War: A Primer for Christians provides a concise introduction to the main approaches that Christians have taken toward war and examines each approach critically. Some Christians have supported their country's wars as crusades of good against evil. Others, as pacifists, have rejected participation in or support for any war. Still others have followed the just-war tradition in holding that it can be justifiable under some conditions to resort to war, but that then Christian love must limit the conduct of war. (...) In an updated preface and new afterword, Allen explores aspects of current international relations that have a special bearing on the context of war. “Joseph Allen’s War: A Primer for Christians is just that: a succinct, fair-minded, wonderfully reasoned, and accessible account of the major Christian traditions on war—Just War, Holy War, and the Pacifist renunciation of violence. His book is also a primer in the further sense, that it will prime the pump for further discussion and debate as to when wars are just and how a nation might keep the means employed under restraints.”—William F. May. (shrink)

In seeking to determine what place, if any, the concept of moral rights can and/or should have in theological ethics, it is first necessary to clarify the nature of the concept. On this task contemporary moral philosophy is found to be especially helpful. It is then suggested that from a theological standpoint an appeal to moral rights might be justified by reference to (1) the moral fabric of persons under God, (2) the worth of persons as ends, and (3) the (...) inclusiveness of the moral community. The author claims that the concept of moral rights is compatible with belief in a sovereign God who promises his steadfast love, and that it need not imply any "natural" ethic in competition with theological ethics. Finally, the affirmation of moral rights is found to be highly appropriate to an emphasis upon love toward other persons. (shrink)

The issue of emotion contagion has been gaining attention. Humans can share emotions, for example, through gestures, through speech, or even through online text via social media. There have been computational models trying to capture emotion contagion. However, these models are limited as they tend to represent agents in a very simplified way. There exist also more complex models of agents and their emotions, but they are not yet addressing emotion contagion. We use a more psychologically realistic and better validated (...) model – the Clarion cognitive architecture – as the basis to model emotion and emotion contagion in a more psychologically realistic way. In particular, we use Clarion to capture and explain human data from typical human experiments on emotion contagion. This approach may open up avenues for more nuanced understanding of emotion contagion and more realistic capturing of its effects in different circumstances. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

The goal of this study was to assess the relationships between computational approaches to analyzing constructed responses made during reading and individual differences in the foundational skills of reading in college readers. We also explored if these relationships were consistent across texts and samples collected at different institutions and texts. The study made use of archival data that involved college participants who produced typed constructed responses under thinking aloud instructions reading history and science texts. They also took assessments of vocabulary (...) knowledge and proficiency in comprehension. The protocols were analyzed to assess two different ways to determine their cohesion. One approach involved assessing how readers established connections with themselves. The other approach involved assessing connections between the constructed responses and the texts that were read. Additionally, the comparisons were made by assessing both lexical and semantic comparisons. The result showed that both approaches for analyzing cohesion and making the comparisons were correlated with vocabulary knowledge and comprehension proficiency. The implications of the results for theory and practice are discussed. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not (...) translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

_John Dewey and Continental Philosophy_ provides a rich sampling of exchanges that could have taken place long ago between the traditions of American pragmatism and continental philosophy had the lines of communication been more open between Dewey and his European contemporaries. Since they were not, Paul Fairfield and thirteen of his colleagues seek to remedy the situation by bringing the philosophy of Dewey into conversation with several currents in continental philosophical thought, from post-Kantian idealism and the work of Friedrich Nietzsche (...) to twentieth-century phenomenology, hermeneutics, and poststructuralism. This unique volume includes discussions comparing and contrasting Dewey with the German philosophers G. W. F. Hegel, Friedrich Nietzsche, Martin Heidegger, and Hans-Georg Gadamer on such topics as phenomenology, naturalism, organicism, contextualism, and poetry. Others investigate a series of connections between Dewey and contemporary French philosophy, including the notions of subjectivity, education, and the critique of modernity in Michel Foucault; language and politics in Jacques Derrida; and the concept of experience in Gilles Deleuze. Also discussed is the question of whether we can identify traces of _Bildung_ in Dewey’s writings on education, and pragmatism’s complex relation to twentieth-century phenomenology and hermeneutics, including the problematic question of whether Heidegger was a pragmatist in any meaningful sense. Presented in intriguing pairings, these thirteen essays offer different approaches to the material that will leave readers with much to deliberate. _ John Dewey and Continental Philosophy_ demonstrates some of the many connections and opportunities for cross-traditional thinking that have long existed between Dewey and continental thought, but have been under-explored. The intersection presented here between Dewey’s pragmatism and the European traditions makes a significant contribution to continental and American philosophy and will spur new and important developments in the American philosophical debate. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

