1. Modes of art -- 2. Ways of art -- 3. Illustrations.

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Bioethicists function in an environment in which their peers - healthcare executives, lawyers, nurses, physicians - assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts (...) that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. (shrink)

Aesthetic normativity continues to be of interest in contemporary aesthetics, and significant contributions to the topic can be found in neo-Kantianism. This article examines the account of aesthetic normativity presented by Jonas Cohn (1869–1947), a member of the Southwestern school of neo-Kantianism and author of a 1901 book on aesthetics. Cohn's Kantian-Hegelian theory of aesthetic normativity deserves more examination than it has so far received. Even if one does not accept all of its main arguments, Cohn's theory (...) offers an interesting alternative to the third Critique's account of the universal validity of aesthetic judgments, and it reveals how Kant's aesthetic theory was appropriated at the turn of the century. Since a number of objections can be raised against Cohn's account, however, at the end of the paper I raise several of them. (shrink)

The abstract structure of inquiry - the process of acquiring and changing beliefs about the world - is the focus of this book which takes the position that the "pragmatic" rather than the "linguistic" approach better solves the philosophical problems about the nature of mental representation, and better accounts for the phenomena of thought and speech. It discusses propositions and propositional attitudes (the cluster of activities that constitute inquiry) in general and takes up the way beliefs change in response to (...) potential new information, suggesting that conditional propositions should be understood as projections of epistemic policies onto the world.Robert C. Stalnaker is a professor in the Sage School of Philosophy at Cornell University. A Bradford Book. (shrink)

Whole genome sequencing is quickly becoming more affordable and accessible, with the prospect of personal genome sequencing for under $1,000 now widely said to be in sight. The ethical issues raised by the use of this technology in the research context have received some significant attention, but little has been written on its use in the clinical context, and most of this analysis has been futuristic forecasting. This is problematic, given the speed with which whole genome sequencing technology is likely (...) to be incorporated into clinical care. This paper explores one particular subset of these issues: the implications of adopting this technology in the prenatal context without a good understanding of when and how it is useful. Prenatal whole genome sequencing differs from current prenatal genetic testing practice in a number of ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. The wealth of new data could enhance reproductive decision‐making, promoting parents' freedom to make well‐informed reproductive decisions. We argue, however, that there is potential for prenatal whole genome sequencing to alter clinical practice in undesirable ways, especially in the short term. We are concerned that the technology could (1) change the norms and expectations of pregnancy in ways that complicate parental autonomy and informed decision‐making, (2) exacerbate the deleterious role that genetic determinism plays in child rearing, and (3) undermine children's future autonomy by removing the option of not knowing their genetic information without appropriate justification. (shrink)

This English version is rewritten with some chapters omitted and 2 new chapters added of the book in Hebrew: ha-Muzikah: shelihut u-vesorah: avne beniyah la-estetikah shel ha-muzikah by Mikhal Zemorah-Kohen and Hertsel Shemueli, published Or Yehudah: Devir, c2007.

This paper revisits some foundational questions concerning the abstract representation of a discourse context. The context of a conversation is represented by a body of information that is presumed to be shared by the participants in the conversation – the information that the speaker presupposes a point at which a speech act is interpreted. This notion is designed to represent both the information on which context-dependent speech acts depend, and the situation that speech acts are designed to affect, and so (...) to be a representation of context that is appropriate for explaining the interaction of context and the contents expressed in them. After reviewing the motivating ideas and the outlines of the apparatus, the paper responds to a criticism of the framework, and considers the way it can help to clarify some phenomena concerning pronouns with indefinite antecedents. (shrink)

Robert C. Stalnaker presents a set of essays on the structure of inquiry. First he focuses on the concepts of knowledge, belief, and partial belief, and on the rules and procedures we ought to use to determine what to believe. Then he explores the relations between conditionals and causal and explanatory concepts.

