To promote so-called cultural competence in work of direct-care providers and other health professionals among diverse peoples, cross-cultural training is now widely advised. However, in ethically assessing aims and content of CCT, and surrounding issues and concerns, what should guide us? And if we can elaborate satisfactory moral touchstones, what do they imply for healthcare professionals, overarching structures, and bioethicists? Building on prior work, this paper tries to help answer these questions.

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

In this paper, we explore best practices for asynchronous discussions in graduate online bioethics education. We explain that online approaches have advantages and challenges in contrast to in-person discussions. Online challenges are lack of visual or auditory cues and technical access. Advantages include extended opportunities for specific focus, thoughtful reflection, and critical review. We found no significant review of related best practices in bioethics. Our more general literature review of graduate education and online approaches, plus experience in our own bioethics (...) graduate program, suggest provisional best practices that we detail. We reason that online graduate discussion provisionally should aim for a “community of inquiry” framework that incorporates cognitive, social, and teaching “presences,” as well as a learning presence. However, we also note unresolved concerns about whether the framework sufficiently addresses learning, is complete, and captures communicative functions. Drawing further on the literature, we also suggest best practices for instructor feedback to students about their discussion performance, including that remarks should be timely and specific. Summaries from two courses in our graduate bioethics program illustrate how we implement discussion strategies. Finally, we review assessment strategies and suggest that embedded formative assessments in discussion support and demonstrate deeper learning. Limitations in generalizability include that our review targets asynchronous and text-based online discussion, our program assessments do not necessarily detail best practices, student expectations and approaches could be rather particular to our program, and specific bioethics content in principle could alter best practices. (shrink)

If you are black, you are more likely to get inferior health care than if you are white. And if you are Hispanic or Native American, odds are you're also in trouble. So finds the Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

The heart-rending story of Mrs. J raises many complex ethical issues. Key elements include suffering, disagreement, culture, religion, perspective, and facts. Overarching concerns include whose voices and stories should count, the connection of pain with suffering, and how healthcare ethics committees should respond.

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

The predominant influences on health are social or upstream factors. Poverty, inadequate education, insecure and toxic environments, and inferior opportunities for jobs and positions are inequitable disadvantages that adversely affect health across the globe. Many causal pathways are yet to be understood. However, elimination of these social inequalities is a moral imperative of the first order. Some physicians by word and deed argue that medical doctors should oppose the “structural violence” of social inequalities that greatly shorten lives and wreak so (...) much suffering. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.

PurposeTo use the power of knowledge acquisition and machine learning in the development of a collaborative computer classification system based on the features of age-related macular degeneration (AMD).MethodsA vocabulary was acquired from four AMD experts who examined 100 ophthalmoscopic images. The vocabulary was analyzed, hierarchically structured, and incorporated into a collaborative computer classification system called IDOCS. Using this system, three of the experts examined images from a second set of digital images compiled from more than 1000 patients with AMD. Images (...) were annotated, and features were identified and defined. Decision trees, a machine learning method, were trained on the data collected and used to extract patterns. Interrelationships between the data from the different clinicians were investigated.ResultsSix drusen classes in the structured vocabulary were largely sufficient to describe all the identified features. The decision trees classified the data with 76.86% to 88.5% accuracy and distilled patterns in the form of hierarchical trees composed of 5 to 15 nodes. Experts were largely consistent in their characterization of soft, and to a lesser extent, hard drusen, but diverge in definition of other drusen. Size and crystalline morphology were the main determinants of drusen type across all experts.ConclusionsMachine learning is a powerful tool for the characterization of disease phenotypes. The creation of a defined feature set for AMD will facilitate the development of an IDOCS-based classification system. (shrink)

This chapter contains sections titled: References and Further Reading.

Although Friedman's The Social Responsibility of Business is to Increase Profits is widely read, the central argument is rarely identified. Stone's discussion of Friedman in Where the Law Ends, is often used as a companion piece. Stone claims that the most important argument in Friedman is the Polestar argument but never succeeds in explaining what it is. This paper shows that Friedman's position must be read in the context of his theory of political economy, and that at least (...) four distinct utilitarian arguments are required to account for his views. Specifically, Friedman relies upon what I describe as Realistic Rule Utilitarianism in which utility is understood in terms of actual preferences. The weaknesses of this theory are then explained. (shrink)