The debate about cloning that took place 25 years ago, although directed toward a different sort of cloning, elucidates fundamental issues currently at stake in reproductive technologies and research. Paul Ramsey and Joseph Fletcher were participants in this early debate. The differences between Ramsey and Fletcher about the meaning and sufficiency of freedom, the understanding and weighing of good and evil, the connection between embodiment and personhood, the relationship of humans with nature, and the meaning of parenthood suggest both (...) a broader agenda for the debate about cloning and a cautious move forward in the development of embryo splitting. (shrink)

Some bioethicists have argued in favor of a sliding scale notion of competence, paternalistically requiring greater competence in relation to more significant risk. I argue against a sliding scale notion, taking issue with the positions of Allen E. Buchanan and Dan W. Brock, Ian Wilkes, and Joel Feinberg. Rejecting arguments that a sliding scale is supported by legal cases, by ordinary usage, and by fallible judgments about competence, I argue in favor of greater evidence of competence when risk is greater. (...) Two clinical cases are examined, both involving amputation, to show that my fixed concept of competence, with a requirement of clearer evidence of competence when risk is high, better accounts for good moral decisions in bioethics. (shrink)

Intra-molecular connectivity (that is, chemical structure) does not emerge from computations based on fundamental quantum-mechanical principles. In order to compute molecular electronic energies (of C 3 H 4 hydrocarbons, for instance) quantum chemists must insert intra-molecular connectivity “by hand.” Some take this as an indication that chemistry cannot be reduced to physics: others consider it as evidence that quantum chemistry needs new logical foundations. Such discussions are generally synchronic rather than diachronic —that is, they neglect ‘historical’ aspects. However, systems of (...) interest to chemists generally are metastable . In many cases chemical systems of a given elemental composition may exist in any one of several different metastable states depending on the history of the system. Molecular structure generally depends on contingent historical circumstances of synthesis and separation, rather than solely or mainly on relative energies of alternative stable states, those energies in turn determined by relationships among components. Chemical structure is usually ‘kinetically-determined’ rather than ‘thermodynamically-determined.’ For instance, cyclical hydrocarbon ring-systems (as in cyclopropene) are produced only in special circumstances. Adequate theoretical treatments must take account of the persistent effects of such contingent historical events whenever they are relevant—as they generally are in chemistry. (shrink)

‘When I use a word’, Humpty Dumpty said, in a rather scornful tone, ‘it means just what I choose it to mean—neither more nor less.’In his recent note on Hipponax in this journal, Joseph Cotter first offers ‘a revised version of LSJ's definition’ of ὄρχις. At LSJ, s.v. ὄρχις I, ‘… testicle Hippon. 92.3 W. …’, he would delete the Hipponactean citation and rewrite the second definition, under ΙΙ, to read: ‘from similarity of shape, 1 glans penis, Hippon. 92, (...) 2. from the form of its root …’. Cotter derives his new definition from his reading of that Hipponactean line, καί μοι τὸν ὄρχιν τῆς φαλ[ …, which he supplements with the name of a marsh bird, φαλ[ηρίδος, also redefined. This supplementary ‘coot’ is said to mean ‘cock’, so that the narrator of the fragment's description of treatment for sexual impotence tells how a Lydian woman ‘thrashed with fig-branch the glans of my cock’. We are presented, then, with two previously unattested meanings of two nouns, ὄρχις and φαληρίς, and an accommodating correction of LSJ. What—I have asked Cotter—might Henry Liddell have thought of these innovations, familiar as he undoubtedly was with Humpty Dumpty's semantics! (shrink)

