Suggestions that academic medicine is systemically racist are increasingly common in the medical literature. Such suggestions often rely upon expansive notions of systemic racism that are deeply controversial. The author argues for an empirical concept of systemic racism and offers a counter argument to a recent suggestion that academic medicine is systemically racist in its treatment of medical trainees: Anderson et al.’s (Academic Medicine, 98(8S), S28–S36, 2023) “The Long Shadow: a Historical Perspective on Racism in Medical Education.” Contra the authors (...) of “The Long Shadow,” the author argues that racial performance disparities in medical education cannot be validly attributed to racism without careful empirical confirmation; he further argues that standards of assessment in medical education cannot be properly deemed racist merely because minority trainees are disproportionately disadvantaged by them. Furthermore, the history of medicine and society in the Anglo-European West is not, as argued by the authors of “The Long Shadow,” best viewed as one long tale of racial oppression culminating in the present day pervasive racism of academic medicine in the United States. Racism is a deplorable stain on our history and our present but it is not the historical essence of Christianity, European civilization, Western medicine, or contemporary academic medical institutions. (shrink)

The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do so is a (...) prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment. (shrink)

Medical academics are increasingly bringing critical race theory (CRT) or its corollaries to their discourse, to their curricula, and to their analyses of health and medical treatment disparities. The author argues that this is an error. The author considers the history of CRT, its claims, and its current presence in the medical literature. He contends that CRT is inimical to usual academic modes of inquiry and has obscured rather than aided the analysis of social and medical treatment disparities. Remedies for (...) racism suggested by CRT advocates will not work and some of them will make things worse. Academic medicine should avoid the embrace of CRT and should maintain an allegiance to rigorous empirical inquiry and to treating patients not as essentialized ethnic group members but as individual human beings in need of care. (shrink)

Contemporary accounts of medical ethics and professionalism emphasize the importance of social justice as an ideal for physicians. This ideal is often specified as a commitment to attaining the universal availability of some level of health care, if not of other elements of a “decent minimum” standard of living. I observe that physicians, in general, have not accepted the importance of social justice for professional ethics, and I further argue that social justice does not belong among professional norms. Social justice (...) is a norm of civic rather than professional life; professional groups may demand that their members conform to the requirements of citizenship but ought not to require civic virtues such as social justice. Nor should any such requirements foreclose reasonable disagreement as to the content of civic norms, as requiring adherence to common specifications of social justice would do. Demands for any given form of social justice among physicians are unlikely to bear fruit as medical education is powerless to produce this virtue. (shrink)

A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to.

Opponents of physician-assisted suicide (PAS) maintain that physician withdrawal-of-life-sustaining-treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing-to-die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction as in (...) the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing-to-die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end-of-life care need not give up on it in response to these arguments. (shrink)

In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient’s “self.” The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is (...) misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient’s right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pacemaker is best seen as such a treatment. As such, its deactivation in the pacemaker-dependent patient is best seen not as withdrawal of support but as active ending of life. That being the case, clinicians adhering to the usual ethical analysis of withdrawal of support are correct to be uncomfortable with pacemaker deactivation at the end of life. (shrink)

The dispute over professional conscientious objection presumes a picture of medicine as a practice governed by rules. This rule-based conception of medical practice is identifiable with John Rawls’s conception of social practices. This conception does not capture the character of medical practice as experienced by practitioners, for whom it is a sensibility or “form of life” rather than rules. Moreover, the sensibility of medical practice as experienced by physicians is at best neutral, and at worst hostile, to the demands of (...) those who would override physician conscientious objection to the provision of currently contested services. That being so, calls for overriding physician conscientious objection are much more demanding of the medical profession than they appear in light of Rawls’s view. As such overriding may entail the forcible transformation of medicine’s form of life, the author contends that it would be more prudent to provide contested services by circumventing the medical profession than by compelling it. (shrink)

Since patient autonomy became a prominent theme in medical ethics in the 1970s and 1980s, it has had a troubled reputation among many physicians, to whom claims for its importance in medical decision making seem unrealistic and even undesirable. Of course the discussion has moved on since the early days in which informative or interpretive models of medical decision-making—in which physicians provided information and helped patients clarify and express preferences that then determined decisions—were contrasted with usual medical practice characterized as (...) paternalism: physicians telling patients what to do and patients acquiescing in physician direction. The... (shrink)

