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)

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)

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)

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.

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.

This volume brings together for the first time a significant number of Reid's manuscript papers on natural history, physiology and materialist metaphysics. An important contribution not only to Reid studies but also to our understanding of eighteenth-century science and its context.

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

Thomas Reid was a philosopher who founded the Scottish school of 'common sense'. Much of Reid's work is a critique of his contemporary, David Hume, whose empiricism he rejects. In this work, written after Reid's appointment to a professorship at the university of Glasgow, and published in 1785, he turns his attention to ideas about perception, memory, conception, abstraction, judgement, reasoning and taste. He examines the work of his predecessors and contemporaries, arguing that 'when we find philosophers maintaining that (...) there is no heat in the fire, nor colour in the rainbow … we may be apt to think the whole to be only a dream of fanciful men, who have entangled themselves in cobwebs spun out of their own brain'. Written by one of the Scottish Enlightenment's most important thinkers, this work brings to life the intellectual debates of the time. (shrink)

Thomas Aquinas produced a voluminous body of work on moral theory, and much of that work is on virtue, particularly the status and value of the virtues as principles of virtuous acts, and the way in which a moral life can be organized around them schematically. Thomas Osborne presents Aquinas's account of virtue in its historical, philosophical and theological contexts, to show the reader what Aquinas himself wished to teach about virtue. His discussion makes the complexities of Aquinas's (...) moral thought accessible to readers despite the differences between Thomas's texts themselves, and the distance between our background assumptions and his. The book will be valuable for scholars and students in ethics, medieval philosophy, and theology. (shrink)

There has been an explosion of interest in the metaphysics of fundamentality in recent decades. The consensus view, called metaphysical foundationalism, maintains that there is something absolutely fundamental in reality upon which everything else depends. However, a number of thinkers have chal- lenged the arguments in favor of foundationalism and have proposed competing non-foundationalist ontologies. This paper provides a systematic and critical introduction to metaphysical foundationalism in the current literature and argues that its relation to ontological dependence and substance should (...) be qualified in important ways. (shrink)

In a recent paper Weinberg (2007) claims that there is an essential mark of trustworthiness which typical sources of evidence as perception or memory have, but philosophical intuitions lack, namely that we are able to detect and correct errors produced by these “hopeful” sources. In my paper I will argue that being a hopeful source isn't necessary for providing us with evidence. I then will show that, given some plausible background assumptions, intuitions at least come close to being hopeful, if (...) they are reliable. If this is true, Weinberg's new challenge comes down to the claim that philosophical intuitions are not reliable since they are significantly unstable. In the second part of my paper I will argue that and why the experimentally established instability of folk intuitions about philosophical cases does not show that philosopher's expert intuitions about these cases are instable. (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.

Looking back on it, it seems almost incredible that so many equally educated, equally sincere compatriots and contemporaries, all drawing from the same limited stock of evidence, should have reached so many totally different conclusions---and always with complete certainty.

I critically examine some deflationary theories of properties, according to which properties are ‘shadows of predicates’ and quantification over them serves a mere quasi-logical function. I start by considering Hofweber’s internalist theory, and pose a problem for his account of inexpressible properties. I then introduce a theory of properties that closely resembles Horwich’s minimalist theory of truth. This theory overcomes the problem of inexpressible properties, but its formulation presupposes the existence of various kinds of abstract objects. I discuss some ways (...) to reduce these existence assumptions, but ultimately suggest that deflationists can hardly avoid quantification over abstract objects of one sort or another. I conclude that property deflationism is perhaps not as deflationary as some philosophers want it to be, but that it’s still apt to call the position ‘deflationary’. (shrink)

