SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of (...) medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines. (shrink)

Bioethics case reports generally treat aspects of moral fathomability, characterised and addressed in different ways. This paper reads the case as a textual model of scenarios and draws attention to its structure, narrative shape, linguistic register, and the effects of tone and temporality on reader expectation and responsiveness. Such textual elements of case composition reflect authorial purpose and influence the interpretation, including moral and ethical interpretation, of bioethics cases.

Volume 20, Issue 7, July 2020, Page W17-W19.

The first part of the book, dedicated to 'Rhetorical and Epistemological Aspects of Science Writing', addresses how scientific pursuits and methods feed into multi-level texts that generate responses within science, society, and culture.

In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently (...) prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally‐determined time targets that are enforced by a top‐down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond. (shrink)

This collection arose out of a conference on intuitions at the University of Notre Dame in April 1996. The papers in it mainly address two related questions: (a) How much evidential weight should be assigned to intuitions? and (b) Are concepts governed by necessary and sufficient conditions, or are they governed by ‘family resemblance’ conditions, as Wittgenstein suggested? The book includes four papers by psychologists relating and analyzing some empirical findings concerning intuitions and eleven papers by philosophers endorsing various answers (...) to these questions. (shrink)

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 717 the work of Arthur Danto. Here the stimulus to reflection is those elements in modern art which " make a farce of traditional art and art theories hy giving us artworks indiscernible from objects found on grocery shelves or in lavatories." If, as Danto suggests, whatever is to count as art is simply what an " artworld " decrees, then the distinction between artefact and artwork (...) can disappear completely (except in terms of somebody's bank balance). The trouble with the remaining essays in this collection is that their authors have not appropriated a truth given lapidary expression in Woods' essay on Kant: "Attention to the works of genius throughout the ages cultivates the sensus communis and establishes a community involved in the beautiful." Thus, while Ted Cohen is right to consider television a possible artistic medium, the objects of televisual appreciation he considers usually witness to a breakdown of a community involved in the beautiful, while the frequently nugatory objects discussed in John Brough's "Who's Afraid of Marcel Duchamp? " testify to the disintegration of the sensus communis concerned. Finally, if Paul Weiss is right in his "Creativity and Beauty" not only to designate beauty " the excellence pertinent to the creation of a work of art," but also to house it together with the quartet of truth, goodness, glory, and justice, then we can get a sense of how wisdom in both philosophy and artistic practice might he restored: through a re· discovery of the interdependence of the transcendentals. But perhaps only the Judaeo-Christian revelation now holds the key to this possibility. AIDAN NICHOLS, O.P. Blackfriars Cambridge, England Through the Tempest: Theological Voyages in a Pluralistic Culture. By LANGDON GILKEY. Ed. Jeff B. Pool. Minneapolis: Fortress Press, 1991. Pp. xx + 252. Langdon Gilkey: Theologian for a Culture in Decline. By BRIAN J. WALSH. Lanham, MD: University Press of America/Institute for Christian Studies, 1991. Pp. xii + 324. $47.50 (cloth); $22.50 (paper). With the exception of two mid-1970s papers, Through the Tempest is a collection of some of the addresses and essays written in the 1980s hy Langdon Gilkey, Shailer Mathews Professor Emeritus at the University of Chicago Divinity School. Title and subtitle are meant to re· 718 BOOK REVIEWS fleet three elements of Gilkey's temper. First, the tempest corresponds to his dramatic vision of the twentieth-century world, with its wars, up· heavals, and destructive forces. Second, the preposition through expresses the sober hope that for all the darkness that surrounds our century, we are actually moving toward a destination beyond the turmoil. And third, his explorations and assessments of the many facets of contemporary culture are theological voyages. In these pages readers will find many of the themes Gilkey has tackled over the years, such as God, Jesus, Creation, Providence, spirituality, the function of symbols, ethics, suffering and death, Christianity and other religions, faith and science, church and public policy. Among the most original pieces are, to my mind, Ch. 10, on the different attitudes to ethics in Christianity and Buddhism, and Ch. 14, which clarifies many aspects of suffering. The general readership made up of those interested in religion will probably enjoy these lectures, while specialists in theology or human studies are likely to find them merely impressionistic and too vague both in their cultural analyses and in their conceptual discussions. Further, there is a discrepancy between Gilkey's assessment of the human predicament and :the theological solutions he puts forward. On the one hand, the mood and the content of his assessment is neo· orthodox (inspired by his master Reinhold Niebuhr). For instance, chapters 11 and 13, on evil and sin, are typical of an acute awareness of the dark side of human conduct. As he follows this vein, Gilkey raises pertinent, profound, and difficult questions. On :the other hand, his prescriptions do not match the depth of his diagnoses. Despite his efforts at overcoming theological liberalism, he often remains confined within the limits of the Western Enlightenment. For example, like most eighteenth-century thinkers, he rejects "a level of grace beyond nature " (54). What he repudiates is in all likeliness the modern separation between nature and supernature, and... (shrink)