Medical work is increasingly being subjected to objective assessment as those who pay for it seek to grasp the quality of that work and how best to improve it. While objective measures have a role in the assessment of health care, I argue that this role is currently overestimated and that no human practice such as medicine can be fully comprehended by objective assessment. I suggest that the character of practices, in which formalizations are combined with judgment, requires that valid (...) assessment involve the perspective of the skilled practitioner. Relying exclusively on objective measures in assessing health care will not only distort our assessments of it but lead to damage as the incentives of health care workers are directed away from the important aspects of their work that are not captured by objective measures. (shrink)

The American Journal of Bioethics, Volume 12, Issue 3, Page 15-17, March 2012.

(2010). Response to Open Peer Commentaries on “The Pitfalls of Deducing Ethics from Economics: Why the Association of American Medical Colleges is Wrong About Pharmaceutical Detailing”. The American Journal of Bioethics: Vol. 10, No. 1, pp. W1-W3.

Issues of reliability are claiming center-stage in the epistemology of machine learning. This paper unifies different branches in the literature and points to promising research directions, whilst also providing an accessible introduction to key concepts in statistics and machine learning – as far as they are concerned with reliability.

Big Ideas for Little Kids includes everything a teacher, a parent, or a college student needs to teach philosophy to elementary school children from picture books. Written in a clear and accessible style, the book explains why it is important to allow young children access to philosophy during primary-school education. Wartenberg also gives advice on how to construct a "learner-centered" classroom, in which children discuss philosophical issues with one another as they respond to open-ended questions by saying whether they agree (...) or disagree with what others have said. (shrink)

Cette étude essaye d’établir qu’il y a deux notions très différentes de « fondation » à l’œuvre dans les Recherches logiques de Husserl. Dans la IIIème Recherche, où le terme est formellement introduit, lorsqu’il se demande quels sont les contenus qui peuvent exister d’une manière autonome (indépendants) et lesquels peuvent exister uniquement en tant que moments d’autre chose (dépendants), Husserl suit ce que j’appelle un « modèle ontologique ». Selon ce modèle, le concret possède une priorité sur à l’abstrait qui (...) est fondé en lui. Dans la VIème Recherche, en revanche, Husserl s’oriente principalement sur un « modèle gnoséologique » qui voit le complexe comme fondé sur ce qui est relativement simple, étant donné que les expériences d’ordre supérieur (telles les perceptions de types d’objets plus complexes) sont « fondées sur » des expériences plus simples, bien qu’elles ne puissent pas y être réduites. L’exemple principal ici est celui des intuitions catégoriales : fondées sur les intuitions sensibles, elles n’y sont pas réductibles. Mais cette distinction entre deux sens différents du terme de « fondation » peut également nous aider à mieux comprendre de nombreuses thèses husserliennes plutôt controversées. Par exemple, elle peut nous permettre de mieux comprendre dans quelle mesure faire l’expérience d’un être humain comme un tout se fonde sur l’expérience d’un corps physique, et cela même si l’étant que nous rencontrons inclut à la fois des aspects corporels et des aspects spirituels – les deux étant vus, d’une manière essentielle, comme des moments de cette unique personne qui fait l’objet de notre expérience. (shrink)

v. 1. Editorial introduction -- v. 2. The English and Latin texts (i) -- v. 3. The English and Latin texts (ii).

In this book, T. M. Scanlon offers new answers to these questions, as they apply to the central part of morality that concerns what we owe to each other.

Thomas Reid , the Scottish natural and moral philosopher, was one of the founding members of the Aberdeen Philosophical Society and a significant figure in the Scottish Enlightenment. Reid believed that common sense should form the foundation of all philosophical inquiry. He criticised the sceptical philosophy propagated by his fellow Scot David Hume and the Anglo-Irish bishop George Berkeley, who asserted that the external world did not exist outside the human mind. Reid was also critical of the theory of (...) ideas propagated by Locke and Descartes, arguing that it was incompatible with physical and experiential facts. For Reid, our senses demonstrate that the external world must exist, and this work is organised in chapters examining each of the senses in turn. The book, based on his lectures, was first published in 1764 when Reid was a regent professor at King's College, Aberdeen, and was reissued in 1818. (shrink)

This paper is an exposition and evaluation of the Agustín Rayo's views about the epistemology and metaphysics of mathematics, as they are presented in his book The Construction of Logical Space.

