The aim of this article is to analyse the contemporary ‘futility discourse’ from a constructivist perspective. I will argue that bioethics discourse typically disregards the con text from which controversies emerge and the processes that inform and constrain such discourse. Constructivists have argued that scientific knowledge is expressive of the dominant paradigm within which a scientific community is working. I will outline an analysis of ‘medical futility’ as a construction of biomedical and bioethical communities (and their respective paradigms). I will (...) trace the emergence and utilization of futility in the literature. My analysis of the context (i.e. the historical circumstances, the particular actors involved) within which the futility discourse emerged suggests that medical futility was constructed, in part, as a means of enhancing physician domination of a context wherein medical authority was threatened. The actors in this debate express widely divergent frameworks of ‘the good’, arguing from distinctive representations of moral agency. At times, this controversy has been argued from incommensurate moral horizons wherein the discussants debate incomparable problems. This discussion is related to a study of the ‘practice’ of futility in the clinical context. Further studies on the construction of bioethical problems are a necessary condition for supporting the truth claims of bioethical arguments. (shrink)

Theoretical and empirical research in bioethics frequently focuses on ethical dilemmas or problems. This paper draws on anthropological and phenomenological sources to develop an alternative framework for bioethical enquiry that allows examination of a broader range of how the moral is experienced in the everyday lives of individuals and groups. Our account of moral experience is subjective and hermeneutic. We define moral experience as “Encompassing a person's sense that values that he or she deem important are being realised or thwarted (...) in everyday life. This includes a person's interpretations of a lived encounter, or a set of lived encounters, that fall on spectrums of right-wrong, good-bad or just-unjust”. In our conceptualisation, moral experience is not limited to situations that are heavily freighted with ethically-troubling ramifications or are sources of debate and disagreement. Important aspects of moral experience are played out in mundane and everyday settings. Moral experience provides a research framework, the scope of which extends beyond the evaluation of ethical dilemmas, processes of moral justification and decision-making, and moral distress. This broad research focus is consistent with views expressed by commentators within and beyond bioethics who have called for deeper and more sustained attention in bioethics scholarship to a wider set of concerns, experiences and issues that better captures what is ethically at stake for individuals and communities. In this paper we present our conceptualisation of moral experience, articulate its epistemological and ontological foundations and discuss opportunities for empirical bioethics research using this framework. (shrink)

Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. (...) The primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

The use of biotechnology in food productiongives rise to consumer concerns. The term ``consumerconcern'' is often used as a container notion. Itincludes concerns about food safety, environmental andanimal welfare consequences of food productionsystems, and intrinsic moral objections againstgenetic modification. In order to create clarity adistinction between three different kinds of consumerconcern is proposed. Consumer concerns can be seen assigns of loss of trust. Maintaining consumer trustasks for governmental action. Towards consumerconcerns, governments seem to have limitedpossibilities for public policy. Under current (...) WTOregulations designed to prevent trade disputes,governments can only limit their policies to 1) safetyregulation based upon sound scientific evidence and 2)the stimulation of a system of product labeling. Ananalysis of trust, however, can show that ifgovernments limit their efforts in this way, they willnot do enough to avoid the types of consumer concernsthat diminish trust. The establishment of a technicalbody for food safety – although perhaps necessary –is in itself not enough, because concerns that relatedirectly to food safety cannot be solved by ``pure''science alone. And labeling can only be a good way totake consumer concerns seriously if these concerns arerelated to consumer autonomy. For consumer concernsthat are linked to ideas about a good society,labeling can only provide a solution if it is seen asan addition to political action rather than as itssubstitution. Labeling can help consumers take uptheir political responsibility. As citizens, consumershave certain reasonable concerns that can justifiableinfluence the market. In a free-market society, theyare, as buyers, co-creators of the market, andsocietal steering is partly done by the market.Therefore, they need the information to co-create thatmarket. The basis of labeling in these cases, however,is not the good life of the individual but thepolitical responsibility people have in their role asparticipants in a free-market. Then, public concernsare taken seriously. Labeling in that case does nottake away the possibilities of reaching politicalgoals, but it adds a possibility. (shrink)

The use of a concept called "explicativity", for (provisionally) accepting a theory or Hypothesis H, has previously been discussed. That previous discussion took into account the prior probability of H, and hence implicitly its theoretical simplicity. We here suggest that a modification of explicativity is required to allow for what may be called the pragmatic simplicity of H, that is, the simplicity of using H in applications as distinct from the simplicity of the description of H.

