After surveying and criticizing some earlier definitions of "disease", we propose that a general term--malady--be used to represent what all diseases, illnesses, injuries, etc., have in common. We define a malady as the suffering, or increased risk of suffering an evil in the absence of a distinct sustaining cause. We discuss the key terms in the definition: evil, distinct sustaining cause, and increased risk. We show that the role of abnormality is to clarify these terms rather than to be used (...) directly in the definition of malady. (shrink)

Unlike the principles of Kant, Mill, and Rawls, those of principlism are not action guides that stem from an underlying, integrated moral theory. Hence problems arise in reconciling the principles with each other and, indeed, in interpreting them as action guides at all, since they have no content in and of themselves. Another approach to "theory and method in bioethics" is presented as an alternative to principlism, though actually the "alternative" predates principlism by about 10 years. The alternative's account of (...) morality stays close to ordinary, common morality with its rules and ideals, which in turn are grounded in aspects of human nature. As such, morality must be understood to be a rational, impartial, and public system that is incumbent on everyone. Morality is a unified and integrated system. The moral rules and ideals are also "culture-" and "profession-sensitive" in that they are interpreted more specifically within these various contexts. (shrink)

The author discusses the contribution of humanities teaching in medical education. Five "qualities of mind" specifically engendered by the humanistic disciplines are isolated, delineated, and illustrated: critical abilities, flexibility of perspective, nondogmatism, discernment of values, and empathy and self-knowledge. Keywords: humanities, humanities and medicine, medical education CiteULike Connotea Del.icio.us What's this?

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics - principlism, put forward by Beauchamp and Childress in Principles of Bioethics , and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals - are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, either (...) the original version, or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

The goal is to isolate points of philosophical interest in the preceding articles on narrative medical ethics in order to focus subsequent dialogue between the two disciplines. Ethics is an enterprise that has over the centuries developed a somewhat malleable structure, comprising characteristics, methods, lines of reasoning, rules, principles, assumptions, and arguments. This structure provides the framework within which many disciplines contribute to ethics through the exercise of their particular interests, skills, and methods. Challenging or changing the structural components requires (...) arguments of a traditional sort appropriate to the discipline of ethics. Three tenets are proposed as comprising the “received view” or credo of the literature and ethics movement. Each is examined. Then the individual articles in this issue are explored to the end of ferreting out points that would be fruitful points of discussion between philosophy and literature folks pursuing their mutual interest in ethics. (shrink)

The essays in this Journal issue offer examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine. The editors' purpose in such an issue is to stimulate discussion between philosopher-ethicists and literary scholars whose work concerns this topic. With the concluding essays by editors Clouser and Hawkins, this discussion begins.

Various meanings of “rational” implicitly and explicitly suggested in this issue's articles are abstracted and stated. Two accounts of rationality are shown to be able to explain most uses of “rational”: the “cool moment” account and a more objective account. The former is examined and modified, but still found inadequate. The objective account of rational is developed, taking “irrational” as the basic concept. “Irrational” is given content in terms of a list, and “rational” is subsequently defined as “not irrational”. Reasons (...) and motives are defined and distinguished. The advantages of the objective account are explored and some challenges to it are answered. (shrink)

Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge (...) to us to show that our account of morality is more adequate than principlism. In particular we show that recognition of morality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label “Dartmouth Descriptivism.”. (shrink)

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods (...) or theories, these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why (...) the medical profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach. (shrink)

The bioethics of four principles, named as principlism, began in 1979 with the work of Principles of Biomedical Ethics by Tom Beauchamp and James F. Childress and has been widely criticized since the 80s. In recent years four rival approaches towards principlism have been specified in this critique. These include: a) impartial rule theory, developed by K. Danner Clouser; b) casuistry, represented by Albert Jensen, and c) virtue ethics, developed by Edmund D. Pellegrino. The critique of principlism presented (...) by K. Danner Clouser, Bernard Gert was not only defended by T. Beauchamp and J.F. Childress themselves, but also by others, including B. Andrew Lustig, David DeGrazia, and Henry Richardson. The discussion has not weakened but continued till the present time. It was presented extensively in the June issue of The Journal of Medicine and Philosophy. We want to join the discussion from the position of personalistic bioethics. (shrink)

