Background: Ethical dilemmas are an integral part of medicine. Whether physicians actually feel that they have made ethically problematic treatment decisions or choices in their work is largely unknown. Identifying physicians with ethical problems, and the types of problems and underlying factors, might benefit organisational and educational efforts to help physicians solve ethical dilemmas in a constructive way. We investigated how the frequency and types of ethically difficult treatment decisions vary by specialty.Method: A mail survey of all non-retired Finnish physicians (...) was conducted in 2004. Of those who had made any ethically problematic treatment decisions, the types of decisions and reasons given for these decisions were asked for. Factor analysis was used to investigate clustering of ethically problematic treatment decisions, and logistic regression to investigate the effect of specialty, adjusted for age and gender.Results: Psychiatrists experienced ethically problematic treatment decisions most frequently, followed by pulmonologists, internists and neurologists. Problems were reported least often by pathologists, laboratory physicians and ophthalmologists. Overtreatment was more common than undertreatment in most specialties, with the exception of psychiatrists who emphasised undertreatment and patient rights issues.Conclusion: Physicians of different specialties differ significantly regarding frequency and types of ethically problematic treatment decisions they have made. Psychiatrists differ from all other specialists in reporting more undertreatment and patient rights issues. Experiencing ethically problematic decisions might affect the quality of care and physician well-being in many ways. The findings could be useful for both under- and postgraduate ethics education. (shrink)

“Towards a Theory of Taxation” is a proper theme for an Englishman to take when giving a paper in America. After all it was from the absence of such a theory that the United States derived its existence. The Colonists felt strongly that there should be no taxation without representation, and George III was unable to explain to them convincingly why they should contribute to the cost of their defense. Since that time, understanding has not advanced much. In Britain we (...) still maintain the fiction that taxes are a voluntary gift to the Crown, and taxing statutes are given the Royal Assent with the special formula, “La Reine remercie ses bons sujets, accepte leur benevolence, et ainsi le veult” instead of the simple “La Reine le veult,” and in the United States taxes have regularly been levied on residents of the District of Columbia who until recently had no representation in Congress, and by the State of New York on those who worked but did not reside in the State, and so did not have a vote. Taxes are regularly levied, in America as elsewhere, on those who have no say on whether they should be levied or how they should be spent. I am taxed by the Federal Government on my American earnings and by state governments on my American spending, but I should be hard put to it to make out that it was unjust. Florida is wondering whether to follow California in taxing multinational corporations on their world-wide earnings. (shrink)

A change in sense of self is an outcome commonly associated with Buddhist meditation. However, the sense of self is construed in multiple ways, and which changes in self-related processing are expected, intended, or possible through meditation is not well understood. In a qualitative study of meditation-related challenges, six discrete changes in sense of self were reported by Buddhist meditators: change in narrative self, loss of sense of ownership, loss of sense of agency, change in sense of embodiment, change in (...) self-other or self-world boundaries, and loss of sense of basic self. Changes in sense of self could be transient or enduring, positive or distressing, enhancing or impairing. These changes were also given varied appraisals, ranging from insights associated with Buddhist doctrines to psychopathologies such as depersonalization. In this study of practitioners reporting meditation-related challenges, more global changes in sense of self were associated with higher levels of impairment. These results have implications for both Buddhist meditation as well as mindfulness-based interventions. (shrink)

In this note we prove that the abstract property "weakly subdirectly indecomposable" does not characterize the class IWs α of weak cylindric set algebras. However, we give another (similar) abstract property characterizing IWs α . The original property does characterize the directed unions of members of $\mathrm{IWs}_alpha \operatorname{iff} \alpha$ is countable. Free algebras will be shown to satisfy the original property.

