Bioethical Prescriptions collects F.M. Kamm's articles on bioethics -- revised for publication in book form -- which have appeared over the last 25 years and which have made her among the most widely-respected philosophers working in this field.

The Mīmā ṃ sā school of Indian philosophy elaborated complex ways of interpreting the prescriptive portions of the Vedic sacred texts. The present article is the result of the collaboration of a group of scholars of logic, computer science, European philosophy and Indian philosophy and aims at the individuation and analysis of the deontic system which is applied but never explicitly discussed in Mīmā ṃ sā texts. The article outlines the basic distinction between three sorts of principles —hermeneutic, linguistic and (...) deontic. It proposes a mathematical formalization of the deontic principles and uses it to discuss a well-known example of seemingly conflicting statements, namely the prescription to undertake the malefic Śyena sacrifice and the prohibition to perform any harm. (shrink)

Ethicism is the most comprehensively defended answer to the question regarding whether ethical properties determine aesthetic properties in artworks. According to ethicism, aesthetically relevant ethical flaws in artworks count as aesthetic flaws and aesthetically relevant ethical merits count as aesthetic merits. In this paper, I argue that ethicism’s most significant argument, the Merited Response Argument suffers from an ambiguity that makes it either unsound or uninteresting. Specifically, the notion of an artwork’s ‘prescribing’ a response, central to MRA, is ambiguous between (...) merely attempting to elicit a response from appreciators as appropriate to a work, and endorsing a response as appropriate to relevant parts of the actual world. While the first sense of ‘prescribe’ does the aesthetic work, the second does the ethical. (shrink)

There seems a potential tension between Hume's naturalistic project and his normative ambitions. Hume adopts what I call a methodological naturalism: that is, the methodology of providing explanations for various phenomena based on natural properties and causes. This methodology takes the form of introducing ‘the experimental method of reasoning into moral subjects’, as stated in the subtitle of the Treatise; this ‘experimental method’ seems a paradigmatically descriptive one, and it remains unclear how Hume derives genuinely normative prescriptions from this methodology. (...) In resolving this problem, I will argue that Hume's naturalistic methodology – that is, his ‘experimental philosophy’, or what has come to be known as his experimental method – consists of the systematization of phenomena pertaining to human nature. In applying his experimental method to normative subjects, Hume systematizes our normative judgements, deriving general principles of normative justification; he then reflexivel... (shrink)

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using (...) a drug safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. (shrink)

Understanding cognitive processes with a formal framework necessitates some limited, internal prescriptive normativism. This is because it is not possible to endorse the psychological relevance of some axioms in a formal framework, but reject that of others. The empirical challenge then becomes identifying the remit of different formal frameworks, an objective consistent with the descriptivism Elqayam & Evans (E&E) advocate.

Critical notice of Christoph Kelp and Mona Simion's _Sharing Knowledge: A Functionalist Account of Assertion_.

There seems a potential tension between Hume’s naturalistic project and his normative ambitions. Hume adopts what I call a methodological naturalism: that is, the methodology of providing explanations for various phenomena based on natural properties and causes. This methodology takes the form of introducing ‘the experimental method of reasoning into moral subjects’, as stated in the subtitle of the Treatise; this ‘experimental method’ seems a paradigmatically descriptive one, and it remains unclear how Hume derives genuinely normative prescriptions from this methodology. (...) -/- In resolving this problem, I will argue that Hume’s naturalistic methodology – that is, his ‘experimental philosophy’ (THN Intro 7), or what has come to be known as his experimental method – consists of the systematisation of phenomena pertaining to human nature. In applying his experimental method to normative subjects, Hume systematises our normative judgments, deriving general principles of normative justification; he then reflexively applies these principles to the pre-philosophical judgments from which they derive, dismissing and/or correcting those that do not accord with his systematised account. I will argue that Hume’s experimental method, far from being wholly descriptive, is in fact thoroughly infused with normativity; furthermore, the very application of this methodology to our normative judgments reveals Hume’s normative ambitions. (shrink)

