Power is an inescapable aspect of all socialrelationships, and inherently is neither goodnor evil. Doctors need power to fulfil theirprofessional obligations to multipleconstituencies including patients, thecommunity and themselves. Patients need powerto formulate their values, articulate andachieve health needs, and fulfil theirresponsibilities. However, both parties canuse or misuse power. The ethical effectivenessof a health system is maximised by empoweringdoctors and patients to develop `adult-adult'rather than `adult-child' relationships thatrespect and enable autonomy, accountability,fidelity and humanity. Even in adult-adultrelationships, conflicts and complexitiesarise. Lack of (...) concordance between doctors andpatients can encourage paternalism but may bebest resolved through negotiated care. Afurther area of conflict involves the `doubleagency' of doctors for both patients and thecommunity. Empowerment of all players is notalways possible but is most likely where eachparty considers and acknowledges power issues. (shrink)

Editors' introduction to 3rd thematic issue on philosophy of medicine.

Person-centered care offers a promising way to manage clinicians’ conscientious objection to providing services they consider morally wrong. Health care centered on persons, rather than patients, recognizes clinicians and patients on the same stratum. The moral interests of clinicians, as persons, thus warrant as much consideration as those of other persons, including patients. Interconnected moral interests of clinicians, patients, and society construct the clinician as a socially embedded and integrated self, transcending the simplistic duality of private conscience versus public role (...) expectations. In this milieu of blurred boundaries, person-centered care offers a constructive way to accommodate conscientious objection by clinicians. The constitutionally social nature of clinicians commits and enables them, through care mechanisms such as self-care, to optimize the quality of health care and protect the welfare of patients. To advance these conditions, it is recommended that the medical profession develop a person-centered culture of care, along with clinician virtues and skills for person-centered communication. (shrink)

Modern technologies sanction a new plasticity of physical form. However, the increasing global popularity of aesthetic procedures produces normative beauty ideals in terms of perfection and symmetry. These conditions limit the semblance of freedom by people to control their own bodies. Cultural emancipation may come from principles in Eastern philosophy. These reveal beauty in authenticity, including imperfection. Wabi-sabi acclaims beauty in common irregularity, while kintsugi celebrates beauty in visible signs of repair, like scars. These principles resist pressure to medicalize dissatisfaction (...) with healthy bodies and invite multi-sited interventions to educate taste and aesthetic choices. (shrink)

Cooperation and conversation in the public sphere may overcome historical and other barriers to rational argumentation. As an alternative to evidence-based medicine (EBM) and patient-centered care (PCC), the recent development of a modern version of person-centered medicine (PCM) signals an opportunity for a conversational pluralogue to replace parallel monologues between EBM and its critics, and the calls to EBM to debate its critics. This article draws upon elements of Habermas’s theory of communicative action in order to suggest the kind of (...) pluralogue that is required for stakeholders in modern medicine to benefit more from publicly conversing with each other than speaking alone or using debate to argue against each other. This reasoned perspective has lessons for all discourse when deep value-based and epistemological differences cannot be easily adjudicated. (shrink)

The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. (...) Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce. (shrink)

Body image research focuses almost exclusively on women or overweight and obesity or both. Yet, body image concerns among thin men are common and can result, at least in part, from mixed messages in society around how men qua men should dress and behave in order to look good and feel good. Stand-alone interventions to meet these different messages tend to provide men with little therapeutic relief. This conceptual paper draws on literature from the medical humanities; gender and body image (...) studies; the social psychology of clothing; and the author’s own lived experience to address this contemporary problem. The paper embraces visual culture as a resource that can frame discussion of how two sets of ‘performativity’ might reduce male anxiety about thinness. First, thin men could choose repeatedly to wear masculine-looking clothing, which could create their masculinity as a personal aesthetic that strengthens the confidence to harness masculine traits in healthy ways. Secondly, health and allied health service providers could promote and reinforce such dress behavior by offering advice that integrates aesthetic and functional aspects of clothing. Empirical studies are needed to test this dual model of performativity. (shrink)

