Speculations of this last type have existed from a much earlier period in the Eastern civilizations, particularly in those areas affected by Hindu philosophy. For example, in the Sánkhya or Yoga-Sútras by Patánjali, we find a very radical distinction between the external world and the individual soul or self. But for Sánkhya, the "external world" includes everything that could possibly be an object of consciousness--physical objects and their relationships, sensations and imaginations, dreams, memories, expectations, etc. In other words, for Sánkhya, (...) our thoughts or desires, far from being the "cause" of the external world as in some forms of Western idealism, are simply other aspects of the external world itself, that is, merely particular items in the totality of our consciousness. On the other hand, the individual soul or self is only the spectator of this consciousness and not ordinarily conscious of itself. If the self were to become conscious of "itself" in the same way that it was conscious of all other objects, all that it would really be aware of would be another object of consciousness---the mere idea of itself, while it would remain the unknown knower. Nevertheless, realizing that a completely "unconscious self" would be simply a postulate of thought and therefore part of the external world, the Sánkhya-Sútras emphasize that the self can become aware of itself by another and more intuitive means. (shrink)

Proclus is the last major Greek philosopher, a prolific Neoplatonic idealist, a polymath, admired by Aquinas, and accorded unusual attention by Hegel. This brief volume contains five hymns by Proclus, translated by Thomas Taylor in 1795, and a listing of his forty-five books, some lost, compiled by Laurence Rosan, the distinguished expert on Proclus.

Proclus is the last major Greek philosopher, a prolific Neoplatonic idealist, a polymath, admired by Aquinas, and accorded unusual attention by Hegel. This brief volume contains five hymns by Proclus, translated by Thomas Taylor in 1795, and a listing of his forty-five books, some lost, compiled by Laurence Rosan, the distinguished expert on Proclus.

This article offers original phenomenological descriptions of empathy, sympathy, and compassion. These descriptions are based on empirical research, and they sample the variety of ways the subject may respond to the suffering of another person. The structure of these different, but similar ways of being are then taken up as clues hinting at a sensibility bearing on the formation of an ethical life. This sensibility is essentially twofold in character. On the one hand, a pairing of the perceived similarities between (...) subject and other opens the subject to a resonance with the humanity of the other. On the other hand, the other’s expressive life awakens the subject’s interest in wanting to know the meaning of these expressions for the other or calls forth a caring regard for the well-being of the other. The ways of being represented by empathy, sympathy, and compassion may be viewed as different ways of organizing or rendering a precise form to the constitutive strands of the aforementioned sensibility. The relevant literature in phenomenology and ethics is commented on as it informs the discussion, but is kept to a minimum. (shrink)

Ben Laurence argues for a political philosophy that unifies theory and practice in pursuit of change. He shows that the task of political philosophy is not complete until the political philosopher asks the question "What is to be done?" and deliberates about the answer with agents of change.

Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...) ethical reasoning, namely ethical analysis informed by pertinent prior work, followed by identifying the implications of clearly articulated ethical concepts, to meet these goals. The professional virtue of civility and the related concept of professional etiquette was first described by the English physician-ethicist Thomas Percival (1740–1804). Based on a historically informed philosophical account, we propose that the professional virtue of civility has cognitive, affective, behavioural and social components based on a commitment to excellence in scientific and clinical reasoning. Its practice prevents a dysfunctional organisational culture of incivility and sustains a civility-based organisational culture of professionalism. Medical educators and academic leaders are in a pivotal and powerful position to role model, promote and inculcate the professional virtue of civility as essential to an organisational culture of professionalism. Academic leaders should hold medical educators accountable for discharge of this indispensable professional responsibility. (shrink)

The clinical ethics literature is striking for the absence of an important genre of scholarship that is common to the literature of clinical medicine: systematic reviews. As a consequence, the field of clinical ethics lacks the internal, corrective effect of review articles that are designed to reduce potential bias. This article inaugurates a new section of the annual "Clinical Ethics" issue of the Journal of Medicine and Philosophy on systematic reviews. Using recently articulated standards for argument-based normative ethics, we provide (...) a systematic review of the literature on concealed medication for the management of psychiatric disorders. Four steps are completed: identify a focused question; conduct a literature search using key terms relevant to the focused question; assess the adequacy of the argument-based methods of the papers identified; and identify conclusions drawn in each paper and whether they apply to the focused question. We identified seven papers and provide an assessment of them. While none of the papers fully meet the standards of argument-based ethics, they did provide rationales for the use of concealed medications, with the important requirement such a practice be accountable in explicit organizational policy to prevent abuse of patients with mental illness or dementia. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

Volume 20, Issue 7, July 2020, Page 9-12.

