Many people see high income as the primary motivation of today's American physicians. But in Dr. Pont offers a provocative new idea: that preserving professional autonomy has been a far more powerful motivation through this century.

The shared values, beliefs, and behaviors by which people interpret life events are what we call culture. More than medical science, culture determines how people react to illness and death. Science may determine which drug or surgery best treats the disease, but culture often determines how the health professional best treats a patient with the disease. Culture influences when the patient believes he is ill, which treatments he accepts, and which results he prefers. Because culture surely affects illness outcomes, health (...) professionals must not ignore it. (shrink)

We surveyed selected physician members of the Society for Health and Human Values (SHHV) to study the benefits and problems of combining a medical career with a strong scholarly interest in the humanities. The 19 usable narrative responses characterized major benefits as experiential base and teaching opportunities. Barriers were numerous and fell under the general headings of: lack of time; lack of institutional rewards; lack of money for research and scholarship; lack of support from humanities peers; lack of suport from (...) medical colleagues; personal financial sacrifice; and lack of training. Some respondents offered creative solutions to these problems, including assertive negotiation of a job description, identification of helpful mentors, and various networking and administrative strategies. The survey results, while preliminary, suggest ways in which SHHV can assist clinicians who wish to develop a serious commitment to humanities study and teaching. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:178 Reviews c:\users\kenneth\documents\type3302\rj 33,2 113 red.docx 2014-01-15 10:04 THE EARLY MOORE AND RUSSELL Ray Perkins, Jr. Philosophy / Plymouth State U. Plymouth, nh 03264 1600, usa [email protected] G. E. Moore. Early Philosophical Writings. Edited and with an Introduction by Thomas Baldwin and Consuelo Preti. Cambridge and New York: Cambridge U. P., 2011. Pp. lxxxv, 251. isbn: 978-0521190145. £68.00; us$114.00. aldwin and Preti have put together a very nice (...) book which gives us G. E. Moore’s 1897 and 1898 Trinity College dissertations and an informative look at the historical context in which they were written. This story—including information about Moore’s early life, the philosophical influences at Cambridge and a critical commentary on his dissertations and readers’ reports— is clearly and carefully presented in their 78-page introduction.1 The book is a valuable addition to the history of analytic philosophy and will be of special interest to Moore (and Russell) scholars and to historians generally who wish to know more about the genesis of the ideas shaping the new analytic philosophy at the end of the century. Moore entered Trinity in 1892 to study classics. There he met Russell (who was in his third year) and took his advice to study philosophy in his last two years and take his final exams (Tripos, Part ii) in both disciplines, which he did successfully in 1896. And like Russell—who had won a Trinity prize fellowship in 1895 (with a dissertation on the foundations of geometry2 ) only one year after his graduation—he submitted a dissertation (1897) in hopes of winning a prize fellowship. Moore’s first attempt failed, but his 1898 version was successful. And not only did the success of the 1898 dissertation launch Moore’s career as a professional philosopher, it also paved the way for the new analytic philosophy of the next century. Moore’s dissertations and his Trinity examiners’ reports (by Caird, Sidgwick, Ward and Bosanquet3 ) are fascinating reading, and it’s a great convenience to have them handy in a single volume. But the editors deserve special 1 Hereafter I shall use the editors’ convention of referring to the pagination of their introduction with roman numerals and to Moore’s dissertations (plus examiners’ reports) with arabic numerals. 2 Russell’s dissertation was published in 1897 as An Essay on the Foundations of Geometry. 3 Edward Caird was an idealist and highly respected Kant scholar at Oxford. Henry Sidgwick was one of Moore’s teachers at Cambridge and author of the influential _= Reviews 179 c:\users\kenneth\documents\type3302\rj 33,2 113 red.docx 2014-01-15 10:04 praise for not only giving the reader an astute critical summary of the dissertations, but also for their skillful reconstruction of Moore’s surviving, but incomplete, 1898 manuscript from which parts of the early chapters had been removed. The editors make a good case (pp. lxxv–lxxix) that those pages became the basis of Moore’s 1899 Mind article, “The Nature of Judgment”. (Those familiar with Russell’s early work may recall it as an article that Russell claimed as of paramount importance for his own early work.4 I’ll return to the question of Russell and Moore and this article’s significance.) the dissertations, 1897 and 1898 Moore’s dissertations reveal a young Moore with remarkable powers of analysis and more than a hint of the careful, courageous scepticism and intellectual honesty for which he later became known. But as the editors make clear, their main importance is the record they reveal of the transition away from Kant and Hegel to the new philosophy, which put a premium on conceptual analysis and metaphysics without Kantian or neo-Hegelian idealism. The 1897 dissertation (“The Metaphysical Basis of Ethics”) is an analysis of the basic concepts of ethics with considerable critical discussion of Kant, especially concerning freedom and reason, and Moore’s attempt to fashion his own good-based ethics utilizing a little from Kant and much from Bradley (p. l). At this time both Moore and Russell were still under the influence of Kant... (shrink)