New Zealand and United Kingdom governments have set new directives for increased consultation with the public about health care. Set against a legacy of modest success with past engagement with public consultations, this paper considers potentially adverse ethical implications of the new directives. Drawing on experiences from New Zealand and the United Kingdom, and on an Orthodox Jewish perspective, the paper seeks to answer two questions: What conditions can compromise the ethics of public consultation? How can the public respond ethically (...) to consultation? In answering these questions, the paper considers how Orthodox Judaism, as a specific positive morality, can aid the development of public policy. It is suggested that an Orthodox Jewish perspective does not require limiting the content of public consultations and helps to define a common procedural morality binding Jews and non-Jews. This procedural morality requires avoiding two conditions that, as shown from Jewish texts, make public consultation unethical. These are overpreparation and underpreparation. Members of the public who deem a consultation unethical should give feedback not on the proposal but on the conditions they perceive to prevent the consulting party from considering their viewpoints on the proposal. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

A Brief History of Time: From the Big Bang to Black Holes is a popular-science book on cosmology (the study of the origin and evolution of the universe) by British physicist Stephen Hawking. It was first published in 1988. Hawking wrote the book for readers who have no prior knowledge of the universe and people who are interested in learning.

Amid neglect of patients’ contribution to error has been a failure to ask whether patients are morally responsible for their errors. This paper aims to help answer this question and so define a worthy response to the errors. Recent work on medical errors has emphasised system deficiencies and discouraged finding people to blame. We scrutinise this approach from an incompatibilist, agent causation position and draw on Hart’s taxonomy of four senses of moral responsibility: role responsibility; capacity responsibility; causal responsibility; and (...) liability responsibility. Each sense is shown to contribute to an overall theoretical judgment as to whether patients are morally responsible for their errors . Though how to weight the senses is unclear, patients appear to be morally responsible for the avoidable errors they make, contribute to or can influence. (shrink)

A comprehensive reassessment of the concept of mimesis in the history of ancient Greek aesthetics and philosophy of art, with particular attention to Plato, Aristotle, Hellenistic philosophy, and neoplatonism. There is also a wide-ranging review of arguments pro and contra the idea of artistic mimesis from the Renaissance to modern literar theory. The book challenges standard accounts in numerous respects and builds a new dialectical model with which to make sense of the entire history of mimeticist thinking in aesthetics.

Patient responsibilities in primary health care are controversial and, by comparison, the responsibilities of high need patients are less clear. This paper aims to suggest why high need patients receiving targeted entitlements in primary health care are free to have prima facie special responsibilities; why, given this freedom, these patients morally have special responsibilities; what these responsibilities are, and how publicly funded health systems ought to be able to respond when these remain unmet. It is suggested that the special responsibilities (...) and their place in public policy acquire moral significance as a means to discharge a moral debt, share special knowledge, and produce desirable consequences in regard to personal and collective interests. Special responsibilities magnify ordinary patient responsibilities and require patients not to hesitate regarding attendance for primary health care. Persistent patient disregard of special responsibilities may necessitate limiting the scope of these responsibilities, removing system barriers, or respecifying special rights. (shrink)

Aboutness has been studied from any number of angles. Brentano made it the defining feature of the mental. Phenomenologists try to pin down the aboutness-features of particular mental states. Materialists sometimes claim to have grounded aboutness in natural regularities. Attempts have even been made, in library science and information theory, to operationalize the notion. But it has played no real role in philosophical semantics. This is surprising; sentences have aboutness-properties if anything does. Aboutness is the first book to examine through (...) a philosophical lens the role of subject matter in meaning. A long-standing tradition sees meaning as truth-conditions, to be specified by listing the scenarios in which a sentence is true. Nothing is said about the principle of selection--about what in a scenario gets it onto the list. Subject matter is the missing link here. A sentence is true because of how matters stand where its subject matter is concerned. Stephen Yablo maintains that this is not just a feature of subject matter, but its essence. One indicates what a sentence is about by mapping out logical space according to its changing ways of being true or false. The notion of content that results--directed content--is brought to bear on a range of philosophical topics, including ontology, verisimilitude, knowledge, loose talk, assertive content, and philosophical methodology. Written by one of today's leading philosophers, Aboutness represents a major advance in semantics and the philosophy of language. (shrink)

In Return to Reason, Stephen Toulmin argues that the potential for reason to improve our lives has been hampered by a serious imbalance in our pursuit of ...

