In the “Appendix” to the Treatise, Hume claims that he has discovered a “very considerable” mistake in his earlier discussion of the self. Hume's expression of the problem is notoriously opaque, leading to a vast scholarly debate as to exactly what problem he identified in his earlier account of the self. I propose a new solution to this interpretive puzzle. I argue that a tension generated by Hume's conceptual skepticism about real “principles of union” and his account of fictions of (...) the imagination is the defect identified in the “Appendix.”. (shrink)

Book reviewed in this article: Balancing Act: The New Medical Ethics of Medicine's New Economics. By E. Haavi Morreim.

One of the most important questions in the ethics of human clinical research asks what obligations investigators owe the people who enroll in their studies. Research differs in many ways from standard care - the added uncertainties, for instance, and the nontherapeutic interventions such as diagnostic tests whose only purpose is to measure the effects of the research intervention. Hence arises the question whether a physician engaged in clinical research has the same obligations toward research subjects that he owes his (...) medical patients, or whether they differ in any fundamental way.Perhaps the most common answer is that the relationship is the same. Investigators, like physicians, are said to be fiduciaries of the volunteers who enroll in research trials. Each owes the best available medical care, which means that a physician can only justify enrolling his patient in research if the study meets the requirements of clinical equipoise, namely, that there is legitimate disagreement within the medical community as to whether the standard treatment or the investigational intervention is superior. (shrink)

One of the most important questions in the ethics of human clinical research asks what obligations investigators owe the people who enroll in their studies. Research differs in many ways from standard care - the added uncertainties, for instance, and the nontherapeutic interventions such as diagnostic tests whose only purpose is to measure the effects of the research intervention. Hence arises the question whether a physician engaged in clinical research has the same obligations toward research subjects that he owes his (...) medical patients, or whether they differ in any fundamental way.Perhaps the most common answer is that the relationship is the same. Investigators, like physicians, are said to be fiduciaries of the volunteers who enroll in research trials. Each owes the best available medical care, which means that a physician can only justify enrolling his patient in research if the study meets the requirements of clinical equipoise, namely, that there is legitimate disagreement within the medical community as to whether the standard treatment or the investigational intervention is superior. (shrink)

Rarely do ethics consults focus on genuine moral puzzlement in which people collectively wonder what is the right thing to do. Far more often, consults are about conflict. Each side knows quite well what is “right.” The problem is that the other side is too blind or stubborn to recognize it. And so the ethics consultant is called, perhaps in the hope that s/he will throw the weight of ethics toward one side and end the controversy so everyone can get (...) on with other business. Perhaps the greater problem in these scenarios is that even if one side “wins” by gaining the power to dictate what happens next, the toxicity permeating the relationships often markedly worsens and other conflicts erupt, major and minor. (shrink)

Hume’s claim that we project necessity onto objects we take to be causally related has been influential in contemporary discussions of modality, inspiring deflationary accounts of our modal commitments. Hume is commonly understood as holding that modal projection explains our judging that an effect must follow its cause. This misunderstands the role of projection in Hume’s discussions of causation and causal judgement. Projection is a diagnosis of a distinctively philosophical confusion: the commitment to mind-independent necessary connections. In arguing for this, (...) I provide an account of the psychological process that, in Hume’s view, underlies projection. This account resolves problems with Hume’s projectivism identified by his commentators. (shrink)

This essay contains an attempt to trace the evolution of the concept of wisdom as found in the thought of Aristotle and Aquinas in terms of how the philosophical concept of wisdom as an intellectual virtue is understood and used to express the theological concept of wisdom as a gift of the Holy Spirit. The main aim is to understand how Aquinas derived the concept of wisdom from Aristotle's metaphysics and developed it in his mysticism. This research is based on (...) a close study of Book Six of Aristotle's Nichomachean Ethics, the corresponding sections of Aquinas' Sententia libri Ethicorum and question forty-five of the second part of the second part of Aquinas' Summa Theologiae. The insights gained from the study are then used to decipher the theoretical meaning of Augustine's famous saying: "love and do what thou wilt" and to expound on the practical value of wisdom for religious leaders. (shrink)

The discussion about complementary and alternative medicine is sometimes rather heated. “Quackery!” the cry goes. A large proportion “of unconventional practices entail theories that are patently unscientific.” “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.” “I submit that (...) if these treatments cannot withstand the test of empirical research, … then we have wasted a lot of time and effort. The time has been wasted on all the people who have spent years learning falsehoods about acupuncture points and the principles of homeopathy. And the patients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.”. (shrink)

Human clinical research trials, by which corporations, universities, and research scientists bring new drugs, devices, and procedures into the practice and marketplace of medicine, have become a huge business. The National Institutes of Health doubled its spending over the past five years, while in the private sector the top twenty pharmaceutical companies have more than doubled their investment in research and development over a roughly comparable period. To date, some twenty million Americans have participated in clinical research trials that now (...) are as common in the private practice setting as in academia.For many years human clinical trials received relatively little public attention. In the wake of several well-publicized research abuses, Congress created in 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to formulate recommendations to protect human research subjects. The Commission’s 1979 Belmont Report helped to guide the Institutional Review Boards that review the ethics of federally funded research. (shrink)