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about (...) the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

: In this paper, I investigate Leibniz's conception of final causation. I focus especially on the role that Leibnizian final causes play in intentional action, and I argue that for Leibniz, final causes are a species of efficient causation. It is the intentional nature of final causation that distinguishes it from mechanical efficient causation. I conclude by highlighting some of the implications of Leibniz's conception of final causation for his views on human freedom, and on the unconscious activity of substances.

In his Disrupted Dialogue: Medical Ethics and the Collapse of Physician-Humanist Communication Robert Veatch presents a scholarly tour de force of eighteenth- and nineteenth-century Anglophone medical ethics to demonstrate how the easy communication between physicians and humanists in the Scottish Enlightenment progressively dissipated as medicine became detached from humanistic disciplines. In this paper I offer two comments—that the discourse of medical ethics in the Scottish Enlightenment was a discourse of Baconian moral science and that nineteenth-century medical ethics in the United (...) States became detached from that discourse. The result was that a principal resource for physicians at the birth of bioethics, the American Medical Association’s Principles of Medicine Ethics of 1957, did not equip physicians with the conceptual tools they needed to formulate and address the ethical challenges that became the agenda of bioethics. The paper opens with a brief portrait of Robert Veatch, the author’s connections to him, and his little-known role as an impresario of the classical music of the Blue Ridge and Appalachia. (shrink)

Volume 20, Issue 3, March 2020, Page 65-68.

IT IS WELL KNOWN THAT LEIBNIZ’S NOTION OF HARMONY plays a crucial role in his philosophical system. Leibniz drew on this concept of harmony in motivating, and explaining, numerous areas of his thought: everything from Leibnizian mathematics and metaphysics to ethics and social philosophy, incorporates the notion of harmony as a central descriptive and explanatory concept. While there has been much discussion of some the applications of harmony in Leibniz’s system– especially the mind-body harmony, and the so-called universal harmony of (...) simple perceiving substances–little attention has been paid to Leibniz’s very concept of harmony. Yet it seems important for understanding Leibniz’s holistic philosophy that we grasp this concept, for he employed the term “harmony” when describing so many features of the created world: there is a harmony between geometry and physics, between efficient and final causation, between nature and grace, to mention just a few. (shrink)

The concept of medicine as a profession in the English-language literature of medical ethics is of recent vintage, invented by the Scottish physician and medical ethicist, John Gregory (1724-1773). Gregory wrote the first secular, philosophical, clinical, and feminine medical ethics and bioethics in the English language and did so on the basis of Hume's principle of sympathy. This paper provides a brief account of Gregory's invention and the role that Humean sympathy plays in that invention, with reference to key texts (...) in Gregory's work. The paper also considers two interesting and perhaps provocative ways in which Hume can be read through Gregory: first, sympathy as a principle of scientific discovery in Hume's science of man and moral physiology; and sympathy as gendered feminine in Hume's moral philosophy. Hume's principle of sympathy is at the core of Gregory's medical ethics and the histories of Western medical ethics and bioethics pivot on Gregory - and, therefore, on Hume - as it does on few other figures. (shrink)

Managed care employs two business tools of managed practice that raise important ethical issues: paying physicians in ways that impose conflicts of interest on them; and regulating physicians' clinical judgment, decision making, and behavior. The literature on the clinical ethics of managed care has begun to develop rapidly in the past several years. Professional organizations of physicians have made important contributions to this literature. The statements on ethical issues in managed care of four such organizations are considered here, the American (...) Medical Association, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics. Three themes common to these statements are identified and critically assessed: the primacy of meeting the medical needs of each individual patient; disclosure of conflicts of interest in how physicians are paid; and opposition to gag orders. The paper concludes with an argument for a basic concept in the clinical ethics of managed care: physicians and institutions as economically disciplined moral co-fiduciaries of populations of patients. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that opponents of abortion (...) want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Nancy Jecker (2013) mounts a sustained and formidable critique of Norman Daniels's prudential lifespan account (PLA) as a reliable basis for justice between age groups in the responsible allocation...

