Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or is it a (...) matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest (...) standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children. (shrink)

This work clarifies the role of the best interest standard (BIS) as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, (...) not taking the family into account and not suitable as limiting principle. This work responds to these criticisms, showing that they do not stand up to scrutiny. They either do not apply to the BIS, only apply to misuses of the BIS or criticise a BIS that is not seriously defended in the literature. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when (...) addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is (...) inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state. (shrink)

Defensive medicine has become pervasive. Defensive medicine is often thought of as a systems issue, the inevitable result of an adversarial malpractice environment, with consequent focus on system-responses and tort reform. But defensive medicine also has ethical and professionalism implications that should be considered beyond the need for tort reform. This article examines defensive medicine from an ethics and professionalism perspective, showing how defensive medicine is deeply problematic. First, a definition of defensive medicine is offered that describes the essence of (...) defensive practice: clinical actions with the goal of protecting the clinician against litigation or some adverse outcome. Ethical arguments against defensive medicine are considered: defensive medicine is deceptive and undermines patient autonomy; defensive medicine subjugates patient interests to physician interests and violate fiduciary obligations; defensive medicine exposes patients to harm without benefit; defensive medicine undermines trust in the profession; and defensive medicine violates obligations of justice. Possible arguments in favor of defensive medicine are considered and refuted. Defensive practice is therefore unethical and unprofessional, and should be viewed as a challenge for medical ethics and professionalism. (shrink)

The interests of a patient are not only related to objective ideas about health, but are also determined by the patient’s own view of the good. To act in the best interests of a patient requires co...

This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are: (1) The obligation to protect patients against COVID-19 spread; (2) The obligation to maintain professional competence and remain available for patients; (3) Clinicians’ role and place in society in relation to COVID-19; (4) The obligation to encourage societal vaccination uptake. These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a (...) duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional’s ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians. (shrink)

Carson and Flood (2017) present an interesting argument regarding a duty to vaccinate as a social obligation. Their argument is based on Catholic social teaching, and particularly on the moral prec...

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

Apparent tensions, even contradictions, within the letters of Paul have led some to abandon the attempt to find coherence in his theology, and others to locate it in his psychological make-up lather than his thought, neither solution represents an adequate response to the apostle's theological reflections.

The basic question today is: Can biblical theology do the job of revitalizing the Bible? And in the discussion around the Bible, is the alternative correct: biblical history or biblical kerygmatic theology? Are we, caught in this alternative, not responsible for the rejection of biblical studies today— for avoiding the heart of Bible, namely, the consideration of the validity of biblical religion for us today?

It is widely agreed that sentences containing a non-denoting description embedded in the scope of a propositional attitude verb have true de dicto interpretations, and Russell's (1905) analysis of definite descriptions is often praised for its simple analysis of such cases, cf. e.g. Neale (1990). However, several people, incl. Elbourne (2005, 2009), Heim (1991), and Kripke (2005), have contested this by arguing that Russell's analysis yields incorrect predictions in non-doxastic attitude contexts. Heim and Elbourne have subsequently argued that once certain (...) facts about presupposition projection are fully appreciated, the Frege/Strawson analysis of definite descriptions has an explanatory advantage. In this paper, I argue that both Russell's analysis and the Frege/Strawson analysis face a serious problem when it comes to the interaction of attitude verbs and definite descriptions. I argue that the problem observed by Elbourne, Heim, and Kripke is much more general than standardly assumed and that a solution requires a revision of the semantics of definite and indefinite descriptions. I outline the conditions that are required to solve the problem and present an analysis couched in dynamic semantics which can provide a solution. I conclude by discussing some further issues related to propositional attitude verbs that complicate a fully general solution to the problem. (shrink)