The author congratulates Dr Brian Hurwitz, who recently reported the successful “intimidation” of an elderly competent widow into accepting badly needed therapy for a huge ulcerated carcinoma. He reports approvingly of the Israeli Patients' Rights Law, enacted in 1996, which demands detailed informed consent from competent patients before permitting treatment. But the law also provides an escape clause which permits coercing a competent patient into accepting life-saving therapy if an ethics committee feels that if treatment is imposed the (...) patient will give his/her consent retroactively. He suggests this approach as an appropriate middle road between overbearing paternalism and untrammelled autonomy. (shrink)

This paper develops a new argument from consciousness to theism: the argument from psychophysical harmony. Roughly, psychophysical harmony consists in the fact that phenomenal states are correlated with physical states and with one another in strikingly fortunate ways. For example, phenomenal states are correlated with behavior and functioning that is justified or rationalized by those very phenomenal states, and phenomenal states are correlated with verbal reports and judgments that are made true by those very phenomenal states. We argue that psychophysical (...) harmony is strong evidence for theism (or, at least, strong evidence against atheism in its standard naturalistic form). (shrink)

Our universe features a harmonious match between laws and states: applying its laws to its states generates other states. This is a striking fact. Matters might have been otherwise. The universe might have been stillborn in a state unengaged by its laws. The problem of nomological harmony is that of explaining the noted striking fact. After introducing and developing this problem, we canvass candidate solutions and identify some of their virtues and vices. Candidate solutions invoke the likes of a designer, (...) axiarchic meta-laws, multiverses, essential causal powers, and Humean laws. (shrink)

"Brian Orend's The Morality of War promises to become the single most comprehensive and important book on just war for this generation. It moves far beyond the review of the standard just war categories to deal comprehensively with the new challenges of the conflict with terrorism. It thoughtfully reviews every major military conflict of the past few decades, mining them for implications of the evolving tradition of just war thinking. It concludes with a critical engagement with the major alternatives (...) to just war thinking: pacifism and 'realism.' It is, in short, the most comprehensive and thoughtful assessment of all aspects of just war since Michael Walzer's classic Just and Unjust Wars." - Martin L. Cook, United States Air Force Academy. (shrink)

Certain puzzling cases have been discussed in the literature recently which appear to support the thought that knowledge can be obtained by way of deduction from a falsehood; moreover, these cases put pressure, prima facie, on the thesis of counter closure for knowledge. We argue that the cases do not involve knowledge from falsehood; despite appearances, the false beliefs in the cases in question are causally, and therefore epistemologically, incidental, and knowledge is achieved despite falsehood. We also show that the (...) principle of counter closure, and the concomitant denial of knowledge from falsehood, is well motivated by considerations in epistemological theory--in particular, by the view that knowledge is first in the epistemological order of things. (shrink)

According to the AI ensoulment hypothesis, some future AI systems will be endowed with immaterial souls. I argue that we should have at least a middling credence in the AI ensoulment hypothesis, conditional on our eventual creation of AGI and the truth of substance dualism in the human case. I offer two arguments. The first relies on an analogy between aliens and AI. The second rests on the conjecture that ensoulment occurs whenever a physical system is “fit to possess” a (...) soul, where very roughly this amounts to being physically structured in such a way that the system can meaningfully cooperate with the operations of the soul. (shrink)

Many philosophers of emotion, whether perceptual or cognitive theorists, have claimed that emotions represent evaluative properties. This is often supported by an appeal to the fittingness of emotion: that emotions can be fitting shows they represent evaluative properties. In this paper, however, I argue that this inference is much too fast. In fact, no aspect of the rational assessment of emotion directly supports the claim that emotions represent evaluative properties. This inference can, however, be matured into an inference to the (...) best explanation. But this requires coming to terms with a significant emerging rival, the attitudinal theory of emotion. In this paper, I show how this can be accomplished and the inference from fittingness to content saved. (shrink)

According to a familiar modern view, color and other so-called secondary qualities reside only in consciousness, not in the external physical world. Many have argued that this “Galilean” view is the source of the mind-body problem in its current form. This paper critically examines a radical alternative to the Galilean view, which has recently been defended or sympathetically discussed by several philosophers, a view I call “anti-modernism.” Anti-modernism holds, roughly, that the modern Galilean scientific image is incomplete – in particular, (...) it leaves out certain irreducible qualitative properties, such as colors – and that we can solve (or dissolve) the hard problem of consciousness by accepting these properties as objective features of the external physical world. I argue, first, that anti-modernism cannot fulfill its promise. Even if the outer world is resplendent with primitive colors, color experience remains a mystery. Second, I argue that the theoretical costs of accepting irreducible colors in the world are enormous. Even if irreducible colors in the world could dispel the mysteries surrounding consciousness, the theoretical benefit would not be worth the cost. If the problems of consciousness and color require that we posit irreducible properties somewhere, it would be far more plausible to accept irreducible phenomenal properties on the side of the subject, and to reject irreducible colors on the side of the object. (shrink)