John Searle's Speech Acts (1969) and Expression and Meaning (1979) developed a highly original and influential approach to the study of language. But behind both works lay the assumption that the philosophy of language is in the end a branch of the philosophy of the mind: speech acts are forms of human action and represent just one example of the mind's capacity to relate the human organism to the world. The present book is concerned with these biologically fundamental capacities, (...) and, though third in the sequence, in effect it provides the philosophical foundations for the other two. Intentionality is taken to be the crucial mental phenomenon, and its analysis involves wide-ranging discussions of perception, action, causation, meaning, and reference. In all these areas John Searle has original and stimulating views. He ends with a resolution of the 'mind-body' problem. (shrink)

John Searle's Speech Acts (1969) and Expression and Meaning (1979) developed a highly original and influential approach to the study of language. But behind both works lay the assumption that the philosophy of language is in the end a branch of the philosophy of the mind: speech acts are forms of human action and represent just one example of the mind's capacity to relate the human organism to the world. The present book is concerned with these biologically fundamental capacities, (...) and, though third in the sequence, in effect it provides the philosophical foundations for the other two. Intentionality is taken to be the crucial mental phenomenon, and its analysis involves wide-ranging discussions of perception, action, causation, meaning, and reference. In all these areas John Searle has original and stimulating views. He ends with a resolution of the 'mind-body' problem. (shrink)

In theology, by W.L. Rowe.--Divine foreknowledge and human freedom, by A. Kenny.--Some puzzles concerning omnipotence, by G.I. Mavrodes.--The paradox of the stone, by C.W. Savage.--Creation ex nihilo, by J. Donnelly.--The miraculous, by R.F. Holland.--On miracles, by P.J. Dietl.--The tacit structure of religious knowing, by J.H. Gill.--On the observability of the self, by R.M. Chisholm.--Re-examining Kierkegaard's "Teleological suspension of the ethical," by J. Donnelly.

The title of The Rediscovery of the Mind suggests the question "When was the mind lost?" Since most people may not be aware that it ever was lost, we must also then ask "Who lost it?" It was lost, of course, only by philosophers, by certain philosophers. This passed unnoticed by society at large. The "rediscovery" is also likely to pass unnoticed. But has the mind been rediscovered by the same philosophers who "lost" it? Probably not. John Searle is (...) an analytic philosopher, with some of the same notions as the positivists and behaviorists who rejected consciousness and "lost" the mind in the first place, but he also does not sound like the kind of reductionist who would have joined that crowd. His views, indeed, are sensible enough, and some of his insights so important, that it is a shame to find his thought profoundly limited by some of the same mistakes and prejudices that ruined philosophy, and not just philosophy of mind, under the influence of those positivists and behaviorists. There is enough of genuine value in his treatment, that it can easily be taken up and, with relatively slight modification, added to what is of permanent value in the history of philosophy. (shrink)

The renowned philosopher John Searle reveals the fundamental nature of social reality. What kinds of things are money, property, governments, nations, marriages, cocktail parties, and football games? Searle explains the key role played by language in the creation, constitution, and maintenance of social reality. We make statements about social facts that are completely objective, for example: Barack Obama is President of the United States, the piece of paper in my hand is a twenty-dollar bill, I got married in London, (...) etc. And yet these facts only exist because we think they exist. How is it possible that we can have factual objective knowledge of a reality that is created by subjective opinions? This is part of a much larger question: How can we give an account of ourselves, with our peculiar human traits DS mind, reason, freedom, society - in a world that we know independently consists of mindless, meaningless particles? How can we account for our social and mental existence in a realm of brute physical facts? In answering this question, Searle avoids postulating different realms of being, a mental and a physical, or worse yet, a mental, a physical, and a social. There is just one reality: Searle shows how the human reality fits into that one reality. Mind, language, and civilization are natural products of the basic facts of the physical world described by physics, chemistry and biology. Searle explains how language creates and maintains the elaborate structures of human social institutions. These institutions serve to create and distribute power relations that are pervasive and often invisible. These power relations motivate human actions in a way that provides the glue that holds human civilization together. Searle shows how this account illuminates human rationality, free will, political power, and human rights. Our social world is a world created and maintained by language. (shrink)

The purpose of this book -- Intentionality -- Collective intentionality and the assignment of function -- Language as biological and social -- The general theory of institutions and institutional facts: -- Language and social reality -- Free will, rationality, and institutional facts -- Power : deontic, background, political, and other -- Human rights -- Concluding remarks : the ontological foundations of the social sciences.