What are the truth conditions of want ascriptions? According to an influential approach, they are intimately connected to the agent’s beliefs: ⌜S wants p⌝ is true iff, within S’s belief set, S prefers the p worlds to the not-p worlds. This approach faces a well-known problem, however: it makes the wrong predictions for what we call (counter)factual want ascriptions, wherein the agent either believes p or believes not-p—for example, ‘I want it to rain tomorrow and that is exactly what is (...) going to happen’ or ‘I want this weekend to last forever, but of course it will end in a few hours’. We solve this problem. The truth conditions for want ascriptions are, we propose, connected to the agent’s conditional beliefs. We substantiate this connection by pursuing a striking parallel between (counter)factual and non-(counter)factual want ascriptions on the one hand and counterfactual and indicative conditionals on the other. (shrink)

Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making , Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society -- namely, an individual's right to make independent (...) decisions -- has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society. (shrink)

The Scottish philosopher Thomas Reid first published Essays on Active Powers of Man in 1788 while he was Professor of Philosophy at King's College, Aberdeen. The work contains a set of essays on active power, the will, principles of action, the liberty of moral agents, and morals. Reid was a key figure in the Scottish Enlightenment and one of the founders of the 'common sense' school of philosophy. In Active Powers Reid gives his fullest exploration of sensus communis as (...) the basis of all philosophical inquiry. He uses common sense realism to argue for the existence of a stable external world, the existence of other minds, and to offer a powerful challenge to versions of the Theory of Ideas advocated by Hume and Locke . This is a key work of the Scottish Enlightenment that made important contributions to fundamental debates about the basis of philosophical inquiry. (shrink)

Tracking the development of Foucault's key concepts Lemke offers the most comprehensive and systematic account of Michel Foucault's work on power and government from 1970 until his death in 1984. He convincingly argues, using material that has only partly been translated into English, that Foucault's concern with ethics and forms of subjectivation is always already integrated into his political concerns and his analytics of power. The book also shows how the concept of government was taken up in different lines of (...) research in France before it gave rise to "governmentality studies" in the Anglophone world. A Critique of Political Reason provides a clear and well-structured exposition that is theoretically challenging but also accessible for a wider audience. Thus, the book can beread both as an original examination of Foucault's concept of government and as a general introduction to his "genealogy of power". (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)

Suppose that one is at least a minimal realist about a given domain, in that one thinks that that domain contains truths that are not in any interesting sense of our own making. Given such an understanding, what can be said for and against the method of reflective equilibrium as a procedure for investigating the domain? One fact that lends this question some interest is that many philosophers do combine commitments to minimal realism and a reflective equilibrium methodology. Here, for (...) example, is David Lewis on philosophy: Our “intuitions” are simply opinions: our philosophical theories are the same. Some are commonsensical, some are sophisticated; some are particular; some general; some are more firmly held, some less. But they are all opinions, and a reasonable goal for a philosopher is to bring them into equilibrium. Our common task it to find out what equilibria there are that can withstand examination, but it remains for each of us to come to rest at one or another of them… Once the menu of well-worked out theories is before us, philosophy is a matter of opinion. Is that to say that there is no truth to be had? Or that the truth is of our own making, and different ones of us can make it differently? Not at all! If you say flatly that there is no god, and I say that there are countless gods but none of them are our worldmates, then it may be that neither of us is making any mistake of method. We may each be bringing our opinions to equilibrium in the most careful possible way, taking account of all the arguments, distinctions, and counterexamples. But one of us, at least, is making a mistake of fact. Which one is wrong depends on what there is (1983: x-xi). In addition to philosophy in general, the method of reflective equilibrium has also been endorsed as the appropriate procedure for investigating various other subject.. (shrink)

This paper presents a new approach to the class-theoretic paradoxes. In the first part of the paper, I will distinguish classes from sets, describe the function of class talk, and present several reasons for postulating type-free classes. This involves applications to the problem of unrestricted quantification, reduction of properties, natural language semantics, and the epistemology of mathematics. In the second part of the paper, I will present some axioms for type-free classes. My approach is loosely based on the Gödel–Russell idea (...) of limited ranges of significance. It is shown how to derive the second-order Dedekind–Peano axioms within that theory. I conclude by discussing whether the theory can be used as a solution to the problem of unrestricted quantification. In an appendix, I prove the consistency of the class theory relative to Zermelo–Fraenkel set theory. (shrink)