In recent years an increasing number of psychologists have begun to explore the prevalence, causes and effects of ordinary people’s intuitions about moral realism. Many of these studies have lacked in construct validity, i.e., they have failed to measure moral realism. My aim in this paper accordingly is to motivate and guide methodological improvements. In analysis of prominent existing measures, I develop general recommendations for overcoming ten prima facie serious worries about research on folk moral realism. G1 and G2 require (...) studies’ answer choices to be as metaethically comprehensive as methodologically feasible. G3 and G4 prevent fallacious inferences from intuitions about related debates. G5 and G6 limit first-order moral and epistemic influences. G7 address studies’ instructions. And G8 and G9 suggest tests of important psychological presuppositions. (shrink)

This volume is a study of the influence of Timaeus on the development of Western cosmology in three axial periods of European culture: Late Antiquity, Middle Ages and Renaissance.

In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy of medical (...) diagnosis, it comes at the expense of opacity when trying to assess the reliability of given diagnosis. Drawing on literature in social epistemology and moral responsibility, we argue that the uncertainty in question potentially undermines the epistemic authority of clinicians. Furthermore, we elucidate potential pitfalls of involving machine learning in healthcare with respect to paternalism, moral responsibility and fairness. At last, we discuss how the deployment of machine learning algorithms might shift the evidentiary norms of medical diagnosis. In this regard, we hope to lay the grounds for further ethical reflection of the opportunities and pitfalls of machine learning for enhancing decision-making in healthcare. (shrink)

Thomas Reid is now recognized as one of the towering figures of the Enlightenment. Best known for his published writings on epistemology and moral theory, he was also an accomplished mathematician and natural philosopher, as an earlier volume of his manuscripts edited by Paul Wood for the Edinburgh Reid Edition, Thomas Reid on the Animate Creation, has shown. The Correspondence of Thomas Reid collects all of the known letters to and from Reid in a fully annotated form. (...) Letters already published by Sir William Hamilton and others have been reedited, and roughly half of the letters included appear in print for the first time. Writing in 1802, Reid's disciple and biographer Dugald Stewart doubted that Reid's correspondence &"would be generally interesting.&" This collection proves otherwise, for the letters illuminate virtually every aspect of Reid's life and career and, in some instances, provide us with invaluable evidence about activities otherwise undocumented in his manuscripts or published works. Through his correspondence we can trace Reid's relations with contemporaries such as David Hume and his colleagues at both King's College, Aberdeen, and the University of Glasgow, as well as his engagement with the most controversial philosophical, scientific, and political issues of his day. If anything, the letters assembled here serve as the starting point for understanding Reid and his place in the Enlightenment. (shrink)

Feeling good: four ways -- Finding that feeling -- The place of pleasure -- Knowing what's what -- Making things happen -- Being good -- Love and friendship -- Putting it together.

Conciliatory theories of disagreement require that one lower one’s confidence in a belief in the face of disagreement from an epistemic peer. One question about which people might disagree is who should qualify as an epistemic peer and who should not. But when putative epistemic peers disagree about epistemic peerhood itself, then Conciliationism makes contradictory demands and paradoxes arise.

Existing research suggests that people's judgments of actual causation can be influenced by the degree to which they regard certain events as normal. We develop an explanation for this phenomenon that draws on standard tools from the literature on graphical causal models and, in particular, on the idea of probabilistic sampling. Using these tools, we propose a new measure of actual causal strength. This measure accurately captures three effects of normality on causal judgment that have been observed in existing studies. (...) More importantly, the measure predicts a new effect ("abnormal deflation"). Two studies show that people's judgments do, in fact, show this new effect. Taken together, the patterns of people's causal judgments thereby provide support for the proposed explanation. (shrink)

A growing number of decision theorists have, in recent years, defended the view that rationality is permissive under risk: Different rational agents may be more or less risk-averse or risk-inclined. This can result in them making different choices under risk even if they value outcomes in exactly the same way. One pressing question that arises once we grant such permissiveness is what attitude to risk we should implement when choosing on behalf of other people. Are we permitted to implement any (...) of the rationally permissible risk attitudes, is there some specific risk attitude that is required when choosing for others, or are we required to defer to the risk attitudes of the people on whose behalf we are choosing? This article elaborates on this question, explains its wider practical and theoretical significance, provides an overview of existing answers, and explores how to go about providing a more systematic account of how to choose on behalf of others in risky contexts. (shrink)