An Integrated Working Memory Model for Time‐Based Resource‐Sharing proposes a formalized a theory of working memory, time‐based resource sharing (TBRS), within the ACT‐R cognitive architecture. Instantiating the theory within ACT‐R allowed the authors to predict task accuracy and response times when an articulatory rehearsal mechanism was included with the TBRS mechanism. This paper was awarded the Allen Newell Award for the best student‐ led paper submitted to ICCM 2018 for their research efforts.

In this first complete account of Hartley's thought, Richard C. Allen explains Hartley's theories of physiology, perception and action, language and cognition, emotional development and transformation, and spiritual transcendence. By drawing a biographical portrait of its subject, the book explores the relationship of mind and body in Hartley's system, and surveys Hartley's influence upon later scientists and social reformers, particularly Joseph Priestley.

continent. 2.1 (2012): 56–58 Nechvatal, Joseph, Immersion Into Noise , Open Humanities Press, 2011, 267 pp, $23.99 (pbk), ISBN 1-60785-241-1. As someone who’s knowledge of “art” mostly began with the domestic (Western) and Japanese punk and noise scenes of the late 80’s and early 90’s, practices and theories of noise fall rather close to my heart. It is peeking into the esoteric enclaves of weird music and noise that helped me understand what I think I might like art to (...) be: A way of learning about the world through perturbation—exploration by incitement and speculation of possible conditions. What I have always loved about artistic investigations influenced by noisy aesthetics or sensibilities is that they can be simultaneously transcendent and absurd, amusing and revelatory, singular and pluralistic, mindless and intensely penetrating. The provocative friction that noise brings to bear on aesthetic experience, artistic practice, and “the” Art World acts as a kind of impulse response, proposing new energies while revealing underlying structure; noise signals are a simultaneous synthesis and analysis of spaces, subjects and relations. About two weeks prior to Christmas 2011, Joseph Nechvatal was generous enough to spend some time with me at 39 Quai des Grands Augustins, Paris . We each had one glass of red wine, briefly discussed common acquaintances, shared points of interest, and his published writings. We also, I recall, disagreed lightheartedly about how much contemporary relevance the ideas of telematic-artist Roy Ascott have for today’s art-and-technology practitioner (Joseph > Jamie). After the encounter, I read through a PDF version of Immersion Into Noise Joseph was kind enough to send me ( the HTML version is here ). A number of points of entry into cultures of “noise” are available these days. There are the acoustic-spatial approaches of thinkers like Douglas Kahn, Brandon LaBelle and Salome Voegelin; the techno-cultural musicologies of Jonathan Sterne and David Toop; the political writings of Jacques Attali, former adviser to President François Mitterrand, in his Noise: The Political Economy of Music (spoiler alert: It’s not really about music). Enter the new writings of one Joseph Nechvatal, with his invitation of an Immersion Into Noise . Nechvatal has been active for over 20 years in on- and off-line discussions of art, technology, virtuality, as well as his own set of art-theoretical departures and terminologies. A practicing artist, and instructor at the School of Visual Arts in New York City, Immersion Into Noise , is Nechvatal’s third published volume. His writings, broadly, address a concern with the possibilities of a synthesis between the biological and the virtual, and the contemporary artistic resonances that these possibilities suggest. Nechvatal’s project is to try to name contemporary currents of artistic practice within our technologized culture. He comes at this through art history, post-modern philosophy, anthropology and consciousness studies. Portions of Immersion Into Noise have appeared in his PhD dissertation, as well as online art publications like Zing Magazine . An open-access publication, and part of the impressive and heartening activities of the Open Humanities Press, Nechvatal’s