How does Hume determine what qualities of the mind count as virtues and what qualities count as vices? By what standard, for example, does Hume dismiss the so-called “monkish virtues”? Hume’s commentators have proposed various possibilities for the standard of virtue, among them the general point of view and the usefulness/agreeableness of qualities. I consider the case for these standards and argue that Hume contends ultimately that consensus decides controversial questions about the status of virtues and vices. I try especially (...) to show that while the usefulness of any quality is not a means by which we can identify virtues or vices, it can be relevant to moral evaluations in so far as it influences what people tend to approve of. (shrink)

In this article I argue that vanity, the desire for and delight in the favorable opinion of others, plays a fundamental role in Hume's account of moral motivation. Hume says that vanity and virtue are inseparable, though he does not explicitly say how or why this should be. I argue that Hume's account of sympathy can explain this alliance. In resting moral sentiment on sympathy, Hume gives a fundamental role to vanity as it becomes either a mediating motive to virtue (...) or else strengthens the otherwise weak motive of moral sentiment. (shrink)

The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of the doctor–patient relationship. (...) I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide. (shrink)

It is sometimes proposed that killing or harming abortion providers is the only logically consistent position available to opponents of abortion. Since lethal violence against morally responsible attackers is normally viewed as justified in order to defend innocent parties, pro-lifers should also think so in the case of the abortion doctor and so they should act to defend the unborn. In our paper, we defend the mainstream pro-life view against killing abortion doctors. We argue that the pro-life view can, in (...) various ways, reject the assumption that defensive violence to save innocent individuals is always permissible. Now even if that assumption is accepted, we contend that defensive violence against abortion doctors still is not justified. Drawing on Frances Kamm’s work, we contend that there are structural similarities between abortion and letting someone die who needs your help to stay alive; and we argue that it is impermissible to kill those who kill in order to avoid giving life-saving aid. (shrink)

There is a growing trend among some physicians, psychiatrists, bioethicists, and other mental health professionals not to treat physician-assisted suicide (PAS) as suicide. The grounds for doing so are that PAS fundamentally differs from other suicides. Perhaps most notably, in 2017 the American Association of Suicidology argued that PAS is distinct from the behavior that their organization seeks to prevent. This paper compares and contrasts suicide and PAS in order to see how much overlap there is. Contrary to the emerging (...) view that emphasizes their differences, I argue that there is significant overlap such that we ought not to separate PAS into its own category, making it diverge from how we think about and address suicide more generally. I start by examining several prominent theories of suicide and argue that PAS fits squarely within them. I then examine several apparent differences between PAS and other kinds of suicide and argue that these differences are merely apparent or they do not justify treating PAS as a fundamentally different kind of thing from suicide. (shrink)

Situationists contend that virtue ethics is empirically inadequate. However, it is my contention that there is much confusion over what “empirical adequacy” or “empirical inadequacy” actually means in this context. My aim in this paper is to clarify the meanings of empirical adequacy in order to see to what extent virtue ethics might fail to meet this standard. I argue that the situationists frequently misconstrue the empirical commitments of virtue ethics. More importantly, depending on what we mean by empirical adequacy, (...) either virtue ethics has no need to be empirically adequate or where it does have such a need, the psychological evidence fails to show that it is empirically inadequate. An additional contribution the paper intends to make is to provide a more detailed discussion of the explanatory nature of virtue ethics. (shrink)

Recent work at the intersection of moral philosophy and the philosophy of psychology has dealt mostly with Aristotelian virtue ethics. The dearth of scholarship that engages with Hume’s moral philosophy, however, is both noticeable and peculiar. Hume's Moral Philosophy and Contemporary Psychology demonstrates how Hume’s moral philosophy comports with recent work from the empirical sciences and moral psychology. It shows how contemporary work in virtue ethics has much stronger similarities to the metaphysically thin conception of human nature that Hume developed, (...) rather than the metaphysically thick conception of human nature that Aristotle espoused. It also reveals how contemporary work in moral motivation and moral epistemology has strong affinities with themes in Hume’s sympathetic sentimentalism. (shrink)

The relevance of double effect for end-of-life decision-making has been challenged recently by a number of scholars. The principal reason is that opioids such as morphine do not usually hasten death when administered to relieve pain at the end of life; therefore, no secondary “double” effect is brought about. In my article, I argue against this view, showing how the doctrine of double effect is relevant to the administration of opioids at the end of life. I contend that the prevailing (...) view suffers from a misunderstanding of the nature of double effect, which includes application to risking a grave harm. (shrink)