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

This article investigates the claim that some truths are fundamentally or really true — and that other truths are not. Such a distinction can help us reconcile radically minimal metaphysical views with the verities of common sense. I develop an understanding of the distinction whereby Fundamentality is not itself a metaphysical distinction, but rather a device that must be presupposed to express metaphysical distinctions. Drawing on recent work by Rayo on anti-Quinean theories of ontological commitments, I formulate a rigourous theory (...) of the notion. In the final sections, I show how this package dovetails with ' interpretationist' theories of meaning to give sober content to thought that some things — perhaps sets, or gerrymandered mereological sums — can be 'postulated into existence'. (shrink)

According to the thought experiment most commonly used to argue against reliabilism, Mr. Truetemp is given an unusual but reliable cognitive faculty. Since he is unaware of the existence of this faculty, its deliverances strike him as rather odd. Many think that Truetemp would not have justified beliefs. Since he satisfies the reliabilist conditions for justified belief, reliabilism appears to be mistaken. I argue that the Truetemp case is underdescribed and that this leads readers to make erroneous assumptions about Truetemp's (...) epistemic situation. After examining empirical studies of actual subjects who, like Truetemp, have received new perceptual faculties, I show that Truetemp must have been endowed with all of the reorganized neural circuitry and cognitive skills that subjects with new perceptual faculties normally acquire during a long and difficult process of adaptation and development. When readers realize how much more the designers of Truetemp's new faculty had to do than simply slip an artificial device under Truetemp's scalp, I find that they no longer think his beliefs would be unjustified. Because the thought experiment fails to support anti-reliabilist intuitions when further details of the case are made explicit, the Truetemp thought experiment does not constitute a clear and decisive counterexample to reliabilism. (shrink)

Dear Mr. Lucas, I was wondering if you had come across Query 44 of George Berkeley's ``Analyst: A discourse addressed to an infidel mathematician"?. It reads: ``Whether the difference between a mere computer and a man of science be not that one computes on principles clearly conceived and by rules evidently demonstrated, whereas the other [i.e a man] doth not?" Not bad for 1734!

There was once a leak from Hebdomadal Council. The Assessor told her husband, who told my wife, who told me that Monday afternoon had been spent discussing what Lucas would say if various courses of action were adopted, leading to the conclusion that it would be best to do nothing. I was flattered, but a bit surprised. The tide of philosophical scepticism had ebbed, and it was generally allowed that a reasonable way of discovering what someone would say was to (...) ask him. Dick Southwood did: he would quiz me in Common Room – sometimes ending "Thank you for letting me bounce these ideas off you" – and had reliable information about how one member of Congregation would react to various proposals. And not only me: he was a listening Vice-Chancellor, who used to bike from Wellington Square to Merton for lunch, greeting many as he passed them, and ready to stop if occasion warranted it. Of course, there are many other leaks. I remember once attending a meeting in the Town Hall to argue for cycle tracks, and someone coming up to me, and saying, "You’re having a tussle with Council, aren’t you? I think you ought to see the minutes of their latest meeting"; the next day there was a copy in my pigeon hole, giving me just the ammunition I needed. What members of Congregation tend the forget is the existence – the other side of the green baize door, so to speak – of a corps of bedells. (shrink)

This article traces the multiple enactments of sex in clinical practices of transgender medicine to argue against the presumed singularity of ‘transexuality’. Using autoethnography to analyse my own experience as a trans patient, I describe my clinical encounters with doctors, psychiatrists and surgeons in order to theorise sex as multiple. Following recent developments in science and technology studies (STS) that advance the work of Judith Butler on sex as performatively reproduced, I use a praxiographic approach to argue that treatment practices (...) produce particular iterations of what sex (and transexuality) ‘is’ and how these processes limit and foreclose other trans possibilities. I consider the ethical, political and material-discursive implications of treatment practices and offer a series of reflections about the effects and effectiveness of current clinical practices and the possibilities for intervening in such processes in order that, following Annemarie Mol, we might (re)make sex (and transexuality) differently. (shrink)

This paper examines two puzzles of indeterminacy. The first puzzle concerns the hypothesis that there is a unified phenomenon of indeterminacy. How are we to reconcile this with the apparent diversity of reactions that indeterminacy prompts? The second puzzle focuses narrowly on borderline cases of vague predicates. How are we to account for the lack of theoretical consensus about what the proper reaction to borderline cases is? I suggest (building on work by Maudlin) that the characteristic feature of indeterminacy is (...) alethic normative silence, and use this to explain both plurality and lack of consensus. (shrink)