In Pascal Boyer’s book Religion Explained inference systems are made to do a lot of work in his attempts to explain cognition in religion. These inference systems are systems in the brain that produces inferences when they are activated by things we perceive in our environment. According to Boyer they perceive things, produce explanations, and perform calculations. However, if Wittgenstein’s observation, that “only of a living human being and what resembles (behaves like) a living human being can one say: it (...) has sensations; it sees; is blind; hears; is deaf; is conscious or unconscious” is correct then it seems that Boyer’s talk of inference systems perceiving and inferring is confused. (shrink)

Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals (...) through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. (shrink)

The cost of health care at the end of life accounts for a high proportion of total health care costs in the United States. The percentage of Medicare payments attributable to patients in their last year of life was 28.3% in 1978 and has remained substantially the same at 25.1% in 2006. This indicates how little progress has been made in containing these costs, though doing so will be important to promote a financially sustainable health care system. These expenditures also (...) highlight the prospect that efforts to reduce health care costs overall are likely to disproportionately affect the care patients receive at the end of life. (shrink)

Race or ethnic identity, despite its imprecise categorization, is a useful means of identifying population differences in mechanisms of disease and treatment effects. Therefore, race and other arbitrary demographic and physiological variables have appropriately served as a helpful guide to clinical management and to clinical trial participation. The African-American Heart Failure Trial was carried out in African-Americans with heart failure because prior data had demonstrated a uniquely favorable effect in this subpopulation of the drug combination in BiDil. The remarkable effect (...) of the drug in reducing mortality in this study has illuminated an important new mechanism of therapy for heart failure. Application of these findings need not be confined to the population studied, but the observation highlights the need for more precise ways to identify individual responsiveness to therapy. (shrink)

Friedrich Nietzsche is one of the most popular and controversial philosophers of the last 150 years. Narcissistic, idiosyncratic, hyperbolic, irreverent--never has a philosopher been appropriated, deconstructed, and scrutinized by such a disparate array of groups, movements, and schools of thought. Adored by many for his passionate ideas and iconoclastic style, he is also vilified for his lack of rigor, apparent cruelty, and disdain for moral decency. In Living with Nietzsche, Solomon suggests that we read Nietzsche from a very different point (...) of view, as a provocative writer who means to transform the way we view our lives. This means taking Nietzsche personally. Rather than focus on the "true" Nietzsche or trying to determine "what Nietzsche really meant" by his seemingly random and often contradictory pronouncements about "the Big Questions" of philosophy, Solomon reminds us that Nietzsche is not a philosopher of abstract ideas but rather of the dazzling personal insight, the provocative challenge, the incisive personal probe. He does not try to reveal the eternal verities but he does powerfully affect his readers, goading them to see themselves in new and different ways. It is Nietzsche's compelling invitation to self-scrutiny that fascinates us, engages us, and guides us to a "rich inner life." Ultimately, Solomon argues, Nietzsche is an example as well as a promulgator of "passionate inwardness," a life distinguished by its rich passions, exquisite taste, and a sense of personal elegance and excellence. (shrink)

Over a career spanning American history from the 1880s to the 1950s, John Dewey sought not only to forge a persuasive argument for his conviction that "democracy is freedom" but also to realize his democratic ideals through political activism. Widely considered modern America's most important philosopher, Dewey made his views known both through his writings and through such controversial episodes as his leadership of educational reform at the turn of the century; his support of American intervention in World War I (...) and his leading role in the Outlawry of War movement after the war; and his participation in both radical and anti-communist politics in the 1930s and 40s. Robert B. Westbrook reconstructs the evolution of Dewey's thought and practice in this masterful intellectual biography, combining readings of his major works with an engaging account of key chapters in his activism. Westbrook pays particular attention to the impact upon Dewey of conversations and debates with contemporaries from William James and Reinhold Niebuhr to Jane Addams and Leon Trotsky. Countering prevailing interpretations of Dewey's contribution to the ideology of American liberalism, he discovers a more unorthodox Dewey—a deviant within the liberal community who was steadily radicalized by his profound faith in participatory democracy. Anyone concerned with the nature of democracy and the future of liberalism in America—including educators, moral and social philosophers, social scientists, political theorists, and intellectual and cultural historians—will find John Dewey and American Democracy indispensable reading. (shrink)

The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in (...) ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics. (shrink)

Author Robert Wright shows how Buddhist meditative practice can loosen the grip of anxiety, regret, and hatred, and deepen your appreciation of beauty and other people." -- Adapted from book jacket.