Many commentators propose that Hume thinks that we are not or should not be motivated to perform naturally virtuous actions from moral sentiments if we want our actions to be genuinely virtuous. It is this proposal with which I take issue in this article, arguing that Hume fully incorporates the moral sentiments into his understanding of how human beings act when it comes to the natural virtues and that he does not see the moral sentiments as a problematic kind of (...) motivation that threatens or weakens the virtuous status of the action. (shrink)

In this paper, I argue that the doctrine of double effect is disposed toward abuse. I try to identify two distinct sources of abuse of double effect: the conditions associated with standard formulations of double effect and the difficulty of fully understanding one’s own intentions in action. Both of these sources of abuse are exacerbated in complex circumstances, where double effect is most often employed. I raise this concern about abuse not as a criticism of double effect but rather as (...) a problem that defenders should observe and try to prevent. I go on to suggest certain methods for avoiding the abuse of double effect such as hesitating to use it, applying it only with other agents, and selectively and carefully propagating it. (shrink)

This paper examines and evaluates from a Christian perspective the common Christian presumption against pleasing people, which is roughly the idea that Christians should not be motivated by or delight in the favorable opinion of others. I argue that several ways of saving the idea that Christians can blamelessly care what others think about them are misguided or insufficient. I contend that the most important way to save this idea is by drawing attention to concern for the opinions of others (...) in the context of a social role. (shrink)

Readers of this journal know that Hume regarded an Enquiry concerning the Principles of Morals as his finest work. It was, Hume said, "incomparably the best." Yet, most of the scholarly work on Hume's moral philosophy in recent decades focuses on the Treatise, which Hume wrote some three decades prior to the Enquiry.There are good reasons to focus on the older work. It is much longer, so there is more to sink our scholarly teeth into. Many discussions and discursions appear (...) in the Treatise that are absent, entirely or nearly so, from the Enquiry, such as the distinction between artificial and natural virtues and the claim that reason is and ought only to be the slave of the passions. Nevertheless, Hume's own... (shrink)

This paper attempts to give a complete and coherent account of how Hume’s moral psychology can explain the cultivation of moral character. I argue that the outcome of a fully formed moral character is an agent who strengthens her calm moral sentiments into settled principles of action. I then take up the question of how the process of strengthening moral sentiments might occur, rejecting the possibilities of sympathy, “reflection,” and “resolution” because either they are too weak or else they make (...) the passion violent, preventing the essential calm nature of moral sentiments. I next argue that custom and the non-moral motives of pride and the love of fame play the critical roles in character formation. Custom can be considered as both the process of education, whereby certain impressions are habitually and formally inculcated into us by educators, and the process of experience in society and conversation, whereby we learn to associate pleasure with the virtues and pain with the vices. In both these processes, Hume implicitly appeals to certain non-moral motives, especially pride and the love of fame, in order to launch the effects of custom. (shrink)

Hume says that sympathy is the source of our moral feeling of approval for useful qualities. But does Hume give the same psychological explanation of our approval of immediately agreeable qualities as he does to our approval of useful qualities? Does he trace our moral approbation of immediately agreeable qualities to sympathy? Some commentators, including Rachel Cohon and Don Garrett, argue that he does not. Let us call this view the ‘narrow view’ of sympathy in contrast to the ‘wide view’ (...) of sympathy, which holds that sympathy is required for every moral sentiment. There is indeed some apparent textual evidence in Hume’s work that seems to support the narrow view. My aim in this paper is to examine that evidence and show how it is merely apparent, in particular by showing how a number of passages can be and are misread. I thus want to argue indirectly for the wide view. (shrink)

Essential to the doctrine of double effect is the idea that agents are prohibited from intending evil as a means to a good end. I argue in this paper that some recent accounts of intention from proponents of double effect cannot sustain this prohibition on harmful means. I outline two ways to gerrymander intention that mark these accounts. First, intention is construed in such a way that an agent intends only those states of affairs that she cares about or finds (...) motivating for their own sake. Second, intention is construed in such a way that what counts as intended is determined sufficiently by the agent’s beliefs. (shrink)

Next SectionIt is commonly proposed that artifacts cannot be understood without reference to human intentions. This fact, I contend, has relevance to the use of artifacts in intentional action. I argue that because artifacts have intentions embedded into them antecedently, when we use artifacts we are sometimes compelled to intend descriptions of our actions that we might, for various reasons, be inclined to believe that we do not intend. I focus this argument to a specific set of artifacts, namely, medical (...) devices, before considering an extended application to emergency contraceptive devices. Although there is some debate about whether emergency contraception has an abortifacient effect, I argue that if there is an abortifacient effect, then the effect cannot normally be a side effect of one’s action. (shrink)

