Allowing algorithms to guide or determine decision-making in ethically complex situations, and eventually satisfying the need for good clinical ethics consultation work, is a philosophically intere...

In this paper, I argue that distinctions between traditional and contemporary accounts of conscience protections, such as the account offered by Aulisio and Arora, fail. These accounts fail because they require an impoverished conception of our moral lives. This failure is due to unnoticed assumptions about the distinction between the traditional and contemporary articulations of conscience protection. My argument proceeds as follows: First, I highlight crucial assumptions in Aulisio and Arora’s argument. Next, I argue that respecting maximal play in values, (...) though a fine goal in our liberal democratic society, raises a key issue in exactly the situations that matter in these cases. Finally, I argue that too much weight is given to a too narrow conception of values. There are differences between appeals to conscience that are appropriately categorized as traditional or contemporary, and a way to make sense of conscience in the contemporary medical landscape is needed. However, the normative implications drawn by Aulisio and Arora do not follow from this distinction without much further argument. I conclude that their paper is a helpful illustration the complexity of this issue and of a common view about conscience, but insofar as their view fails to account for the richness of our moral life, they fail to resolve the issue at hand. (shrink)

Christopher Meyers attempts a utilitarian defense of the deception of patients when the purported harms of truthful disclosure outweigh its benefits. He suggests that honesty i...

In this paper, I consider the role of conscience in medical practice. If the conscientious practice of individual practitioners cannot be defended or is incoherent or unreasonable on its own merits, then there is little reason to support conscience protection and to argue about its place in the current medical landscape. If this is the case, conscience protection should be abandoned. To the contrary, I argue that conscience protection should not be abandoned. My argument takes the form of an analysis (...) of an essential feature of the conscience dissenter’s argument, the role of disagreement within “the medical profession.” Conscience dissenters make certain assumptions within their arguments about the profession, disagreements within the professions, and how such disagreement should be adjudicated. If it is the case that these assumptions are accurate reflections of the current medical landscape, then the advocate of conscience protection has one less leg to stand on. I aim to show that this is not the case and that the assumptions of the conscience dissenter are not only mistaken but are mistakes of significant magnitude, so significant as to raise serious questions about the merit of their position. If the argument in this paper is sound, then, at the very least, the conversation over conscience protection in medicine, in particular, and health care, in general, must continue. (shrink)

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy. The five articles in this issue address a range of topics from the human embryo and substantial change to conceptions of disability. They engage claims of moral status, defense of our humanity, and argue for an accurate and just classification of persons of different communities within a healthcare system. I argue in this essay that though their concerns are diverse, the authors in this issue (...) help to answer a common question: “Who counts as one of us?” Reading these articles through the lens of membership and the themes of dignity illustrates this commonality and bears fruit for further reflection on many of the challenging issues addressed in the subsequent papers. (shrink)

In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator and turning off a cardiac pacemaker. It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these devices: (...) physicians, nurses, and allied professionals. Next, I offer a few possible analyses of the situation, relying on recent work in medical ethics. Considerations of intention, responsibility, and replacement support my distinguishing between ICDs and CPs. I conclude by recommending a change in policy of one of the leading cardiac societies. (shrink)

In “IRBs and The Protection Inclusion Dilemma: Finding a Balance,” Friesen et al. (2023) argue that IRBs ought to attend more, and better, to the need for the inclusion of under-researched populati...

In their thoughtful and well-supported target article, Andrew Garland, Stephanie Morain, Jeremy Sugarman (2023) argue that clinicians have a duty to participate in pragmatic clinical trials. This d...

Understanding what sorts of things one might be responsible for is an important component of understanding what one should do in situations where the administration of artificial hydration and nutrition are required to sustain the life of a patient. Relying on work done in the philosophy of action and on moral responsibility, I consider the implications of omitting the administration of artificial hydration and nutrition and instances in which the omitting agent would and would not be responsible for the death (...) of the patient. I am primarily interested in arguing against those who wish to seat responsibility for the death of a patient in an underlying pathology, even when the underlying pathology is not the cause of the patient’s death. (shrink)