Augustine’s metaphysics is a subject little studied, but often much criticized. Among the recent studies of Augustine’s metaphysics, Scott MacDonald’s interpretation of Augustine’s notion of goodness claims that Augustine’s account is incoherent. This suggests a reading of Augustine that is somewhat problematic. This article argues that much of the difficulty that MacDonald claims rests on a misunderstanding of Augustine’s views about the goodness of creation and existence and the corruptibility of created things. Augustine’s position takes for granted an understanding of (...) existence as a good and the participation of all things in the pre–eminent good, that is God. (shrink)

Iris Murdoch’s Metaphysics as a Guide to Morals ranges wide over the field of Western philosophical thought. Throughout the work, Murdoch proposes and enacts a form of philosophical inquiry that she believes supports a moral philosophy based on the idea of the good. One of her attempts, partly inspired by Paul Tillich and J. N. Findlay, centers on her critique and appropriation of the structure of the so-called “ontological argument” in Anselm’s Proslogion. This study assesses Murdoch’s accomplishment and the (...) tenability of the kind of Platonism she proposes against Anselm’s argument about the good in both the Monologion and the Proslogion. My claim is that Anselm’s conception of the good simply does not permit the kind of interpretation that Murdoch puts on the “ontological argument.”. (shrink)

Objective: To assess the adequacy of the process of informed consent for surgical patients at the University Hospital of the West Indies. Method: The study is a prospective, cross-sectional, descriptive study. 210 patients at the University Hospital of the West Indies were interviewed using a standardised investigator-administered questionnaire, developed by the authors, after obtaining witnessed, informed consent for participation in the study. Data were analysed using SPSS V.12 for Windows. Results: Of the patients, 39.4% were male. Of the surgical procedures, (...) 68.6% were scheduled, 7.6% urgent and 23.8% emergency, 35.2% were minor and 64.8% major. Information imparted/received was acceptable in 40% of cases, good in 24% and inadequate (unacceptable) in 36% of cases. Almost all (97.6%) patients stated that they understood why an operation was planned and 93.3% thought that they had given informed consent. Most (95.2%) thought that they had free choice and made up their own mind. A quarter (25.2%) of all patients were told that it was mandatory for them to sign the form. There was a discussion of possible side effects and complications in 56.7% of patients. Conclusions: This study clearly indicates that surgical patients at the University Hospital of the West Indies feel that they have given informed consent. However, it also suggests that more information should be given to patients for consent to be truly informed. (shrink)

Writing about the intellectual development of a philosopher is a delicate business. My own endeavor to reinterpret the influence of Hegel on Dewey troubles some scholars because, they believe, I make Dewey seem less original.1 But if, like Dewey, we overcome Cartesian dualism, placing the development of the self firmly within a complex matrix of social processes, we are forced to reexamine, without necessarily surrendering, the notion of individual originality, or what Neil Gross calls “discourse[s] of creative genius.”2 To use (...) a mundane example, I can recall several conversations with Dewey scholars about his dislike for his home state of Vermont, all of which revolved around personal reasons he may.. (shrink)

Perhaps no one in the English speaking world has carried on a philosophical defence of theism like Richard Swinburne. Yet in all of Swinburne's work there is little use of a long‐standing view in the Christian tradition that God is good, and that his goodness is interchangeable with his being. While Swinburne does little with the idea of goodness, Iris Murdoch proposes an anti‐theistic view that insists on the Good without God. My argument is that both Swinburne's indifference (...) to the notion of the good and Murdoch's ‘Good without God’ take away from the promise of theism. I suggest an Augustinian alternative that insists on the equation of God and the Good without falling into the problems inherent in both Swinburne and Murdoch's views. (shrink)

Some day, it may be, a betterGreek scholar and more skilful emendator than I will summon to hisaid from among scientists familiar with the Levant a botanist, aherbalist, a herpetologist, and an entomologist, empanel forconsultations a small body of medical men who have practised in theNear East, and produce an annotated text and translation of Nicander;and when this has been done it will be possible to read him, notindeed with pleasure, but with a good deal less labour and vexationthan (...) attend the process at present. Meanwhile, those whose dutyobliges them to struggle through the Theriaca andAlexipharmaca with the aids now available stand in no need ofthe injunction not to forget him which the author has appended tothose two poems. (shrink)

This volume contains the Dialogues, The Natural History of Religion, and several short essays and selections from other works. The selection is a good one, but the editor's introduction does little to explicate the principles upon which Hume's writings on religion are based or to connect them with his other philosophical work.—A. F. G.