Spectres of False Divinity presents a historical and critical interpretation of Hume's rejection of the existence of a deity with moral attributes. In Hume's view, no first cause or designer responsible for the ordered universe could possibly have moral attributes; nor could the existence of such a being have any real implications for human practice or conduct. Hume's case for this 'moral atheism' is a central plank of both his naturalistic agenda in metaphysics and his secularizing program in moral theory. (...) It complements his wider critique of traditional theism, and threatens to rule out any religion that would make claims on moral practice. Thomas Holden situates Hume's commitment to moral atheism in its historical and philosophical context, offers a systematic interpretation of his case for divine amorality, and shows how Hume can endorse moral atheism while maintaining his skeptical attitude toward traditional forms of cosmological and theological speculation. (shrink)

With Jan Degenaar and Kevin O’Regan’s (D&O) critique of (what they call) ‘autopoietic enactivism’ as point of departure, this article seeks to revisit, refine, and develop phenomenology’s significance for the enactive view. Arguing that D&O’s ‘sensorimotor theory’ fails to do justice to perceptual meaning, the article unfolds by (1) connecting this meaning to the notion of enaction as a meaningful co-definition of perceiver and perceived, (2) recounting phenomenological reasons for conceiving of the perceiving subject as a living body, and (3) (...) showing how the phenomenological perspective does a better job at fulfilling D&O’s requirement for grounding notions of mentality in ‘outer’ criteria than they do. The picture that thus emerges is one of perceptual meaning as an integration of lived, living, and behavioral aspects – a structure of behavior that cannot be captured by appeal to sensorimotor capacities alone but that is adequately illuminated by the enactive notion of adaptive autonomy. (shrink)

This is a new edition of T. H. Green's Prolegomena to Ethics (1883), a classic of modern philosophy, in which Green sets out his perfectionist ethical theory. In addition to the text of the Prolegomena itself, this new edition provides an introductory essay, a bibliographical essay, and an index. Brink's extended editorial introduction examines the context, themes, and significance of Green's work and will be of special interest to readers working on the history of ethics, ethical theory, political philosophy, and (...) nineteenth century philosophy. (shrink)

This volume offers an English translation of John of St. Thomas's Cursus theologicus I, question I, disputation 2. In this particular text, the Dominican master raises questions concerning the scientific status and nature of theology. At issue, here, are a number of factors: namely, Christianity's continual coming to terms with the "Third Entry" of Aristotelian thought into Western Christian intellectual culture - specifically the Aristotelian notion of 'science' and sacra doctrina's satisfaction of those requirements - the Thomistic-commentary tradition, and (...) the larger backdrop of the Iberian Peninsula's flourishing "Second Scholasticism." In this latter context, John of St. Thomas applies the theological principles of Thomas Aquinas to the Scholastic disputes preoccupying Thomist, Franciscan, and Jesuit theologians, such as Cajetan, Bañez, Luis de Molina, Vazquez, Suárez - to name only a few - in a tour de force of theological thinking throughout the entire period of Scholasticism. In the process - and not insignificantly - the status quaestionis of theology's scientific character is clearly framed and answered according to John's satisfaction. Key to John of St. Thomas's resolution of the question is his understanding of the continuity of the power of human reason with the super-intelligibility of divine revelation spelled out in terms of what he calls "virtual revelation." This text presented in this volume is a quintessential example of the deep and abiding harmony that flourished between faith and reason as well as grace and nature within the golden era of Baroque Scholasticism. (shrink)

My aim in this paper is to develop and defend a novel answer to a question that has recently generated a considerable amount of controversy. The question concerns the normative significance of peer disagreement. Suppose that you and I have been exposed to the same evidence and arguments that bear on some proposition: there is no relevant consideration which is available to you but not to me, or vice versa. For the sake of concreteness, we might picture.