This Element focuses on three challenges of evolution to religion: teleology, human origins, and the evolution of religion itself. First, religious worldviews tend to presuppose a teleological understanding of the origins of living things, but scientists mostly understand evolution as non-teleological. Second, religious and scientific accounts of human origins do not align in a straightforward sense. Third, evolutionary explanations of religion, including religious beliefs and practices, may cast doubt on their justification. We show how these tensions arise and offer potential (...) responses for religion. Individual religions can meet these challenges, if some of their metaphysical assumptions are adapted or abandoned. (shrink)

This article is a response to Thomas David Riisfeldt’s paper entitled ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’. It is shown that as far as euthanasia and palliative sedation are concerned, Riisfeldt has not established that a common ground, or a similarity, between the two is the relief of suffering. Quite the contrary, this is not characteristic of euthanasia, neither by definition nor from a clinical point of view. Hence, the argument hinges on a conceptually (...) and empirically erroneous premise and is accordingly a non-starter. (shrink)

Reasoning with quantifier expressions in natural language combines logical and arithmetical features, transcending strict divides between qualitative and quantitative. Our topic is this cooperation of styles as it occurs in common linguistic usage and its extension into the broader practice of natural language plus ‘grassroots mathematics’.We begin with a brief review of by changing the semantics of counting in natural ways. A first approach replaces cardinalities by abstract but well-motivated values of ‘mass’ or other mereological aggregating notions. A second approach (...) keeps the cardinalities but generalizes the meaning of counting to work in models that allow dependencies between variables.Finally, we return to our starting point in natural language, confronting the architecture of our formal systems with linguistic quantifier vocabulary and syntax, as well as with natural reasoning modules such as the monotonicity calculus. In addition to these encounters with formal semantics, we discuss the role of counting in semantic evaluation procedures for quantifier expressions and determine, for instance, which binary quantifiers are computable by finite ‘semantic automata’. We conclude with some general thoughts on yet further entanglements of logic and counting in formal systems, on rethinking the qualitative/quantitative divide, and on connecting our analysis to empirical findings in cognitive science. (shrink)

In this article, we develop a bimodal perspective on possibility semantics, a framework allowing partiality of states that provides an alternative modelling for classical propositional and modal logics. In particular, we define a full and faithful translation of the basic modal logic K over possibility models into a bimodal logic of partial functions over partial orders, and we show how to modulate this analysis by varying across logics and model classes that have independent topological motivations. This relates the two realms (...) under comparison both semantically and syntactically at the level of derivations. Moreover, our analysis clarifies the interplay between the complexity of translations and axiomatizations of the corresponding logics: adding axioms to the target bimodal logic simplifies translations, or vice versa, complex translations can simplify frame conditions. We also investigate a transfer of first-order correspondence theory between possibility semantics and its bimodal counterpart. Finally, we discuss the conceptual trade-off between giving translations and giving new semantics for logical systems, and we identify a number of further research directions to which our analysis gives rise. (shrink)

Psychological evidence suggests that laypeople understand the world around them in terms of intuitive ontologies which describe broad categories of objects in the world, such as ‘person’, ‘artefact’ and ‘animal’. However, because intuitive ontologies are the result of natural selection, they only need to be adaptive; this does not guarantee that the knowledge they provide is a genuine reflection of causal mechanisms in the world. As a result, science has parted ways with intuitive ontologies. Nevertheless, since the brain is evolved (...) to understand objects in the world according to these categories, we can expect that they continue to play a role in scientific understanding. Taking the case of human evolution, we explore relationships between intuitive ontological and scientific understanding. We show that intuitive ontologies not only shape intuitions on human evolution, but also guide the direction and topics of interest in its research programmes. Elucidating the relationships between intuitive ontologies and science may help us gain a clearer insight into scientific understanding. (shrink)