Let us look at autonomy in a new way. Autonomy has a richly deserved place of honor in bioethlcs. It has led the set of principles that formed the basis of the discipline since the beginning. It is the leading principle In what is now regularly called “the Georgetown Mantra,” a phrase suggested by one of the first philosophers ever to be hired In a medical school, K. Danner Clouser. The phrase applies to the principled approach of autonomy, (...) beneficence, nonmaleficence, and justice. This kind of bioethics was developed by scholars like Beauchamp and Childress, Veatch, and Engelhardt, during their association with Georgetown University. (shrink)

Rosamond Rhodes has written a welcome, clear, and expansive yet precise book that challenges the hegemonic influence of principlism in biomedical ethics and presents a viable alternative. At the outset, Rhodes critiques the idea of common morality underpinning the four principles from Tom Beauchamp and James Childress's Principles of Biomedical Ethics and ten rules from Bernard Gert, Charles Culver, and K. Danner Clouser in Bioethics: A Systematic Approach. Rhodes not only argues for why medicine is unlike everyday practices (...) and requires a unique ethics but also offers a positive program to meet medicine's "uncommon morality."This "uncommon morality" gives rise to sixteen duties that guide medical practice. Each... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Principles and Theory in BioethicsPat Milmoe McCarrick (bio)The following citations were selected from BIOETHICSLINE, the online database prepared at the Kennedy Institute of Ethics for the National Library of Medicine's MEDLARS system. Searching the keywords autonomy, beneficence, casuistry, justice, and virtues, as well as the text word principlism produced more than 400 citations. Only the citations concerned with theory and principle in the practice of bioethics are included here—e.g., (...) works about justice in resource allocation have been deleted.Arkes, Hadley V. When Bungling Practice Is Joined to Absurd Theory: Doctors, Philosophers, and the Right to Die. In Set No Limits: A Rebuttal to Daniel Callahan's Proposal to Limit Health Care for the Elderly, ed. Robert L. Barry and Gerard V. Bradley, pp. 31-44. Urbana: University of Illinois Press, 1991.Arnason, Vilhjalmur. Towards Authentic Conversations: Authenticity in the Patient-Professional Relationship. Theoretical Medicine 15 (3): 227-42, September 1994.Arras, John D. Getting Down to Cases: The Revival of Casuistry in Bioethics. Journal of Medicine and Philosophy 16 (1): 29-51, February 1991.Arras, John D. Principles and Particularity: The Role of Cases in Bioethics. Indiana Law Journal 69 (4): 983-1014, Fall 1994.Beauchamp, Tom L. Principles and Other Emerging Paradigms in Bioethics. Indiana Law Journal 69 (4): 955-71, Fall 1994.Beauchamp, Tom L. The Principles Approach. Hastings Center Report 23 (6): S9, November-December 1993.Beauchamp, Tom L., and Childress, [End Page 279] James F. Principles of Biomedical Ethics. 4th ed. New York: Oxford University Press, 1994. 752 p.Beauchamp, Tom L., and Walters, LeRoy. Ethical Theory and Bioethics. In their Contemporary Issues in Bioethics. 4th ed., pp. 1-38. Belmont, CA: Wadsworth, 1994.Beldecos, Athena, and Arnold, Robert M. Gathering Information and Casuistic Analysis. [Commentary]. Journal of Clinical Ethics 4 (3): 241-45, Fall 1993.Bole, Thomas J. The Rhetoric of Rights and Justice in Health Care. In Rights to Health Care, ed. Thomas J. Bole and William B. Bondeson, pp. 1-19. Boston: Kluwer Academic, 1991.Broome, John. Fairness Versus Doing the Most Good. [Commentary]. Hastings Center Report 24 (4): 36-39, July-August 1994.Campbell, Courtney S. Gifts and Caring Duties in Medicine. In Duties to Others, ed. Courtney S. Campbell and B. Andrew Lustig, pp. 181-97. Boston: Kluwer Academic, 1994.Carson, Ronald A.; Callahan, Sidney; Ross, Judith Wilson; and May, William F. Spirit, Emotion, and Meaning: The Many Voices of Bioethics. Hastings Center Report 24 (3): 26-27, May-June 1994.Charlesworth, Max. Bioethics in a Liberal Society. New York: Cambridge University Press, 1993. 172 p.Cherbas, Peter. Paradigms and Our Shrinking Bioethics. Indiana Law Journal 69 (4): 1105-13, Fall 1994.Childress, James F. Ethical Theories, Principles, and Casuistry in Bioethics: An Interpretation and Defense of Principlism. In Religious Methods and Resources in Bioethics, ed. Paul F. Camenisch, pp. 181-201. Boston: Kluwer Academic, 1994.Childress, James F., and Fletcher, John C. Individualism and Community: The Contested Terrain of Respect for Autonomy. Hastings Center Report 24 (3): 34-35, May-June 1994.Clouser, K. Danner, and Gert, Bernard. A Critique of Principlism. Journal of Medicine and Philosophy 15 (2): 219-36, April 1990.Devettere, Raymond J. Clinical Ethics and Happiness. Journal of Medicine and Philosophy 18 (1): 71-89, February 1993.DeGrazia, David. Moving Forward in Bioethical Theory: Theories, Cases, and Specified Principlism. Journal of Medicine and Philosophy 17 (5): 511-39, October 1992.Donnelly, William J. From Principles to Principals: The New Direction in Medical Ethics. [Commentary]. Theoretical Medicine 15 (2): 141-48, June 1994.Downie, Robin. Health Care Ethics and Casuistry. [Editorial]. Journal of Medical Ethics 18 (2): 61-62, 66, June 1992. [End Page 280]DuBose, Edwin R.; Hamel, Ronald P.; and O'Connell, Laurence J., eds. A Matter of Principles? Ferment in U.S. Bioethics. Valley Forge, PA: Trinity Press International, 1994. 381 p.Fox, Renée C. The Entry of U.S. Bioethics into the 1990s: A Sociological Analysis, pp. 21-71.Gudorf, Christine E. A Feminist Critique of Biomedical Principlism, pp.164-81.Campbell, Courtney S. Principlism and Religion: The Law and the Prophets, pp. 182-208.Charon, Rita. Narrative Contributions to Medical Ethics: Recognition, Formulation, Interpretation, and Validation... (shrink)