As Louisiana and Cuba emerged from slavery in the late nineteenth century, each faced the question of what rights former slaves could claim. Degrees of Freedom compares and contrasts these two societies in which slavery was destroyed by war, and citizenship was redefined through social and political upheaval. Both Louisiana and Cuba were rich in sugar plantations that depended on an enslaved labor force. After abolition, on both sides of the Gulf of Mexico, ordinary people-cane cutters and cigar workers, laundresses (...) and labor organizers-forged alliances to protect and expand the freedoms they had won. But by the beginning of the twentieth century, Louisiana and Cuba diverged sharply in the meanings attributed to race and color in public life, and in the boundaries placed on citizenship. Louisiana had taken the path of disenfranchisement and state-mandated racial segregation; Cuba had enacted universal manhood suffrage and had seen the emergence of a transracial conception of the nation. What might explain these differences? Moving through the cane fields, small farms, and cities of Louisiana and Cuba, Rebecca Scott skillfully observes the people, places, legislation, and leadership that shaped how these societies adjusted to the abolition of slavery. The two distinctive worlds also come together, as Cuban exiles take refuge in New Orleans in the 1880s, and black soldiers from Louisiana garrison small towns in eastern Cuba during the 1899 U.S. military occupation. Crafting her narrative from the words and deeds of the actors themselves, Scott brings to life the historical drama of race and citizenship in postemancipation societies. (shrink)

The study of rationality and practical reason, or rationality in action, has been central to Western intellectual culture. In this invigorating book, John Searle lays out six claims of what he calls the Classical Model of rationality and shows why they are false. He then presents an alternative theory of the role of rationality in thought and action. A central point of Searle's theory is that only irrational actions are directly caused by beliefs and desires—for example, the actions of (...) a person in the grip of an obsession or addiction. In most cases of rational action, there is a gap between the motivating desire and the actual decision making. The traditional name for this gap is "freedom of the will." According to Searle, all rational activity presupposes free will. For rationality is possible only where one has a choice among various rational as well as irrational options. Unlike many philosophical tracts, Rationality in Action invites the reader to apply the author's ideas to everyday life. Searle shows, for example, that contrary to the traditional philosophical view, weakness of will is very common. He also points out the absurdity of the claim that rational decision making always starts from a consistent set of desires. Rational decision making, he argues, is often about choosing between conflicting reasons for action. In fact, humans are distinguished by their ability to be rationally motivated by desire-independent reasons for action. Extending his theory of rationality to the self, Searle shows how rational deliberation presupposes an irreducible notion of the self. He also reveals the idea of free will to be essentially a thesis of how the brain works. (shrink)

Disputes between those holding differing political views are ubiquitous and deep-seated, and they often follow common, recognizable lines. The supporters of tradition and stability, sometimes referred to as conservatives, do battle with the supporters of innovation and reform, sometimes referred to as liberals. Understanding the correlates of those distinct political orientations is probably a prerequisite for managing political disputes, which are a source of social conflict that can lead to frustration and even bloodshed. A rapidly growing body of empirical evidence (...) documents a multitude of ways in which liberals and conservatives differ from each other in purviews of life with little direct connection to politics, from tastes in art to desire for closure and from disgust sensitivity to the tendency to pursue new information, but the central theme of the differences is a matter of debate. In this article, we argue that one organizing element of the many differences between liberals and conservatives is the nature of their physiological and psychological responses to features of the environment that are negative. Compared with liberals, conservatives tend to register greater physiological responses to such stimuli and also to devote more psychological resources to them. Operating from this point of departure, we suggest approaches for refining understanding of the broad relationship between political views and response to the negative. We conclude with a discussion of normative implications, stressing that identifying differences across ideological groups is not tantamount to declaring one ideology superior to another. (shrink)

The human cognitive architecture consists of a set of largely independent modules associated with different brain regions. This book discusses in detail how these various modules can combine to produce behaviours as varied as driving a car and solving an algebraic equation.