I am going to be discussing a mode of moral responsibility that anglophone philosophers have largely neglected. It is a type of responsibility that looks to the future rather than the past. Because this forward-looking moral responsibility is relatively unfamiliar in the lexicon of analytic philosophy, many of my locutions will initially strike many readers as odd. As a matter of everyday speech, however, the notion of forward-looking moral responsibility is perfectly familiar. Today, for instance, I said I would be (...) responsible for watching my nieces while they swam. Neglecting this responsibility would have been a moral fault. When people marry, they undertake responsibilities, of moral import, of fidelity and mutual support. When people have children, they accrue moral responsibilities to feed, rear, and educate them. Not all forward-looking responsibilities are moral. While finishing this essay, I have had to keep an eye on a number of my administrative responsibilities, and, while reading it, you may well be occasionally distracted by some of your own. The notion of a responsibility that we accrue or take on, to look out for some range of concerns over some range of the future, is, then, perfectly familiar. Because this common notion of forward-looking responsibility has not been integrated into recent moral theory, however, my philosophical discussion of it will initially seem strange. (shrink)

Henry Richardson argues that we can determine our ends rationally. He constructs a rich and original theory of how we can reason about our final goals. Richardson defuses the counter-arguments for the limits of rational deliberation, and develops interesting ideas about how his model might be extended to interpersonal deliberation of ends, taking him to the borders of political theory. Along the way Richardson offers illuminating discussions of, inter alia, Aristotle, Aquinas, Sidgwick, and Dewey, as well as the work (...) of several contemporary philosophers. (shrink)

Researchers do not owe their subjects the same level of care that physicians owe patients, but they owe more than merely what the research protocol stipulates. In keeping with the dynamics of the relationship between researcher and subject, they have limited but substantive fiduciary obligations.

Henry S. Richardson is Professor of Philosophy at Georgetown University. From 2008-18, he was the editor of Ethics. His previous books include Practical Reasoning about Final Ends, Democratic Autonomy, and Moral Entanglements. He has held fellowships sponsored by the Alexander von Humboldt Foundation, the National Endowment for the Humanities, and the University Center for Human Values at Princeton University.

Frances Kamm has for some time now been a foremost champion of non-consequentialist ethics. One of her most powerful non-consequentialist themes has been the idea of inviolability. Morality's prohibitions, she argues, confer on persons the status of inviolability. This thought helps articulate a rationale for moral prohibitions that will resist the protean threat posed by the consequentialist argument that anyone should surely be willing to violate a constraint if doing so will minimize the overall number of such violations. As Kamm (...) put it in a 1992 article, ‘If morality permitted minimizing violations of persons by violating other persons, then each of those saved as well as those persons used to save others would be less inviolable. It is the permission, not any actual violation of persons, that makes this so.’ Now, as thus baldly asserted, this claim borders on the conclusory. It is almost as if the claim were that morality conferred on persons the following status: that of being protected from consequentialism. One wants to hear in what inviolability consists, in more detail, so that we can understand it independently of the negation of consequentialism. And there is also an opposite problem: if inviolability is a good, then why can't consequentialism take it into account? Hence, one also wants to hear why this would not be the case. (shrink)

Henry Richardson argues that we can determine our ends rationally. He constructs a rich and original theory of how we can reason about our final goals. Richardson defuses the counter-arguments for the limits of rational deliberation, and develops interesting ideas about how his model might be extended to interpersonal deliberation of ends, taking him to the borders of political theory. Along the way Richardson offers illuminating discussions of, inter alia, Aristotle, Aquinas, Sidgwick, and Dewey, as well as the work (...) of several contemporary philosophers. (shrink)

The philosopher Henry Richardson's short book is a defense of a position on a neglected topic in medical research ethics. Clinical research ethics has been a longstanding area of study, dating back to the aftermath of the Nazi death-camp doctors and the Tuskegee syphilis study. Most ethical regulations and institutions have developed in response to those past abuses, including the stress on obtaining informed consent from the subject. Richardson points out that that these ethical regulations do not address one (...) of the key dilemmas faced by medical researchers -- whether or not they have obligations towards subjects who need care not directly related to the purpose of the study, termed 'ancillary care obligation'. (shrink)

The notion that it is useful to specify norms progressively in order to resolve doubts about what to do, which I developed initially in a 1990 article, has been only partly assimilated by the bioethics literature. The thought is not just that it is helpful to work with relatively specific norms. It is more than that: specification can replace deductive subsumption and balancing. Here I argue against two versions of reliance on balancing that are prominent in recent bioethical discussions. Without (...) meaning to address the substance or the overall merits of either view I criticize, I attack Gert, Culver and Clouser's implicit reliance on some overall dimension of balancing as a basis of resolving conflicts among norms and Beauchamp and Childress's residual acceptance of 'justified balancing'. The former authors' description of resolving conflicts depends upon a type of value commensurability that (as they otherwise seem to admit) does not obtain, while the latter authors' role for justified balancing would be better served by continued specification. (shrink)