Les sites de réseaux socionumériques, Facebook en premier chef, ont développé une véritable stratégie d’exploitation de la participation, originale et sophistiquée. Elle consiste à instrumentaliser chaque utilisateur de la plateforme en le plaçant en situation de prescripteur ordinaire auprès de son propre réseau socionumérique. Par le biais d’applications spécifiques et d’une structure sociale particulière, il est converti en relais prescriptif. Dans ce système de prescription généralisée, au moins deux finalités peuvent être identifiées : la prescription de la consommation (...) et des marques dans une logique marketing, et la prescription de l’action collective sur les réseaux socionumériques.Social networking sites, and Facebook in particular, have developed an original and sophisticated strategy for exploiting user participation. This involves instrumentalising every platform user by putting them in a position where they themselves have to prescribe usage on their own online networks. Through specific applications and a particular social structure, every user becomes a prescriptive relay. In this relentlessly prescriptive system, it is possible to identify at least two goals: prescribed consumption and brand names following a marketing logic, and prescribed collective action through online social networking. (shrink)

The ills of psychiatry are currently diagnoses with the aid of deficient etiologies. The currently proposed prescriptions for psychiatry are practically impossible. The defective part of the profession is its leadership which in its very defensiveness sticks to the status quo, thereby owning the worst defects and impeding all possible cure. The current discussions of the matter are pretentious and thus woolly. The minimal requirement from the profession as a whole and from each of its individual members is that they (...) be not defensive and clear. In this vein I offer here preliminary discussions of propriety, of responsibility and of science. (shrink)

Global Prescriptions scrutinizes the movement to export a U.S.-oriented version of the " rule of law," found in the activities of philanthropic foundations, the World Bank, the U.S. Agency for International Development, and several other developmental organizations. Yves Dezalay and Bryant G. Garth have brought together a group of scholars from a variety of disciplines--anthropology, economics, history, law, political science, and sociology--to create tools for understanding this movement. Comprised of two sections, the volume first develops theoretical perspectives key to an (...) understanding of the production and impact of new "global legal prescriptions." The second part shifts attention to the national importation of these legal orthodoxies. The scholars provide a diverse set of sophisticated approaches, both to the circumstances promoting the production of these prescriptions and to the limitations of the prescriptions in the different national settings. Thus, Global Prescriptions provides a unique treatment for readers interested in globalization generally or the potential spread of the "rule of law" in particular. This volume will intrigue scholars and students interested in a political science, economics, history, anthropology, law, and sociology. Contributors are Jeremy Adelman, Robert Boyer, Elizabeth Heger Boyle, Miguel Angel Centeno, Heinz Klug, Larissa Adler Lomnitz, John W. Meyer, Setsuo Miyazawa, Hiroshi Otsuka, Rodrigo Salazar, Kathryn Sikkink, Anne-Marie Slaughter, and Catalina Smulovitz. Yves Dezalay is Director of Research, National Center for Scientific Research, Paris. Bryant G. Garth is Director of the American Bar Foundation. (shrink)

Research on ethical norms has grown in recent years, but imprecise language has made it unclear when these norms prescribe “what ought to be” and when they merely describe behaviors or perceptions (“what is”). Studies of ethical norms, moreover, tend not to investigate whether participants were influenced by the prescriptive aspect of the norm; the studies primarily demonstrate, rather, that people will mimic the behaviors or perceptions of others, which provides evidence for the already well-substantiated social proof theory. In this (...) review article, we delineate three streams of norms research in business ethics: behavioral, perceptual, and prescriptive. We argue that by properly categorizing norms, and designing studies to investigate when prescriptions, more than mere mimicry, improve ethical outcomes in organizations, researchers can enhance managers’ efforts to promote ethical outcomes in organizations. (shrink)