The purpose of this paper is to identify a kind of discrimination that has hitherto gone unrecognised. ‘Terminalism’ is discrimination against the dying, or treating the terminally ill worse than they would expect to be treated if they were not dying. I provide four examples from healthcare settings of this kind of discrimination: hospice eligibility requirements, allocation protocols for scarce medical resources, right to try laws and right to die laws. I conclude by offering some reflections on why discrimination against (...) the dying has been hard to identify, how it differs from ageism and ableism, and its significance for end-of-life care. (shrink)

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds. Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices. This paper (...) undertakes such a comparison. My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS. In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS. This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position. (shrink)

The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are (...) no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

I appreciate all of the commentaries for their careful and thoughtful engagement with my article. Because of limited space, I can only focus on some criticisms and cannot develop my responses as fully as I would like. This is probably best for the reader anyway. John Keown worries about the ‘dualism’ of the third objection against expressivism. By this I think he means that critics of the expressivist argument at the beginning of life view a certain class of human beings (...) as ‘non-persons’ and therefore not worthy of protection. Obviously, a pro-life stance will take issue with classifying the unborn as non-persons, as defenders of selective abortion and other biotechnologies do, but I did not think it relevant to get into the weeds on this issue. Keown claims that the worrisome dualism views those with intellectual disabilities, whether ‘newborns or adults’, as non-persons who lack a right not to be killed. However, I do not think defenders of either selective abortion or assisted suicide are committed to this. Many would insist that once you are born, you are a person and therefore cannot …. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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Sudaτ 134: Ταρσοὶ καλάμων. οἱ δὲ Λαζοὶ βόθρους ὀρύξαντες καὶ δόρατα τοῖς βόθροις ἐγκαταπήξαντες ταρσοῖς καλάμων καὶ ὕλῃ μὴ βεβαίαν ἐχούσῃ βάσιν, ἀλλὰ πρὸς τὸ ἐπιφερόμενον ἄχθος ὀλισθαινούσῃ, τὰ στόματα τῶν ὀρυγμάτων ἐκάλυψαν· καὶ χοῦν ἐπιβαλόντες τά τε παρ’ ἑκάτερα χωρία γεωργήσαντες καὶ πυροὺς σπείραντες ἐτροπώσαντο τοὺς Ῥωμαίους. Ταρσοὶ καλάμων παρ’ Ἡροδότῳ ἡ τρασιά (πρασιάmss), οὗ ἐξήραινον τὴν πλίνθον.Frames of reeds. ‘The Lazi, having dug pits and securely fixed spears within them, concealed the openings of the holes with frames of (...) reeds and material that has no firm foundation but would give way to any load placed upon it; and having thrown earth on top and tilled the ground to either side and sewn wheat, they put the Romans to flight.’ Frames of reeds in Herodotus are the drying-rack, where they used to dry bricks.This entry in theSudacomprises three elements. First, the lemma Ταρσοὶ καλάμων, compared with the usual format of the lexicon, is atypical (though not unparalleled) both in being a two-word phrase and in lacking an explanatory gloss. The word ταρσός most frequently denotes various artefacts with a flat and/or interwoven structure, such as screens, baskets and mats, and by extension is used figuratively of surfaces that resemble wickerwork or basketry. The phrase ταρσοὶ καλάμων or καλάμου is otherwise attested, with somewhat different meanings, in only three ancient authors: Herodotus, Thucydides and Aeneas Tacticus. Second, an anonymous extract from an unidentified historical work supplies a sample usage of the headword phrase, in this instance a military ruse in which wicker screens are instrumental in concealing pits dug by the Lazi prior to an engagement with the Romans. The historical setting, the style and language of the extract, along with the known sources and methodology of the compiler(s) of theSuda, indicate that the quotation belongs to a classicizing historian of Late Antiquity. These issues will be examined below. Third, as testimony to an alternative meaning of ταρσοὶ καλάμων, the compiler adduces a gloss on Herodotus’Histories, which he drew from an earlier glossary of Herodotean usages. Here two problems arise. The definition of a drying-rack for bricks indicates that the original glossarist (and in turn theSudacompiler) did not in fact understand Herodotus’ technical description. In any case, the reading πρασιά, transmitted in all codices of theSuda, and accepted by Adler, should undoubtedly read τρασιά. (shrink)