ABSTRACTRational agents have consistent beliefs. Bayesianism is a theory of consistency for partial belief states. Rational agents also respond appropriately to experience. Dogmatism is a theory of how to respond appropriately to experience. Hence, Dogmatism and Bayesianism are theories of two very different aspects of rationality. It's surprising, then, that in recent years it has become common to claim that Dogmatism and Bayesianism are jointly inconsistent: how can two independently consistent theories with distinct subject matter be jointly inconsistent? In this (...) essay I argue that Bayesianism and Dogmatism are inconsistent only with the addition of a specific hypothesis about how the appropriate responses to perceptual experience are to be incorporated into the formal models of the Bayesian. That hypothesis isn't essential either to Bayesianism or to Dogmatism, and so Bayesianism and Dogmatism are jointly consistent. That leaves the matter of how experiences and credences are related, a... (shrink)

This paper defends a non-reductive realist view of the sensible qualities—roughly, the view that the sensible qualities are really instantiated by the external objects of perception, and not reducible to response-independent physical properties or response-dependent relational properties. I begin by clarifying and motivating the non-reductive realist view. I then consider some familiar difficulties for the view. Addressing these difficulties leads to the development and defence of a general theory, inspired by Russellian Monist theories of consciousness, of how the sensible qualities (...) relate to physical reality. I conclude by showing how this theory, which I call ‘Secondary Quality Russellian Monism’, resolves the most significant difficulties for the non-reductive realist view of the sensible qualities. (shrink)

Perceptual illusionism is the view that perceptual experience is, in general, radically illusory. That is, perceptual experience presents objects as having certain sensible properties and standing in certain sensible relations, but nothing in the subject’s environment has those properties or stands in those relations. This paper makes the case for perceptual illusionism by showing how a broad set of philosophical and scientific considerations converge to support illusionism about the full range of sensible properties and relations. After clarifying the illusionist thesis, (...) I set out the argument in three parts. First, I briefly make the case for an illusionist view of color. I then argue for illusionism about the spatial/temporal properties presented in experience on the assumption that some “radical” view of space (and/or time) is correct—that is, some view according to which nothing like our ordinary three-dimensional space (or four-dimensional spacetime) exists at the fundamental level. Finally, I argue that there is a strong case for illusionism even if all radical views turn out to be false. (shrink)

Infallibilism leads to skepticism, and fallibilism is plagued by the threshold problem. Within this narrative, the pragmatic turn in epistemology has been marketed as a way for fallibilists to address the threshold problem. In contrast, pragmatic versions of infallibilism have been left unexplored. However, I propose that going pragmatic offers the infallibilist a way to address its main problem, the skeptical problem. Pragmatic infallibilism, however, is committed to a shifty view of epistemic certainty, where the strength of a subject’s epistemic (...) state can vary depending upon the practical context. Pragmatic views of epistemic strength are quite radical so the argumentative goal of my discussion is to argue for its plausibility, thereby arguing for the plausibility of pragmatic infallibilism. To do so, I discuss the role that the framing of decision problems and the construction of our deliberative attitudes have in our theories of rational choice. And I explore a way in which these necessary components of a normative theory of rationality can be used to motivate pragmatic views of evidential support. Finally, since the plausibility of our pragmatic account will depend upon the plausibility of a constructive account of rational choice, I conclude by comparing the adequacy of the constructive account with orthodox Bayesian and knowledge-based accounts. (shrink)

In the last decade, experimental philosophers have documented systematic asymmetries in the attributions of mental attitudes to agents who produce different types of side effects. We argue that this effect is driven not simply by the violation of a norm, but by salient-norm violation. As evidence for this hypothesis, we present two new studies in which two conflicting norms are present, and one or both of them is raised to salience. Expanding one’s view to these additional cases presents, we argue, (...) a fuller conception of the side-effect effect, which can be reversed by reversing which norm is salient. (shrink)