The proper role of conscience in healthcare continues to be a topic of deep interest for bioethicists, healthcare professionals, and health policy experts. This issue of HEC Forum brings together a collection of articles about features of these ongoing discussions of conscience, advancing the conversations about conscience in healthcare from a variety of perspectives and on a variety of fronts. Some articles in this issue take up particularly challenging cases of conscientious objection in practice, such as Fleming, Frith, and Ramsayer’s (...) contextually rich piece on midwives in Scotland or Harter’s professionally grounded analysis; others engage the changing institutional landscapes which impact considerations of conscience, such as Cummins’ work on the role of employers in institutional policies about conscience and Ben Moshe’s discussion of publicity and institutional committees. Pieces by Howard and Pilkington both raise conceptual considerations about how we think about the role of conscience in medicine, questioning the use of “conscientious objection” in these discussions, and Byrnes pushes back on the most influential work in this area by Mark Wicclair. The issue concludes with a piece by Wicclair, which engages each of these distinct offerings, further extending the discussions of conscience in healthcare and helpfully connecting key themes discussed by authors in this issue to his contributions and to the longer tradition of discussions of conscience in medicine. This issue challenges readers to engage different arguments from different perspectives and asks them—in some cases—to be open to revising how they think about the role of conscience and the existence of and justification for conscientious objection in the dynamic, interdisciplinary fields of healthcare. (shrink)

One of the perplexing features of an infectious disease is the damage it causes, not only to physical health, but to mental health and to social relationships. This tension between the separation that is required for safety and the human need for contact is especially felt by institutions of higher education. Many such institutions not only educate students but seek to foster the kinds of communities which have thrived on personal interaction and shared physical space. Different institutions have responded to (...) COVID-19 and its impacts on their members differently. Given that the spring semester will begin months before COVID-19 vaccines are widely available, we offer seven recommendations and argue that for a university, college, or other similarly situated educational institution to ethically respond to the pandemic, it must follow these recommendations. These recommendations are grounded in both scientific research and ethical analysis. Proper ethical analysis, which is necessary for the implementation of good policies, cannot be accomplished without an evidence-based grounding. After describing features of the virus and the situation that faces higher education institutions, in general, we turn to a detailed discussion of transmission. We discuss interventions available to institutions, including masking, hygiene, barriers, and testing and surveillance. Our recommendations are supported by an ethical analysis reliant on four themes: expertise, planning, stewardship, and dignity. (shrink)

J Med Philos, 2020; 45: 28–41; doi:_ 10.1093/jmp/jhz031 _.

We applaud Sedlakova and Trachsel’s work and their description of conversational artificial intelligence (CAI) as possessing a hybrid nature with features of both a tool and an agent (Sedlakova and...

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

Discussions of the proper role of conscience and practitioner judgement within medicine have increased of late, and with good reason. The cost of allowing practitioners the space to exercise their best judgement and act according to their conscience is significant. Misuse of such protections carve out societal space in which abuse, discrimination, abandonment of patients, and simple malpractice might occur. These concerns are offered amid a backdrop of increased societal polarization and are about a profession which has historically fought for (...) such privileged space. There is a great deal that has been and might yet be said about these topics, but in this paper I aim to address one recent thread of this discussion: justification of conscience protection rooted in autonomy. In particular, I respond to an argument from Greenblum and Kasperbaur and clarify a critique I offered of an autonomy-based conscience protection argument which Greenblum and Kasperbaur seek to improve and defend. To this end, I briefly recap the central contention of that argument, briefly describe Greenblum and Kasperbaur’s analysis of autonomy and of my critique, and correct what appears to be a mistake in interpretation of both my work and of autonomy-based defenses of conscience protection in general. (shrink)

The question of whether nursing ethics is a distinct entity within bioethics is an important and thought-provoking one. Though fundamental bioethical principles are appreciated and applied within the practice of nursing ethics, there exist distinct considerations which make nursing ethics a unique subfield of bioethics. In this article, we focus on the importance of relationships as a distinguishing feature of the foundation of nursing ethics, evidenced in its education, practice, and science. Next, we consider two objections to our claim of (...) distinctiveness: first, that nursing ethics is merely an application of bioethical principles; second, that many bioethical subfields emphasize relationships. We respond by highlighting that throughout nursing education and generally in every career path that follows, the creation and nurturing of relationships is emphasized. Compassion and respect for the dignity of every patient is the framework upon which these therapeutic relationships are built. Much of the focus of nursing science rests on creating meaningful interpersonal experiences and human connection. After responding to each objection, we turn to the implications of this distinctiveness on clinical ethics practice, arguing that the strengths of our approach outweigh the limitations. The deep emphasis on creating meaningful interpersonal experiences and human connection supports a greater integration of relationships and social contexts into the evaluation of whether an action is ethically permissible, which is an important benefit in addressing the challenging human situations that patients face. Moreover, this perspective allows nurse ethicists to account for diverse and complex social structures and their influence in making ethical determinations. These strengths outweigh the limitations of potential inconsistencies between nurse and non-nurse clinical ethicists on the same service, a result we attribute to nursing ethics—and, in turn, the practice of the nurse ethicist—being framed by relationships to a larger extent than other bioethical subfields. (shrink)