Recent work on incidental fndings, concentrating on the difcult problems posed by the ambiguous results often generated by high-tech medicine, has proceeded largely independently from recent work on medical researchers' ancillary-care obligations, the obligations that researchers have to deal with diseases or conditions besides the one(s) under study. This paper contends that the two topics are morally linked, and specifcally that a sound understanding of ancillary-care obligations will center them on incidental fndings. The paper sets out and defends an understanding (...) of ancillary-care obligations, which is based on the idea that when participants signed up for a study they may — independently of their beliefs and expectations and of those of the researchers — be taken to have partially entrusted certain aspects of their health into the researchers' hands. This partial-entrustment model of ancillary-care obligations, in turn, has substantive implications for how to deal ethically with incidental fndings; for instance, it suggests that researchers have no moral obligation to hunt for incidental fndings. (shrink)

Moral reasoning is individual or collective practical reasoning about what, morally, one ought to do. Philosophical examination of moral reasoning faces both distinctive puzzles — about how we recognize moral considerations and cope with conflicts among them and about how they move us to act — and distinctive opportunities for gleaning insight about what we ought to do from how we reason about what we ought to do.

This paper explores the convergence of two recent and growing streams of bioethical work and concern. Each has originated independently, but each arises from the fact that the Common Rule that has shaped medical research ethics, as institutionalized in the United States and also abroad, is largely silent about what needs to be done in response to researchers’ positive obligations. One stream concerns what to do about the sometimes vast range of findings that may arise incidentally to performing research procedures. (...) The other asks whether medical researchers owe their study participants any “ancillary care” — that is, medical care that their study participants need but that goes beyond what is required to do the science safely. (shrink)

Martha Nussbaum has powerfully argued in Frontiers ofJustice and elsewhere that John Rawls’s sort of social-contract theory cannot usefully be deployed to deal with issues pertaining to justice for the disabled. To counter this claim, this article deploys Rawls’s sort of social-contract theory in order to deal with issues pertaining to justice for the disabled—or, since, as Nussbaum stresses, we all have some degree of disability—for the severely disabled. In this way, rather than questioning one by one Nussbaum’s interpretive claims (...) about Rawls’s view, one can simply see how the Rawlsian framework can work in application to this issue. Following Rawls’s lead, the paper utilizes the idealized “initial choice situation” as an analytic and comparative device for examining alternative principles of justice, developing three different interpretations of the initial choice situation that each correspond to a different set of principles that apply to people of all levels of disability. One of these sets of principles is a simple extension of Rawls’s, one is very close to what Nussbaum herself recommends, and the third is a kind of hybrid. In this way, it is shown not only that Rawls’s social-contract device can usefully be applied to these issues, but also that it is helpful for exploring the deep commitments underlying each of these competing sets of principles. (shrink)

In various contexts, it is thought to be important that we reason together. For instance, an attractive conception of democracy requires that citizens reach lawmaking decisions by reasoning with one another. Reasoning requires that reasoners survey the considerations that they take to be reasons, proceed by a coherent train of thought, and reach conclusions freely. De facto reliance on experts threatens the possibility of collective reasoning by making some reasons collectively unsurveyable, raising questions about the coherence of the resulting train (...) of thought. De jure reliance on experts threatens the possibility of collective reasoning by seeming to make some conclusions irreversible. The paper argues that collective reasoning that relies on experts would nonetheless be possible if the unsurveyable reasons "mesh," if the expert considerations are at least in principle publicly recoverable, and if de jure authority of expert decision is always subject to appeal. (shrink)

This paper aims to establish three major theses: (1) Not only declarative sentences, but also interrogatives and imperatives, may be classified as true or as false. (2) Declarative, imperative, and interrogative utterances may also be classified as honest or as dishonest. (3) Whether an utterance is honest or dishonest is logically independent of whether it is true or is false. The establishment of the above theses follows upon the adoption of a principle for identifying what is meant by any sentence, (...) declarative, interrogative, or imperative. The analysis aims to show that meaning is to be attributed to the uttered or written sentence-token, rather to the thereby exhibited sentence-type. Further, the meaning of the sentential token is to be identified with a purpose of the speaker, that the speaker would reveal to the addressee by uttering the sentence. The to be revealed purpose is analysed into two components: an ultimate concern (that the addressee stand in such and such a relation--e.g., of believing, or informing the speaker about, or making it true that) and an ultimate topic of concern (the state of affairs, i.e., proposition, relative to which the speaker would have the addressee stand in the specified relation). Sentential utterances "signify" different purposes by "expressing" different ultimate concerns and "indicating" different ultimate topics of concern. Variations in expressed concern are correlated with variations in sentential form, such as declarative, interrogative and imperative. Variations in indicated topic of concern are correlated with variations in the subject and predicate of the uttered sentence. Thus, for example, utterances of "Johnny will jump in the lake," "Will Johnny jump in the lake?" and "Johnny, go jump in the lake!" all indicate one and the same ultimate topic of concern but express different ultimate concerns with this topic. A sentential utterance is true or false according as its indicated topic of concern is true or false. Hence, declaratives, interrogatives and imperatives may all be classified as true or as false. But honesty or dishonesty is a function (explained in the paper) of the expressed concern, rather than of the topic of concern. Hence, although utterances of all sentential forms are honest or dishonest, their honesty or dishonesty is logically independent of their truth or falsity. (shrink)