The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)
Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.
As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)
A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide better answers (...) to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)
This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)
Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.
The contributors to this new philosophical and historical examination of Vico, Herder, Schiller, and Goethe are Karl J. Fink, James W. Marchand, Harry Ritter, K. Michael Seibt, and David R. Stevenson. Their essays and commentary address the question why this generation represented by its great minds suddenly discovered science—a question posed previously but only tentatively explored. Taken together, the essayists reveal significant new insights into the roles of language, imagination, intuition, empathy, modes of perception, and individualism in scientific creativity (...) and provide important new contributions to the history of arts and sciences. (shrink)
In this chapter we consider three philosophical perspectives (including those of Stalnaker and Lewis) on the question of whether and how the principle of conditional excluded middle should figure in the logic and semantics of counterfactuals. We articulate and defend a third view that is patterned after belief revision theories offered in other areas of logic and philosophy. Unlike Lewis’ view, the belief revision perspective does not reject conditional excluded middle, and unlike Stalnaker’s, it does not embrace supervaluationism. We adduce (...) both theoretical and empirical considerations to argue that the belief revision perspective should be preferred to its alternatives. The empirical considerations are drawn from the results of four empirical studies (which we report below) of non-experts’ judgments about counterfactuals and conditional excluded middle. (shrink)
This major new book contains a collection of papers that examine the current state-of-the-art in the valuation of environmental resources. In particular, they assess the meaningfulness of environmental resource values obtained through the contingent valuation metho.
In this multi-faceted volume, Christian and other religiously committed theorists find themselves at an uneasy point in history—between premodernity, modernity, and postmodernity—where disciplines and methods, cultural and linguistic traditions, and religious commitments tangle and cross. Here, leading theorists explore the state of the art of the contemporary hermeneutical terrain. As they address the work of Gadamer, Ricoeur, and Derrida, the essays collected in this wide-ranging work engage key themes in philosophical hermeneutics, hermeneutics and religion, hermeneutics and the other arts, hermeneutics (...) and literature, and hermeneutics and ethics. Readers will find lively exchanges and reflections that meet the intellectual and philosophical challenges posed by hermeneutics at the crossroads. Contributors are Bruce Ellis Benson, Christina Bieber Lake, John D. Caputo, Eduardo J. Echeverria, Benne Faber, Norman Lillegard, Roger Lundin, Brian McCrea, James K. A. Smith, Michael VanderWeele, Kevin Vanhoozer, and Nicholas Wolterstorff. (shrink)
The purpose of this study is to take preliminary steps to unify psychoacoustic techniques with reaction-time methodologies to address the perceptual mechanisms responsible for the detection of one vs. multiple sounds. We measured auditory redundancy gains for auditory detection of pure tones widely spaced in frequency using the tools of Systems Factorial Technology to evince the system architecture and workload capacity in two different scenarios. We adopted an experimental design in which the presence or absence of a target at each (...) of two frequencies was combined factorially with two stimulus levels. Replicating previous work, results did not allow an assessment of system architecture due to a failure to observe factor influence at the level of distribution ordering for dual-target stimuli for both SOFT and LOUD scenarios. All subjects demonstrated very modest redundancy gains for the dual-target compared to the single-target stimuli, and results were similar for both LOUD and SOFT. We propose that these results can be predicted by a mental architecture that falls into the class of integrated subadditive parallel systems, using a well-supported assumption that reaction time is driven by loudness. We demonstrate that modeled loudness of the experimental sounds is highly correlated with mean reaction time, and we provide a proof-of-concept model based on Steven’s Power law that predicts both a failure of distributional ordering for dual-target stimuli and very modest redundancy gains. (shrink)