The Joy of Philosophy is a return to some of the perennial questions of philosophy--questions about the meaning of life; about death and tragedy; about the respective roles of rationality and passion in the good life; about love, compassion, and revenge; about honesty, deception, and betrayal; and about who we are and how we think about who we are. Recapturing the heart-felt confusion and excitement that originally brings us all to philosophy, internationally renowned teacher and lecturer Robert C. Solomon (...) offers both a critique of contemporary philosophy and an invitation to engage in philosophy in a different way. He attempts to save philosophy from itself and its self-imposed diet of thin arguments and logical analysis to recover the richness and complexity of life in thought. Solomon defends the passionate life in contrast to the life of thoughtful contemplation idealized by so many philosophers, attempting to recapture the kind of philosophy that Nietzsche celebrated as a "joyful wisdom.". (shrink)

One of our great behavioral scientists, the bestselling author of Behave, plumbs the depths of the science and philosophy of decision-making to mount a devastating case against free will, an argument with profound consequences Robert Sapolsky's Behave, his now classic account of why humans do good and why they do bad, pointed toward an unsettling conclusion: We may not grasp the precise marriage of nature and nurture that creates the physics and chemistry at the base of human behavior, but (...) that doesn't mean it doesn't exist. Now, in Determined, Sapolsky takes his argument all the way, mounting a brilliant (and in his inimitable way, delightful) full-frontal assault on the pleasant fantasy that there is some separate self telling our biology what to do. Determined offers a marvelous synthesis of what we know about how consciousness works-the tight weave between reason and emotion and between stimulus and response in the moment and over a life. One by one, Sapolsky tackles all the major arguments for free will and takes them out, cutting a path through the thickets of chaos and complexity science and quantum physics, as well as touching ground on some of the wilder shores of philosophy. He shows us that the history of medicine is in no small part the history of learning that fewer and fewer things are somebody's "fault"; for example, for centuries we thought seizures were a sign of demonic possession. Yet, as he acknowledges, it's very hard, and at times impossible, to uncouple from our zeal to judge others and to judge ourselves. Sapolsky applies the new understanding of life beyond free will to some of our most essential questions around punishment, morality, and living well together. By the end, Sapolsky argues that while living our daily lives recognizing that we have no free will is going to be monumentally difficult, doing so is not going to result in anarchy, pointlessness, and existential malaise. Instead, it will make for a much more humane world. (shrink)

Many idealists have thought that realism raises epistemological problems. The worry is that, if it is possible for truths about ordinary objects to outstrip our experiences in the ways that realists typically suppose, we could never be justified in our beliefs about objects. Few contemporary theorists find this argument convincing; philosophers have offered a variety of responses to defend the epistemology of our object judgments under the assumption of realism. But in this paper, I offer a new type of epistemic (...) argument against realism which is immune to the standard responses in the literature. In addition to raising a challenge for realism, the epistemology of our object judgments has implications for how the idealist should develop her own positive metaphysical view. So in the second half of this paper, I discuss how the idealist should understand the dependence between objects and our experiences if she is to secure epistemic advantages over the realist. (shrink)

Machine‐learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well‐represented populations. Faced with this dilemma (...) between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well‐represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms—showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings. (shrink)

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

This study of American intellectual histories sketches their development from colonial chronicles to today's professional scholarship. It concentrates upon the writings of a dozen or more major historians between the late 1800's and the middle 1900's who have contributed to the study of the history of ideas in America, including Moses Coit Tyler, Edward Eggleston, Charles Beard, Carl Becker, Vernon Farrington, Merle Curti, Perry Miller, and Ralph Gabriel. The various histories are analyzed partly from the perspective of a developing scholarly (...) discipline and partly from the perspective of the "climate of opinion" in which the histories were written. The methods employed by the historians in studying ideas, as well as the substantive interpretations expressed in the histories, are analyzed in relation to the "world-views" or "ideological positions" of the historians themselves. Originally published in 1966. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

This book is of vital interest to anyone who yearns to know how science, theology, ethics, art, and politics do really afford objective truths. Not only that, but how these truths in seemingly clashing areas are interrelated by common sense and rooted in our incontrovertible consciousness of Being itself. Being itself, as the basis for truth, is defended against truth-denying modern philosophers who, having headed in the wrong direction with tragic costs of murderous ideologies, have completely misunderstood the simple origin (...) of truth in the realist tradition of Aristotle, Aquinas, Étienne Gilson, and others. Their profoundness is not bamboozled by the covert and corrupting sophism of today’s teachings. Anyone interested in surmounting these teachings that include political correctness and a false divide of fact from value, which paralyze the very modern ethics that helped to create them, should read this book. The book reveals how ethics, art, and politics can be as true as the sciences that inform them. (shrink)