BackgroundBiobanks and biomedical research data repositories collect their samples and associated data from volunteer participants. Their aims are to facilitate biomedical research and improve health, and they are framed in terms of contributing to the public good. Biobank resources may be accessible to researchers with commercial motivations, for example, researchers in pharmaceutical companies who may utilise the data to develop new clinical therapeutics and pharmaceutical drugs. Studies exploring citizen perceptions of public/private interactions associated with large health data repositories/biobanks indicate (...) that there are sensitivities around public/private and/or non-profit/profit relationships and international sample and data sharing. Less work has explored how biobanks communicate their public/private partnerships to the public or to their potential research participants. MethodsWe explored how a biobank’s aims, benefits and risks, and private/public relationships have been framed in public facing recruitment documents.ResultsBiobank documents often communicate their commercial access arrangements but not the detail about what these interactions would entail, and how risks and benefits would be distributed to the public.ConclusionWe argue that this leads to a polarised discourse between public and private entities and/or activities, and fails to attend to the blurred lines between them. This results in a lack of attention to more important issues such as how risks and benefits in general are distributed to the public. We call for a nuanced approach that can contribute to the much-needed dialogue in this space. (shrink)

This large anthology offers a well-chosen selection of writings on defining the good, the free-will problem, ethical method, and political and social implications of ethics. Of special interest is the inclusion of four relevant articles by social scientists. Editorial material is brief but useful and the selections are of ample length, several complete works being included.—A. F. G.

Contains three lectures on vaguely related topics. John Cogley outlines the sources of religious conflict in the United States. Holding that the First Amendment was intended not to discourage religion but to promote religious liberty, he develops principles for the solution of problems of Church-State relations. Paul Weiss discusses the more theoretical problem of the relationship of natural and supernatural law. Natural law derives from a common good relative to a particular group, and is strictly utilitarian. Reference to a (...) supernatural or divinely given good is necessary to adjudicate between and order the differing and possibly conflicting common goods of different groups, and to provide for ethical laws that transcend utilitarian considerations. John Wu sees the main prerequisite of a future world democracy as a meeting of the insights and cultures of the East and West.--A. F. G. (shrink)

In the Nicomachean Ethics, Aristotle appears to use an elegant short argument to attack Plato's doctrine of the good, which argument equally appears to attack Aristotle's own doctrine of the good. I consider these two questions: First: Why does Aristotle reverse the judgment of Socrates/Plato on the issue: Which is better - things that are good in themselves, or things that are both good in themselves and good for their consequences? Second: Why does Aristotle attack (...) Plato's doctrine that the Form of the Good is the chief good, with an argument that appears to threaten his own view that eudaimonia is the chief good? I think the answers to these two questions are related. The elegant short argument in question I call "Aristotle's Fast Argument." After apologizing for criticizing views held by friends of his, Aristotle deploys the Fast Argument as a clincher to cap off his refutation of Plato's view that the Form of the Good is the chief good: "And one might ask the question, what in the world they mean by 'a thing itself', if in man himself and in a particular man the account of man is one and the same. For in so far as they are men, they will in no respect differ; and if this is so, neither will there be a difference in so far as they are good. But again it will not be good any the more for being eternal, since that which lasts long is no whiter than that which perishes in a day.". I explore this sketchily presented Fast Argument. I consider why Aristotle may think it is valid and why he does not seem to realize that, on readings that make it effective against Plato's view, his Fast Argument also seems to apply to his own view that eudaimonia is the chief good. This is what I will call "Aristotle's Dilemma." If the Fast Argument is interpreted too narrowly, its point about the whiteness of a white thing being independent of its duration will not apply to the goodness of the Form of the Good. If it is interpreted broadly enough to undermine the claim of the Form of the Good to be the chief good, it will equally undermine that claim for eudaimonia. Finally, I discuss some of the things Plato and Aristotle say about the chief good, and comparable things Immanuel Kant says about the good will. I draw some speculative conclusions that focus on the importance for Aristotle of the goodness of the chief good not being at risk. (shrink)

Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This (...) article aims at describing the experiences and processes of two MCD groups with client participation in a mental healthcare institution. A responsive evaluation was conducted examining stakeholders’ issues concerning client participation. Findings demonstrate that participation initially creates uneasiness. As routine builds up and client participants meet certain criteria, both clients and professionals start thinking beyond ‘us-them’ distinctions, and become more equal partners in dialogue. Still, sentiments of distrust and feelings of not being safe may reoccur. Client participation in MCD thus requires continuous reflection and alertness on relational dynamics and the quality of and conditions for dialogue. Participation puts the essentials of MCD (i.e., dialogue) to the test. Yet, the methodology and features of MCD offer an appropriate platform to introduce client participation in healthcare institutions. (shrink)

Some day, it may be, a betterGreek scholar and more skilful emendator than I will summon to hisaid from among scientists familiar with the Levant a botanist, aherbalist, a herpetologist, and an entomologist, empanel forconsultations a small body of medical men who have practised in theNear East, and produce an annotated text and translation of Nicander;and when this has been done it will be possible to read him, notindeed with pleasure, but with a good deal less labour and vexationthan (...) attend the process at present. Meanwhile, those whose dutyobliges them to struggle through the Theriaca andAlexipharmaca with the aids now available stand in no need ofthe injunction not to forget him which the author has appended tothose two poems. (shrink)

Neptunus et Apollo dicuntur Troiam muro cinxisse; his rex Laomedon uouit quod regno suo pecoris eo anno natum esset immolaturum. id uotum auaritia fefellit. alii dicunt †parum eum promisisse. The story that Neptune and Apollo together built the walls of Troy for Laomedon is well known from Homer. At the end of their year's service the perfidious king refused to pay the agreed wages. Ovid tells the familiar story in one of his transitional sections in the Metamorphoses. Hyginus' account poses (...) the textual problem indicated above. H. I. Rose comments on ‘parum’ as follows: ‘procul dubio corruptum hoc neque arridet Schmidtii coniectura promsisse. fuitne partum equarum? hoc enim plerumque narratur, equos quos a Ioue accepisset promisisse Laomedontem mercedis nomine…sed Herculi; quod facile ad deos mercennarios transferri potuit; atque non equos sed equas fuisse tradit Apollod. II, 104’. Rose rightly rejects Schmidt's emendation ‘promsisse’. ‘Promisisse’ has every sign of soundness and the difficulty lies, as Rose sees, with ‘parum’. Rose's own conjecture ‘partum equarum’, however, will not do. Apart from the oddity of the expression, one would need a good deal more persuasion than Rose offers to accept that the well-known promise of Zeus' horses which Laomedon made to Hercules was transferred from Hercules to Neptune and Apollo. There is no suggestion anywhere in the sources that Laomedon promised to give Neptune and Apollo the famous horses as payment for building the walls. (shrink)

Neptunus et Apollo dicuntur Troiam muro cinxisse; his rex Laomedon uouit quod regno suo pecoris eo anno natum esset immolaturum. id uotum auaritia fefellit. alii dicunt †parum eum promisisse. The story that Neptune and Apollo together built the walls of Troy for Laomedon is well known from Homer. At the end of their year's service the perfidious king refused to pay the agreed wages. Ovid tells the familiar story in one of his transitional sections in the Metamorphoses. Hyginus' account poses (...) the textual problem indicated above. H. I. Rose comments on ‘parum’ as follows: ‘procul dubio corruptum hoc neque arridet Schmidtii coniectura promsisse. fuitne partum equarum? hoc enim plerumque narratur, equos quos a Ioue accepisset promisisse Laomedontem mercedis nomine…sed Herculi; quod facile ad deos mercennarios transferri potuit; atque non equos sed equas fuisse tradit Apollod. II, 104’. Rose rightly rejects Schmidt's emendation ‘promsisse’. ‘Promisisse’ has every sign of soundness and the difficulty lies, as Rose sees, with ‘parum’. Rose's own conjecture ‘partum equarum’, however, will not do. Apart from the oddity of the expression, one would need a good deal more persuasion than Rose offers to accept that the well-known promise of Zeus' horses which Laomedon made to Hercules was transferred from Hercules to Neptune and Apollo. There is no suggestion anywhere in the sources that Laomedon promised to give Neptune and Apollo the famous horses as payment for building the walls. (shrink)