Stephen Hetherington's prominent career within epistemology has been a series of distinctive, bold, varied and provocative arguments and ideas. Bringing together Hetherington's unique body of writing for the first time, this collection features previously published as well as new material that link his approaches to key issues including knowledge, justification, fallibility, scepticism and the Gettier Problem. Advancing our understanding of the systemic nature of Hetherington's thinking, Stephen Hetherington on Epistemology presents his distinctive perspective on some of philosophy's central (...) questions about knowledge - an inviting blend of forensic detail and 'big picture' proposals. (shrink)

Defenders of pragmatic encroachment in epistemology (or what I call practicalism) need to address two main problems. First, the view seems to imply, absurdly, that knowledge can come and go quite easily—in particular, that it might come and go along with our variable practical interests. We can call this the stability problem. Second, there seems to be no fully satisfying way of explaining whose practical interests matter. We can call this the “whose stakes?” problem. I argue that both problems can (...) be addressed in roughly the same terms. More exactly, I argue that by first clarifying the whose stakes? problem an answer to the stability problem naturally falls out. (shrink)

Elizabeth Anscombe famously argued that "modern moral philosophy" centrally involved unsupported notions of obligation and culpability. Modern Moral Philosophy: From Grotius to Kant exhibits, for the first time, resources that modern moral philosophers had to respond to Anscombe's challenge, also enhancing our own philosophical grasp of morality and its foundations.

In this paper I elucidate various ways in which understanding can be seen as an excellence of the mind or intellectual virtue. Along the way, I take up the neglected issue of what it might mean to be an “understanding person”—by which I mean not a person who understands a number of things about the natural world, but a person who steers clear of things like judgmentalism in her evaluation of other people, and thus is better able to take up (...) different perspectives and view them with a sympathetic eye. Being an understanding person in this sense seems to be a character-level virtue that interestingly combines moral and epistemic elements; it also seems to be a virtue particularly needed in our age of deep political division, where it is commonly said that failures of mutual understanding are partly to blame for this problem. (shrink)

Keith Augustine’s critical evaluation of the essay contest sponsored by the Bigelow Institute of Consciousness Studies (BICS) is an interesting but problematic review. It mixes reasonable and detailed criticisms of the contest and many of the winning essays with a disappointing reliance on some of the most trite and superficial criticisms of parapsychological research. Ironically, Augustine criticizes the winning essays for using straw-man arguments and cherry-picked evidence even though many of his own arguments commit these same errors.

Can hybridism about moral claims be made to work? I argue it can if we accept the conventional implicature approach developed in Barker (Analysis 2000). However, this kind of hybrid expressivism is only acceptable if we can make sense of conventional implicature, the kind of meaning carried by operators like ‘even’, ‘but’, etc. Conventional implictures are a form of pragmatic presupposition, which involves an unsaid mode of delivery of content. I argue that we can make sense of conventional implicatures, but (...) doing so requires we embrace a form of pure, non-hybrid expressivism. This is a cognitivist expressivism I have developed elsewhere. We need cognitivist expressivism to make sense of how we evaluate—judge as correct or incorrect—implicature-bearing sentences. Once we embraced the possibility of this pure expressivism, we might as well be pure expressivists about normative discourse too. I show how we can do that. The motivations for a specifically hybrid theory are dialectically undercut. (shrink)

Many experimental philosophers are philosophers by training and professional affiliation, but some best work in experimental philosophy has been done by people who do not have advanced degrees in philosophy and do not teach in philosophy departments. This chapter explains that the experimental philosophy is the empirical investigation of philosophical intuitions, the factors that affect them, and the psychological and neurological mechanisms that underlie them. It explores what are philosophical intuitions, and why do experimental philosophers want to study them using (...) the methods of empirical science. The positive program in experimental philosophy shares the goal of the substantial part of traditional philosophy that is concerned with the analysis of important philosophical concepts. The negative program has implications for philosophical projects whose goal is conceptual analysis. There have been a number of responses to the challenge posed by experimental philosophy's negative program. The chapter also focuses on the expertise defense. (shrink)

In November 2022, OpenAI released ChatGPT, an incredibly sophisticated chatbot. Its capability is astonishing: as well as conversing with human interlocutors, it can answer questions about history, explain almost anything you might think to ask it, and write poetry. This level of achievement has provoked interest in questions about whether a chatbot might have something similar to human intelligence or even consciousness. Given that the function of a chatbot is to process linguistic input and produce linguistic output, we consider the (...) question whether a sophisticated chatbot might have inner speech. That is: Might it talk to itself, internally? We explored this via a conversation with ‘Playground’, a chatbot which is very similar to ChatGPT but more flexible in certain respects. We asked it questions which, plausibly, can only be answered if one first produces some inner speech. Here, we present our findings and discuss their philosophical significance. (shrink)