Cet essai présente une description de plusieurs travaux inédits de Jacques Derrida au sujet de Marx et d'Althusser datant des années 1960 et 1970. Au-delà du travail philologique, il s'agit aussi d'une étude théorique de notions telles que 'idéologie', 'fétichisme', 'reproduction', 'division du travail', 'différence sexuelle', 'domination', 'économie politique', 'matérialisme dialectique', ou 'production culturelle' — tout autant à travers les textes marxistes que dans les lectures déconstructives qu'en propose alors Derrida. Durant les années 1970, dans le cadre de son séminaire, (...) Derrida s'efforce de penser une autre économie politique, au-delà de l'économie du propre qu'il identifie aussi bien chez les économistes classiques que chez leurs critiques marxistes. Ces lectures détaillées et combattives de textes marxistes restent aujourd'hui inédites. Leur prise en compte contribue à redéfinir l'image de Derrida et de la déconstruction, en témoignant de ses discussions très avancées de Marx, d'Althusser, et de la pensée marxiste — et ce dès la fin des années 1960 et le début des années 1970, plus de 20 ans avant la publication de Spectres de Marx (1993). -/- Une version plus courte de cet article fut traduite en espagnol par Ramiro Parodi, et publiée en 2019 dans le numéro 7 de la revue Demarcaciones — numéro consacré au 25ème anniversaire de la publication de Spectres de Marx. (shrink)

In this important book, Thomas R. Flynn reinterprets and evaluates Sartre's social and political philosophy, arguing that the existential ethics of Sartre's ...

Thomas Hill, a leading figure in the recent development of Kantian moral philosophy, presents a set of essays exploring the implications of basic Kantian ideas for practical issues. The first part of the book provides background in central themes in Kant's ethics; the second part discusses questions regarding human welfare; the third focuses on moral worth-the nature and grounds of moral assessment of persons as deserving esteem or blame. Hill shows moral, political, and social philosophers just how valuable moral (...) theory can be in addressing practical matters. (shrink)

Respect, Pluralism, and Justice is a series of essays which sketches a broadly Kantian framework for moral deliberation, and then uses it to address important social and political issues. Hill shows how Kantian theory can be developed to deal with questions about cultural diversity, punishment, political violence, responsibility for the consequences of wrongdoing, and state coercion in a pluralistic society.

Typically, nudging is a technique for steering the choices of people without giving reasons or using enforcement. In benevolent cases, it is used when people are insufficiently responsive to reason. The nudger triggers automatic cognitive mechanisms – sometimes even biases – in smart ways in order to push irrational people in the right direction. Interestingly, this technique can also be applied to doxastic attitudes. Someone who is doxastically unresponsive to evidence can be nudged into forming true beliefs or doxastic attitudes (...) that are propositionally justified. When doxastic nudging uses non-rational mechanisms, the worry is that nudging cannot result in justified beliefs or knowledge, as the resulting doxastic attitudes lack the right kind of basis. In this paper, I will argue that given the right background views about knowledge, justified beliefs and the relevant processes, epistemic nudging is possible even in these cases. That is, all kinds of nudging can – in appropriate circumstances – produce justified beliefs or knowledge in the nudgee. (shrink)

T. H. Green's Prolegomena to Ethics is a classic of modern philosophy. It begins with Green's idealist attack on empiricist metaphysics and epistemology and develops a perfectionist ethical theory that aims to bring together the best elements in the ancient and modern traditions, and that provides the moral foundations for Green's own distinctive brand of liberalism. David Brink's new edition will restore this great work to prominence, after two decades in which it has been hard to obtain. The present edition (...) uses the text of the fifth edition, accompanied by a new introductory essay, bibliographical essay, and index. Translations are provided for Green's quotations from other languages. Of particular importance is the editor's extended introductory essay, which situates the Prolegomena in its intellectual context, sympathetically but critically engages its main themes, and explains Green's enduring significance for the history of philosophy and contemporary ethical theory. Students and scholars of the history of ethics, ethical theory, political philosophy, and nineteenth century philosophy will find this new edition an invaluable resource. (shrink)