It has long been one of the most fundamental problems of philosophy, and it is now, John Searle writes, "the most important problem in the biological sciences": What is consciousness? Is my inner awareness of myself something separate from my body? In what began as a series of essays in The New York Review of Books, John Searle evaluates the positions on consciousness of such well-known scientists and philosophers as Francis Crick, Gerald Edelman, Roger Penrose, Daniel Dennett, David (...) Chalmers, and Israel Rosenfield. He challenges claims that the mind works like a computer, and that brain functions can be reproduced by computer programs. With a sharp eye for confusion and contradiction, he points out which avenues of current research are most likely to come up with a biological examination of how conscious states are caused by the brain. Only when we understand how the brain works will we solve the mystery of consciousness, and only then will we begin to understand issues ranging from artificial intelligence to our very nature as human beings. (shrink)

"The philosophy of mind is unique among contemporary philosophical subjects," writes John Searle, "in that all of the most famous and influential theories are false." In Mind, Searle dismantles these famous and influential theories as he presents a vividly written, comprehensive introduction to the mind. Here readers will find one of the world's most eminent thinkers shedding light on the central concern of modern philosophy. Searle begins with a look at the twelve problems of philosophy of mind--which he calls (...) "Descartes and Other Disasters"--problems which he returns to throughout the volume, as he illuminates such topics as the freedom of the will, the actual operation of mental causation, the nature and functioning of the unconscious, the analysis of perception, and the concept of the self. One of the key chapters is on the mind-body problem, which Searle analyzes brilliantly. He argues that all forms of consciousness--from feeling thirsty to wondering how to translate Mallarme--are caused by the behavior of neurons and are realized in the brain system, which is itself composed of neurons. But this does not mean that consciousness is nothing but neuronal behavior. The main point of having the concept of consciousness, Searle points out, is to capture the first person subjective features of the phenomenon and this point is lost if we redefine consciousness in third person objective terms. Described as a "dragonslayer by temperament," John Searle offers here a refreshingly direct and open discussion of philosophy, one that skewers accepted wisdom even as it offers striking new insights into the nature of consciousness and the mind. (shrink)

In this first comprehensive treatment of Plato’s political thought in a long time, John Wallach offers a "critical historicist" interpretation of Plato. Wallach shows how Plato’s theory, while a radical critique of the conventional ethical and political practice of his own era, can be seen as having the potential for contributing to democratic discourse about ethics and politics today. The author argues that Plato articulates and "solves" his Socratic Problem in his various dialogues in different but potentially complementary ways. (...) The book effectively extracts Plato from the straightjacket of Platonism and from the interpretive perspectives of the past fifty years—principally those of Karl Popper, Leo Strauss, Hannah Arendt, M. I. Finley, Jacques Derrida, and Gregory Vlastos. The author’s distinctive approach for understanding Plato—and, he argues, for the history of political theory in general—can inform contemporary theorizing about democracy, opening pathways for criticizing democracy on behalf of virtue, justice, and democracy itself. (shrink)

Cognitive science typically postulates unconscious mental phenomena, computational or otherwise, to explain cognitive capacities. The mental phenomena in question are supposed to be inaccessible in principle to consciousness. I try to show that this is a mistake, because all unconscious intentionality must be accessible in principle to consciousness; we have no notion of intrinsic intentionality except in terms of its accessibility to consciousness. I call this claim the The argument for it proceeds in six steps. The essential point is that (...) intrinsic intentionality has aspectual shape: Our mental representations represent the world under specific aspects, and these aspectual features are essential to a mental state's being the state that it is. (shrink)

John R. Schneider explores the problem that animal suffering, caused by the inherent nature of Darwinian evolution, poses to belief in theism. Examining the aesthetic aspects of this moral problem, Schneider focuses on the three prevailing approaches to it: that the Fall caused animal suffering in nature (Lapsarian Theodicy), that Darwinian evolution was the only way for God to create an acceptably good and valuable world (Only-Way Theodicy), and that evolution is the source of major, God-justifying beauty (Aesthetic Theodicy). (...) He also uses canonical texts and doctrines from Judaism and Christianity - notably the book of Job, and the doctrines of the incarnation, atonement, and resurrection - to build on insights taken from the non-lapsarian alternative approaches. Schneider thus constructs an original, God-justifying account of God and the evolutionary suffering of animals. His book enables readers to see that the Darwinian configuration of animal suffering unveiled by scientists is not as implausible on Christian theism as commonly supposed. (shrink)

In Mind: An Introduction, for the first time John Searle offers a general introduction to the philosophy of the mind. Giving a broad survey of all the major issues under discussion in the field, including philosophical issues in cognitive science and neurobiology, Searle argues for his own distinctive point of view. He leads the reader through the variety of theories that reduce the mind to aspects that can be fully explained by physics, and then concludes with his own view (...) that such reductionist theories ignore or cannot adequately explain the most fundamental aspect of the mind - subjective consciousness. (shrink)