The notion of risk plays a central role in economics, finance, health, psychology, law and elsewhere, and is prevalent in managing challenges and resources in day-to-day life. In recent work, Duncan Pritchard (2015, 2016) has argued against the orthodox probabilistic conception of risk on which the risk of a hypothetical scenario is determined by how probable it is, and in favour of a modal conception on which the risk of a hypothetical scenario is determined by how modally close it is. (...) In this article, we use Pritchard’s discussion as a springboard for a more wide-ranging discussion of the notion of risk. We introduce three different conceptions of risk: the standard probabilistic conception, Pritchard’s modal conception, and a normalcy conception that is new (though it has some precursors in the psychological literature on risk perception). Ultimately, we argue that the modal conception is ill-suited to the roles that a notion of risk is required to play and explore the prospects for a form of pluralism about risk, embracing both the probabilistic and the normalcy conceptions. (shrink)

This is the first complete English translation of Gottlob Frege's Grundgesetze der Arithmetik, with introduction and annotation. The importance of Frege's ideas within contemporary philosophy would be hard to exaggerate. He was, to all intents and purposes, the inventor of mathematical logic, and the influence exerted on modern philosophy of language and logic, and indeed on general epistemology, by the philosophical framework.

Abstractionism, which is a development of Frege's original Logicism, is a recent and much debated position in the philosophy of mathematics. This volume contains 16 original papers by leading scholars on the philosophical and mathematical aspects of Abstractionism. After an extensive editors' introduction to the topic of abstractionism, the volume is split into 4 sections. The contributions within these sections explore the semantics and meta-ontology of Abstractionism, abstractionist epistemology, the mathematics of Abstractionis, and finally, Frege's application constraint within an abstractionist (...) setting. (shrink)

In this paper I will argue that Boghossian's explanation of how we can acquire a priori knowledge of logical principles through implicit definitions commits a transmission of warrant-failure. To this end, I will briefly outline Boghossian's account, followed by an explanation of what a transmission of warrant-failure consists in. I will also show that this charge is independent of the worry of rule-circularity which has been raised concerning the justification of logical principles and of which Boghossian is fully aware. My (...) argument comes in two steps: firstly, I will argue for the insufficiency of Boghossian's template which is meant to explain how a subject can acquire a warrant for logical principles. I will show however that this insufficiency of his template can be remedied by adopting what I call the Disquotational Step. Secondly, I will argue that incorporating this further step makes his template subject to a transmission of warrant-failure, assuming that certain rather basic and individually motivated principles hold. Thus, Boghossian's account faces a dilemma: either he adopts the Disquotational Step and subjects his account to the charge of a transmission of warrant-failure, or he drops this additional step leaving the account confronted with explaining the gap that has previously been highlighted. I will then suggest various rejoinders that Boghossian might adopt but none of which - I will argue - can resolve the dilemma. Lastly, I will raise and briefly discuss the question whether this worry generalizes to other accounts, such as Hale and Wright's that aim to explain our knowledge of logic and/or mathematics in virtue of implicit definitions. (shrink)

The volume is the first collection of essays that focuses on Gottlob Frege's Basic Laws of Arithmetic (1893/1903), highlighting both the technical and the philosophical richness of Frege's magnum opus. It brings together twenty-two renowned Frege scholars whose contributions discuss a wide range of topics arising from both volumes of Basic Laws of Arithmetic. The original chapters in this volume make vivid the importance and originality of Frege's masterpiece, not just for Frege scholars but for the study of the history (...) of logic, mathematics, and philosophy. (shrink)

This is the first complete English translation of Gottlob Frege's Grundgesetze der Arithmetik (1893 and 1903), with introduction and annotation. As the culmination of his ground-breaking work in the philosophy of logic and mathematics, Frege here tried to show how the fundamental laws of arithmetic could be derived from purely logical principles.