In the Nicomachean Ethics, Aristotle appears to use an elegant short argument to attack Plato’s doctrine of the good, which argument equally appears to attack Aristotle’s own doctrine of the good. I consider these two questions: First: Why does Aristotle reverse the judgment of Socrates/Plato on the issue: Which is better – things that are (only) good in themselves, or things that are both good in themselves and good for their consequences? Second: Why does Aristotle (...) attack Plato’s doctrine that the Form of the Good is the chief good, with an argument that appears to threaten his own view that eudaimonia is the chief good? I think the answers to these two questions are related. The elegant short argument in question I call “Aristotle’s Fast Argument.”After apologizing for criticizing views held by friends of his, Aristotle deploys the Fast Argument as a clincher to cap off his refutation of Plato’s view that the Form of the Good is the chief good: “And one might ask the question, what in the world they mean by ‘a thing itself’, if in man himself and in a particular man the account of man is one and the same. For in so far as they are men, they will in no respect differ; and if this is so, neither will there be a difference in so far as they are good. But again it will not be good any the more for being eternal, since that which lasts long is no whiter than that which perishes in a day.” (Aristotle, Nichomachean Ethics, 1096 a34–b4). I explore this sketchily presented Fast Argument. I consider why Aristotle may think it is valid and why he does not seem to realize that, on readings that make it effective against Plato’s view, his Fast Argument also seems to apply to his own view that eudaimonia is the chief good. This is what I will call “Aristotle’s Dilemma.” If the Fast Argument is interpreted too narrowly, its point about the whiteness of a white thing being independent of its duration will not apply to the goodness of the Form of the Good. If it is interpreted broadly enough to undermine the claim of the Form of the Good to be the chief good, it will equally undermine that claim for eudaimonia. Finally, I discuss some of the things Plato and Aristotle say about the chief good, and comparable things Immanuel Kant says about the good will. I draw some speculative conclusions that focus on the importance for Aristotle of the goodness of the chief good not being at risk. (shrink)

Intended as an introduction to ethics, this book examines four main problems: obligation, moral value, intrinsic goods and the justification of moral judgments. Frankena's approach to each problem is to examine critically the main types of theory and then develop his own position. Of particular interest is his discussion of the meaning and justification of moral judgments; while joining recent English thought in holding that a non-descriptivist position does not imply the impossibility of sensible discussion of normative problems, Frankena suggests (...) that this need not necessitate even an ultimate relativism, since broad standards of rationality may be applied in cases of conflict. By approaching ethics through types of ethical theory rather than concrete examples, and because of the great variety of subjects discussed within this brief compass, a necessary over-simplification and superficiality results which may inhibit the beginning student from developing his own thinking. A more selective approach might have been both less confusing and more stimulating.--A. F. G. (shrink)

At some time during the years 398–395 B.C. the people of Rhodes revolted against Sparta, freed themselves from the oppression of the Spartan empire and admitted to their city the Persian fleet commanded by Conon, the Athenian. This fact was overlooked by Xenophon, but reported by Diodorus and Pausanias who quotes Androtion. It seemed, before the discovery of the Hellenica Oxyrhynchia, that the revolt of Rhodes from Sparta was in some way associated with internal party strife, for Xenophon relates that (...) exiled Rhodian oligarchs appealed to Sparta for help in 391 B.C. Such an interrelation between internal politics and foreign policy had, of course, been a feature of Greek political life since the early years of the Peloponnesian War, as Thucydides was not slow to recognize. The discovery of the Hellenica Oxyrhynchia, which devotes a chapter to a democratic revolution at Rhodes in 395 B.C, provided a good deal of new information on the political situation in that city, notably that, contrary to what we might have expected, the revolt from Sparta and the democratic revolution were not contemporaneous. Let us review briefly the details of these two events as far as our information permits. (shrink)

We consider random choice rules that, by satisfying a weak form of Luce’s choice axiom, embody a form probabilistic rationality. We show that for this important class of stochastic choices, the law of demand for normal goods—arguably the main result of traditional consumer theory—continues to hold on average when strictly dominated alternatives are dismissed.

The qualitative theory of nomic truth approximation, presented in Kuipers in his, in which ‘the truth’ concerns the distinction between nomic, e.g. physical, possibilities and impossibilities, rests on a very restrictive assumption, viz. that theories always claim to characterize the boundary between nomic possibilities and impossibilities. Fully recognizing two different functions of theories, viz. excluding and representing, this paper drops this assumption by conceiving theories in development as tuples of postulates and models, where the postulates claim to exclude nomic impossibilities (...) and the models claim to represent nomic possibilities. Revising theories becomes then a matter of adding or revising models and/or postulates in the light of increasing evidence, captured by a special kind of theories, viz. ‘data-theories’. Under the assumption that the data-theory is true, achieving empirical progress in this way provides good reasons for the abductive conclusion that truth approximation has been achieved as well. Here, the notions of truth approximation and empirical progress are formally direct generalizations of the earlier ones. However, truth approximation is now explicitly defined in terms of increasing truth-content and decreasing falsity-content of theories, whereas empirical progress is defined in terms of lasting increased accepted and decreased rejected content in the light of increasing evidence. These definitions are strongly inspired by a paper of Gustavo Cevolani, Vincenzo Crupi and Roberto Festa, viz., “Verisimilitude and belief change for conjunctive theories” :183–222, 2011). (shrink)

Researchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings. The Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal people (...) were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced. Interviews with Aboriginal leaders were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research—finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity—two-way learning; and Reaching consent. The project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution (...) is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

This volume contains the Dialogues, The Natural History of Religion, and several short essays and selections from other works. The selection is a good one, but the editor's introduction does little to explicate the principles upon which Hume's writings on religion are based or to connect them with his other philosophical work.—A. F. G.

An excellent account of one of those rare occasions in history when a number of great minds, working on a common problem independently, come up with sufficiently new answers as to send their science, and in this case a good part of human thinking, in a completely new direction.

The main formal notion involved in qualitative truth approximation by the HD-method, viz. ‘more truthlike’, is shown to not only have, by its definition, an intuitively appealing ‘model foundation’, but also, at least partially, a conceptually plausible ‘consequence foundation’. Moreover, combining the relevant parts of both leads to a very appealing ‘dual foundation’, the more so since the relevant methodological notions, viz. ‘more successful’ and its ingredients provided by the HD-method, can be given a similar dual foundation. According to the (...) resulting dual foundation of ‘naive truth approximation’, the HD-method provides successes (established true consequences) and counterexamples (established wrongly missing models) of theories. Such HD-results may support the tentative conclusion that one theory seems to remain more successful than another in the naive sense of having more successes and fewer counterexamples. If so, this provides good reasons for believing that the more successful theory is also more truthlike in the naive sense of having more correct models and more true consequences. (shrink)

Reilly approaches his topic by presenting the spirit of science and the phases of scientific inquiry as Peirce saw it, keeping before the reader, at all times, Peirce’s overarching view of man and the universe. The two prevailing themes guiding Peirce’s thought are 1) that there is a special conformity of the human mind to nature and of nature to God, and 2) that there is an architectonic qualifying all the various types and levels of treatment which occupy the philosopher’s (...) interest. The first question examined is the nature of the scientific concern. For Peirce, the scientist’s spirit is marked by the pure love of knowledge. It is important to note the theoretical aspect because it explains the possibility of holding belief in abeyance while examining nature: the purity of motive allows that proper questions will be asked and errors will be readily corrected. The scientist’s purpose is the real truth of things; he begins with questions about the world. There are four stages of scientific method: 1) The scientist observes nature as a thinking, analytic inquirer. Observation presupposes that nature is intelligibly structured. 2) He formulates an explanatory hypothesis which is a process of bringing a manifold of characters to a unified whole. 3) By deduction, the inquirer gathers experiential consequents of the hypothesis. 4) By induction the question is put to nature and observed phenomena are matched to the predicted phenomena, resulting in either truth or a modified hypothesis. Peirce’s principle of the kinship of man’s mind to nature supports his dictum to follow instinct over reasoned likelihood in choosing hypotheses. Also important is the doctrine of moderate fallibilism which holds that there is a convergence upon the truth founded upon the regularity of nature, but that chance is a real factor due to nature’s evolution. Reilly’s book gives an adequate account of the aspects of Peirce’s scientific method sacrificing specific and detailed analysis to a more general approach wherein he shows the unity operative throughout Peirce’s thinking. A good index and copious notes are provided.—W. A. F. (shrink)