Written for undergraduates, the educated layperson, and scholars in fields other than philosophy, _The Myth of Religious Neutrality _offers a radical reinterpretation of the general relations between religion, science, and philosophy. This new edition has been completely revised and updated by the author.

_Der Mythos der religiösen Neutralität_ bietet eine radikale Neuinterpretation der allgemeinen Beziehungen zwischen Religion, Wissenschaft und Philosophie.

Dooyeweerd’s account of abstraction is examined and found to be faulty. He holds that abstract thinking isolates aspects which must then be synthesized, whereas I argue that we cannot isolate any aspect from the others however so hard we try. But our very inability to isolate aspects is then turned into an alternative version of a transcendental critique of theory making. Instead of asking for a basis for synthesizing aspects we have isolated, the new version asks: what is the nature (...) of the aspectual connectedness which is so strong that it cannot be interrupted even by abstraction? I argue that it is impossible for anyone to understand the meaning of a concept fully without taking a position on this issue, whether that is done implicitly or explicitly. Moreover, every answer to this question presupposes a divinity belief. Hence, this recasting of the critique yields a demonstration of the religious regulation of all concepts and every theory. In this way the goal of Dooyeweerd’s critique is achieved, even if not in the way he envisioned. (shrink)

the lack of unity among Christians represents the grave obstacle for the proclamation of the gospel, we should take every suitable opportunity to increase the unity of all Christians. The present essay is meant as a contribution toward this goal.” . The increased unity he has in mind is a reconciliation of the traditional scholastic interpretation of Christian doctrine , and the Calvinist tradition . More specifically, he seeks a unity between them concerning the relation of faith and reason, that (...) is, the role of reason in belief in God. To this end he compares what he understands of the CT, as represented by Calvin and Dooyeweerd, with the TSC as represented by St Thomas and the encyclical, Fides et Ratio by Pope John Paul II. In all that follows I will be agreeing with Echeverria that this is, indeed, an important concern and a laudable goal, and I hope that what I offer here in reply to his essay will be taken in that same charitable spirit. So even though I find that Echeverria’s account of the differences between the TSC and the CT is seriously mistaken, I do agree that it would go a long way toward greater cooperation between our two traditions if we could at least agree on what our differences are and work toward resolving them. For that reason I will be more concerned here with clarifying those differences than with arguing for the CT. That does not mean that I will not at times offer brief accounts of why I think the CT is right to differ from the TSC on certain points; it only means that I do not regard the case I will make for these points as anywhere near complete. This brevity is made necessary because I find the misunderstandings of Calvin, and especially of Dooyeweerd, to be so many and so knotted in “Fides et Ratio” as to form a tangled skein that would require more than just one article to unravel. I have also decided that there are so many strands to this skein that for the sake of clarity I will restrict myself to only a few of them. My assumption is that it would be better to make real progress with getting a few key differences in focus, than to end up producing a tangle of my own in an attempt to cover every point raised in Echeverria’s long article. My hope is that the treatment of the points I do cover will be sufficient to indicate how a more thorough untangling would proceed. (shrink)