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations (...) converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented? (shrink)

In this commentary on Carse and Rushton’s call for reorientation of moral distress, we state agreement with the authors that the discourse of moral distress should refocus on the moral components of integrity. We then explain how our philosophical taxonomy of moral distress, mentioned by the authors, appeals to moral integrity. In this process, we clarify our taxonomy’s appeal to Aristotle’s concept of akrasia. We conclude by offering support of Carse and Rushton’s challenge to organizations to strengthen moral integrity by (...) fostering resilience. (shrink)

In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the (...) commentators expand on these components in important ways. Xuhao et al emphasises the importance of role models, especially in the hierarchical context of medical education.2 The hierarchy of faculty in the senior position and junior doctors and other learners below them has characterised medical education for centuries. Xuhao et al rightly call for academic leaders to shape this hierarchy in a morally responsible way, by becoming ‘exemplary role models’.2 Berry, a clinician manager, in critiquing our account, calls for an increased appreciation for the psychological and environmental factors that might explain why uncivil behaviour occurs.3 …. (shrink)

L’objet de cette contribution est de montrer comment le recours « aveugle » aux caractères et au formalisme transforme, pour Leibniz, l’exercice de l’attention. Plus précisément, il s’agira de montrer en s’appuyant sur divers opuscules que le formalisme permet à la fois d’épargner l’attention, de la concentrer, de l’élargir, de la séquencer et de la transformer en un exercice collectif.

Leibniz’s conception of the relativity of motion has been discussed at length for a very long time. This paper doesn’t aim to give a full solution to this question, but to contribute to the debate by clarifying how the principle of relativity is introduced, justified and used in the “Dynamica”. Four different principles are identified : one purely geometrical, and three (meta) physical principles, which express God’s wisdom : a principle of equivalence of hypotheses linked to the action/reaction principle, a (...) Galilean principle of relativity and a general principle which apply not only to rectilinear motions but also to circular ones. I argue that to appreciate the coherence of Leibniz’ approach, we should distinguish these principles more sharply than he himself did and pay more attention to their status : are they consequences of the definition of motion, consequences of the physical laws or necessary conditions for any physical theory? (shrink)

Cette étude s’annonce dans le prélude (p. 9-17) comme une réflexion délibérément affranchie des critères historiques et des écoles doctrinales pour dégager d’une « constellation » d’images choisies les lignes-forces de la notion complexe (« contradictoire », préfère l’auteur) de ravissement, qui épouse à la fois les termes de la dépossession et de la possession, de l’extériorité et de l’intériorité, de l’actif et du passif, de l’absence et de la présence, de la perte de soi et de sa conquête....

_From the Eye of the Storm: Regional Conflicts and the Philosophy of Peace_ presents to the reader a cross section of an emerging field of study: the philosophy of peace. The editors bring together articles that explore the philosophic implications of many recent regional conflicts. Reflecting the diversity and vitality and any new field of study, this volume contains five sections: Conceptual Foundations; America's Homefront; Desert Storm Assessments; _Jihad, Intifada_, and Other Mideast Concerns; and Latin American Issues. The topics of (...) the articles include war, militarism, patriotism, nationalism, nonviolence, conscientious objection, feminist peace, the media, the ethics of the Gulf War, the Israeli-Palestinian conflict, Islamic pacifism, and Latin American resistance. A concluding postscript assesses prospects for achieving peace and change within our fast changing international scene. This volume has an extensive bibliography of writings concerning peace and conflict and is suited to professional and student audiences. (shrink)

Emmanuel Levinas’s philosophy demonstrates that intelligence is ultimately at the behest of responsibility. He is one of a number of philosophers who made the paradigm shift from an individualized notion of self to a social conception of self. He used the language of his teachers, Husserl and Heidegger, to move beyond their philosophies to a fundamental paradigm shift, in which ethics is prior to epistemology.