The paper is devoted to the problem of formal representation of prescriptive obligation, i.e., the obligation concerning the way in which an action is to be performed. Improper representation of prescriptive obligation leads to Forrester's Paradox. In the paper I first present a new version of Forrester's Paradox that generalizes the observation on which the original version is based. Then I challenge the two existing solutions to the paradox. I reject the solution of H.-N. Castañeda and analyze problems to which (...) the solution of W. Sinnott-Armstrong leads. I conclude the paper with a proposal for how to improve Sinnott-Armstrong's solution. (shrink)

People’s beliefs about normality play an important role in many aspects of cognition and life (e.g., causal cognition, linguistic semantics, cooperative behavior). But how do people determine what sorts of things are normal in the first place? Past research has studied both people’s representations of statistical norms (e.g., the average) and their representations of prescriptive norms (e.g., the ideal). Four studies suggest that people’s notion of normality incorporates both of these types of norms. In particular, people’s representations of what is (...) normal were found to be influenced both by what they believed to be descriptively average and by what they believed to be prescriptively ideal. This is shown across three domains: people’s use of the word ‘‘normal” (Study 1), their use of gradable adjectives (Study 2), and their judgments of concept prototypicality (Study 3). A final study investigated the learning of normality for a novel category, showing that people actively combine statistical and prescriptive information they have learned into an undifferentiated notion of what is normal (Study 4). Taken together, these findings may help to explain how moral norms impact the acquisition of normality and, conversely, how normality impacts the acquisition of moral norms. (shrink)

Pharmaceutical companies have exploited health information technology to “mine” data from drug prescriptions and use the data to better target their sales pitches to physicians. This article considers the policy arguments and first amendment implications regarding state regulation of data mining. It concludes that the legislative provisions are desirable and should withstand constitutional challenge.

Under what circumstances should the federal government pay for outpatient prescription drugs? Should the government (and by extension, taxpayers) pay for all of the drugs prescribed by health care providers, regardless of price or use—adhering to a medical standard? Or should taxpayers only pay for prescriptions supported by scientific evidence of effectiveness—a scientific standard?

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

Tom Campbell is well known for his distinctive contributions to legal and political philosophy over three decades. In emphasising the moral and political importance of taking a positivist approach to law and rights, he has challenged current academic orthodoxies and made a powerful case for regaining and retaining democratic control over the content and development of human rights. This collection of his essays reaches back to his pioneering work on socialist rights in the 1980s and forward from his seminal book, (...) The Legal Theory of Ethical Positivism (1996). An introductory essay provides an historical overview of Professor Campbell's work and argues for the continuing importance of 'democratic positivism' at a time when it is again becoming clear that courts are ineffective protectors of human rights. (shrink)

Examines the ethics of euthanasia, and discusses capital punishment, organ donation, and the Hippocratic oath.

Since the very emergence of the syncretic, sentient human species, it has been handicapped by numerous incipient, continuing and new limitations. Thus, we have not yet quite escaped the overwhelming tyranny of biological evolution with its constraining strait jacket of natural selection. At this threshold of knowledge and awareness, the mantle falls on the Homo sapiens of planet Earth to at least dream of, and formulate prescriptions for Utopias without the inane internecine conflicts, and physical as well as spiritual carnages (...) which continue unabated from the dawn of history to date, and which could now well aggravate towards inexorable total extinction. Channelisation of accumulated, collective wisdom, scienctific insights and technological skills towards universal humanistic rationality, emanicpation, and empowerment must be the primary edict of humankind. An equation incorporating Life, the human species, and various variables affecting these, is presented as a prescription for continuance and flowering of Life in the Universe. (shrink)

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. (...) In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

This paper examines critically the current state of affairs in philosophy of science. It focuses on the well-Known puzzle about the relationship between the normative prescriptive methodology of science and positive descriptive history of science. This puzzle has dogged philosophers of science for over a generation and is still controversial. My conclusion is that there is really no escape from it. The best way to characterize it is as follows: "philosophy of science without history of science is empty; history of (...) science without philosophy of science is blind.". (shrink)