Human clinical research trials, by which corporations, universities, and research scientists bring new drugs, devices, and procedures into the practice and marketplace of medicine, have become a huge business. The National Institutes of Health doubled its spending over the past five years, while in the private sector the top twenty pharmaceutical companies have more than doubled their investment in research and development over a roughly comparable period. To date, some twenty million Americans have participated in clinical research trials that now (...) are as common in the private practice setting as in academia.For many years human clinical trials received relatively little public attention. In the wake of several well-publicized research abuses, Congress created in 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to formulate recommendations to protect human research subjects. The Commission’s 1979 Belmont Report helped to guide the Institutional Review Boards that review the ethics of federally funded research. (shrink)

Tort and contract law have not kept pace with the stunning changes in medicine's economics. Physicians are still expected to deliver the same standard of care to everyone, regardless whether it is paid for. Health plans increasingly face liability for unfortunate outcomes, even those stemming from society's mandate to keep costs down while improving population health. This book sorts through the chaos. After reviewing the inadequacies of current tort and contract law, Morreim proposes that an intelligent assignment of legal (...) liability must rest on an intelligent division of labor between health plans and providers, beginning with the question "who should be doing what, for the best delivery of health care." She also provides a comprehensive reference source of case law, commentary, and empirical literature. (shrink)

This paper aims to clarify Locke’s distinction between simple and complex ideas. I argue that Locke accepts what I call the “compositional criterion of simplicity.” According to this criterion, an idea is simple just in case it does not have another idea as a proper part. This criterion is prima facie inconsistent with Locke’s view that there are simple ideas of extension. This objection was presented to Locke by his French translator, Pierre Coste, on behalf of Jean Barbeyrac. Locke responded (...) to Barbeyrac’s objection, but his response, along with a passage from Chapter XV of Book II of the Essay, “Of Duration and Expansion, considered together,” has been taken to show that he did not accept the compositional criterion. I examine these passages and argue that they are not in tension with but rather affirm that criterion. (shrink)

Storchak, Ehlis, and Fallgatter provide an extensive literature review on electrophysiological measurements, which indicate that general predictive deficits in self‐monitoring are associated with various positive symptoms in patients with schizophrenia.

The discussion about complementary and alternative medicine is sometimes rather heated. “Quackery!” the cry goes. A large proportion “of unconventional practices entail theories that are patently unscientific.” “It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.” “I submit that (...) if these treatments cannot withstand the test of empirical research, … then we have wasted a lot of time and effort. The time has been wasted on all the people who have spent years learning falsehoods about acupuncture points and the principles of homeopathy. And the patients have wasted their time, money, and efforts receiving treatments that were not what they were represented to be or were harmful.”. (shrink)

Public discussion of new medical trials is desirable, but not moment‐by‐moment disclosure of patients' ups and down. Nor is such disclosure necessary: the public is not entitled to all information about a trial as soon as it is available. What should be given the press, and what withheld, cannot be decided without appreciating the surprising number and intricate interrelations of the parties' needs and interests.

The federal government's introduction in 1983 of DRG‐based reimbursement for Medicare patients shook the entire health care industry into the vigorous and dramatic cost containment efforts which today are reshaping health care in America.

Fiester and Yuan (2023) address an important, hitherto underdiscussed issue: ethical hazards of behavior contracts linked to patients’ and families’ demeanor in interacting with the healthcare team...

The “futility debate” turns on intractable conflicts of deeply held beliefs about the value of life. It raises practical moral dilemmas of how best to permit parties to honor their own values without coercing unwilling others.

Universal access to health care is still a dream rather than a reality in the United States. This is partly because a rule of rescue, by impelling us to help people in need, urges us to ignore the limits of our health care policies wherever those limits would adversely affect a given individual. As the rule of rescue undermines whatever limits we set on health care entitlements, it can thwart the cost containment so essential to expanding access. Rather than accept (...) unlimited expense, we have thus far declined to universalize health care. The situation is exacerbated by an economic insulation shielding patients and physicians from the costs of care, prompting both to regard health care as free, an unlimited right. To reverse this costly entitlement mentality and place reasonable limits on rescue, patients must exercise greater personal responsibility for the costs of their care by directly experiencing some of the economic consequences of their health care decisions. Several mechanisms are available to accomplish this goal without posing economic barriers to needed care or penalizing people for becoming ill. Keywords: Clinton health plan, rationing, rule of rescue CiteULike Connotea Del.icio.us What's this? (shrink)

In contemporary debates in religious epistemology, theistic philosophers provide differing responses to the evidentialist argument against religious beliefs. Plantinga’s strategy is to argue that evidence is not needed to justify religious beliefs while Swinburne’s strategy is to argue that religious beliefs can be justified by evidence. However, in Aquinas’ account of religious epistemology, he seems to employ both strategies. In his account of religious knowledge by faith, he argues that evidence is unnecessary for religious beliefs. But in his account of (...) religious knowledge by science, he argues that there is evidence for religious beliefs. In this paper, I argue that there is no real dichotomy between Plantinga’s and Swinburne’s responses to the evidentialist argument. From a Thomistic perspective, Reformed Epistemology and Natural Theology are different but compatible responses to Evidentialism. (shrink)

Autumn Fiester (2015) argues that when an ethics consult simply issues a recommendation it may leave a vacuum then filled by moral distress or moral emotion. “Assisted conversation”—a dialogue-focu...

