of the volume's publication. It also includes a biographical essay on Dewey and his replies to the assembled essays.

The conflict between Kant and the medical faculty was far more complex and substantial than is indicated in the section of his famous Conflict of the Faculties addressing this matter. In this essay I will consider not only what Kant, as a philoso­pher, thought of medicine as a faculty, but what medicine as a faculty thought of Kant as a philosopher.

The conflict between Kant and the medical faculty was far more complex and substantial than is indicated in the section of his famous Conflict of the Faculties addressing this matter. In this essay I will consider not only what Kant, as a philoso­pher, thought of medicine as a faculty, but what medicine as a faculty thought of Kant as a philosopher.

In “Causality and Determination,” Anscombe rejects the two received opinions on the nature of causality in the modern philosophical tradition. She rejects the Humean conception of universal generalization based on the constant conjunction in experience of cause and effect, and she also rejects the notion that causality entails a necessary connection between cause and effect. As an alternative, she suggests that the core notion of causality is one of the derivativeness of the effect from the cause. Her consideration of causality (...) ranges generally over all types of causality, but I believe that the most significant implication of her position is in application to the causality of human action. In this paper, I will articulate what I take to be that position. (shrink)

In “Causality and Determination,” Anscombe rejects the two received opinions on the nature of causality in the modern philosophical tradition. She rejects the Humean conception of universal generalization based on the constant conjunction in experience of cause and effect, and she also rejects the notion that causality entails a necessary connection between cause and effect. As an alternative, she suggests that the core notion of causality is one of the derivativeness of the effect from the cause. Her consideration of causality (...) ranges generally over all types of causality, but I believe that the most significant implication of her position is in application to the causality of human action. In this paper, I will articulate what I take to be that position. (shrink)

Except for Dewey's and James H. Tufts' 1932 Ethics (Volume 7 of The Later Works), this volume brings together Dewey's writings for 1931–1932.

Catholic moral philosophy requires an absolute prohibition against the direct killing of innocents. In this paper I consider some examples of justified actionswhich involve the killing of innocent persons and will present them as cases about which I am confident many others will share the same intuitions. I willthen try to show what conditions apply in such cases that justify those intuitions. I will argue that their justification is in accordance with a modified version of theFinnis, Grisez, Boyle interpretation of (...) the doctrine of double effect; it defends their interpretation of what is direct versus indirect in cases of double effect, and meets the proportionality condition in a way suggested by Philippa Foot regarding the virtues of justice and charity. (shrink)

In Empowering the Lonely Crowd, John Raymaker simplifies and extends arguments made in his previous book, A Buddhist-Christian Logic of the Heart, in particular the notion of a spiritual genome. Raymaker explores and compares John Paul II and Lonergan's thought in relation to Buddhism, concluding that while all life has a coded genome, all humans have a free, uncoded spiritual genome that is a viable alternative to postmodern scepticism.

_ Source: _Page Count 9 Robert Doran claims that the sublime is all about transcendence transferred from the religious to the aesthetic domain of experience. Taken in this philosophical rather than stylistic sense, it proved crucial for the development of modern subjectivity. Doran traces the issue from Longinus through the decisive reception of Nicolas Boileau, who first distinguished le sublime from le style sublime, on to an extended engagement with Immanuel Kant. In all this he seeks its place in the (...) rise of the modern bourgeois subject. The social-historical connections tend to be a bit overstated, first, with regard to Boileau and the idea of the honnête homme, and especially with the claim that “Burke treats aesthetic concepts as proxies for sociopolitical categories.” It is not fruitful for an understanding of Kant, either. This weakens his powerful argument for the philosophical significance of the sublime in modern thought. (shrink)

Epigenesis has become a far more exciting issue in Kant studies recently, especially with the publication of Jennifer Mensch’s Kant’ Organicism. In my commentary, I propose to clarify my own position on epigenesis relative to that of Mensch by once again considering the discourse of epigenesis in the wider eighteenth century. In order to situate more precisely what Kant made of it in his own thought, I distinguish the metaphysical use Kant made of epigenesis from his rejection of its aptness (...) as a theory for life science. In that light, I raise questions about the scope and authority of philosophy vis à vis natural science. (shrink)

Epigenesis has become a far more exciting issue in Kant studies recently, especially with the publication of Jennifer Mensch’s Kant’ Organicism. In my commentary, I propose to clarify my own position on epigenesis relative to that of Mensch by once again considering the discourse of epigenesis in the wider eighteenth century. In order to situate more precisely what Kant made of it in his own thought, I distinguish the metaphysical use Kant made of epigenesis from his rejection of its aptness (...) as a theory for life science. In that light, I raise questions about the scope and authority of philosophy vis à vis natural science. (shrink)

Herder's Naturalist Aesthetics, by ZuckertRachel. Cambridge, UK: Cambridge University Press, 2019. Pp. 276.

The principle of "organism"—of intrinsic and dynamic unity—and the existence of "organized bodies"—of living things—in the physical world represented crucial preoccupations for philosophers of nature and experimental naturalists across the eighteenth century. How to make sense of these in a manner consistent with a unified scientific understanding of the physical world became the inevitable challenge that accompanied these recognitions. In just this theoretical enterprise, Leibniz emerges to historical scrutiny as an indispensable and pervasive influence. Thus, we are very fortunate to (...) have the body of scholarship that François Duchesneau has devoted to this topic over the course of his illustrious career. In this... (shrink)

Evidentialism is generally taken to be a position which is not friendly to a religious epistemology. However, in this paper, I will argue for a religious epistemology which is compatible with fundamental tenets of an evidentialist position on epistemic justification. It is a position which entails both a “will to believe” which goes beyond the standard evidentialist principles governing the appropriate doxastic attitude towards a proposition, but nonetheless satisfies epistemic principles at the basis of an evidentialist position on justification. If (...) my argument is successful, a proponent of a conception of religious faith may be able to have her cake and eat it too: namely, she may be able to fundamentally accept both the evidentialist demand that epistemically rational belief fit, or be supported by evidence as well as the position that rational faith is willing belief beyond what one’s evidence strictly demands. (shrink)

In his Inductive Inference and Its Natural Ground: An Essay in Naturalistic Epistemology, Hilary Kornblith presents an argument for the justification of induction that is bold, brilliant, and plausible, but radically incomplete. In the development of this position, Kornblith relies heavily on the philosophical work of Richard Boyd as well as on some empirical psychological studies. As Kornblith sees it, the philosophical position entailed by his proposed solution to the problem is a thoroughgoing, realistic, scientific materialism. I will argue that (...) the brand of realism that Kornblith’s solution to the problem of induction presupposes is inexplicable within the context of the non-reductive materialism that he espouses. Although Kornblith provides us with valuable elements for a solution to the problem of induction, it needs to be supplemented with something like a renovated Aristotelian notion of form in order for the solution to be plausible. (shrink)