We applaud Shen et al. (2024) for offering a framework to address how to return research results from digital phenotyping within the discipline of psychiatry. However, given the value-laden nature...

In their compelling argument for the use of role morality as a means to aid physicians in navigating potential conflicts of interest, Doernberg and Truog (2023) posit the existence of distinct sphe...

The authors, one a trained geneticist and the other a trained ethicist, designed and team-taught a bioethics course where nineteen third- and fourth-year undergraduate students were enrolled at Aquinas College in Grand Rapids, Michigan, during the fall 2016 semester. The syllabus, including democratically-chosen ethical debate topics, peer-led student working groups, and varied assessment methods were novel aspects of the course. The students, being either philosophy or biology majors or minors, successfully completed the course and indicated being highly satisfied with the (...) course at its completion. Although there were limitations to a course such as this one, educators at similar small liberal arts institutions could offer a bioethics course by following our suggestions, including collaborative teaching and assessment and incorporating students’ preferences into the scheduled curriculum. (shrink)

In the piece, “What Should ChatGPT Mean for Bioethics?” Professor Cohen proposes that the introduction of AI generally, and generative AI specifically, requires that patients be informed of, and co...

Chat Generative Pre-Trained Transformer (ChatGPT) has been a growing point of interest in medical education yet has not been assessed in the field of bioethics. This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character count (...) were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient–physician relationships and performed poorly on questions pertaining to informed consent. Of all the specialties, it performed best in paediatrics. Yet, certain specialties and bioethical categories were under-represented. Among the errors made, it tended towards content errors and application errors. There were no significant associations between character count and accuracy. Nevertheless, this investigation contributes to the ongoing dialogue on artificial intelligence’s (AI) role in healthcare and medical education, advocating for further research to fully understand AI systems’ capabilities and constraints in the nuanced field of medical bioethics. (shrink)

In a recent article for this journal, Bryan Pilkington makes a number of critical observations about one of our arguments for non-traditional medical conscientious objectors’ duty to refer. Non-traditional conscientious objectors are those professionals who object to indirectly performing actions—like, say, referring to a physician who will perform an abortion. In our response here, we discuss his central objection and clarify our position on the role of value conflicts in non-traditional conscientious objection.

Montague and Kaplan began a revolution in semantics, which promised to explain how a univocal expression could make distinct truth-conditional contributions in its various occurrences. The idea was to treat context as a parameter at which a sentence is semantically evaluated. But the revolution has stalled. One salient problem comes from recurring demonstratives: "He is tall and he is not tall". For the sentence to be true at a context, each occurrence of the demonstrative must make a different truth-conditional contribution. (...) But this difference cannot be accounted for by standard parameter sensitivity. Semanticists, consoled by the thought that this ambiguity would ultimately be needed anyhow to explain anaphora, have been too content to posit massive ambiguities in demonstrative pronouns. This article aims to revived the parameter revolution by showing how to treat demonstrative pronouns as univocal while providing an account of anaphora that doesn't end up re-introducing the ambiguity. (shrink)

In the language of second-order logic, first- and second-order variables are distinguished syntactically and cannot be grammatically substituted. According to a prominent argument for the deployment of these languages, these substitution failures are necessary to block the derivation of paradoxes that result from attempts to generalize over predicate interpretations. I first examine previous approaches which interpret second-order sentences using expressions of natural language and argue that these approaches undermine these syntactic restrictions. I then examine Williamson’s primitivist approach according to which (...) second-order sentences are not offered readings in a previously understood language. I argue that the syntactic restrictions alone do not block the derivation of the paradox, unless they are backed by a principled reason that the language cannot be expanded to allow the grammatical substitution of first- and second- order variables. I argue that there is neither a syntactic nor a semantic principle that prohibits such an expansion. (shrink)