Keith DeRose has argued that the two main problems facing subject-sensitive invariantism come from the appropriateness of certain third-person denials of knowledge and the inappropriateness of now you know it, now you don't claims. I argue that proponents of SSI can adequately address both problems. First, I argue that the debate between contextualism and SSI has failed to account for an important pragmatic feature of third-person denials of knowledge. Appealing to these pragmatic features, I show that straightforward third-person denials are (...) inappropriate in the relevant cases. And while there are certain denials that are appropriate, they pose no problems for SSI. Next, I offer an explanation, compatible with SSI, of the oddity of now you know it, now you don't claims. To conclude, I discuss the intuitiveness of purism, whose rejection is the source of many problems for SSI. I propose to explain away the intuitiveness of purism as a side-effect of the narrow focus of previous epistemological inquiries. (shrink)

List of Illustrations Introduction 1 The Didactic and the Elegant: Some Thoughts on Scientific and Technological Illustrations in the Middle Ages and Renaissance 3 2 Temples of the Body and Temples of the Cosmos: Vision and Visualization in the Vesalian and Copernican Revolutions 40 3 Descartes’s Scientific Illustrations and ’la grande mecanique de la nature’ 86 4 Illustrating Chemistry 135 5 Representations of the Natural System in the Nineteenth Century 164 6 Visual Representation in Archaeology: Depicting the Missing-Link in Human (...) Origins 184 7 Towards an Epistemology of Scientific Illustration 215 8 Illustration and Inference 250 9 Visual Models and Scientific Judgment 269 10 Are Pictures Really Necessary? The Case of Sewall Wright’s ’Adaptive Landscapes’ 303 Bibliography 339 Notes on Contributors 373 Index 377. (shrink)

The gist of the many-subjects argument is that, given physicalism, it’s hard to avoid the absurd result that there are many conscious subjects in your vicinity with more-or-less the same experiences as you. The most promising ways of avoiding this result have a consequence almost as bad: that there are many things in your vicinity that are in a state only trivially different from being conscious, a state with similar normative significance. This paper clarifies and defends three versions of the (...) many-subjects argument. One version poses the threat of conscious parts. Its key premise is that if physicalism is true, then not only you, but also certain parts of your body, are conscious. These parts might include your brain, your head, all-of-you-except-your-left-pinky, all-of-your-brain-except-one-neuron, or your left cerebral hemisphere. A second version poses the threat of conscious coinciders, things that currently occupy the same spatial region as you and share all your matter. Its key premise is that if physicalism is true, then not only you, but also some things that currently coincide with you, are conscious. These might include your body or the aggregate of particles of which you are currently composed. A third version poses the threat of conscious person candidates, the many human-body-shaped material objects in your vicinity that mostly overlap one another, differing only in a few peripheral atoms. This version claims that if physicalism is true, then there are many conscious person-candidates in your vicinity. -/- . (shrink)

Can war ever be just? By what right do we charge people with war crimes? Can war itself be a crime? What is a good peace treaty? Since the Cold War ended in the early 1990s, many wars have erupted, inflaming such areas as the Persian Gulf, Central Africa and Central Europe. Brutalities committed during these conflicts have sparked new interest in the ethics of war and peace. Brian Orend explores the ethics of war and peace from a Kantian (...) perspective, emphasizing human rights protection, the rule of international law and a fully global concept of justice. Contending that Kant’s just war doctrine has not been given its due, Orend displays Kant’s theory to its fullest, impressive effect. He then completely and clearly updates Kant’s perspective for application to our time. Along the way, he criticizes pacifism and realism, explores the nature of human rights protection during wartime, and defends a theory of just war. He also looks ahead to future developments in global institutional reform using cases from the Persian Gulf War, Somalia, Bosnia, and Rwanda to illustrate his argument. Controversial and timely, perhaps the most important contribution War and International Justice: A Kantian Perspective makes is with regard to the question of justice after war. Orend offers a principled theory of war termination, making an urgent plea to reform current international law. (shrink)

War should be understood as an actual, intentional and widespread armed conflict between political communities. Thus, fisticuffs between individual persons do not count as a war, nor does a gang fight, nor does a feud on the order of the Hatfields versus the McCoys. War is a phenomenon which occurs only between political communities, defined as those entities which either are states or intend to become states (in order to allow for civil war). Classical war is international war, a war (...) between different states, like the two World Wars. But just as frequent is war within a state between rival groups or communities, like the American Civil War. Certain political pressure groups, like terrorist organizations, might also be considered “political communities,” in that they are associations of people with a political purpose and, indeed, many of them aspire to statehood or to influence the development of statehood in certain lands. (shrink)

Thomas Aquinas was one of the greatest Western philosphers and one of the greatest theologians of the Christian church. In this book we at last have a modern, comprehensive presentation of the total thought of Aquinas. Books on Aquinas invariably deal with either his philosophy or his theology. But Aquinas himself made no arbitrary division between his philosophical and his theological thought, and this book allows readers to see him as a whole. It introduces the full range of Aquinas' thinking; (...) and it relates his thinking to writers both earlier and later than Aquinas himself. (shrink)