An account is offered of Dooyeweerd’s non-reductionist ontology. It also includes the role of religious belief in theory making, although it omits his case for why such a role is unavoidable. The ontology is a theory of the nature of (created) reality which presupposes and is regulated by belief in the God of Judeo-Christian theism. Because it takes everything in creation to be directly dependent on God, it offers an account of the natures of both natural things and artifacts which (...) avoids regarding anything in the cosmos as what all else in the cosmos depends on. (shrink)

This paper presents a new argument against philosophical theories based on arguments in favor of ontological reductions. The argument is an experiment in thought that has transcendental force, because it demonstrates the impossibility of forming a concept of anything with a reductionist nature. So although we consider as examples only theories that try to reduce everything in accordance with the currently popular materialisms or dualism, the argument applies as well to every sort of reduction theory whatever.

We consider foundational questions related to the definition of functions by corecursion. This method is especially suited to functions into the greatest fixed point of some monotone operator, and it is most applicable in the context of non-wellfounded sets. We review the work on the Special Final Coalgebra Theorem of Aczel [1] and the Corecursion Theorem of Barwise and Moss [4]. We offer a condition weaker than Aczel's condition of uniformity on maps, and then we prove a result relating the (...) operators satisfying the new condition to the smooth operators of [4]. (shrink)

Educational transitions play a pivotal role in shaping educational careers, and ultimately social inequality. Whereas parental socioeconomic status (SES) and cognitive ability have long been identified as key determinants of successful educational transitions, much less is known about the role of socio-emotional skills. To address this gap, the present study investigated whether Big Five personality traits predict success in the transition from secondary school to vocational education and training (VET) above and beyond SES, cognitive ability, and other covariates. Using data (...) from Starting Cohort 4 of the German National Educational Panel Study (NEPS; N = 4,137), we defined seven indicators of successful transition: obtaining a VET position, number of acceptances for VET positions, starting a VET position, (the absence of) dropout intentions and actual dropout, final VET grade, and satisfaction with VET. The results revealed that some Big Five traits were incrementally associated with several indicators of transition success. Conscientiousness emerged as the single most relevant trait, predicting all the transition success indicators but one (dropout intentions). The other Big Five traits had much weaker and less consistent links with transition success. Extraversion predicted the final VET grade and obtaining a VET position; Agreeableness was linked to a higher risk of dropout. Openness and Emotional Stability had no incremental effects on transition success. There was also some evidence for both compensatory and synergistic interactive effects, with Openness moderating mainly the effects of parental SES (on dropout intentions, actual dropout, and number of acceptances), and Agreeableness moderating the effects of cognitive ability (on obtaining a VET position, number of acceptances, and satisfaction with VET). Although individual effect sizes were small, the Big Five’s joint contribution to transition success was non-negligible, and often larger than that of sociodemographic characteristics and cognitive ability. Our results suggest a hitherto underappreciated contribution of personality to successful transitions to VET. (shrink)

Economic cooperative practices increase the ability of agents and communities to resist or curb ecologically damaging practices and to adapt to inevitable cultural and material transitions due to climate change. The history of African American economic cooperatives demonstrates how such efforts can build practical and leadership skills, transform local culture, and lay groundwork for wider collective action. Such practices fit Willis Jenkins’s model of prophetic pragmatism insofar as they draw on inherited traditions and transform culture and us. Contemporary Christians and (...) church communities can encourage economic cooperation as a form of resistance to ecological destruction and, in doing so, encourage the habits of humility, hope, and courage. (shrink)

A logical system is studied whose well-formed representations consist of diagrams rather than formulas. The system, due to Shin [2, 3], is shown to be complete by an argument concerning maximally consistent sets of diagrams. The argument is complicated by the lack of a straight forward counterpart of atomic formulas for diagrams, and by the lack of a counterpart of negation for most diagrams.