A traditional and widespread belief among theists is that God administers punishment for sins and/or immoral actions. In this paper, Iargue that there is good reason to believe that the infliction of any suffering on humans by God (i.e., a perfectly just being) is morally unjustified. This is important not only because it conflicts with a deeply entrenched religious belief, but also because, as I show, a number of recent argumentative strategies employed by theistic philosophers require that divine punishment be (...) morally justifiable. I conclude, then, that the arguments put forth by these theistic philosophers do not succeed. (shrink)

Laurence Lampert is well-known for philosophical studies on Nietzsche, Plato, and Leo Strauss. His work is animated by the notion that Nietzsche is the key figure in Strauss's thought and that Strauss is a Nietzschean in disguise. In How Socrates Became Socrates, Lampert brings his work on Nietzsche into conversation with his work on Plato, showing how the "mature" Socrates is himself a Nietzschean avant la lettre, and that this is how Strauss understands him, bringing to completion a decades-long (...) philosophical project in thrilling fashion. (shrink)

Bioethics as a field began some years before it was finally named in the early 1970s. In many ways, bioethics originated in response to urgent matters of the moment, including the controversy over disconnecting Karen Quinlan's respirator, the egregious paternalism of Donald Cowart's doctors in the famous “Dax” case, the abuse of research subjects in the notorious Tuskegee Syphilis Study, and the need to devise an intellectual framework for the development of federal regulations to protect human subjects of research. The (...) phrase “new and unprecedented” became a common description of the topics and issues to which people who later came to be called “bioethicists” responded. It should come as no surprise that bioethics and its practitioners soon came to the self-understanding that their work was new and unprecedented, much as the innovations of biomedical science and their clinical applications were thought to be. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Innovative Interaction Between Medicine and the HumanitiesLaurence B. McCullough and Warren Thomas ReichThe past three decades have witnessed the emergence and remarkable success of the fields of bioethics and medical humanities. The intellectual landscape of medicine and that of the humanities have been remarkably altered in the process. Twenty-five to 30 years ago in the United States there existed but a few courses in what came (...) to be called “bioethics” in departments of philosophy, religious studies, and theology in colleges and universities, a handful of programs of teaching in medical schools such as the University of Texas Medical Branch at Galveston and Pennsylvania State University School of Medicine at Hershey, and but one independent research center (the Hastings Center) and one university-based research center (the Kennedy Institute of Ethics at Georgetown University). Articles on bioethics began to appear in the peer-reviewed medical, nursing, and humanities literature and some books were published. There was only one journal in bioethics, The Hastings Center Report (which consolidated two previously separate journals from the Hastings Center). Graduate programs in bioethics and medical humanities in colleges and universities and fellowship training in bioethics and medical humanities in medical schools did not exist. Very little existed in colleges, universities, and medical schools in other countries. Now, of course, everything is different.Teachers, scholars, and students of bioethics and medical humanities should not take these remarkable changes for granted, for they represent a sustained and innovative interaction between medicine and the humanities. We have chosen the metaphor of “laying medicine open” to characterize the history of bioethics and medical humanities of the past three decades. This surgical metaphor was used in eighteenth-century Britain by a number of writers who wanted to make medical science and practice more accessible to the sick and to the lay public more generally (Lawrence 1975). We use the metaphor to characterize the efforts of teachers and [End Page 1] scholars over the past three decades and more to make the value-laden dimensions of biomedical science and practice and of health care policy more accessible to patients and to the lay public more generally. The result of this laying open of medicine has gone a long way toward bringing closer together the two cultures of science and the humanities that had, as C. P. Snow famously described, become significantly isolated from each otherAlbert Jonsen (1998) has recently contributed the first book-length history of what he calls the “birth” of bioethics, adding to the work of other scholars such as Warren Reich (1994; 1995) and Robert Baker (1993) and, before them, Corrado Viafora (1990) and David Rothman (1991). The articles in this issue of the Kennedy Institute of Ethics Journal make additional contributions to the developing understanding of the history of the past thirty years of interaction between medicine and the humanities.Laurence McCullough provides an historical context for the three accounts of the recent laying open of medicine that follow. McCullough examines two times in the history of medicine when it has been laid open to accountability (in addition to its being laid open to and by bioethics and medical humanities). The first laying open occurred in the work of the eighteenth-century Scottish physician and philosopher John Gregory, who set out to create a profession of medicine in a true moral sense of a fiduciary profession by making medicine accountable for its scientific and moral quality. The second occurred in the late twentieth century in which the managed practice of medicine in general, and managed care in particular, have begun to lay medicine open to accountability for its scientific and moral quality, as well as its cost and, at least in the public sector, its accessibility. McCullough argues that, just as Gregory responded to the ethical challenges of medicine laid open more than two centuries ago, bioethics should respond to the ethical challenges in the current laying open of medicine.Warren Reich provides an account of André Hellegers, whose premature death left an enormous gap in the field that will never be filled. Reich claims that Hellegers was engaged substantially in much more than the laying open of medicine: he... (shrink)