Some rules seem more important than others. The moral rule to keep promises seems more important than the aesthetic rule not to wear brown with black or the pool rule not to scratch on the eight ball. A worrying number of metaethicists are increasingly tempted to explain this difference by appealing to something they call “authoritative normativity” – it’s because moral rules are “authoritatively normatively” that they are especially important. The authors of this chapter argue for three claims concerning “authoritative (...) normativity”: (1) that motivation for it originates in a parochial conception of “normative flavours”; (2) that arguments against alternative ways of explaining e.g., morality’s importance are overblown; and (3) that there are strong reasons against theorizing in terms of “authoritative normativity”. The overarching aim is not to show that “authoritative normativity” is incoherent or entirely unmotivated. Rather, it is to discuss some of “authoritative normativity’s” deeper commitments to correct the impression that is it largely benign or that it is entailed by familiar and popular “metanormative” positions. Authoritative normativity, it seems to us, is a solution in search of a problem. (shrink)

: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality (...) is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. (shrink)

Carlo Levi was a painter, writer, and antifascist Italian from a Jewish family, and his political activism forced him into exile for most of the Second World War. While in exile, he wrote _Christ Stopped at Eboli_, a memoir, and _Fear of Freedom_, a philosophical meditation on humanity's flight from moral and spiritual autonomy and our resulting loss of self and creativity. Brooding on what surely appeared to be the decline, if not the fall of Europe, Levi locates the human (...) abdication of responsibility in organized religion and its ability to turn the sacred into the sacrificial. In doing so, he references the entire intellectual and cultural estate of Western civilization, from the Bible and Greek mythology to Sigmund Freud and Carl Jung. This edition features newly published pieces of Levi's artwork and the first English translation of his essay "Fear of Painting," which was appended to a later publication of the work. It also includes an introduction that discusses Levi's life and enduring legacy. Written as war clouds were gathering over Europe, _Fear of Freedom_ not only addresses a specific moment in history and a universal, timeless condition, but it is also a powerful indictment of our contemporary moral and political failures. (shrink)

A special report of The Hastings Center and the Association of American Medical Colleges addressed the ethical oversight of learning health systems, which seek to combine high‐quality patient care with routine data collection aimed at improving patient outcomes. The report contained two position papers, authored by a number of distinguished bioethicists, and several commentaries. The position papers urged two changes. First, they urged a rethinking of our approach to the regulation of human subjects research, so as to make it easier (...) in the future for learning health systems to function well. Second, they argued that the rethinking required dispensing with a strict distinction between research and therapy, which has been a major tenet of bioethics since the Belmont Report, which explicated basic ethical principles governing human subjects research. We fully support the objectives of the authors, and we agree that the learning health system is an important advance that serves patients well. Unnecessary regulatory burden ought not impede this progress. We disagree, however, that the best way to bring about these needed changes in the regulatory environment is to reject the basic distinction between research and treatment. Unfortunately, we find the arguments in favor of that strategy to be, in places, reminiscent of what we take to be basic conceptual errors that hampered the ethical understanding of human subjects research prior to adoption of the Belmont Report. To see why one need not reject the research‐treatment distinction in order to promote learning health systems, we first investigate in some detail the arguments offered for eliminating the distinction. We next turn to an issue not addressed by those authors, namely, the relationship between the physician or investigator and the patient or subject, to illustrate why the distinction is important and what is lost if it is jettisoned. (shrink)

In Memories and Portraits: Explorations in American Thought, H. G. Callaway embeds his distinctive contextualism and philosophical pluralism within strands of history and autobiography, spanning three continents. Starting in Philadelphia, and reflecting on the meaning of home in American thought, he offers a philosophically inspired narrative of travel and explorations, in Europe and Africa, illuminating central elements of American thought—partly out of diverse foreign and domestic reactions and fascinating cultural contrasts. -/- This book is of interest for the contemporary interplay (...) of analytic philosophy with American pragmatism and for those focused on the interaction of European and Anglo-American thought and society. In this book, the formalism of analytic philosophy encounters a logically articulate version of the contextualism implicit in the pragmatist tradition; and a deep and abiding interest in natural science is augmented by a more literary account of the social and cultural contexts of inquiry—encountered in many years of travel and life abroad. The final chapter, employing a methodological naturalism, brings the perspectives and lessons, from near and far, back home for renewed reflection. (shrink)

Throughout his career, Derek Parfit made the bold suggestion, at various times under the heading of the "Normativity Objection," that anyone in possession of normative concepts is in a position to know, on the basis of their competence with such concepts alone, that reductive realism in ethics is not even possible. Despite the prominent role that the Normativity Objection plays in Parfit's non-reductive account of the nature of normativity, when the objection hasn't been ignored, it's been criticized and even derided. (...) We argue that the exclusively negative attention that the objection has received has been a mistake. On our reading, Parfit's Normativity Objection poses a serious threat to reductivism, as it exposes the uneasy relationship between our a priori knowledge of a range of distinctly normative truths and the typical package of semantic commitments that reductivists have embraced since the Kripkean revolution. (shrink)

