[TofC cont.] Social ideals: Justice, A utilitarian theory of justice / J.S. Mill, Egalitarianism with changed motivation / G. Cohen; Equality, Multidimensional equality / M. Walzer, Equality of capacity / A. Sen; Liberty, rights, property, and self-ownership, A defense of the primacy of liberty rights / L. Lomasky, Atomism and the primacy of rights / C. Taylor -- Social institutions: Education, Educating about familial values / W. Galston, For vouchers and parental choice / M. Friedman; Family, In defense of filial (...) obligations / C.H. Sommers; Punishment, A utilitarian theory of punishment / J. Bentham. In [this book, the editors] provide students [with] a wide variety of readings covering the problems of political and social philosophy. Such topics as political obligation, democracy, rights, and justice are represented, in addition to less widely discussed subjects as the family. Both common approaches and those which are less familiar are presented, as well as recent developments in the topic area. -Back cover. (shrink)

In The Healer's Power, Howard Brody placed the concept of power at the heart of medicine's moral discourse. Struck by the absence of “power” in the prevailing vocabulary of medical ethics, yet aware of peripheral allusions to power in the writings of some medical ethicists, he intuited the importance of power from the silence surrounding it. He formulated the problem of the healer's power and its responsible use as “the central ethical problem in medicine.” Through the prism of power (...) he refracted a wide range of ethical problems, from informed consent to truth-telling, from confidentiality to futility, from the physician's fantasies to the physician's virtues. At times this prism shed new light on old problems, enabling us to see from an unexpected angle the elements of which the problem was composed. At other times it exposed issues of ethical significance that had been neglected in the bioethics literature. (shrink)

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

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

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

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

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

Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)

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

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

In recent work, Adlam (2022b), Chen & Goldstein (2022), and Meacham (2023) have defended accounts of laws that take laws to be primitive global constraints. A major advantage of these accounts is that they’re able to accommodate the many different kinds of laws that appear in physical theories. In this paper I’ll present these three accounts, highlight their distinguishing features, and note some key differences that might lead one to favor one of these accounts over the others. I’ll conclude by (...) briefly discussing a version of a “constraint” account that I think is especially attractive. (shrink)

*The opinions expressed are the views of the author and do not necessarily reflect the policy of the National Institutes of Health, the Public Health Service, or the U.S. Department of Health and Human Services.

The first English translation of Fichte’s second set of 1804 lectures on the Wissenschaftslehre.

It is proved that the relevance logic \ has no structurally complete consistent axiomatic extension, except for classical propositional logic. In fact, no other such extension is even passively structurally complete.

Descartes nimmt in Anspruch, daß sein Argument des Deus malignus über die Einwände der Skeptiker hinausgehe. Was fügt es dem Traumargument hinzu? Die verbreitete Ansicht, der Dämon stelle die Erkenntnis mathematischer und logischer Wahrheiten in Frage, wird im folgenden diskutiert und zurückgewiesen. Die richtige Interpretation lautet: Die Annahme des Dämons unterstützt den Skeptizismus und verstärkt die Zweifel an der Existenz äußerer Objekte. Es werden drei Einwände gegen diese Interpretation erörtert und zurückgewiesen. Eine andere Auffassung vertritt Frankfurt: Die Rolle des Traumarguments (...) sei wesentlich begrenzt; die durch den Dämon aufgeworfenen Zweifel seien umfassender. Eine genaue Analyse der Entwicklung des Traumarguments in der Ersten Meditation führt zur Widerlegung dieser Interpretation. (shrink)

This essay is written on the following premises and argues for them. “Enlightenment” is a word or signifier, and not a single or unifiable phenomenon which it consistently signifies. There is no single or unifiable phenomenon describable as “the Enlightenment,” but it is the definite article rather than the noun which is to be avoided. In studying the intellectual history of the late seventeenth century and the eighteenth, we encounter a variety of statements made, and assumptions proposed, to which the (...) term “Enlightenment” may usefully be applied, but the meanings of the term shift as we apply it. The things are connected, but not continuous; they cannot be reduced to a single narrative; and we find ourselves using the word “Enlightenment” in a family of ways and talking about a family of phenomena, resembling and related to one another in a variety of ways that permit of various generalizations about them. We are not, however, committed to a single root meaning of the word “Enlightenment,” and we do not need to reduce the phenomena of which we treat to a single process or entity to be termed “the” Enlightenment. It is a reification that we wish to avoid, but the structure of our language is such that this is difficult, and we will find ourselves talking of “the French” or “the Scottish,” “the Newtonian” or the “the Arminian” Enlightenments, and hoping that by employing qualifying adjectives we may constantly remind ourselves that the keyword “Enlightenment” is ours to use and should not master us. (shrink)

Originally published in 1913. Author: Henri Lichtenberger Language: English Keywords: History Many of the earliest books, particularly those dating back to the 1900s and before, are now extremely scarce and increasingly expensive. Obscure Press are republishing these classic works in affordable, high quality, modern editions, using the original text and artwork.Keywords: English Keywords 1900s Language English Artwork.

Logics that do not have a deduction-detachment theorem (briefly, a DDT) may still possess a contextual DDT —a syntactic notion introduced here for arbitrary deductive systems, along with a local variant. Substructural logics without sentential constants are natural witnesses to these phenomena. In the presence of a contextual DDT, we can still upgrade many weak completeness results to strong ones, e.g., the finite model property implies the strong finite model property. It turns out that a finitary system has a contextual (...) DDT iff it is protoalgebraic and gives rise to a dually Brouwerian semilattice of compact deductive filters in every finitely generated algebra of the corresponding type. Any such system is filter distributive, although it may lack the filter extension property. More generally, filter distributivity and modularity are characterized for all finitary systems with a local contextual DDT, and several examples are discussed. For algebraizable logics, the well-known correspondence between the DDT and the equational definability of principal congruences is adapted to the contextual case. (shrink)