Those of us who take skepticism seriously typically have two relevant beliefs: (a) it’s plausible (even if false) that in order to know that I have hands I have to be able to epistemically neutralize, to some significant degree, some skeptical hypotheses, such as the brain-in-a-vat (BIV) one; and (b) it’s also plausible (even if false) that I can’t so neutralize those hypotheses. There is no reason for us to also think (c) that the BIV hypothesis, for instance, is plausible (...) or probably true. In order to take skepticism seriously it’s sufficient to hold (a) and (b); one need not hold (c). Indeed, philosophers who accept (a) and (b) never endorse (c). Show me a philosopher who suspects that he is a brain in a vat and I’ll show you someone who is deranged! That’s one thing that bothers undergraduates in philosophy. They object: why on earth do some philosophers take the BIV hypothesis to pose any threat at all to our beliefs given that those very same philosophers think that there’s no real chance that the BIV hypothesis is true? Sure, the BIV hypothesis is formally inconsistent with my belief that I have hands, so if the former is true then my belief is false. But so what? Why should that bare inconsistency matter so much? Is this strange attitude amongst philosophers the result of some logic fetish infecting the philosophical community? It is sometimes said that the skeptical hypotheses are not only inconsistent with our beliefs but are explanatory of our experiences, which is supposed to make them more of a threat. But students aren’t fooled: although the skeptical hypotheses may attempt to explain why our experience is as it is, it’s the kind of attempt appropriate for science fiction movies that are all special effects and virtually no plot. No one with any sense of reality will take the evil demon hypothesis to be even tenuously explanatory. (shrink)

The Greek word eoikos can be translated in various ways. It can be used to describe similarity, plausibility or even suitability. This book explores the philosophical exploitation of its multiple meanings by three philosophers, Xenophanes, Parmenides and Plato. It offers new interpretations of the way that each employs the term to describe the status of their philosophy, tracing the development of this philosophical use of eoikos from the fallibilism of Xenophanes through the deceptive cosmology of Parmenides to Plato's Timaeus. The (...) central premise of the book is that, in reflecting on the eoikos status of their accounts, Xenophanes, Parmenides and Plato are manipulating the contexts and connotations of the term as it has been used by their predecessors. By focusing on this continuity in the development of the philosophical use of eoikos, the book serves to enhance our understanding of the epistemology and methodology of Xenophanes, Parmenides and Plato's Timaeus. (shrink)

The principle of compositionality requires that the meaning of a complex expression remains the same after substitution of synonymous expressions. Alleged counterexamples to compositionality seem to force a theoretical choice: either apparent synonyms are not synonyms or synonyms do not syntactically occur where they appear to occur. Some theorists have instead looked to Frege’s doctrine of “reference shift” according to which the meaning of an expression is sensitive to its linguistic context. This doctrine is alleged to retain the relevant claims (...) about synonymy and substitution while respecting the compositionality principle. Thus, Salmon (Philos Rev 115(4):415, 2006) and Glanzberg and King (Philosophers’ Imprint 20(2):1–29, 2020) offer occurrence-based accounts of variable binding, and Pagin and Westerståhl (Linguist Philos 33(5):381–415, 2010c) argue that an occurrence-based semantics delivers a compositional account of quotation. Our thesis is this: the occurrence-based strategies resolve the apparent failures of substitutivity in the same general way as the standard expression-based semantics do. So it is a myth that a Frege-inspired occurrence-based semantics affords a genuine alternative strategy. (shrink)

If you retain your belief upon learning that a large number and percentage of your recognized epistemic superiors disagree with you, then what happens to the epistemic status of your belief? I investigate that theoretical question as well has the applied case of philosophical disagreement—especially disagreement regarding purely philosophical error theories, theories that do not have much empirical support and that reject large swaths of our most commonsensical beliefs. I argue that even if all those error theories are false, either (...) (a) the average philosopher’s true commonsensical beliefs are epistemically impoverished, or (b) a good portion of philosophy is bunk and philosophers should give up most of their error theories despite the fact that their supporting arguments are generally as good as or even better than other philosophical arguments. (shrink)

Aristotle’s theory of human happiness in the Nicomachean Ethics explicitly depends on the claim that contemplation (theôria) is peculiar to human beings, whether it is our function or only part of it. But there is a notorious problem: Aristotle says that divine beings also contemplate. Various solutions have been proposed, but each has difficulties. Drawing on an analysis of what divine contemplation involves according to Aristotle, I identify an assumption common to all of these proposals and argue for rejecting it. (...) This allows a straightforward solution to the problem and there is evidence that Aristotle would have adopted it. (shrink)

Goodman and Lederman (2020) argue that the traditional Fregean strategy for preserving the validity of Leibniz’s Law of substitution fails when confronted with apparent counterexamples involving proper names embedded under propositional attitude verbs. We argue, on the contrary, that the Fregean strategy succeeds and that Goodman and Lederman’s argument misfires.