Meaning without Analyticity draws upon the author’s essays and articles, over a period of 20 years, focused on language, logic and meaning. The book explores the prospect of a non-behavioristic theory of cognitive meaning which rejects the analytic-synthetic distinction, Quinean behaviorism, and the logical and social-intellectual excesses of extreme holism. Cast in clear, perspicuous language and oriented to scientific discussions, this book takes up the challenges of philosophical communication and evaluation implicit in the recent revival of the pragmatist tradition—especially those (...) arising from its relation to prior American analytic thought. This volume continues the work of Callaway’s 1993 book, Context for Meaning and Analysis, building on the “turn toward pragmatism.” . (shrink)

Davidson approaches the notions of meaning and interpretation with the aim of characterizing semantic competence in the syntactically characterized natural language. The objective is to provide a truth-theory for a language, generating T-sentences expressed in the semantic metalanguage, so that each sentence of the object language receives an appropriate interpretation. Proceeding within the constraints of referential semantics, I will argue for the viability of reconstructing the notion of linguistic meaning within the Tarskian theory of reference. However, the view proposed here (...) involves a revision of Davidson’s con-ception of the object of semantic investigation. Taking (idealized) language-theories as the proper object of semantic characterization, provides solutions to outstanding problems in Davidson’s views, better approximates the practice in standard model-theoretic semantics, and incorporates the elements of semantic competence sought for in tradi¬tional theories of lexical analysis. Sources of evidence beyond those emphasized by Davidson will be invoked in order to allow for the selection of interpre¬tive T-sentences. In the final section, possible Quinean objections will be considered. (shrink)

A predominant ethical view holds that physician‐investigators should conduct their research with therapeutic intent. And since a physician offering a therapy wouldn't prescribe second‐rate treatments, the experimental intervention and the best proven therapy should appear equally effective. "Clinical equipoise" is necessary. But this perspective is flawed. The ethics of research and of therapy are fundamentally different, and clinical equipoise should be abandoned.

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (RCTs). The appearance, however, is deceptive. In this article we argue that clinical equipoise is defective and incoherent in multiple ways. First, it conflates the sound methodological principle that RCTs should begin with an honest null hypothesis with the questionable ethical norm that participants in these trials should never be randomized (...) to an intervention known to be inferior to standard treatment. Second, the claim that RCTs preserve the therapeutic obligation of physicians misrepresents the patient-centered orientation of medical care. Third, the appeal to clinical equipoise as a basic principle of risk-benefit assessment for RCTs is incoherent. Finally, the difficulties with clinical equipoise cannot be resolved by viewing it as a presumptive principle subject to exceptions. In the final sections of the article, we elaborate on the non-exploitation framework for the ethics clinical research and indicate issues that warrant further inquiry. (shrink)

The 1964 theorem of John Bell shows that no model that reproduces the predictions of quantum mechanics can simultaneously satisfy the assumptions of locality and determinism. On the other hand, the assumptions of signal locality plus predictability are also sufficient to derive Bell inequalities. This simple theorem, previously noted but published only relatively recently by Masanes, Acin and Gisin, has fundamental implications not entirely appreciated. Firstly, nothing can be concluded about the ontological assumptions of locality or determinism independently of each (...) other—it is possible to reproduce quantum mechanics with deterministic models that violate locality as well as indeterministic models that satisfy locality. On the other hand, the operational assumption of signal locality is an empirically testable (and well-tested) consequence of relativity. Thus Bell inequality violations imply that we can trust that some events are fundamentally unpredictable, even if we cannot trust that they are indeterministic. This result grounds the quantum-mechanical prohibition of arbitrarily accurate predictions on the assumption of no superluminal signalling, regardless of any postulates of quantum mechanics. It also sheds a new light on an early stage of the historical debate between Einstein and Bohr. (shrink)

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

The practice of voluntary physician‐assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity.

John Howard Whitehouse was a British educational and social reformer and the founder of Bembridge School on the Isle of Wight. George Peabody Gooch was a British historian and Liberal Party politician. Originally published in 1924, this book contains essays by Whitehouse and Gooch putting forward the case for an international perspective on education and educational policy, with particular emphasis placed upon links with the United States. This book will be of value to anyone with an interest in educational (...) theories and the history of education. (shrink)

With breathtalung speed, traditional criminal prohibitions against assisted suicide have been declared unconstitutional in twelve states, including California and New York. This poses great promise and great peril. The promise is that competent terminally ill patients, as a compassionate measure of last resort, will have the option of putting an end to their suffering by physician-assisted suicide. More sigmficant, legally permitting this controversial option may be a catalyst for doctors, health care institutions, and society to improve the care of the (...) dying. PAS should be limited only to those relatively few competent patients who continue to suffer intolerably despite unrestrained efforts to palliate and who face a continued existence that they regard as worse than death. When dying patients know they will not be abandoned to miserable and pointless suffering if palliative care fails, they will be fortified to cope better with the process of dying.The immediate peril is that PAS will become a quick fix, available on demand to any patient diagnosed as terminally ill, thus bypassing palliative care and producing premature deaths. (shrink)