Some of my best friends are women, but I would not want my sister to marry one of them. Modern-minded persons criticize me for manifesting such out-dated prejudices, and would like to send me to Coventry for a compulsory course of reindoctrination. They may be right. It could conceivably be the case that in due course the Sex Discrimination Act will be tightened up, even to the extent of our recognizing that there are no ‘good reasons why the State should (...) not recognize contracts which are in all respects like marriage, except for the sex of the parties concerned’. We can envisage a society so enlightened that the relations between men and women will be purely platonic and it will be a matter of no concern whether two people are members of the opposite sex or not: or, alternatively, our feelings could be so completely homogenized, that it will make no difference to an emotional relationship whether Leslie and Julian have only one Y-chromosome between them, or two, or none at all. In that event I shall be shown to be wrong, and my critics entitled to erect a monument to female equality on my grave. But I have doubts, and suspect that long after I am dead men will go on falling in love with women and women will continue to find their hearts wooed and won by men. And this fact, if it is a fact, makes a profound difference to our social institutions. I want to follow out the logic of social differentiation, relying as little as I can on putative facts about the differences between the sexes. Scientifically attested knowledge is scarce in this field. Many academics take refuge in a safe suspension of judgment, but this is a craven dereliction of duty. We have yet to develop an adequate theory of knowledge in social matters, and only by thrashing out the apparently telling arguments on this and similar issues can we clear our minds about the nature of social knowledge. Moreover, if those who might argue rationally draw back from doing so, they leave the field clear for others who suffer from fewer inhibitions and fewer scruples. And finally, serious social consequences can follow from public confusion about the logic of a situation, and what things are possible and what desirable. There is a danger that in our attempts to remedy the real wrongs done to women we shall only succeed, as with much modern legislation, in making a bad case worse. (shrink)

South. So we have agreed to bury intuitionism. Well, I dare say it is right. But we ought to bury some of the grave-diggers too. Some of the things that Ross said are no doubt wrong, or at least misleading: but they are a lot less wrong than most of the things said since the war.

In the literature on supervaluationism, a central source of concern has been the acceptability, or otherwise, of its alleged logical revisionism. I attack the presupposition of this debate: arguing that when properly construed, there is no sense in which supervaluational consequence is revisionary. I provide new considerations supporting the claim that the supervaluational consequence should be characterized in a ‘global’ way. But pace Williamson (1994) and Keefe (2000), I argue that supervaluationism does not give rise to counterexamples to familiar inference-patterns (...) such as reductio and conditional proof. (shrink)

In this article I consider a two-page autobiographical recount which appears at the end of Nelson Mandela's book Long Walk to Freedom as a summary of his life and what he has learned from it. My aim is to illustrate the role of a detailed analysis of single texts in the field of discourse analysis, as opposed to studies of selected variables across a corpus of texts. The analysis is conducted within the general theoretical framework of systemic functional linguistics, with (...) special attention to transitivity, mood, theme, grammatical metaphor, lexical relations, conjunction, tense, phase, process type, hierarchy of periodicity, polarity, continuity, elaboration, extension and the analysis of images in multimodal text. Through these procedures I show the way in which Mandela reconciles the linear unfolding of his life history with the deepening understanding of freedom that gives meaning to his life - by means of a spiral texture which returns again and again to the meaning of freedom at different levels of abstraction. The effect, I think, is inspirational - with no tinge of bitterness or betrayal; rather a message of hope and wisdom - grace personified. The approach exemplifies a positive style of discourse analysis that focuses on hope and change, by way of complementing the deconstructive exposé associated with critical discourse analysis. (shrink)

The juxtaposition of models of God and Christian faith may seem repugnant to many, as models are tentative and faith aims at an abiding certainty. In fact, for many Christians, using models of God in worship amounts to idolatry. By examining Biblical and extra-Biblical views of idolatry, I argue that models are not idols. To the contrary, the practice of God-modeling inoculates Christians against one of the most seductive idols of our age: the love of certainty. Furthermore, by examining meditations (...) upon certainty in Melville’s Moby Dick and the early discourses of the Buddha, I suggest that overweening conviction is a vice that hinders rather than guarantees Christian discipleship, and that Christian faith is better defined as any or all of the following: relative confidence in propositions, faithful relationship, and a virtue of disciplined credulity. (shrink)