book is a somewhat unexpected addition to the Critical Climate Change series edited by Tom Cohen of SUNY University and Claire Colebrook of Penn State. Other titles in the series have address themes of post-globalism and cultures of threat. Joseph Nachvetal’s title is the first to focus entirely on art history, art practice and aesthetics. It is awkward to too easily fit Nechvatal’s writings in with the aforementioned burgeoning canon of cultural and artistic practice in, and writings on, noise (Russolo, Schaeffer, Cage and Yves Klein through to Kahn, LaBelle, Voegelin, et. al). Immersion Into Noise is not primarily an examination of sound-noise or phenomenologies of sound, and the relativist, non-objectivist possibilities arising therefrom in social, public, and exhibition art practices. Although Nechvatal makes mention of sonic practice and experience (his own encounter in 1968 with the technological complex was set in motion at a Jimi Hendrix concert at the Chicago Coliseum), he does so only by way of introducing a broader concept of “art-noise.” The noise-scape can envelope various kinds of involvement in all kinds of art, by artists, audiences, and distributed amalgams of all of these. Midway through the book, we are offered characteristics of an “immersive noise vision theory.” This theory, leading to an even more syncretic thinking about the art experience, is sketched out through further reference to the author’s personal observation, as well as his art-historical research and notes. Personal examples take on the reflex of a kind of art-noise-travel-writing, as Nechvatal visits Ryoji Ikeda’s Datamatics [ver 2.0] installation at the Centre Pompidou, Paris), hears Cecil Taylor at Alice Tully Hall in New York, spends time with the cave paintings of Lascaux, France, and explores the Wagner-inspired Venus Grotto of Linderhof, Bavaria, to name a few. These site-events, to varying degrees, are renderings of noise-art’s potential to “place us back into a ritual position by dragging art down into the felt 360° noise-perspective of the enthusiastic and participatory.” (p.103) The arc of the ideas proposed here position immersiveness, saturation and “scopic all-over tension” as most productively foundational to noise art, or art-noise. An itinerary from the most ancient of artistic expressions (cave drawings) to the most digital of presentations is charted (Ikeda’s minimal/maximal bitwise works for synchronized audio and visual projection). The harsh sonic onslaught of Masami Akita (a.k.a. Merzbow), is, under this analysis, not so far from colossal denseness of the churches of the High Baroque (Nechvatal visits the Rosario Chapel in Santo Domingo Church, Puebla, Mexico). And there is much more here, eaten up by noise: A rethinking of the work of Duchamp, Jackson Pollock, Nicolas Schöffler (whom Nechvatal names the true “the Father of Cybernetic Art”) and the Happenings of Alan Kaprow, all as art-noise in their own right. Each of these artists and moments demonstrate techniques of destabilization, immersiveness, frame-breaking and “all-over fullness and fervor.” Here is writing on art and art history that is as ambitious as it is promising: “wildly visionary,” Nechvatal states as in conclusion. Self-admittedly far-reaching to the point of verging on totalization, we are asked to consider that the moments, spaces, arts and artists Nechvatal appreciates in the book all derive from an increasingly prevalent “noise consciousness.” Along the way we gain an appreciation of noise as a productive and proactive tension in art, rather than an unwanted signal or unwelcome intrusion. Most promising here for me are Nechvatal’s revealing descriptions of the potential for noise to make manifest the material-perceptual framework of individual and collective art experience. How might we allow what we have been repeatedly taught is our contemporary condition of “information overload” to transform itself into a calm, warm, sympathetic kind of inundation. Treatment of experience in this way, dissolves boundaries between the bodily, informational, material and technical complexes that make up our world, and is the promise of a radical, if momentary, Immersion Into Noise. (shrink)