This is a new critical latin edition, with facing English translation, of Peter Abelard’s ethical treatise, sometimes entitled "Know Thyself." The book is one in the series of Oxford Medieval Texts. Accompanying the latin text and simple, easy reading translation is a most helpful introduction by Luscombe which points out the historical importance of this little treatise as among the first finely articulated attempts at bringing the classical concerns with human virtues and character together with the theological concerns of a (...) believing Christian. Ethics deals with the problem of how we may properly speak of the moral formation of a person. Abelard’s treatment is more weighted toward the attitudes of man than the nature of his deeds. What is worked out, with the help of many suggestive examples and frequent reference to the religious practices of the twelfth-century church, is a crucial theory of intention and a definition of sin. He holds that our intention, measured to the standards of divine law, determines the morality of our actions : "We consider morals to be the vices or virtues of the mind which make us prone to good or bad works." Good and bad emerge from the struggle where there is consent to an act virtuously or viciously motivated. Morality does not come from the inclination since the constitution of man includes both his virtues and his vices; nor does it come from his acts since all acts are indifferent, before God, to good or bad. It is the intent or consent to act that is determinant. Sin, the other major theme, complementary to intention, is defined as contempt for God, i.e., "to do by no means on his account what we believe we ought to do for him." He founds his notions of morality on God as that good, the source and whole, such that "although... there is a number of good things so that goodness exists in plurality, it does not follow therefore that goodness is greater." By working out these notions, Abelard delivers an innovative morality of conduct for a man beset with a character marked with both virtues and vices, emphasizing man’s faculty of choice and underscoring his ability to know and be responsible to the divine law. Besides the introduction and text, Luscombe has included a description of the manuscripts used in preparing the text and indices of quotations, allusions, and manuscripts.—W. A. F. (shrink)

Reilly approaches his topic by presenting the spirit of science and the phases of scientific inquiry as Peirce saw it, keeping before the reader, at all times, Peirce’s overarching view of man and the universe. The two prevailing themes guiding Peirce’s thought are 1) that there is a special conformity of the human mind to nature and of nature to God, and 2) that there is an architectonic qualifying all the various types and levels of treatment which occupy the philosopher’s (...) interest. The first question examined is the nature of the scientific concern. For Peirce, the scientist’s spirit is marked by the pure love of knowledge. It is important to note the theoretical aspect because it explains the possibility of holding belief in abeyance while examining nature: the purity of motive allows that proper questions will be asked and errors will be readily corrected. The scientist’s purpose is the real truth of things; he begins with questions about the world. There are four stages of scientific method: 1) The scientist observes nature as a thinking, analytic inquirer. Observation presupposes that nature is intelligibly structured. 2) He formulates an explanatory hypothesis which is a process of bringing a manifold of characters to a unified whole. 3) By deduction, the inquirer gathers experiential consequents of the hypothesis. 4) By induction the question is put to nature and observed phenomena are matched to the predicted phenomena, resulting in either truth or a modified hypothesis. Peirce’s principle of the kinship of man’s mind to nature supports his dictum to follow instinct over reasoned likelihood in choosing hypotheses. Also important is the doctrine of moderate fallibilism which holds that there is a convergence upon the truth founded upon the regularity of nature, but that chance is a real factor due to nature’s evolution. Reilly’s book gives an adequate account of the aspects of Peirce’s scientific method sacrificing specific and detailed analysis to a more general approach wherein he shows the unity operative throughout Peirce’s thinking. A good index and copious notes are provided.—W. A. F. (shrink)

Hoping to overcome the deficiencies of Bailey and Dewitt, and taking into account the insights of Diano, Kleve, and Merlan, Rist presents this book as an accurate and complete doxology of Epicurus’ philosophy. The book is written in a condensed style where doctrines treated early in the book are not fully explained until the completion of later parts. In trying to pin down Epicurus, distinct from the Epicureans, he depends heavily upon Lucretius and the few extant writings of Epicurus himself, (...) but he does range over the works of all the later students and commentators. Even so, much is left either vaguely outlined or problematic, and what is accepted from the more distant or biased sources is judiciously measured against the more accepted teachings. There are seven major chapters dealing with the canonic, physics, man and the cosmos, soul and mind and body, pleasure, friendship, and gods and religion. Certain of the teachings presented have a bearing, one upon the other, throughout the book and do much toward showing some consistency and richness to Epicurus’ philosophy: In the canonic, three types of criteria for judging as to the existence of a thing or the truth of a proposition are explained, viz., sensation, general concepts, and feeling. In the physics, a crucial topic is the role of the swerve with its logical priority. In the cosmos, there is the developmental, evolutionary character of the universe. In the soul and body of man, the animus/anima distinction is worked out. The interrelation of all these is brought to bear on the central theme of pleasure and the gods. Pleasure, as the stable condition of the flesh and confident expectation of the future on this score, with complete absence of pain and anxiety, involves the physics, friendship, the soul of man, and the canonic. Also important to his teaching on pleasure is the interplay of those pleasures based upon want and that pleasure which is a state of untroubledness. Rist makes good use of the teachings of the canonic to establish the existence of the gods. In describing their structure, he shows how the gods, as detached exemplars, fit in with the physics and canonic, and with the teaching on pleasure and friendship. He assiduously refrains from interpreting the role of the gods in Epicurus’ philosophy, but with their existence so presented future interpretations should be much enriched. This book is a superb piece of scholarship and an invaluable aid to the study of Greek philosophy.—W. A. F. (shrink)