The relation between logic and philosophy of science, often taken for granted, is in fact problematic. Although current fashionable criticisms of the usefulness of logic are usually mistaken, there are indeed difficulties which should be taken seriously -- having to do, amongst other things, with different "scientific mentalities" in the two disciplines. Nevertheless, logic is, or should be, a vital part of the theory of science. To make this clear, the bulk of this paper is devoted to the key notion (...) of a "scientific theory" in a logical perspective. First, various formal explications of this notion are reviewed, then their further logical theory is discussed. In the absence of grand inspiring programs like those of Klein in mathematics or Hilbert in metamathematics, this preparatory ground-work is the best one can do here. The paper ends on a philosophical note, discussing applicability and merits of the formal approach to the study of science. (shrink)

This article discusses the meanings of “creativity”—tvorchestvo—as we encounter it in Georges Florovsky’s thought, first and foremost in his magnum opus Ways of Russian Theology (1937). Tvorchestvo had by this time become a key concept in Russian pre-revolutionary and later émigré thought. It is associated above all with Nikolai Berdyaev’s philosophy, but it also plays an important role in Sergei Bulgakov’s philosophy of economy. In both cases, it stands for the human response to divine creation. Moreover, and somewhat less famously, (...) it was also an epistemological concept in the religious idealism of Vladimir Solovyov as well as in Russian neo-Kantianism (Fyodor Stepun), where it stood for the active, synthetic faculty of our minds. Florovsky, meanwhile, used it as a description of how we should relate to the patristic heritage, but also to history more generally: Our attitude should be “creative,” active, as well as both backward- and forward-looking. This “return to the Fathers” was a central component of Florovsky’s neopatristic program, but, interestingly, in order to conceptualize this return, Florovsky took over a concept from traditions that his own approach otherwise firmly criticized. By analyzing Florovsky’s use of tvorchestvo, this article addresses the broader question as to the differences and parallels between the neopatristic movement and the legacy of the Russian Renaissance (Silver Age). (shrink)

Transparency is a crucial condition to implement a CSR policy based on the reputation mechanism. The central question of this contribution is how a transparency policy ought to be organised in order to enhance the CSR behaviour of companies. Governments endorsing CSR as a new means of governance have different strategies to foster CSR transparency. In this paper we discuss the advantages and disadvantages of two conventional policy strategies: the facilitation policy and the command and control strategy. Using three criteria (...) (efficiency, freedom and virtue) we conclude that both strategies are defective. Most attention is paid to the facilitation strategy since governments nowadays mainly use this. In evaluating this strategy we analyse the Dutch case. As an alternative we introduce a third government policy: the development of a self-regulating sub-system. By construing an analogy with the historical development of corporate financial disclosure, we point out that the vital step in the creation of a self-regulating subsys- tem is the creation of strong informational intermediate organisations. (shrink)

Contemporary historians of logic tend to credit Bernard Bolzano with the invention of the semantic notion of consequence, a full century before Tarski. Nevertheless, Bolzano's work played no significant rôle in the genesis of modern logical semantics. The purpose of this paper is to point out three highly original, and still quite relevant themes in Bolzano's work, being a systematic study of possible types of inference, of consistency, as well as their meta-theory. There are certain analogies with Tarski's concerns here, (...) although the main thrust seems to be different, both philosophically and technically. Thus, if only obliquely, we also provide some additional historical perspective on Tarski's achievement. (shrink)

This paper examines explanations for human artistic behavior in two reductionist research programs, cognitive neuroscience and evolutionary psychology. Despite their different methodological outlooks, both approaches converge on an explanation of art production and appreciation as byproducts of normal perceptual and motivational cognitive skills that evolved in response to problems originally not related to art, such as the discrimination of salient visual stimuli and speech sounds. The explanatory power of this reductionist framework does not obviate the need for higher-level accounts of (...) art from the humanities, such as aesthetics, art history or anthropology of art. (shrink)

Providing a possible worlds semantics for a logic involves choosing a class of possible worlds models, and setting up a truth definition connecting formulas of the logic with statements about these models. This scheme is so flexible that a danger arises: perhaps, any logic whatsoever can be modelled in this way. Thus, the enterprise would lose its essential 'tension'. Fortunately, it may be shown that the so-called 'incompleteness-examples' from modal logic resist possible worlds modelling, even in the above wider sense. (...) More systematically, we investigate the interplay of truth definitions and model conditions, proving a preservation theorem characterizing those types of truth definition which generate the minimal modal logic. (shrink)