In this paper I address the phenomenon of syncretism with respect to Chinese religions. An analysis of the syncretism that takes place between the three major Chinese religious traditions is first done in its personal and social dimensions. The social structure of Chinese religion is then used as a framework to understand how Buddhism and Daoism were made compatible with Confucianism. All this will serve as a background for the case study of Macau, where Chinese religious syncretism is very much (...) alive. Three popular religious festivals are celebrated annually and simultaneously on the eighth day of the fourth lunar month, namely, zuilongjie (醉龍節) Feast of the Drunken Dragon, tangongdan (譚公誕) Tam Kung Festival and fodanjie (佛誕節) Feast of the Buddha. (shrink)

The Molyneux problem is one of the major questions addressed by early modern authors. Whereas Locke’s response to Molyneux’s question has been the subject of extensive scholarly discussion, Leibniz’s response has received comparatively little attention. This paper defends an interpretation of Leibniz’s nuanced response to the problem and criticizes a competing interpretation that has recently been proposed.

That Socrates took himself to possess a divine sign is well attested by ancient sources. Both Plato and Xenophon mention Socrates’ daimonion on numerous occasions. What is problematic for contemporary scholars is that Socrates unfailingly obeys the warnings of his sign. Scholars have worried that Socrates seems to ascribe greater epistemic authority to his sign than his own critical reasoning. Moreover, he never so much as questions the authority of his sign to guide his actions, much less its divine nature. (...) Socrates’ unquestioning obedience to his sign thus appears to be in conflict with another of Socrates’ defining characteristics: namely, his relentless rationality. However, Socrates does not seem to recognize such inconsistency. The problem of the daimonion, then, is this: is Socrates’ professed commitment to rationality consistent with his unquestioning deference to his daimonion’s warnings? And if so, how? In this paper, I first discuss several solutions to the problem of the daimonion. I aim to show that none of the accounts of Socrates’ sign that have appeared in the scholarly literature are adequate. I then propose a new account of the daimonion, which, I argue, secures the rationality of Socrates’ obedience to his divine sign. (shrink)

Cost‐containment pressures impose fiscal responsibilities upon physicians that can conflict with their fiduciary commitment to patients. Should the law permit health care providers to adjust standards of care according to patients' financial resources? The legal concept of “rebuttable presumption” should be used to reconceive the traditional requirement of a uniform standard of care.

In response to rapidly rising health care costs in the United States, federal and state governments and private industry are instituting numerous and diverse cost-containment plans. As devices for coping with a scarcity of resources, such plans present serious challenges to physicians' traditional single-minded devotion to patient welfare. Those which contain costs by directly limiting medical options or by controlling physicians' daily clinical decisions can threaten the quality of medical care by allowing economic authorities to make essentially medical judgments. In (...) contrast, other plans coax compliance by arranging incentives, e.g., offering financial rewards for successful cost containment. While they allow for clinical freedom, these plans create conflicts between physicians' fiduciary obligations to their patients and the competing interests of the payers. Such conflicts arise as physicians try to work within governmental or corporate cost containment policies, and also as they attempt to streamline clinical efficiency. Throughout, issues of justice emerge as physicians seek to reconcile their own patients' claims upon limited common resources with others' equally legitimate claims. (shrink)

Confucian education is best captured by the programme described in the Great Learning. Education is presented first as the process of self-cultivation for the sake of developing virtuous character. Self-cultivation then allows for virtue to be cultivated in the familial, social and international dimensions. My central thesis is that Confucianism can serve as a universal framework of educating people for the common good in its promotion of personal cultivation for the sake of human progress. On this account the common good (...) specifically refers to the social order accomplished by the virtuous behaviour found in the members of society. In this paper I argue that the Confucian notion of “lesser learning” sheds light on the concept of general education and the notion of “greater learning” improves our understanding of liberal education. Under this analysis the necessity of general education is assured although its importance should not be overly exaggerated. Furthermore, the objectives of liberal education deserve greater emphasis due to their historical importance and enduring relevance to promoting the common good of universal humanity. (shrink)

In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...) we should do from the broader universe of what we can do.The challenges to measuring QL are formidable. Researchers debate whether to measure general QL or disease-specific QL; whether to focus on functional status such as the patient's ability to walk and dress himself, or on the value people ascribe to that functional status; whether to seek the values of the general public, or to concentrate on people actually affected by a given disease or disability. (shrink)

In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...) we should do from the broader universe of what we can do.The challenges to measuring QL are formidable. Researchers debate whether to measure general QL or disease-specific QL; whether to focus on functional status such as the patient's ability to walk and dress himself, or on the value people ascribe to that functional status; whether to seek the values of the general public, or to concentrate on people actually affected by a given disease or disability. (shrink)