In this paper, we present the results of two surveys that investigate subjects’ judgments about what can be known or justifiably believed about lottery outcomes on the basis of statistical evidence, testimonial evidence, and “mixed” evidence, while considering possible anchoring and priming effects. We discuss these results in light of seven distinct hypotheses that capture various claims made by philosophers about lay people’s lottery judgments. We conclude by summarizing the main findings, pointing to future research, and comparing our findings to (...) recent studies by Turri and Friedman. (shrink)

This thesis is concerned with explaining how a subject can acquire a priori knowledge of arithmetic. Every account for arithmetical, and in general mathematical knowledge faces Benacerraf's well-known challenge, i.e. how to reconcile the truths of mathematics with what can be known by ordinary human thinkers. I suggest four requirements that jointly make up this challenge and discuss and reject four distinct solutions to it. This will motivate a broadly Fregean approach to our knowledge of arithmetic and mathematics in general. (...) Pursuing this strategy appeals to the context principle which, it is proposed, underwrites a form of Platonism and explains how reference to and object-directed thought about abstract entities is, in principle, possible. I discuss this principle and defend it against different criticisms as put forth in recent literature. Moreover, I will offer a general framework for implicit definitions by means of which - without an appeal to a faculty of intuition or purely pragmatic considerations - a priori and non-inferential knowledge of basic mathematical principles can be acquired. In the course of this discussion, I will argue against various types of opposition to this general approach. Also, I will highlight crucial shortcomings in the explanation of how implicit definitions may underwrite a priori knowledge of basic principles in broadly similar conceptions. In the final part, I will offer a general account of how non-inferential mathematical knowledge resulting from implicit definitions is best conceived which avoids these shortcomings. (shrink)

Abstract In this essay, a new approach for the ethical study of emerging technology ethics will be presented, called anticipatory technology ethics (ATE). The ethics of emerging technology is the study of ethical issues at the R&D and introduction stage of technology development through anticipation of possible future devices, applications, and social consequences. I will argue that a major problem for its development is the problem of uncertainty, which can only be overcome through methodologically sound forecasting and futures studies. I (...) will then consider three contemporary approaches to the ethics of emerging technologies that use forecasting: ethical technology assessment, the techno-ethical scenarios approach and the ETICA approach, and I considered their strengths and weaknesses. Based on this critical study, I then present my own approach: ATE. ATE is a conceptually and methodologically rich approach for the ethical analysis of emerging technologies that incorporates a large variety of ethical principles, issues, objects and levels of analysis, and research aims. It is ready to be applied to contemporary and future emerging technologies. Content Type Journal Article Category Original Paper Pages 1-13 DOI 10.1007/s11569-012-0141-7 Authors Philip A. E. Brey, Department of Philosophy, School of Behavioral Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands Journal NanoEthics Online ISSN 1871-4765 Print ISSN 1871-4757. (shrink)

In this short letter to Ed Zalta we raise a number of issues with regards to his version of Neo-Logicism. The letter is, in parts, based on a longer manuscript entitled “What Neo-Logicism could not be” which is in preparation. A response by Ed Zalta to our letter can be found on his website: http://mally.stanford.edu/publications.html (entry C3).

In this article, I explore a Bayesian approach to avalanche decision-making. I motivate this perspective by highlighting a version of the base-rate fallacy and show that a similar pattern applies to decision-making in avalanche-terrain. I then draw out three theoretical lessons from adopting a Bayesian approach and discuss these lessons critically. Lastly, I highlight a number of challenges for avalanche educators when incorporating the Bayesian perspective in their curriculum.

Avalanche studies have undergone a transition in recent years. Early research focused mainly on environmental factors. More recently, attention has turned to human factors in decision making, such as behavioural and cognitive biases. This article adds a social component to this human turn in avalanche studies. It identifies lessons for decision making by groups of skiers from the perspective of social choice theory, a sub-field of economics, decision theory, philosophy and political science that investigates voting methods and other forms of (...) collective decision making. In the first part, we outline the phenomenon of wisdom of crowds, where groups make better decisions than their individual members. Drawing on the conceptual apparatus of social choice theory and using idealised scenarios, we identify conditions under which wisdom of crowds arises and also explain how and when deciding together can instead result in worse decisions than may be expected from individual group members. In the second part, we use this theoretical understanding to offer practical suggestions for decision making in avalanche terrain. Finally, we make several suggestions for risk management in other outdoor and adventure sports and for outdoor sports education. (shrink)