Nurses in all practice roles and settings need to understand the therapeutic use and potential for abuse of prescription drugs. Nursing roles, which include the administration and prescription of medication, health teaching and the implications of application, and the detection of drug-related problems, require that such education be timely and comprehensive. This paper discusses the state of knowledge dissemination about prescription drugs within the general context of nursing education. It highlights educational needs and explores the attitudinal factors (...) and knowledge deficits that influence the nursing practices of prescribing, pain management, nursing assessment, and care of persons with drug problems.Standard educational requirements in all nursing curricula undergird teaching about licit and illicit drugs and medication, as well as their therapeutic use, misuse, and abuse. It has been recognized widely since the early 1980s, however, that clinical experiences and didactic content on licit and illicit drugs presented in nursing programs is inadequate. (shrink)

Nurses in all practice roles and settings need to understand the therapeutic use and potential for abuse of prescription drugs. Nursing roles, which include the administration and prescription of medication, health teaching and the implications of application, and the detection of drug-related problems, require that such education be timely and comprehensive. This paper discusses the state of knowledge dissemination about prescription drugs within the general context of nursing education. It highlights educational needs and explores the attitudinal factors (...) and knowledge deficits that influence the nursing practices of prescribing, pain management, nursing assessment, and care of persons with drug problems.Standard educational requirements in all nursing curricula undergird teaching about licit and illicit drugs and medication, as well as their therapeutic use, misuse, and abuse. It has been recognized widely since the early 1980s, however, that clinical experiences and didactic content on licit and illicit drugs presented in nursing programs is inadequate. (shrink)

R. M. Hare has brought together in this volume the best of his uncollected essays in moral philosophy, several of them previously unpublished or revised for this collection. They span the whole range of his ethical interests, from the most abstract to the most down-to-earth. The volume provides a compelling demonstration of Hare's commitment to bringing together the theoretical and the practical in ethics.

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

In this Response to Professor Peters, Professor Greenawalt argues that prescriptive equality does have meaningful normative force. Prescriptive equality plays a reinforcing role when it agrees with nonegalitarian justice and is not incoherent when it pulls against nonegalitarian justice. Specifically, when one individual has been treated better than is required by nonegalitarian justice, a similarly situated and significantly related individual who is aware of that treatment may merit equivalent treatment because of widespread and deep-seated feelings about equality.

In my book God’s Call1 I gave an historical account of the debate within twentieth century analytic philosophy between moral realism and expressivism. Moral realism is the view that moral properties like goodness or cruelty exist independently of our making judgements that things have such properties. Such judgements are, on this theory, objectively true when the things referred to have the specified properties and objectively false when they do not. Expressivism is the view that when a person makes a moral (...) judgment, she is expressing emotion or desire or will. I used the term ‘orectic’ to refer to these mental states, because we do not have in English a sufficiently general term. In God’s Call, I started with a moral realist whom I called a ‘platonist’, G. E. Moore, and then I traced the argument through the emotivists, A. J. Ayer and Charles Stevenson, and the prescriptivist, R. M. Hare, and Iris Murdoch, whom I called a ‘humble platonist’, and J. L. Mackie’s ‘error theory’, and John McDowell, whose theory I call ‘disposition theory’, and David Brink, the ‘new-wave realist’, and Allan Gibbard, who calls his own theory ‘ norm expressivism ’. My project was to collect together the concessions that the two sides of the debate have made to each other over the course of this history, and then to construct a position which molds these concessions into a single coherent theory. I called this theory ‘prescriptive realism’. (shrink)

Neuroscience and psychiatry -- Psychotherapy and psychiatry -- Diagnosis in psychiatry -- The boundaries of mental disorders -- Mood and mental illness -- Psychiatry's problem children -- Evidence-based psychiatry -- Psychiatric drugs: miracles and limitations -- Talk therapies: the need for a unified method -- Psychiatry in practice -- Training psychiatrists -- Psychiatry and society -- The future of psychiatry.