In Eco’s work between around 1960 and 1992, “openness” in a modern literary text can mean (a) “permitting more than one interpretation,” and (b) “requiring a good deal of decoding work from the reader,” which is close to my own position. These two aspects of openness are demonstrated using Baudelaire’s Les Chats, in regard to which Eco denies that the text may be cristallin in Lévi-Strauss’s sense, while still requiring constructive effort from the reader. It is apparent that this (...) term is equivalent to Riffaterreʼs textual “monumentality.” Eco does not go into detail about the reader’s work in assembling the text’s global propositional structure. It is left to Riffaterre and myself to detail the various stages of this work, involving comparison of images in order to discover their common underlying generative proposition. In contrast to Riffaterre, I have long suggested that the modern poetic text is built on two such propositions. It is at the stage of relations between text and sociolect that Eco contributes much to modern poetics. Openness (b) seems to be a prerequisite for perceptual change in the reader, produced by contrast between textual structure and its sociolectic context. Riffaterre prefers to remain within the text/intertext/interpretant triad, preventing him from describing the text-sociolect relation, where the propositional innovation of the modernist text takes effect. (shrink)

Introduction While quizzing during informed consent for research to ensure understanding has become commonplace, it is unclear whether the quizzing itself is problematic for potential participants. In this study, we address this issue in a multinational HIV prevention research trial enrolling injection drug users in China and Thailand. Methods Enrolment procedures included an informed consent comprehension quiz. An informed consent survey followed. Results 525 participants completed the informed consent survey (Heng County, China=255, Xinjiang, China=229, Chiang Mai, Thailand=41). Mean age was (...) 33 and mean educational level was 8 yrs. While quizzing was felt to be a good way to determine if a person understands the nature of clinical trial participation (97%) and participants did not generally find the quiz to be problematic, minorities of respondents felt pressured (6%); anxious (5%); bored (5%); minded (5%); and did not find the questions easy (13%). In multivariate analysis, lower educational level was associated with not minding the quizzing (6–10 yrs vs 0–5 yrs: OR=0.27, p=0.03; more than 11 yrs vs 0–5 yrs: OR=0.18, p=0.03). There were also site differences (Heng County vs Xinjiang) in feeling anxious (OR=0.07; p=<0.01), not minding (OR=0.26; p=0.03), being bored (OR=0.25; p=0.01) and not finding the questions easy (OR=0.10; p=<0.01). Conclusions Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. Trial Registration clinicaltrials.gov number NCT00270257. (shrink)

This is an excellent introductory account of Socrates’s life and thought. The most valuable aspect of the book is that his experiences and ideas are integrated in such a way that his ideas are always shown to arise in the context of some concrete event of his life. Of course, in the case of Socrates, it is not difficult to display such synthesis of what may be called theory and practice: in fact, what the present author gives us is an (...) original translation of selected parts of 13 of the most Socratic of Plato’s dialogues, interspersed with a running commentary designed to give relevant information, to make necessary clarifications, and to convey her own interpretations. Nevertheless, it is always good to be reminded that such was the essential characteristic of the philosophy of "the father of Western philosophy." The book is beautified by 12 original drawings by Joseph Sheppard representing various faces and scenes discussed in the text; these drawings, besides making the book a pleasant and interesting work of art, bring additional life to discussions in the text, though their content and form alone would have been more than sufficient in bringing Socrates to life. There is also an introduction by George N. Shuster discussing the relevance and value of Socrates for contemporary culture. (shrink)

Objectives: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study’s objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. Design: A survey among nursing home physicians. Setting & Participants: We sent a questionnaire to all (356) nursing (...) homes in the Netherlands, to be completed by one of the physicians. Results: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). Conclusions: In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures. (shrink)

I discuss in a systematic order the most important epistemological positions in the instrumentalism-realism debate, viz., instrumentalism, constructive empiricism, referential realism, and theory realism. My conclusions are as follows. There are good reasons for the instrumentalist to become a constructive empiricist. In turn, the constructive empiricist is forced to become a referential realist in order to give deeper explanations of success differences. Consequently, there are further good reasons for the referential realist to become a theory realist.