There are distinctive methodological and conceptual challenges in rare and severe event (RSE) forecast verification, that is, in the assessment of the quality of forecasts of rare but severe natural hazards such as avalanches, landslides or tornadoes. While some of these challenges have been discussed since the inception of the discipline in the 1880s, there is no consensus about how to assess RSE forecasts. This article offers a comprehensive and critical overview of the many different measures used to capture the (...) quality of categorical, binary RSE forecasts – forecasts of occurrence and non-occurrence – and argues that of skill scores in the literature there is only one adequate for RSE forecasting. We do so by first focusing on the relationship between accuracy and skill and showing why skill is more important than accuracy in the case of RSE forecast verification. We then motivate three adequacy constraints for a measure of skill in RSE forecasting. We argue that of skill scores in the literature only the Peirce skill score meets all three constraints. We then outline how our theoretical investigation has important practical implications for avalanche forecasting, basing our discussion on a study in avalanche forecast verification using the nearest-neighbour method (Heierli et al., 2004). Lastly, we raise what we call the “scope challenge”; this affects all forms of RSE forecasting and highlights how and why working with the right measure of skill is important not only for local binary RSE forecasts but also for the assessment of different diagnostic tests widely used in avalanche risk management and related operations, including the design of methods to assess the quality of regional multi-categorical avalanche forecasts. (shrink)

We investigate differences in perceived danger and recklessness judgements by experts (experienced skiers, N=362) and laypeople (N=2080) about participation in adventure sports across the same judgemental task using a third person perspective. We investigate the relationship between danger and recklessness and the extent to which fatality frequency, as well as other contextual factors such as gender, dependants, competence, and motivations of the sports participant affect expert and laypeople judgements respectively. Experienced skiers gave lower overall danger and recklessness ratings than non-skiers. (...) Experienced skiers’ judgements were also more sensitive than non-skiers’ to variations in the fatality rate of the activity and the competence level of the participant, yet were less sensitive to whether the event was done for external benefit such as a charity. Recklessness judgements were overall more sensitive to changes in activity descriptions than danger judgements. Our findings support the emerging picture of adventure sports participants as rational and sensitive to risk-relevant features rather than somehow pathological in their risk perception. (shrink)

Mountaineering is a dangerous activity. For many mountaineers, part of its very attraction is the risk, the thrill of danger. Yet mountaineers are often regarded as reckless or even irresponsible for risking their lives. In this paper, we offer a defence of risk-taking in mountaineering. Our discussion is organised around the fact that mountaineers and non-mountaineers often disagree about how risky mountaineering really is. We hope to cast some light on the nature of this disagreement – and to argue that (...) mountaineering may actually be worthwhile because of the risks it involves. Section 1 introduces the disagreement and, in doing so, separates out several different notions of risk. Sections 2–4 then consider some explanations of the disagreement, showing how a variety of phenomena can skew people's risk judgements. Section 5 then surveys some recent statistics, to see whether these illuminate how risky mountaineering is. In light of these considerations, however, we suggest that the disagreement is best framed not simply in terms of how risky mountaineering is but whether the risks it does involve are justified. The remainder of the paper, sections 6–9, argues that risk-taking in mountaineering often is justified – and, moreover, that mountaineering can itself be justified by and because of the risks it involves. (shrink)

In recent years, interest has increased in regenerative practices as a strategy for transforming food systems and solving major environmental problems such as biodiversity loss and climate change. However, debates persist regarding these practices and how they ought to be defined. This paper presents a framework for exploring the regenerative potential of food systems, focusing on how food systems activities and technologies are organized rather than the specific technologies or practices being employed. The paper begins with a brief review of (...) debates over sustainable food systems and the varying ways that regenerative food systems have been defined and theorized. Then, it provides the theoretical backing of the framework—the conservation of change principle—which is an interpretation of the laws of thermodynamics and theories of adaptive change as relevant to the regenerative capacity of living systems. Next, the paper introduces the framework itself, which comprises two independent but intersecting dimensions of food systems organization: resource diversity and livelihood flexibility. These two dimensions result in four archetypical regimes for food systems: degenerative, regenerative, impoverished, and coerced. The paper defines each and offers real-world examples. Finally, the paper concludes with a discussion of pathways for transforming food systems and opportunities for additional research. (shrink)

In this essay, a new approach to the ethics of emerging information technology will be presented, called anticipatory technology ethics (ATE). The ethics of emerging technology is the study of ethical issues at the R&D and introduction stage of technology development through anticipation of possible future devices, applications, and social consequences. In the essay, I will first locate emerging technology in the technology development cycle, after which I will consider ethical approaches to emerging technologies, as well as obstacles in developing (...) such approaches. I will argue that any sound approach must centrally include futures studies of technology. I then present ATE and some applications of it to emerging information technologies. In ATE, ethical analysis is performed at three levels, the technology, artifact and application levels, and at each levels distinct types of ethical questions are asked. ATE analyses result in the identification and evaluation of a broad range of ethical issues that can be anticipated in relation to an emerging information technology. This ethical analysis can then be used for ethical recommendations for design or governance. (shrink)