It may be objected that musical analysts claim to be working with objective methodologies which leave no place for aesthetic criteria, for the consideration of value. If that were the case, the reluctance of so many writers to subsume analysis under criticism might be understandable. But are these claims true? Are they, indeed, even seriously entered?Certainly the original masters of analysis left no doubt that for them analysis was an essential adjunct to a fully articulated aesthetic value system. Heinrich Schenker (...) always insisted on the superiority of the towering products of the German musical genius. Sir Donald Tovey pontificated about "the main stream of music" and on occasion developed this metaphor in considerable detail. It is only in more recent times that analysts have avoided value judgments and adapted their work to a format of strictly corrigible propositions, mathematical equations, set-theory formulations, and the like—all this, apparently, in an effort to achieve the objective status and hence the authority of scientific inquiry. Articles on music composed after 1950, in particular, appear sometimes to mimic scientific papers in the way that South American bugs and flies will mimic the dreaded carpenter wasp. In a somewhat different adaptation, the distinguished analyst Allen Forte wrote an entire small book, The Compositional Matrix, from which all affective or valuational terms are meticulously excluded. The same tendency is evident in much recent periodical literature.Joseph Kerman, professor of music at the University of California at Berkeley, has been the editor of Nineteenth-Century Music. His books include Opera as Drama, The Elizabethan Madrigal, The Beethoven Quartets, Listen , and The Masses and Motets of William Byrd. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Heidegger and RhetoricPhilippe-Joseph SalazarHeidegger and Rhetoric. Edited by Daniel M. Gross and Ansgar Kemmann. Albany: State University of New York Press, 2005. Pp. 195. $21.95, paperback.I have to confess to double ignorance. I have never paid much attention to/Heidegger and Rhetoric/ (let me use forward slashes to indicate a commonplace) because, in spite of all efforts of reconciliation between France and Germany, my knowledge of German is (...) not so adequate that I would ever contemplate reading Heidegger in his native tongue. As a rule I mistrust translations and rely on derivative knowledge only in cases of extreme urgency. This being said, I must add that such ignorance is somewhat informed by some knowing—where would French philosophy and French philosophy of rhetoric be without the long-standing and continuous dialogue between Heidegger and France, from Levinas’s seminal essay to today’s iterative debate on Heidegger’s so-called introduction of Nazism in philosophy? Be that as it may, I read the edited volume by Gross and Kemmann as a naive reader would, undisturbed by and unaware of intra-ecclesial wrangling. As it happened, as I was reading this book, I had advanced knowledge of a stunning little book byValerie Allen and Ares Axiotis (2007), on Heidegger’s plea for exoneration in July 1945. It was a numinous conjunction.Recalling Arendt’s distinction, in politics of course, among aim, end, and meaning, it is clear that Heidegger and Rhetoric has all three—the gesture [End Page 305] is indeed political, at least within our scholarly community. This book has a meaning—its elucidation imposes on readers to move from chapter to chapter, seriatim. It has an aim, the reality of which only comes to the fore as we close the book. It has an end, which, somehow, allows us to pass judgment with regard to the superior life of the discipline, if there is any.Back to the commonplace, which grounds all three. The difficulty with titles like this is that, more often than not, they promise more than they deliver. One asks oneself: Why not Rhetoric and Heidegger? Which leads to: What “rhetoric”? Aristotle’s? Rhetoric as attributed, by a growing population of ignoramuses, to “rhetoriticians”?The function of a commonplace is to evoke common ground, and in this instance, the common ground has a deep fault line. Indeed, as we read Gross’s erudite introductory essay (chapter 1), it is unclear whether the volume is dedicated to Heidegger’s Summer Seminar of 1924 devoted to Aristotle’s Rhetoric or to rhetoric in/around/about Heidegger. To compound it, we learn, in footnote 1 (41) that in one particular but revealing occurrence, Heideggerian scholars differ about the transcription: although the seminar was on the Rhetoric, does Heidegger refer to Rhetorik or to Logik when he defines “concrete function,” a highly operative definition indeed? Much of the volume hinges on how Heidegger defines the political function of rhetoric. Notwithstanding this casualty of scholarship, and Gross’s thoughtful transcription and explanation of key passages from the seminar, readers will wonder: “Where is the Urtext?” Unless one reads German and has at hand both volume 18 of the Collected Works and the rival transcript (pending, of course, the discovery of yet another transcript), one is reduced to rely on the authors’ word and view (an English translation is in preparation at Indiana University Press). This is the surface of the fault line.Below the surface of the text runs a deeper rift. Nonspecialists are left with the impression that Heidegger’s Summer Seminar of 1924 is a text by Heidegger, when, in fact, if I am not mistaken, Heidegger destroyed his notes and what we are left with are students’ notes cobbled together; they probably turned Heidegger’s lectures into their own commonplaces, which is what students usually do, as we all know. (We may as well have one of the famous imitations of the master with which Heidegger’s brother entertained his drinking friends, perched on a beer barrel like a bibulous orator.)Incidentally, I wish specialists would stop using the acronym SS 1924 to refer to the text. It has a sinister... (shrink)