Many pharmaceuticals are available to patients only with a physician’s prescription. Although it is often not recognized as such, this is a classic example of paternalism in public policy. Pharmaceuticals are often perceived as carrying dangerous side effects. Access is restricted to protect patients from their own bad decisions. This chapter explores the moral justification for such paternalism and finds it wanting. It raises the question of whether there is adequate justification for this restriction. Consistency requires that pharmaceuticals posing (...) dangers primarily to the individual be available to competent consumers and that even moderate risks to third parties be tolerated. The chapter begins by arguing that all drug usage involves evaluative judgments about the relative benefits and harms of the agents and that physicians must make value judgments in deciding whether to prescribe. (shrink)

The aim of this paper is to show that descriptive statements can be action-Guiding; that oughts and imperatives, If they are to be justified at all, Must be derived from statements of fact; that factual-Prudential moral reasoning is logically universalizable; and that the demand for universalizability, And thus ultimately for moral reasoning, Is itself only prudentially justifiable. These points are argued by way of an examination and criticism of hare's discussion of prescription and universalizability in moral reasoning.

R.M. Hare had an ambitious scheme of providing a unified account of meta-ethics and normative ethics by combining expressivism with Kantianism and utilitarianism. The project of this thesis is to defend Hare’s theory in its most ambitious form. This means not just showing how the expressivist, Kantian and utilitarian elements are consistent, or that the three are each correct, but also that they are interdependent. The only defensible form of expressivism is Kantian; the only defensible Kantian theory is both expressivist (...) and utilitarian; the only defensible utilitarianism is Kantian. The thesis is divided into four chapters. Chapter 1 aims to show how expressivism can provide a coherent account of moral judgement and discourse. The argument for expressivism draws on Hare’s thought that the main error of moral realism is to think of moral objectivity as requiring objects, moral properties which are really there in the world. It is shown, using an argument based on the Euthyphro and the Open Question Argument that realism is untenable because it makes this mistake, and this clears the path to expressivism. Chapter 2 is a full account of the issues surrounding the Frege-Geach problem (often pressed against Hare), showing how it can be solved and how exactly the expressivist’s embrace of minimalism about truth interacts with the solution to the Frege-Geach Problem. I include an explanation of how the expressivist is able to solve the most threatening version of the problem: Schroeder’s discussion of negation. Chapter 3 argues for the connection between expressivism and Kantianism. The argument (roughly following Korsgaard) is that Humean versions of expressivism run into a sceptical challenge of normative regress. Kant employed a transcendental argument to resolve this regress, deriving his Formula of Universal Law from the Categorical Imperative. This argument defended with expressivism playing a crucial role. This chapter thus explains how Hare is entitled to universalizability in a way that avoids the shmoralising objection: it is not justified merely by being derived from our moral concepts but rather from our inescapable nature as agents. Chapter 4 illuminates the other connection, between Kantianism and utilitarianism. The largest part of the chapter is spent defending Hare’s argument from universalizability to utilitarianism. Doing so shows how Hare’s utilitarianism depends on his Kantianism, and so also how it indirectly depends on his utilitarianism. I then go on to defend Hare’s distinctive two-level version of utilitarianism, especially against the objections of Bernard Williams. It is also argued that various difficulties for utilitarianism – utility monsters, interpersonal comparison, Korsgaard’s objections – can be met by a form of utilitarianism like Hare’s, which is Kantian, and thus that such a form of utilitarianism is indeed the most defensible. (shrink)

The history of benzodiazepine supply, as negotiated in the GDR following its commercial success in western markets in 1960, demonstrates how patients in East Germany (GDR) influenced drug policies by assuming the role of consumers. This article traces general political discussions on psycho-pharmaceuticals as essential components of a healthcare system that faced grave financial constraints, then focuses on the “Wunschverordnung” concept, that is, a prescription that was filled on request. This concept was ideologically employed to portray the rising demand (...) for tranquilizer drugs as inadequate. The ways in which citizens of the GDR influenced state decisions—import and production alike—on tranquilizer supply through petitions is investigated. The article concludes by discussing the scope and function of the activist role of patients as consumers in a socialist state. (shrink)