In a brilliant and explosively controversial work, the author attacks modern science for destroying our spiritual sense of self. What is the role of science in present-day society? Should we be as dazzled as we are by the innovations, the insights, and the miraculous improvements in material life that science has wrought? Or is there a darker, more pernicious side to our scientific success? Renowned British science columnist Bryan Appleyard thoroughly explores each of these provocative topics in a book (...) that has incited the ire of the scientific community. He points out that while scientists have shaped our lives and our beliefs, they have consistently failed to explain human consciousness, the soul, or the meaning of life. From Galileo to Darwin, from Copernicus to Oppenheimer, countless scientists have proclaimed a universe in which human beings are only an accidental presence. The unwitting result is that science has cast humankind adrift, paralyzing us with fear and cutting us off from personal or religious truth. In Appleyard's view, science has done us "appalling spiritual damage." These startling conclusions have prompted strong counterattacks from the scientific establishment. Yet regardless of where one falls in the debate, Understanding the Present forces readers to re-examine society's blind faith in the benevolence of modern science. "An exposition that is dazzling for its concrete illustrations and examples."--The New York Times "A withering indictment of modern science . . . This should crack a few test tubes."--Kirkus Reviews. (shrink)

After a period of inactivity, interest in explanationism as a thesis about the nature of epistemic justification has been renewed. Poston and McCain have both recently offered versions of explanationist evidentialism. In this paper, we pose two objections to explanationist evidentialism. First, explanationist evidentialism fails to state a sufficient condition for justification. Second, explanationist evidentialism implies a vicious regress.

:Since the advent of recombinant DNA technology, expectations about the potential for altering genes and controlling our biology at the fundamental level have been sky high. These expectations have gone largely unfulfilled. But though the dream of being able to control our biology is still far off, gene editing research has made enormous strides toward potential clinical use. This paper argues that when it comes to determining permissible uses of gene editing in one important medical context—germline intervention in reproductive medicine—issues (...) about enhancement and eugenics are, for the foreseeable future, a red herring. Current translational goals for gene editing research involve a different kind of editing than would be required to achieve manipulation of complex traits such as intelligence, and there are more pressing questions that need attention if clinical use of gene editing in reproductive medicine ever becomes a possibility. (shrink)

A central dispute in understanding Frege’s philosophy concerns how the sense of a complex expression relates to the senses of its component expressions. According to one reading, the sense of a complex expression is a whole built from the senses of the component expressions. On this interpretation, Frege is an early proponent of structured propositions. A rival reading says that senses compose by functional application: the sense of a complex expression is the value of the function denoted by its functional (...) component for the arguments denoted by its remaining components. I argue that two non-negotiable Fregean theses entail that senses compose by functional application. One thesis is that referents compose by functional application. The other thesis is that an expression in an indirect context refers to its customary sense. (shrink)

This practical guide helps us identify the wrong beliefs about God we received from our families of origin and replace them with truth so we can embrace the abundant Christian life we long for.

Beginning with the death of Socrates in 399 BC, and following the strand of philosophical inquiry through the centuries to recent figures such as Bertrand Russell and Wittgenstein, Bryan Magee's conversations with fifteen contemporary writers and philosophers provide an accessible and exciting account of Western philosophy and its greatest thinkers. With contributions from A. J. Ayer, Bernard Williams, Martha Nussbaum, Peter Singer, and John Searle, the book is not only an introduction to the philosophers of the past, but gives (...) an invaluable insight into the view and personalities of some of the most influential philosophers of the twentieth century. (shrink)

This is a revised and enlarged version of Bryan Magee's widely praised study of Schopenhauer, the most comprehensive book on this great philosopher. It contains a brief biography of Schopenhauer, a systematic exposition of his thought, and a critical discussion of the problems to which it gives rise and of its influence on a wide range of thinkers and artists. For this new edition Magee has added three new chapters and made many minor revisions and corrections throughout. This new (...) edition will consolidate the book's standing as the definitive study of Schopenhauer. (shrink)