Equality in the present age has become an idol, in much the same way as property was in the age of Locke. Many people worship it, and think that it provides the key to the proper understanding of politics, and that on it alone can a genuinely just society be reconstructed. This is a mistake. Although, like property, it is a useful concept, and although, like property, there are occasions when we want to have it in practice, it is not (...) a fundamental concept any more than property is, nor can having it vouchsafe to us the good life. In an earlier paper I argued against equality by showing that the concept of equality was confused and that many of the arguments i egalitarians adduced were either invalid or else supported conclusions I which were not really egalitarian at all. Many egalitarians, however, have complained that my arguments were not fair, because I had failed to elucidate the concept adequately, or because the position I attacked was not one that any egalitarian really wished to maintain, or because I had overlooked other arguments which were effective in establishing egalitarian conclusions, or because the positive counter-arguments of my own I put forward more as a matter of taste than of serious political commitment. In this paper, therefore, I want to elucidate the concept more fully, concede what I should to my critics, point out that, even so, their conclusions do not follow, and give further reasons not only for supposing that egalitarian arguments are invalid but for discerning positive merits in some forms of inequality. (shrink)

The problem with which I wish to deal in this paper is the problem of singular reasons in the humanities, whether they exist, or rather, whether they can exist: for it would seem that the word “reason” carried with it some idea of generality, so that the phrase “singular reason” was a contradiction in terms, a specification which could never be fulfilled. But humanists are always sensing the singularity of their studies: and the philosopher wondering about the nature of humane (...) thinking either must conclude that it is really only inadequate science, its singularity being the mark of the fact that we never really have an adequate basis for any of our generalizations, an unfortunate reminder that the whole structure is built on the shakiest of inductive foundations; or , if he is unwilling to allow that humanists are just bad, or at least amateur, scientists, he is tempted to vindicate the rationality of their reasoning by inventing a special faculty of particular ratiocination which is able to perceive particular truths—the intuition of the moralists or the insight of the Collingwoodian mode. (shrink)

Of course I have an axe to grind. I am one of the old school of tutors, generally regarded as outmoded and amateurish by our more up-to-date successors, who are anxious to introduce more professionalism into Oxford's academic life. I probably shan't be replaced, but if I am, it will be by somebody competent, capable of looking the twenty-first century in the face, who knows what he is about, and adopts effective means to bringing it about.

A section I had written for my Principles of Politics, but decided not to use. I recently dug it out for an American friend. I publish it here, in case it is of use to anyone else.

viva was unmistakable; I had sat in when a friend was being done, to spot the form; it was the same room, which I had not been into since my own viva in Greats many years ago, the same table, the lonely candidate on one side, the sombre Inquisitors on the other, courteous, considerate, anxious that the candidate should acquit himself well, but sure to notice every fallacy or error. Others, too, had sensed the likeness. ``Yes, I think the candidate (...) passed'' one tutor said meditatively of an ennobled Vice-Chancellor; ``I think the Examiners passed too; very fair, very fair---but very searching. You had better look out.'' A blur of people, perhaps friends and supporters. Kindly, encouraging questions, some expected, some not. Balls asking to be hit for six; dropped catches---why had not I gone armed with a list of a dozen different ways in which Oxford was more up to date than other places? missed cues; fumbled answers; moments of caution; moments of over-confidence-- -``I have heard tell of a women's college where...'', biting my tongue just too late. (shrink)

This paper outlines Lewis’s favoured foundational account of linguistic representation, and outlines and briefly evaluates variations and modifications. Section 1 gives an opinionated exegesis of Lewis’ work on the foundations of reference—his interpretationism. I look at the way that the metaphysical distinction between natural and non-natural properties came to play a central role in his thinking about language. Lewis’s own deployment of this notion has implausible commitments, so in section 2 I consider variations and alternatives. Section 3 briefly considers a (...) buck-passing strategy involving fine-grained linguistic conventions. (shrink)

The Unity of Science is often thought to be reductionist, but this is because we fail to distinguish questions from answers. The questions asked by different sciences are different---the biologist is interested in different topics from the physicist, and seeks different explanations---but the answers are not peculiar to each particular science, and can range over the whole of scientific knowledge. The biologist is interested in organisms--- concept unknown to physics---but explains physiological processes in terms of chemistry, not a mysterious vital (...) force. The replacement of Laplacian determinism by quantum mechanics further erodes the tendency towards reductionism. The answers given in different explanations are not subsumed under one complete theory; and quantum mechanics does not have a concept of haecceitas, "this-i-ness" which would make its entities the fundamental constituents of everything. (shrink)