Humans have a tendency to reason teleologically. This tendency is more pronounced under time pressure, in people with little formal schooling and in patients with Alzheimer’s. This has led some cognitive scientists of religion, notably Kelemen, to call intuitive teleological reasoning promiscuous, by which they mean teleology is applied to domains where it is unwarranted. We examine these claims using Kant’s idea of the transcendental illusion in the first Critique and his views on the regulative function of teleological reasoning in (...) the third Critique. We examine whether a Kantian framework can help resolve the tension between the apparent promiscuity of intuitive teleology and its role in human reasoning about biological organisms and natural kinds. (shrink)

The present contribution defends that remittances should be taken into account and integrated into an ethical framework on migration. This main thesis is two-fold. First, we argue that if a normative approach to migration is to claim practical relevance, it should integrate remittances as a relevant empirical parameter into an ethical framework. The empirical assessment of the scientific evidence available on remittances therefore proves to be extremely important. Secondly, assuming that remittances have to be taken seriously, we consider their positive (...) and negative impacts against two backgrounds. First, we emphasize the increased autonomy of persons who pull themselves and their dependents out of economic hardship. Second, affluent states who enable this process through their labor legislation contribute to the fulfillment of their duty of assistance. In this respect, our thesis is to claim that remittances should be considered as an amplifying factor for normative arguments in favor of a liberalization of labor migration. Remittances stand for a liberal way of fulfilling a responsibility to help, namely through the elimination of obstacles which in turn allow people to support themselves and lead an autonomous life. (shrink)

According to cognitive science of religion (CSR) people naturally veer toward beliefs that are quite divergent from Anselmian monotheism or Christian theism. Some authors have taken this view as a starting point for a debunking argument against religion, while others have tried to vindicate Christian theism by appeal to the noetic effects of sin or the Fall. In this paper, we ask what theologians can learn from CSR about the nature of the divine, by looking at the CSR literature and (...) what it identifies as commonalities across religions. We use a pluralist, non-confessional approach to outline properties of the divine. We connect our approach to Hick’s religious pluralism, Ramakrishna’s realization of God through multiple spiritual paths, and Gellman’s inexhaustible plenitude. (shrink)

_In this paper, we support the adoption of an empirical approach in development ethics research and show that the theoretical insights and methodological guidelines in Sen’s capability approach can offer helpful guidance to development ethicists on designing and execution of such research. To this end, we show how specific insights in the CA guide one to identify and engage with relevant stakeholders in extensive dialogues about the ethical issues underlying their development practices and in gathering empirical data for further ethical (...) reflections. Drawing on an empirical development ethics research project we conducted in the fisheries sector of Ukerewe District in Tanzania, we illustrate how the CA supported us in identifying 310 representatives of various categories of small-scale fishers and stakeholders, and in designing and executing empirical development ethics research in the form of progressive stages of dialogues in stakeholder groups. The participants in these stakeholder groups reflected on and assessed their individual and collective values, capacities, roles and interests in the fisheries sector. In turn, we gathered empirical data on the nature and causes of the poverty of small-scale fishers and ways to overcome it, the __moral roots of the prevalence of institutional and professional apathy, and stakeholders’ motivations and concrete actions to support the redressing of the challenges facing small-scale fishers. Later, we used these empirical data to theorise about moving small-scale fishers from poverty to prosperity, and about the development ethic best suited to guide future initiatives in combatting poverty and generating wealth through the fisheries sector in Ukerewe District._ _Keywords: _Empirical Ethics, Development Ethics, Capability Approach, Small-scale Fisheries, Poverty, Ukerewe District, Tanzania. (shrink)