Neuron diagrams are heavily employed in academic discussions of causation. Stephen Mumford and Rani Lill Anjum, however, offer an alternative approach employing vector diagrams, which this paper attempts to develop further. I identify three ways in which dispositionalists have taken the activities of powers to be related: stimulation, mutual manifestation, and contribution combination. While Mumford and Anjum do provide resources for representing contribution combination, which might be sufficient for their particular brand of dispositionalism, I argue that those resources are not (...) flexible enough to further accommodate either stimulation or mutual manifestation. Representational tools are provided to address these limitations, improving the general value of the vector model for dispositionalist approaches to causation. (shrink)

This paper examines the need for static dispositions within the basic ontology of the powers view of properties. To lend some focus, Neil Williams’s well developed case for static dispositions is considered. While his arguments are not necessarily intended to address fundamental ontology, they still provide a useful starting point, a springboard for diving into the deeper metaphysical waters of the dispositionalist approach. Within that ontological context, this paper contends that Williams’s arguments fail to establish the need to posit static (...) dispositions, or at least any sort not already well appreciated by advocates of the powers view. The paper then proceeds to suggest an alternative motivation for positing static dispositions, the success of which depends greatly on which ontological approach to objects is paired with the powers view. (shrink)

In taking properties to have powerful or dispositional essences, dispositionalism is primed to provide an account of causation. This paper lays out a challenge confronting the dispositionalist’s ability to account for how powers causally interact with one another so as to bring about collective results. The challenge, here labeled the “interaction gap,” is raised for two competing kinds of approaches to dispositional interaction: contribution combinationist and mutual manifestationist. After carefully highlighting and testing potential resources for closing the interaction gap, it (...) is concluded that the mutual manifestationist approach holds a significant advantage. In turn, the importance of the interaction gap itself is highlighted. While powers prime an ontology to yield an account of causation, how far that account can actually go depends on the metaphysical details of one’s view of powers and their causal interaction. (shrink)

In taking properties to have powerful or dispositional essences, dispositionalism is primed to provide an account of causation. This paper lays out a challenge confronting the dispositionalist’s ability to account for how powers causally interact with one another so as to bring about collective results. The challenge, here labeled the “interaction gap,” is raised for two competing kinds of approaches to dispositional interaction: contribution combinationist and mutual manifestationist. After carefully highlighting and testing potential resources for closing the interaction gap, it (...) is concluded that the mutual manifestationist approach holds a significant advantage. In turn, the importance of the interaction gap itself is highlighted. While powers prime an ontology to yield an account of causation, how far that account can actually go depends on the metaphysical details of one’s view of powers and their causal interaction. (shrink)

It is a commonsense thesis that unactualized possibilities are not parts of actuality. To keep his modal realism in line with this thesis, David Lewis employed his indexical account of the term “actual.” I argue that the addition of counterpart theory to Lewis’s modal realism undermines his strategy for respecting the commonsense thesis. The case made here also reveals a problem for Lewis’s attempt to avoid haecceitism.